197 GENERAL DISCUSSION intend to refer to the dermatologist. In addition, teledermoscopy eases the burden on dermatology care as it prevents physical referrals to the dermatologist for patients with low-complex benign skin lesions. Despite these benefits, interrelated factors, such as GPs’ and patients’ limited photography skills, costs and lack of appropriate equipment, human-computer interface and interoperability issues on the platform, and differences in use procedures, impeded the use and full potential of teledermatology, teledermoscopy and digital dermatology home consultation in Dutch general practice. Since these sociotechnical aspects are interrelated and influence each other, this indicates that not just the right competencies of GPs and patients (training and instructions on the use of equipment to take high-quality images), or modifications in the digital dermatology platform, or proper imaging equipment are relevant, but that various adjustments in the entire digital dermatology process are needed to further improve and scale up these services in GP practices. It is important to co-create future digital dermatology services and the corresponding care path together with GPs, dermatologists, patients, health insurance companies, government policy makers and patient advocacy organizations to realize sustainable services. Additionally, future studies should be devoted to patients’ and dermatologists’ perspectives on these (enhanced) services and on the use and merits of AI applications. 8
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