1. KSYOS TeleMedical Centre  KSYOS TeleMedical Centre founded in 2005  First official virtual health institution  TeleDermatology Consultation since June 2005  November 2009: 2500 GP’s and 175 Dermatologists  November 2009: 33.500 TeleDermatology Consults  Contracts with all health insurers for TeleDermatology Consultations  Reimbursements per TeleDermatology Consult

2.  Implementation:  Software (GP-IS interface)  Hardware  Education, onsite training  Administration and finance  Liability  Contracts Health Insurance Companies  Helpdesk  Quality indicators TeleDermatology

3. The TeleDermatology process

4. Step 1: The GP takes pictures of the skin problem

5. Overview

6. Detail

7. Step 2: The GP transfers the pictures to the computer

8. Step 3: The GP starts the TeleDermatology webbased system

9. Step 4: The GP logs into the system, using a Username and Password

10. Step 5: The GP opens a New Consult

11. Step 6: The GP answers the evaluation question Evaluation questions are built in the system, to be able to measure the efficiency output of TeleDermatology

12. Step 7: The GP completes the TeleConsult

13. Step 8: The GP uploads the pictures from the computer

14. Step 9: The institution of the dermatologist is selected, the GP sends the TeleConsult

15. Step 10: When the dermatologist has answered the TeleConsult, the GP receives a notification email New reply by dermatologist

16. Step 11: The GP opens the TeleConsult in the list ‘Open Consults’

17. Step 12: The GP reads the answer of the dermatologist, closes the TeleConsult or sends back to the dermatologist for a second round

18. Results in the Netherlands  70% of all live referrals could be prevented.  Mean response time 5.6 hours (median < 3 hours!).  45% cost reduction.  Teledermatology enriches GP and dermatologists work experience.  Quality improvement and learning effect.