41 TWO DECADES OF TELEDERMATOLOGY care at home avoids traveling to a physician and long appointments during work time. Patients can capture images with their smartphone (when they have time) and send the images to their healthcare provider. There are yet some issues that should be considered before implementing a teledermatology program, e.g., technology, security and privacy, legal risks, ethical issues, and reimbursement. Teledermatology has been fully reimbursed and integrated into the Netherlands and some states in the USA. Reimbursement has a positive influence on the integration in national health systems and the number of teleconsultations conducted in the Netherlands. However, less is published about the integration of teledermatology in healthcare systems of other countries. Due to its merits, we yet expect teledermatology becoming integrated into more healthcare systems in the future. Nami et al. [51] for example believe that teledermatology will become more and more integrated into national health services and clinical practice as smartphones are integrated into our lives. The number of smartphone users is increasing exponentially and will enable us to perform teledermatology via mobile applications. Therefore, we expect that the number of teledermatology services will increase as well. There are some shortcomings of this review. First, the search was conducted in one database only (PubMed) and no searches were performed in other databases, e.g., MEDLINE and EMBASE. Secondly, publications were selected and included by one reviewer only, which could have resulted in selection bias. CONCLUSION In conclusion, teledermatology provides care, which is of similar quality compared to conventional care but often more efficient and effective. It is a promising technique for geographically underserved patients and in countries with long patient wait lists. It reduces costs, wait times, travel time, and the number of unnecessary referrals. In the future, more research is needed on the impact of teledermatology on the quality of life and on validated methods for measuring experiences of patients to ensure that teledermatology services are viewed as beneficial from the patients’ perspective. 2
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