Two Decades of Teledermatology: Current Status and Integration in National Healthcare Systems

Abstract

Teledermatology, originating in 1995, has been one of the first telemedicine services to see the light of day. Two decades of teledermatology research is summarized in this review. A literature search was conducted in PubMed. Search terms included “teledermatology,” “teledermoscopy,” “tele wound care,” “telederm*,” “(dermatology OR dermoscopy OR wound care OR skin) AND (telemedicine OR ehealth or mhealth OR telecare OR teledermatology OR teledermoscopy).” Inclusion criteria were (i) Dutch or English written papers and (ii) publication year from 2011 to present or (iii) (systematic) reviews with publication year before 2011. One hundred fourteen publications and 14 (systematic) reviews were included for full text reading. Focus of this review is on the following outcomes: (i) actors (primary, secondary, tertiary), (ii) purposes (consultation, triage, follow-up, education) and subspecialties (tele-wound care, burn care, teledermoscopy (teledermatoscopy), teledermatopathology, and mobile teledermatology), (iii) delivery modalities and technologies (store and forward, real-time interactive, and hybrid modalities using web-based systems, email, mobile phones, tablets, or videoconferencing equipment), (iv) business models, (v) integration of teledermatology into national healthcare systems, (vi) preconditions and requirements for implementation (security, ethical issues, responsibility, reimbursement, user satisfaction, technique, and technology standards), and (vii) added value.To conclude, teledermatology is an efficient and effective healthcare service compared to in-person care. Teledermatology reduces patients’ travel time and waiting time, avoids (unnecessary) dermatologic visits, and improves access of care to underserved patients.

Use of Smartphones for Early Detection of Melanoma: Systematic Review (Preprint)

“…On the one hand, this result may lead to further studies in the general population to assess the performance of the procedures in a primary care setting. On the other hand, this review emphasizes that the publication of data related to up-to-date technologies is a challenge in teledermatology [20,66]; it is notable that up to 70% of the photographs were of poor quality in a study performed in 2007 [51], whereas all photographs were interpretable in 2016 [50].…”

“…Patients reported that one limitation of the applications was the difficulty of not having any human contact [20]. For both procedures, a limitation was the loss of the face-to-face patientphysician relationship, which may be critical since a melanoma is diagnosed early, at a severe stage, or in the ageing population [35,40,49,73].…”

“…Many countries have tested the use of telemedicine in dermatology as a way to increase access to health care services when distance is a critical factor [18][19][20][21][22][23][24][25][26]. Videoconferences, which allow a patient and a dermatologist to be connected for a consultation, are timeconsuming for the dermatologist and may require expensive material [20,27].…”

“…Videoconferences, which allow a patient and a dermatologist to be connected for a consultation, are timeconsuming for the dermatologist and may require expensive material [20,27]. In contrast, smartphones have now revolutionized the daily life of physicians in all western countries [19,24,28].…”

“…One of the present issues is whether such applications can help in the early diagnosis of melanoma. Another issue to be addressed is to determine whether smartphone use has been assessed for store-and-forward teledermatology procedures, which are based on sending information and photographs to a dermatologist for a deferred medical opinion [20].…”