54 CHAPTER 3 GPs signed a contract with Ksyos by which they permitted to evaluate the teledermoscopy quality and performance by evaluation questions. Ethical approval was therefore not needed to evaluate the teledermoscopy quality and performance outcomes. Study design Using an anonymized extract of the nationwide Ksyos teledermoscopy service database, retrospective teledermoscopy consultations data from routine clinical practice performed between February 2009 and February 2020 (the first sent teledermoscopy consultation until data extraction) in the Netherlands were analyzed. Data also included timestamps of creating and sending a teledermoscopy consultation by the GP to the teledermatologist, and the time needed by the teledermatologist to send a response to the GP. The fixed non-mandatory evaluation questions implemented in the Ksyos system were also subject to the teledermoscopy quality and performance outcomes. GPs and teledermatologists who performed these teledermoscopy consultations differed in their years of experience in the field of (tele)dermoscopy. Because GPs use a variety of technological tools (types of digital camera, smartphone and digital dermoscope), the specific tool type was not considered in the data analysis. Consultations with missing timestamps, responses to evaluation questions or which were responded with “NA” by the teledermatologist (Q2) were excluded from the analyses. Teledermoscopy quality and performance outcomes Teledermoscopy quality and performance outcomes were based on the five evaluations questions (Figure 3.1. Q; question) and various timestamps recorded by the teledermoscopy system (e.g., times that GPs created, sent and teledermatologists answered a teledermoscopy consultation). An overview and detailed descriptions of teledermoscopy quality and performance outcomes and evaluation questions are given in Table 3.1.
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