152 CHAPTER 7 Table 7.5: Sociotechnical considerations for remote digital dermatology. Barriers Recommendations for future GPs’a and patients’ limited digital photography skills • Accredited, continuous, web-based, and good practice training sessions and video instructions as refreshers for GPs (e.g., recap about the use of the imaging equipment and the platform) • (Video) instructions for GPs and patients about how to obtain adequate photographs • Understandable, straightforward, step-by-step guide for GPs and patients Costs and the lack of appropriate imaging equipment • Solutions for the availability of appropriate imaging equipment (e.g., purchasing or hiring up-to-date equipment) Human-computer interface and interoperability issues • Quality validation in the teledermatology platform that verifies whether the photograph’s quality is sufficient and whether the correct number of images are taken and uploaded • Implementing image quality checklists and guidelines about taking (dermoscopic) images Different use procedures • Policy development about the use of the teledermatology service • Training of GPs (by the telemedicine organization and during GP education programs) when they can or cannot use the teledermatology service a GP: general practitioner. Limitations The first limitation of this study is that the questionnaire was distributed to GPs affiliated with the telemedicine organization who performed a store-and-forward consultation between October 2019 and September 2021. In doing so, we excluded GPs working with other telemedicine organizations, GPs who chose not to use the service during the pandemic, or GPs who were less comfortable with using the service. However, the main aim of this study was to assess GPs’ perspectives about 3 types of digital dermatology consultation in the Netherlands. Future studies should expand upon the use of digital dermatology care during the COVID-19 pandemic from the perspectives of other involved stakeholders, such as dermatologists and patients. The second limitation is that the study data were only collected for 1 already existing Dutch store-and-forward digital dermatology service, even though this service has been implemented nationwide. This may limit the generalizability of our findings to other (Western European) countries that have implemented digital dermatology services, which are still in the preliminary stages. In many countries, teledermatology was not reimbursed before the pandemic, which has driven providers away from practicing teledermatology
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