35 TWO DECADES OF TELEDERMATOLOGY services location independent but not time independent. Real-time allows direct interaction between the general practitioner (GP), patient, and dermatologists. They should all be available at the same time, which makes real-time consultation scheduling logistically challenging. Furthermore, real-time is time consuming, interrupts the routine workflow, and is more expensive [9,12,14,22]. The duration of the videoconference is mostly as long as the conventional consultation and is not cost-effective in case of short travel distances. Hybrid modalities combine features from store-and-forward and real-time. Direct interaction between healthcare professionals and additionally viewing high-quality images is possible by use of hybrid modalities [7]. Technologies which are used for store-and-forward and real-time are web-based systems or email and videoconferencing equipment. Furthermore, mobile phones and tablets could be used for capturing and sending images. Image quality of these devices has been improved and is no longer a barrier in teledermatology [9]. Mobile teledermatology and mobile teledermoscopy are specialties that use mobile devices (i.e., phones, tablets) while performing teledermatology. Smartphones and tablets can be used by patients to capture images and transfer them to their healthcare provider or by GPs to send images for advice to a dermatologist. Business models Teledermatology has many advantages over current conventional care modes. However, many teledermatology implementations fail when the business models behind the service are either not well understood and subsequently poorly implemented or not implemented at all. Challenges and issues that should be considered in business modeling concern, e.g., technology, security and privacy, legal risks, ethical issues, and reimbursement. Pak [23] describes five important steps for integrating teledermatology into a well-defined business process and model: “(1) understanding how the organization delivers care, (2) analyzing the alternatives including cost-benefit analysis, (3) obtaining organizational support, (4) formulating an execution plan, (5) training staff and monitoring the process.” Defining a good business and reimbursement model depends on the teledermatology modality used (store-and-forward, real-time, hybrid), consultation, follow-up, and referral process. If teledermatology is implemented in the appropriate setting, it could increase the access and quality of care while decreasing costs [23]. A survey (2011) among teledermatology programs in the USA [20] concluded that 12 of the surveyed programs (33%) accepted payments from Medicare, Medicaid, Health Maintenance Organizations (HMO), private payers, and self-payers. Furthermore, eight teledermatology programs (22%) received federal funding from the Veterans Administration or US military and two programs (6%) provided teledermatology as a 2
RkJQdWJsaXNoZXIy MTk4NDMw