72 CHAPTER 4 Figure 4.1: Overview of the teledermoscopy consultation process between general practitioner (GP) and teledermatologist (TD). In the Netherlands, diagnoses given by the GP and TD within a teledermoscopy consultation are classified to the corresponding ICD-10 code. The International Statistical Classification of Diseases and Related Health Problems (ICD) is an international diagnostic classification standard for reporting health conditions and diseases released by the World Health Organization [8]. This ICD-10 code can be used to analyze, compare and monitor diagnoses worldwide. Since July 2015, classifying diagnoses in compliance to this ICD-10 code has been mandatory in specialized care for reimbursement according to the Dutch Healthcare Authority (Dutch: Nederlandse Zorgautoriteit, NZa). And since this date, the 10th revision of this standard (ICD-10) has also been used in the Ksyos digital health record system. However, the effect of teledermoscopy on GPs’ expertise in diagnosing skin disorders, based on the ICD-10 codes in the Netherlands has not been systematically investigated. The aim of this paper is therefore to assess if, since the introduction of the ICD-10 codes in July 2015, GPs are gaining expertise in diagnosing (specific) skin problems conform ICD-10 after one, two and three years of teledermoscopy use. In our analysis we specifically focused on the development in the number, ICD-10 type and correctness of GPs in prediagnosing skin disorders compared to the TD diagnoses. In doing so, we aimed to address the added value of continued use of teledermoscopy for GP melanoma detection. METHODS Setting and study population We conducted a retrospective study in the Netherlands on the value of teledermoscopy to GPs’ expertise in diagnosing skin disorders in three years’ time. All teledermoscopy consultations sent by affiliated GPs to a TD between July 2015 and June 2018 and completed before the 18th of October 2018 were extracted from the Ksyos digital health record system. A cohort of experienced GPs was selected for inclusion in the data analysis. GPs were classified as experienced if they performed at least five teledermoscopy consultations for each of the included years, respectively (July 2015 – June 2016, July 2016 – June
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