13 GENERAL INTRODUCTION This thesis focuses on store-and-forward primary and secondary teledermatology in GP practices (in this thesis also referred to and explained further below as dermatology home consultation and teledermatology or teledermoscopy, respectively). This means that patient information and digital images of a skin lesion are asynchronously exchanged between a patient and his/her GP or between a GP and a TD. TELEDERMATOLOGY FLOW OF A DUTCH TELEMEDICINE ORGANIZATION Healthcare organizations that facilitate digital services such as teledermatology are either mostly traditional healthcare institutions or innovative ICT providers. In contrast, Ksyos (formerly also known as Ksyos Telemedical Center), is a digital hospital that provides lowcomplex medical specialist care using innovative ICT techniques [50]. Ksyos operates on a national scale and is the largest telemedicine organization providing store-and-forward teleconsultation in the Netherlands. “[The telemedicine organization] is an innovative colleague who helps to improve the digital means of communication between primary and secondary care” (Respondent questionnaire, 2019) Ksyos contracts medical specialists, paramedics, and GPs to perform digital health services through a platform in fields such as dermatology, cardiology, ophthalmology, mental health, and somnology. Research in this thesis was conducted in collaboration with Ksyos within the path of dermatology care and from the perspective of the GPs. Approximately half of all Dutch GPs are affiliated with Ksyos and have been registered for the digital dermatology service. In this thesis Ksyos will be referred to as the telemedicine organization. This Dutch telemedicine organization facilitates three types of store-andforward digital dermatology consultation: (1) teledermatology, (2) teledermoscopy, and (3) dermatology home consultation (Figure 1.3). In the Netherlands, with nearly 18 million inhabitants, there were in 2022 approximately 4900 GP practices and 11,754 operating GPs (i.e., self-employed GP practice owners, GPs employed at a GP practice (Dutch: Huisarts in dienst van een huisarts), and freelance GPs (Dutch: waarnemers)) available [52,53]. In 2022, in about one out of five GP practices, GPs had performed a teledermatology, teledermoscopy, or digital dermatology home consultation in the Dutch telemedicine organization’s platform. Between 2005 and 2022, a total of 203,862 teledermatology consultations, 25,891 teledermoscopy, and 17,142 digital dermatology home consultations had been performed via the Dutch digital dermatology platform (Figure 1.4). The total number of performed digital dermatology consultations in the Netherlands might be higher because there are more digital dermatology providers on the market. 1
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