146 CHAPTER 7 Lack of appropriate up-to-date imaging equipment and equipment costs The second barrier relates to the lack of up-to-date, appropriate, digital dermatology imaging equipment and equipment costs. In the past, the telemedicine organization offered up-to-date, free-of-charge equipment to GPs in exchange for performing a minimum number of digital dermatology consultations, but they do not provide this equipment anymore. Nowadays, technology develops rapidly and GPs must purchase the latest off-the-shelf equipment themselves. GPs reported that especially dermoscopes are very expensive and that the provision of digital dermatology imaging equipment by the telemedicine organization is an extra incentive to use the service. GPs missed an appropriate mobile phone–attached dermoscope or had troubles with using the outdated attachment and reported that their photographs were not with sufficient quality with the current conversion lens. Human-computer interface and interoperability issues The third barrier relates to the human-computer interface and interoperability issues on the telemedicine platform. Interface issues included platform usability issues, strict validation on capitalization of address data, linking new user accounts, and changing layout. Interoperability issues included difficulties in uploading all patient information (e.g., medical history, medication, and address) from the GP Information System (Dutch: Huisarts Informatie Systeem) into the digital dermatology consultation and vice versa in loading relevant patient data back from the digital consultation into the GP Information System. Furthermore, for teledermatology and teledermoscopy, most GPs take images with their mobile phones and upload these images via an app into the digital dermatology consultation form. Subsequently, on their computer, they complement the digital dermatology consultation form and send it to a teledermatologist. This process is time-consuming and complex; therefore, GPs prefer to start the digital dermatology consultation on their phones and directly send the consultation request and the images from their phone to a dermatologist. Different use procedures The fourth encountered barrier is that GPs have various reasons to use or to not use the service. Of the 66 GPs, 5 (8%) GPs reported no threshold for use at all, whereas other GPs experience thresholds for use. For example, if a patient has >1 skin abnormality, they have to create a new consultation for each abnormality. Another threshold for use is if they are not able to upload the images. Other reasons for a GP to not request a digital dermatology consultation are when an in-person visit or treatment or biopsy in the hospital is required anyway, or when in their opinion, a digital dermatology consultation is not indicated. In addition, GPs do not perform teledermatology when the patient prefers a physical consultation or disagrees with a digital consultation, for atypical or pigmented nevi for which skin inspection by touch is required for a correct diagnosis, for unclear skin abnormalities, for common skin lesions, or for urgent skin problems such as suspicion of melanoma or malignancy (36/66, 55%). In the latter possibly malignant cases, GPs
RkJQdWJsaXNoZXIy MTk4NDMw