64 CHAPTER 3 Also, there are currently no validated indicators for evaluating teledermoscopy systems. Interviews could first investigate the need for such indicators. If such a need exists, then focus groups could assess in-depth the domains for which indicators concerning quality and performance are desirable. Carefully designed indicators could help in objectively evaluating the progress in quality and performance of teledermoscopy systems, as well as comparing the outcomes of different teledermoscopy systems. The embedded evaluation questions in the Ksyos teledermoscopy system may serve as a starting point for developing such indicators. CONCLUSION Based on 11 years of data, this study indicates that the availability of teledermoscopy in the GPs’ practices is a useful tool for requesting dermatologist advice to resolve doubts by GPs about the diagnosis and management concerning a patient’s suspicious lesion. Teledermoscopy supported GPs to uncover new cases of patients in need of secondary dermatology care. GPs often follow the teledermatologists’ advice on patient referral and reported that the TDs’ responses were helpful and instructive. Furthermore, a majority of patients for whom the GPs requested a teledermoscopy consultation was not physically referred to a dermatologist after the teledermoscopy consultation. Hence, teledermoscopy is a useful tool to support primary care with dermatologist expertise at lower costs. ACKNOWLEDGMENTS The authors would like to thank Dr D.C.K.S. Tio and Dr J.P. van der Heijden for their review of the manuscript.
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