31 TWO DECADES OF TELEDERMATOLOGY INTRODUCTION Telemedicine, as defined by the World Health Organization, is the use of communication technologies in healthcare for the exchange of medical information for diagnosis, treatment, prevention, research, evaluation, and education over a distance [1]. Teledermatology is a mature and frequently used form of telemedicine. The first publications about teledermatology listed in PubMed were published in 1995 [2-5] and the number has grown exponentially. At the end of the year 2015, the number of publications in PubMed with search term “teledermatology” evolved to 477 publications. The visual character of dermatology makes it well-suited for telemedicine. Colors of the skin and distribution of skin lesions provide indications and clues in accurate diagnosing lesions and rashes [6]. Teledermatology has proven to be comparable in accuracy rates to in-person conventional care concerning diagnosis, management, and clinical outcomes [7], clearing many of the barriers mentioned when teledermatology was first implemented. However, some barriers in teledermatology remain, e.g., security, privacy and legal issues, and the absence of palpation of the skin [8,9], but can be solved relatively easy through selection of patients by the GP, education, and proper implementation of the service. Teledermatology is currently applied throughout all kinds of medical settings, e.g., in hospital and primary care, nursing homes, home care settings and is applicable in underserved and remote areas to deliver care over a distance. Furthermore, it is applied in countries (e.g., Switzerland, the Netherlands, and the USA) known for their long patient waiting times and/or capacity limits for dermatologic consultation. Teledermatology has been used during wars, in military and maritime settings and reduced the number of medical evacuations [10,11]. Finally, it provides care to patients in developing countries who have no access to (dermatologic) care [12]. The aim of this narrative review is to give an overview of the current status of teledermatology concerning (1) the actors of teledermatology, (2) the purposes and subspecialties of teledermatology research, (3) the delivery modalities and technologies used, (4) business models used, (5) the integration of teledermatology in national health infrastructures, (6) preconditions and requirements for implementation of teledermatology, and (7) surplus merits of teledermatology. METHOD A literature search was conducted in PubMed. Search terms included “teledermatology,” “teledermoscopy,” “tele wound care,” “telederm*,” “(dermatology OR dermoscopy OR wound care OR skin) AND (telemedicine OR ehealth or mhealth OR telecare OR teledermatology OR teledermoscopy).” Inclusion criteria were (i) Dutch or English written papers and (ii) publication year from 2011 to present or (iii) (systematic) reviews 2
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