39 TWO DECADES OF TELEDERMATOLOGY developed and implemented in teledermatology yet [39]. Therefore, Quigley et al. conducted a systematic review summarizing technology and technique imaging standards for acquiring digital dermatologic images [39]. Technology standards include spatial and color resolution, reproduction ratios, postacquisition image processing, color calibration, compression, image output, image archiving and storage, and image security during transmission and storage. A study (1997) concluded that a resolution of 768 × 512 pixels suits teledermatology purposes as well [40]. The American Telemedicine Association’s Practice Guidelines for teledermatology (2008) advised at least 24 bits of color which results in 16,777,216 available colors [41]. The most recent American Telemedicine Association guideline (2012) recommended minimal 800 × 600 pixels and preferred a resolution of 1024 × 768 pixels for store-and-forward teledermatology [42]. Technique standards include environmental conditions (i.e., lighting, background, camera position), patient pose and standard view sets, patient consent, privacy, and confidentiality [39]. Environmental conditions affect the quality, appearance, and consistency of images [39]. And privacy, security, and confidentiality standards depend on region specific laws and regulations. Added value One of the benefits of teledermatology is reduction of travel by patients. A systematic review by Wootton et al. summarized 18-94% (mean 43%) of travel was avoided by teledermatology [43]. Another advantage of teledermatology is the number of dermatologic visits averted and a reduction in unnecessary in-patient visits. A recent review by Whited [7] summarizes that 13-81% (average 45.5%) of dermatologic visits were avoided while using store-and-forward, and 44.4-82% (average 61.5%) of visits were averted with real-time interactive teledermatology. As shown by Eminović et al. [44], teleconsultation reduces the number of unnecessary physical referrals to the dermatologist leading to lower costs and higher efficiency. Furthermore, van der Heijden et al. [45] conclude that teledermatology averts 74% of physical referrals and leads to an 18% cost reduction compared to in-patient dermatologic care. Teledermatology improves patient access to dermatologic expertise to patients who were underserved by dermatology care for geographic reasons [12]. It further reduces long patient waiting lists, streamlines patient care, and allows shared decision-making with other physicians. Teledermatology consultation, applied in the right setting, provides care equal to but often more efficient and effective as physical patient care and at least does not negatively influence the quality of care delivered to the patient [45,46]. As described by Landow et al. [47] “teledermatology makes three promises: better, cheaper and faster dermatologic care.” 2
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