128 CHAPTER 7 INTRODUCTION Background The COVID-19 pandemic had a major impact on the access and delivery of primary care owing to social distancing and other public health measures, such as lockdowns or stayat-home mandates [1]. This unprecedented crisis forced health care organizations to consider innovative ways to plan and deliver their care remotely [2] and led to substantial changes in health care delivery. One of those changes has been the rapid growth and uptake of digital health solutions such as telemedicine [3,4], including the use of remote digital dermatology care [5-7]. Digital dermatology allows general practitioners (GPs), the patient’s first point of contact, to digitally contact the patient or to consult a remote dermatologist for advice [8-11]. Digital dermatology is suitable for web-based assessment of skin lesions because it provides a digital representation of the skin. Moreover, this type of service has enabled Dutch GPs to continually provide dermatology care to patients while minimizing the number of (unnecessary) conventional face-to-face consultations (in dermatology or GP practice) and the risk of exposure to SARS-CoV-2. The Netherlands is one of the few countries where an integrated remote digital dermatology service in GP care has been operating, integrated, and fully reimbursed since 2006 [12]. Therefore, it was expected that GPs could smoothly apply the service in their work practices during the COVID-19 pandemic. However, how the pandemic subsequently influenced the existing digital dermatology care delivery and affected the Dutch GP work processes remains unknown. The digital dermatology service cannot be adequately evaluated in isolation from the organizational context in which it is implemented. Organizational factors such as the lack of adequate training and technological support, existing and new policies, leadership and change management, and communication needs can hinder the adoption and implementation of digital health tools [13,14]. Moreover, digital dermatology is used in a complex health system that consists of numerous interconnected components (e.g., technological elements and social human system aspects) that interact and must work together to positively contribute to the delivery of such a service [15,16]. Digital services affect the work processes of health care providers and the way in which they deliver care to patients. Ideally, such telemedicine service should be seamlessly incorporated into the provider’s day-to-day work processes [13], but achieving that goal requires insight into the aspects that affect GPs’ satisfaction and the continued use of the service. Sociotechnical models provide a framework to focus on a broad range of factors that influence the use and adoption of health IT and incorporate technical and nontechnical factors [17]. In other words, the entire implementation process and evaluation of a digital innovation includes the interactions among the technical, social, workflow,
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