8 CHAPTER 1 TELEMEDICINE IN DERMATOLOGY The worldwide aging population and the rise in patients with chronic diseases have increased the healthcare demands and corresponding healthcare costs [1-3]. In the Netherlands, expenditure on healthcare and welfare as a percentage of the gross domestic product increased from 10% in 1998 to 13.2% in 2022 [4]. These expenditures on healthcare will triple between now and 2060 if healthcare is not reformed [5]. Furthermore, healthcare personnel shortages exists and currently one out of seven Dutch employees are already working in the healthcare sector [6]. In addition, there is an increasing shortage and outflow of general practitioners (GPs) [7] and an increasing number of tasks have been shifted to primary care. If nothing changes, it is estimated that one out of three employees will be working in healthcare in 2040 [6] resulting in a shortage of staff in other social sectors such as education, construction, and energy [8]. Therefore, healthcare organizations, such as GP practices, need to reorganize and transform their existing care flow and innovate by use of digital health solutions to avoid a standstill in healthcare [1,9]. Digital transformations of sectors and businesses are a part of everyday life at the time of this writing and already widely applied in banking, shopping, traveling, consuming media, communication etcetera but are lagging behind in healthcare. Reasons for this delay are interwoven and complex, such as lack of interoperability standards and synergy between countries and healthcare organizations. This leads to a very difficult process to upscale innovations in digital healthcare transformations [10]. Telemedicine – the delivery of health care services where patients and care providers or two or more care providers are digitally brought together – has been one of the first internet-based solutions in the digital transformation of healthcare and is one of the more successfully adopted transformations in healthcare worldwide. Telemedicine, which can be applied in various care settings, provides opportunities to keep healthcare accessible and affordable and of high quality [11]. The visual features of dermatology (skin lesions have specific colors or shapes) make it well-suited for the application of telemedicine [12-14]. Telemedicine in dermatology, also called teledermatology, digital dermatology, or remote dermatology care, was one of the first telemedicine services that became available worldwide. Teledermatology aims “to provide the highest quality of dermatologic care more efficiently by moving patient information rather than patients” [15]. In other words, teledermatology includes medical specialist (diagnostic) care close to the patient (for example, at the patient’s home or in a GP practice) under remote supervision by a (tele) dermatologist (TD) [16]. The first publications in PubMed related to teledermatology date back to 1995 [17-20]. In the meantime, articles about teledermatology are being published worldwide [14]. Research on teledermatology solutions have proven that these services are effective, save the wait and travel time of the patient, cut healthcare and travel costs and reduce the number of unnecessary physical referrals of patients [12,14,21-25]. Furthermore,
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