33 TWO DECADES OF TELEDERMATOLOGY Figure 2.1: Actors teledermatology. Purposes and subspecialties of teledermatology Pak defines the goal of teledermatology as: “to provide the highest quality of dermatologic care more efficiently by moving patient information rather than patients” [14]. Teledermatology can be classified by the different purposes it serves: consultation, triage, follow-up, and education. Likewise, it is used for screening (of melanoma), wound treatment, (international) knowledge exchange between healthcare professionals, second opinion, and referrals prevention. The systematic review of van der Heijden et al. [13] found different purposes of tertiary teledermatology. Tertiary teledermatology could be used for receiving an expert opinion from a more specialized colleague (e.g., academic dermatologist) or a second opinion. Furthermore, it could be used for resident training and ongoing medical education [13]. Teledermatopathology, teledermoscopy (teledermatoscopy), and tele-wound care are subspecialties of teledermatology. Tele-wound care is a subspecialty used in chronic wound care. A study of Litzinger et al. found that 83% of the nurses improved their productivity and efficiency by using video conferencing in tele-wound care [15]. Telewound care reduces (transportation and staff) costs, improves quality of life for chronic wound patients, and is equally effective to conventional care [16,17]. Teledermoscopy could be used in the examination of pigmented skin lesions, for the early detection of skin cancer and for triage. Coates et al. summarize an accuracy of teledermoscopic diagnoses, ranging from 75 to 95% [18]. A new application of teledermoscopy concerns the use of mobile teledermoscopy. Burn care telemedicine makes it possible to get expertise from a healthcare professional of a specialized burn center. It has been shown to be technically and clinically feasible to provide burn care telemedicine [19]. Delivery modalities and technologies Teledermatology can be delivered by three different modalities: store-and-forward, realtime interactive, and hybrid. Choice of a modality depends on the structure of the local health care system, decisions of stakeholders, like hospital management and physicians 2
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