194 CHAPTER 8 Furthermore, literature shows that after the pandemic only a small percentage of Dutch GP practices expect to intensify their use of digital health solutions [47]. Currently there is the opportunity to tackle the existing digital dermatology barriers and train GPs to maintain the popularity of the services, before GPs switch back to prepandemic conventional physical patient referrals where digital care was not the standard. The adoption of these digital dermatology services is easier if the need and added value are recognized by patients, GPs, and dermatologists. Their motivation and willingness to change from standard physical dermatology care to digital dermatology influence the success of these services [48]. Therefore, in the post COVID-19 scenario, studies should continue assessing experiences of patients, GPs, and dermatologists and study how to ultimately adapt the digital dermatology services to their needs. Furthermore, future studies should explore possible alternative digital dermatology flows. An example is emergency digital dermatology consultation where the TD can be reached immediately while the patient is waiting in the GP waiting room instead of waiting for a response for (a maximum of) two working days. Alternatively, future studies could explore the options to allocate time slots on the physical dermatology consultation hours by dermatologists for patients that have doubtful lesions or for patients referred by the GP based on digital dermatology assessment. These allocated time slots might stimulate the GPs to use the digital dermatology services for doubtful cases because it reduces the wait time for patients. GPs could also allocate time slots for dermatology home consultations assessment so that patients receive a fast digital assessment of their skin lesion and would not always need to physically visit the GP practice. In addition, GPs and digital dermatology providers should investigate for which skin conditions it is feasible (if photograph quality is guaranteed) to provide a dermatology home consultation as a standard prior to a physical GP visit and whether a financial compensation instead of a free-of-charge service will stimulate GPs in their use. Finally, the telemedicine provider could experiment with a question-and-answer chat function between the patient and the GP or the GP and dermatologist instead of a standardized request or could investigate whether it is relevant if patients and GPs upload videos in addition to photographs. Artificial Intelligence Various Artificial Intelligence (AI) applications and systems in dermatology are already applied in clinical practice [49-53]. For example, Vodrahalli et al. [54] showed positive findings with an automated machine learning algorithm that assesses the quality of dermatology photographs and, if necessary, gives patients specific suggestions and instructions on how to enhance the quality of their photographs. Su et al. [55] introduced a feedback algorithm that uses “smart phrases” to persuade patients to retake photographs if their most recent photographs were of inadequate quality. This feedback algorithm checked whether the photographs were in focus, well-lit and whether both the distance and close-up photographs were appropriate. Future studies could focus on the implementation of such algorithms in the Dutch digital dermatology platform. These algorithms could be used in the digital dermatology service to validate the quality of the
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