34 CHAPTER 2 as prospective users of the service, payers such as health insurance companies, and the competences of the referring physician [12]. Store-and-forward is the most offered and used modality in teledermatology [7,11,12,20]. As described in the literature, the use of store-and-forward telehealth is increasing and real-time use is decreasing [21]. Table 2.1 summarizes the advantages and disadvantages of store-and-forward and realtime interactive technologies. Store-and-forward and real-time interactive modes of teledermatology have in common that they are independent of space. These modes are especially beneficial in low-resource settings and the USA with large distances between the patient and the dermatologists. By use of these delivery modalities, dermatologists in other geographic areas could be reached [7,8,12,22]. Table 2.1: Advantages and disadvantages store-and-forward and real-time. Store-and-forward Real-time interactive Digital images Video conferencing Asynchronous: Space and time independent, flexible Synchronous: Independent of space, dependent on time, less flexible No or minimal interaction possible Direct interaction possible sender and recipient (GP, patient, dermatologist) Consultation time is short Time consuming Low costs Expensive and not cost-effective short distance Medical history and images stored and transferred, standardized More clinical (in depth) and complete information acquired from patient Response delayed: Wait between consultation and advice dermatologist Immediate response: Advice dermatologist and diagnosis can be obtained immediately during consultation High-resolution digital images Lower resolution images Fits better in daily workflow Interferes with daily workflow Store-and-forward technology includes the exchange of high-quality digital images between a general or nurse practitioner and a dermatologist or between two dermatologists. Distinctive for a store-and-forward mode is that it can be used time independent, making it more flexible in practice, fitting in daily workflow, and applicable for the exchange of information between different time zones. However, direct interaction between actors is not possible. Use of store-and-forward technology for delivering teledermatology services shortens the consultation time compared to real-time and conventional care, which makes it a lower cost intervention [9]. However, responses are delayed, and patients have to wait for the advice of the dermatologist [8,22]. The real-time interactive modality uses video conferencing equipment during a teledermatology consultation. Use of this modality makes delivery of teledermatology
RkJQdWJsaXNoZXIy MTk4NDMw