Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20 Teledermatology in Belgium: a pilot study Julie Kips, Jo Lambert, Katia Ongenae, An De Sutter & Evelien Verhaeghe To cite this article: Julie Kips, Jo Lambert, Katia Ongenae, An De Sutter & Evelien Verhaeghe (2019): Teledermatology in Belgium: a pilot study, Acta Clinica Belgica, DOI: 10.1080/17843286.2018.1561812 To link to this article: https://doi.org/10.1080/17843286.2018.1561812 Published online: 08 Jan 2019. Submit your article to this journal Article views: 7 View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yacb20 ACTA CLINICA BELGICA https://doi.org/10.1080/17843286.2018.1561812 Teledermatology in Belgium: a pilot study Julie Kipsa, Jo Lambertb, Katia Ongenaeb, An De Sutter c and Evelien Verhaegheb aGeneral practitioner, Ghent University, Ghent, Belgium; bDepartment of Dermatology, Ghent University, Ghent, Belgium; cDepartment of General practice and primary health care, Ghent University, Ghent, Belgium ABSTRACT KEYWORDS Background: Teledermatology, the application of telemedicine in the field of dermatology, Telemedicine; can be a valuable tool to improve the efficiency of care in general practice. teledermatology; Objectives: In this pilot study, we implemented a teledermatology programme in Belgian dermatology; e-Health; context to assess the effect on referral rate and to evaluate the acceptability of teledermatol- organisation of health care ogy by clinicians and patients. Material and methods: A store-and-forward teledermatology service between 12 general practitioners (GPs) and 3 academic dermatologists was evaluated for a period of 3–6 months. Clinicians and patients were questioned about satisfaction, benefits and barriers. Results: In total, 54 teledermatologic consultations were performed. The referral rate was reduced. Thirty-one teleconsulations were performed instead of physical referral, of which nine patients were actually referred. In 23 cases, performed for a second opinion, two more patients were referred on the dermatologist’s advice. All clinicians want to continue working with teledermatology. GPs highlighted the educa- tional benefit, whereas dermatologists were interested in the triage effect and reduced referral rate. Patients indicated that teledermatology would encourage them to consult a GP sooner when experiencing dermatologic problems. Conclusion: Teledermatology proved to be a feasible and acceptable tool for both clinicians and patients. It also shows to be a valuable for triage and reducing unnecessary referrals. Considering the emergent pressure on health care in the next decades, teledermatology following GP selection could be useful for the Belgian health care system and deserves further elaboration in the search for effective tools to strengthen first line health care and streamline referral to secondary care. Introduction comparable with conventional face-to-face consulta- tions [1,2,4–7]. In order for teledermatology to be Telemedicine is the use of communication technologies considered reliable, the diagnosis must be reproduci- in health care for the exchange of medical information ble by physicians using different modalities. over a distance. The visual character of dermatology Therefore, it is important to compare dermatologist makes it well-suited for telemedicine. Teledermatology in-person consultations and teledermatology for diag- has been the subject of research since 1995 and is one nostic agreement. Systematic reviews by Levin and of the most evolved telemedicine services [1]. Warshaw (2009) and Whited et al. (2015) reported Teledermatology has two established modalities: that good diagnostic agreement is the conclusion, store-and-forward teledermatology (SAFT) and live when comparing a teledermatology diagnosis and in- interaction teledermatology (LI). In the SAFT modality, person dermatologic diagnosis or histopathology with digital images and associated patient data are sent to traditional face-to-face consultations [1,7]. However, a distant site clinician who reviews the data hours or several factors may directly impact the reliability of days later. The LI modality involves real-time video teledermatology including proper imaging, compre- interaction between the consulting party and the hensive history, and skills of the teledermatologists teledermatologist. Store-and-forward modality is the and referring physicians. Therefore, it is imperative main technology of choice because of its technologi- to create good conditions and provide support and cal flexibility and lower cost of service delivery [2,3]. education to referring general practitioners (GPs) [4,7]. Teledermatology can be used either between another Currently, teledermatology is applied throughout all physician and a teledermatologist for triage/consulta- kinds of medical settings, e.g. in hospital and primary care, tion, or directly between patient and dermatologist nursing homes, home care settings. Although it was initi- (direct-to-consumer teledermatology) (Figure 1). ally developed for underserved and remote areas, the The diagnostic reliability of teledermatology for evidence for its cost-effectiveness in more densely popu- non-pigmented lesions has been shown to be lated settings is growing [2,6,8]. Teledermatology is CONTACT Julie Kips [email protected] General practitioner, Merelbeke, Belgium © 2019 Acta Clinica Belgica 2 J. KIPS ET AL. Store-and- Live-interactive: Direct-to- Triage/ forward: Sending Consulting party consumer: The Consultative: stored digital and patient sends Another physician images and teledermatologist images or interacts sends images or associated patient interact via live live with the interacts live with a data to a distant site video. dermatologist. dermatologist for provider. either consultation or triage. Figure 1. Modalities and uses of teledermatology. Adapted from teledermatology toolkit, American Academy of Dermatology [17]. integrated in the national health system of the melanoma were excluded by the GPs. The teledermatol- Netherlands, United Kingdom, Canada, Norway and ogy service was provided by KSYOS TeleMedical Centre, Saudi Arabia. In other countries like North America and a Dutch health care institution specialising in telemedi- Australia, it is supplied by large programmes [9–11]. cine. All GPs received on-site training in clinical photogra- Teledermatology can be of interest for different part- phy and the use of the teledermatology system before ners in the Belgian health care system. It can provide starting teledermatology. The GPs selected patients with atriagesystem,thatcouldbevaluableinacontextof skin conditions that were in their opinion suitable for emergent pressure on health care as our ageing popula- a teleconsult. The database of KSYOS TeleMedical tion will entail an increased demand for care, which will Centre used for this study held records on all teleconsults not be followed by an equal increase in health care work- performed from mid-July 2016 till the end of ers [12]. As teledermatology can reduce the number of January 2017. To create and close a teleconsult, GPs had face-to-face visits, it could lead to shorter waiting lists by to answer mandatory questions on outcome parameters. triage and better access to dermatologic advice. Therefore, teledermatology could provide a valuable The teledermatology consultation process tool to keep health care accessible and sustainable. In the field of telemedicine, however, Belgium is falling GPs sent teleconsults to the dermatologists with the use behind in comparison to other countries. Agoria, the of the SAF-based KSYOS Teledermatology Consultation Belgian federation of technology industry, stated in its System. A teleconsult consisted of two parts. The first part position paper on e-Health that the development of tele- contained basic patient data, clinical photographs, the medicine is slowed down by the lack of objective stimu- patient’shistoryandtheGP’s questions to the dermatol- lating measures, resulting from a lack of confidence, ogist. The second part was optional and contained more caused by insufficient knowledge of the evidence and detailed information on patient history and condition, the small scale of experimental projects in Belgium [12]. partly based on semistructured questions. If necessary, In this study, we aim to explore the benefits and a second teleconsultation round could be included, barriers of teledermatology in a Belgian pilot study, when the dermatologist needed more information which can provide a basis for larger scale projects. about the case or when the GP needed clarification of the dermatologist’s advice. After one or two rounds, the teleconsult was actively closed by the GPs. Clinicians were Materials and methods notified of new, answered or second-round teleconsults Setting by means of an anonymous notification e-mail in their regular e-mail inbox. Dermatologists were asked to The teledermatology service was implemented during answer a teleconsult within two working days. the period from mid-July 2016 until the end of GPs made pictures with the camera on their smart- January 2017. The setting for the study was phone or the Nikon Coolpix digital photo camera pro- a neighbourhood health centre in Ghent and a group vided by KSYOS (resolution of 16,1 Megapixels). There practice in Merelbeke. The teleconsults were answered