Digital dermatology in the Dutch treatment landscape

Dr Milan Tjioe (Bravis Hospital, the Netherlands) discussed the rise of digital dermatology in the Netherlands, highlighting its potential to offer opportunities for patients and physicians but also noting important pitfalls.

“We see an increasing population of elderly people in the Netherlands and a rising incidence of skin cancer,” said Dr Tjioe [1]. “The expectation is that the current healthcare system is not sufficiently equipped to manage the increasing trend in dermatologic malignancies in the future. Tele-dermatology and artificial intelligence (AI) may help alleviate the pressure on the health system.

A challenge is the high rate of individuals above 75 years old in the Netherlands who have never used the internet (>20%). Thus, we cannot expect them to understand and use digital care technology without help. “Moreover, many ICT systems are now available to manage patient information in the various Dutch healthcare facilities, but there is little communication between these systems,” said Dr Tjioe. This lack of interconnectivity complicates the use of digital care. “In Germany and Belgium, patient information is better organised, which makes it easier for patients and healthcare professionals to use digital technology.”

Another question is whether the use of digital care improves work efficiency. “The re-use of information, readability, and traceability of data are positive elements of an electronic patient information system,” mentioned Dr Tjioe. “However, these are expensive systems, and hospitals often aim to reduce the costs by not hiring administrative employees.” These administrative tasks often fall to the physicians. Hence, using electronic patient information systems does not necessarily relieve the work pressure of physicians.

On the other hand, one could argue that digital care can improve patients' independence by delivering information about their disease and treatment. “I am positive that digital care will alleviate work pressure,” said Dr Tjioe. “Also, AI may improve diagnostics, therapeutics, and personalised medicine, and can deliver extra guidance for patients through chatbots.”

Dr Tjioe mentioned the application NUANCE as a possible digital innovation to help physicians. This application records the conversation with patients and transfers and structures relevant information in the patient's electronic file. It saves time and improves physician-patient interactions because it eliminates the need for physicians to make notes. “Although it is currently only available in English, this can save time for physicians in the Netherlands in the future,” commented Dr Tjioe.

Painting a picture of the future of telemedicine, Dr Tjioe said that the telehealth market will grow massively in the coming years. The EU has already documented that citizens should have safe access to their online health data across the EU [2]. “At this moment, the smartphone is the most frequently used hardware system to access the internet,” according to Dr Tjioe. “Patients want to receive digital healthcare through their smartphones, including having direct contact with a healthcare provider, with 24-hours-a-day access from anywhere in the world.” This is in line with the upcoming on-demand economy.

In the Netherlands, medical specialists are not yet allowed to charge for direct-to-consumer teledermatology. However, non-specialists are allowed to charge for skin appointments and foreign companies, such as SkinDr and Dermanostic. “Another element concerning digital innovation in dermatology to be aware of is the amount of available apps. Many of these ‘AI-apps’ do not actually use AI, are not approved, and lack quality measures.”

“Nonetheless, it is obvious that teledermatology is on the rise, increasing the flexibility of patients and physicians,” concluded Dr Tjioe.

1. Tjioe M. Digitale dermatologie onvermijdelijk grensoverschrijdend. Dermatologendagen 2024, 11–12 April, Amsterdam, the Netherlands.
2. European Shaping Europe’s digital future. Available from: https://digital-strategy.ec.europa.eu/en/policies/ehealth.

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Posted on 31 May 20244 June 2024