Eleven years of teledermoscopy in the Netherlands: A retrospective quality and performance analysis of 18,738 consultations

Introduction: Teledermoscopy supports and enhances the early detection of skin lesions by general practitioners in primary practice through remote consultation with dermatologists. Teledermoscopy has been a regular health service in Dutch primary care since February 2009. Teledermoscopy quality and performance outcomes on Dutch general practitioner primary care 11 years after its implementation were assessed. Methods: Dutch primary care teledermoscopy consultation data was retrospectively analysed on timestamps and responses on non-mandatory evaluation questions posed to the general practitioner and teledermatologist during the teledermoscopy consultation process. Anonymized data (February 2009–February 2020) was extracted from a Dutch teledermoscopy service database. The timestamps and evaluation questions data were subject to the teledermoscopy quality and performance outcomes. A limited cost evaluation was performed. Results: A total of 18,738 teledermoscopy consultations were sent by 1341 general practitioners (February 2009–February 2020). For 3908 (31.9%) teledermoscopy consultations, the general practitioner requested second opinion advice which led to 712 (18.2%) extra teledermoscopy referrals of patients who would not have been referred without teledermoscopy, including skin cancer teledermoscopy diagnoses. The general practitioner followed the teledermatologists’ advice on patient referral for 8813 (88.5%) patients, reported 97.3% of the teledermoscopy consultations as helpful and 95.1% as instructive, referred 68.0% less patients with teledermoscopy availability, referred overall 59.4% less patients, and needed 5.4 minutes (median) for sending a teledermoscopy consultation. Teledermatologist's median answer and response time was 2 minutes and 2.4 hours, respectively. The estimated cost reduction was €144.18 ($164.65) (50.2%) per teledermoscopy patient. Discussion: Teledermoscopy is a useful service in general practitioner practice for requesting dermatologist advice in primary care settings to support the detection of skin lesion at an early stage and at lower costs. Teledermoscopy could also decrease the burden of secondary dermatology care since general practitioners reported that they did not refer the majority of patients to a dermatologist after the teledermoscopy consultation compared to their initial referral decision. General practitioners reported the teledermoscopy system as helpful and instructive which could contribute to enhancement of their dermatological knowledge