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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">According to a 2010 report on telemedicine published by a World Health Organization &#40;WHO&#41; initiative called the Global Observatory for eHealth &#8220;Access&#44; equity&#44; quality&#44; and cost-effectiveness are key issues facing health care in both developed and less economically developed countries&#46; Modern information and communication technologies&#44; &#91;&#8230;&#93; are revolutionizing how individuals communicate with each other&#8230;&#46; These technologies have great potential to help address contemporary global health problems&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The breadth of the WHO&#39;S vision of the role these technologies can play in improving the various dimensions of healthcare &#40;equity&#44; access&#44; quality&#44; and cost-effectiveness&#41; stands out in contrast to the debate that has been taking place in the West over the last decade on the subject of telemedicine in general&#44; and teledermatology &#40;TD&#41; in particular&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> TD&#44; which is the use of information and communication technologies to deliver dermatological healthcare services&#44; is the third most common application of telemedicine in number of active programs&#44; coming after teleradiology and telepathology&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Over the last 15 years&#44; references to TD in the literature have been numerous and increasingly frequent&#46; A basic search of the MEDLINE database &#40;via PubMed&#41; using the search term <span class="elsevierStyleItalic">teledermatology</span> identified 477 articles between 2000 and 2015&#46; In many cases these articles were primary studies by authors who assessed the validity and reliability of the different modalities of TD &#40;store and forward&#44; real time&#44; and mobile&#41; in the diagnosis of skin disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#8211;7</span></a> In general&#44; they reported better results&#44; measured in terms of the reproducibility and validity of the decisions taken&#44; for in-person clinical consultations than for teleconsultations&#46; However&#44; there is no need or justification in this context for us to defend the merits of any of the modalities of teleconsultation or to compare them to the nuanced judgments&#44; assessment&#44; and decisions facilitated by an in-person consultation with a patient&#46; There is no comparison between the detailed medical history complemented by a physical examination &#40;observation and palpation&#41; and other exploratory techniques &#40;dermoscopy or even ultrasound&#41; that can be obtained in the context of a conventional face-to-face consultation and the prioritization of clinical situations and referral of patients facilitated by TD&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Other studies have evaluated the usefulness of TD as a healthcare process or services delivery method&#46; From this perspective&#44; researchers have studied the effectiveness and efficiency of TD and evaluated the satisfaction of both service providers and users&#46; All these aspects have been evaluated in various care settings &#40;urban&#44; rural&#44; etc&#46;&#41; and using TD for different clinical objectives &#40;screening for skin cancer and&#47;or other skin conditions&#44; presurgical assessment&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">7&#8211;10</span></a> In this context&#44; TD offers clear advantages over the classic procedures used to prioritize and refer patients from primary care to a dermatologist&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> Based on this evidence&#44; and in order to resolve a decade-long debate&#44; we need to accept the basic premise that&#44; in most cases&#44; teleconsultation complements in-person consultation with a dermatologist rather than replacing patient visits with a specialist clinician&#46; However&#44; what TD can reliably replace &#40;and is replacing&#41; are the traditional referral procedures&#44; and in this context it achieves better results than traditional methods&#46; Before the implementation of the current TD programs&#44; patient referrals to a different level of care &#40;primary&#44; secondary&#44; etc&#46;&#41; were made through written requests from the primary care physician or referring specialist&#46; These traditional procedures have been shown to be clearly inadequate in terms of the appropriate prioritization of patients according to the seriousness of their clinical condition&#44; even when the model of care prioritizes patients who may have cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In various forums&#44; we have expressed our opinion that the principal achievement of teledermatology in our country has been to improve the quality of the healthcare processes managed with information and communication technologies&#46; In order to make such an assertion we need to refer to some of the many characterizations that have been used to define quality in healthcare&#46; One of the most pragmatic and specific definitions of quality in healthcare was issued by the Department of Health in the United Kingdom in 1997&#58; &#8220;Doing the right things&#44; at the right time&#44; for the right people&#44; and doing them right the first time&#8230; the quality of the patient&#39;s experience as well as the clinical result&#44; quality measured in terms of prompt access&#44; good relationships and efficient administration&#46;&#8221; However&#44; we must recognize that the principle of &#8220;doing the right things&#44; at the right time&#44; for the right people&#44; and doing them right the first time&#8221; has not been applied fully in the practice of conventional clinical dermatology&#46; We must ask ourselves whether&#44; applying this definition of quality&#44; we would consider adequate and efficient the care provided in hospital dermatology clinics to patients with common skin lesions &#40;common warts&#44; acrochordons&#44; lipomas&#44; etc&#46;&#41; or mild and transient skin conditions &#40;acute urticaria&#44; seborrheic dermatitis&#44; etc&#46;&#41; Similarly&#44; the fact that the same standards and waiting time targets are applied to all requests for a consultation with a specialist dermatologist&#44; irrespective of the seriousness of the patient&#39;s condition&#44; represents a failure to fulfill the criteria embodied in the concept of quality healthcare&#46; Finally&#44; TD improves the process of referring the patient to a specialist or directly to a surgeon &#40;presurgical teleconsultation&#44; for example&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> and even offers the possibility that patients who have reduced mobility or are confined to bed can be assessed by a specialist without having to leave their own homes&#46; These advantages also reflect a level of care that meets the standards of quality which should apply from the patient&#39;s first contact with the healthcare system&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; despite the obvious potential of TD&#44; reports published by the WHO and other organizations recognize the existence of barriers which&#44; in recent years&#44; have hindered the more generalized implementation of TD programs in routine care settings&#46; Among the barriers cited by the WHO are budgetary considerations &#40;particularly in developing countries&#41;&#44; legal issues arising from the delivery of telemedicine services in different countries&#44; and cultural factors associated with physicians as well as patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In Spain&#44; we have encountered the same barriers and difficulties&#44; which have been the result of multiple factors&#46; Contributing factors range from the current configuration of Spain&#39;s health services to the view of TD held by medical professionals and the health services in the country&#39;s different autonomous communities&#46; The division of Spain&#39;s healthcare system into 17 separate health services &#40;one for each autonomous communities governed by a regional government&#41; has made it impossible to implement common telemedicine strategies&#44; the approach recommended by the WHO&#46; This fragmentation gives rise to significant variability in how and why we use TD in dermatology departments across the country&#46; The fact that some health administrations view TD as a short-term and less expensive solution to the age-old problem of waiting lists has been one of the principal obstacles to the full incorporation of TD into our services&#46; The presentation of TD as an alternative to face-to-face consultation with a dermatologist triggered very strong resistance within our own community because dermatologists viewed the introduction of TD into the system as a threat to jobs in the field of dermatology&#46; In many cases&#44; TD programs were put in place with little or no input from the dermatologist during the development phases of the project&#44; even to identify needs&#46; The lack of a clear legal and regulatory framework for telemedicine has in recent years been another reason for insecurity and even anxiety among medical professionals&#44; particularly in teleconsulting projects involving different territories&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">After 10 years of debate on TD&#44; we have reached a situation in which the threats to the profession have dissipated&#44; the strengths of the new systems have been observed&#44; and the areas of dermatological care improved through telemedicine have been identified&#59; and the Spanish dermatologist now occupies a privileged position&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> Spain is the third country worldwide in scientific production on the subject of TD&#44; only surpassed by the United States and the United Kingdom &#40;according to a search using the term <span class="elsevierStyleItalic">teledermatology</span> in the <a href="http://www.gopubmed.org/">www&#46;gopubmed&#46;org</a> search engine&#41;&#46; Furthermore&#44; the number of TD programs in our country tripled in only 5 years from 21 in 2009 to 68 in 2014 &#40;survey carried out by the AEDV&#39;s eDermatology and Imaging Group coordinated by Dr&#46; Guillermo Romero and Dr&#46; Diego de Argila&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This privileged position should translate into a more settled scenario in which we can start to develop a framework for working with TD that will provide guarantees of safety for both patients and professionals and ensure the quality of telemedicine services&#46; Three basic principles are fundamental to the formulation of such a framework and objectives and should underpin all future development of TD services&#58; the dermatologist must play a leading role in the design&#44; development&#44; implantation&#44; and coordination of all TD programs&#59; all TD activity must be integrated into the portfolio of services authorized by the health services&#59; and scientific associations and working groups must develop guidelines and standards for the practice of quality TD&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The teams involved in the development and implementation of TD programs are necessarily multidisciplinary &#40;primary care physicians&#44; technicians&#44; decision-makers&#44; etc&#46;&#41; and&#44; in this context&#44; the leadership of the dermatologist will make it possible to identify from the outset the problems that can be improved through the intensive application of information and communication technologies&#46; In other words&#44; it is essential to avoid at all cost situations in which TD programs are launched in response to an instruction received from a health agency or administration without first identifying the target area that can be improved by TD&#44; and this analysis must be done by experts in the field&#44; namely&#44; dermatologists&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">TD activity must be integrated into the portfolio of services authorized by hospitals and health services&#46; After completion of the preliminary phase involving analysis and validation&#44; all TD activity should be integrated into the system in the form of an official and authorized program recognized by the hospital and the health authorities&#46; Moreover&#44; like other official programs&#44; TD systems should be assigned specific resources &#40;the necessary working time and appropriate equipment&#41;&#46; This integration of TD activity into the hospitals&#8217; official portfolio of services carries with it implicit recognition of the organization&#39;s responsibility for the appropriate legal coverage required by the medical professionals involved&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Since the beginning of this debate&#44; professionals involved in TD programs have lacked proper guidelines to help them rationalize and optimize the use of this tool&#46; In recent years&#44; however&#44; a number of scientific societies and related organizations&#8212;<span class="elsevierStyleItalic">American Telemedicine Association&#44; British Teledermatology Society&#44; American Academy of Dermatology</span>&#44; etc&#46;&#8212;have published standards and recommendations on the practice of quality TD &#40;<a href="http://www.americantelemed.org/">http&#58;&#47;&#47;www&#46;americantelemed&#46;org&#47;</a>&#44; <a href="http://www.bad.org.uk/healthcare-professionals/specialist-groups/british-teledermatology-society">www&#46;bad&#46;org&#46;uk&#47;healthcare-professionals&#47;specialist-groups&#47;british-teledermatology-society</a>&#44; <a href="http://www.aad.org/forms/policies/uploads/ps/ps-teledermatology.pdf">www&#46;aad&#46;org&#47;forms&#47;policies&#47;uploads&#47;ps&#47;ps-teledermatology&#46;pdf</a>&#41;&#46; These documents&#44; which are of great interest&#44; are serving as the basis for the work currently being undertaken by the recently created Grupo Espa&#241;ol de e-Dermatolog&#237;a e Imagen &#40;GEDEI&#44; the Spanish eDermatology and Imaging Group&#41; at the request of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41;&#46; The aim of this work is to create a framework for TD activity that can guarantee standards of quality in care that would be difficult to achieve without the rational application of current information and communications technologies&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; after a decade of intense debate about TD&#44; we are sailing into calmer waters&#46;</p></span>"
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OPINION ARTICLE
Teledermatology: From the Tempest of Debate to Calmer Waters
Teledermatología, del debate a la calma
D. Moreno-Ramíreza,
Autor para correspondencia
, G. Romero-Aguilerab
a Unidad de Gestión Clínica de Dermatología MQyV, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">According to a 2010 report on telemedicine published by a World Health Organization &#40;WHO&#41; initiative called the Global Observatory for eHealth &#8220;Access&#44; equity&#44; quality&#44; and cost-effectiveness are key issues facing health care in both developed and less economically developed countries&#46; Modern information and communication technologies&#44; &#91;&#8230;&#93; are revolutionizing how individuals communicate with each other&#8230;&#46; These technologies have great potential to help address contemporary global health problems&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The breadth of the WHO&#39;S vision of the role these technologies can play in improving the various dimensions of healthcare &#40;equity&#44; access&#44; quality&#44; and cost-effectiveness&#41; stands out in contrast to the debate that has been taking place in the West over the last decade on the subject of telemedicine in general&#44; and teledermatology &#40;TD&#41; in particular&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> TD&#44; which is the use of information and communication technologies to deliver dermatological healthcare services&#44; is the third most common application of telemedicine in number of active programs&#44; coming after teleradiology and telepathology&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Over the last 15 years&#44; references to TD in the literature have been numerous and increasingly frequent&#46; A basic search of the MEDLINE database &#40;via PubMed&#41; using the search term <span class="elsevierStyleItalic">teledermatology</span> identified 477 articles between 2000 and 2015&#46; In many cases these articles were primary studies by authors who assessed the validity and reliability of the different modalities of TD &#40;store and forward&#44; real time&#44; and mobile&#41; in the diagnosis of skin disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#8211;7</span></a> In general&#44; they reported better results&#44; measured in terms of the reproducibility and validity of the decisions taken&#44; for in-person clinical consultations than for teleconsultations&#46; However&#44; there is no need or justification in this context for us to defend the merits of any of the modalities of teleconsultation or to compare them to the nuanced judgments&#44; assessment&#44; and decisions facilitated by an in-person consultation with a patient&#46; There is no comparison between the detailed medical history complemented by a physical examination &#40;observation and palpation&#41; and other exploratory techniques &#40;dermoscopy or even ultrasound&#41; that can be obtained in the context of a conventional face-to-face consultation and the prioritization of clinical situations and referral of patients facilitated by TD&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Other studies have evaluated the usefulness of TD as a healthcare process or services delivery method&#46; From this perspective&#44; researchers have studied the effectiveness and efficiency of TD and evaluated the satisfaction of both service providers and users&#46; All these aspects have been evaluated in various care settings &#40;urban&#44; rural&#44; etc&#46;&#41; and using TD for different clinical objectives &#40;screening for skin cancer and&#47;or other skin conditions&#44; presurgical assessment&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">7&#8211;10</span></a> In this context&#44; TD offers clear advantages over the classic procedures used to prioritize and refer patients from primary care to a dermatologist&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> Based on this evidence&#44; and in order to resolve a decade-long debate&#44; we need to accept the basic premise that&#44; in most cases&#44; teleconsultation complements in-person consultation with a dermatologist rather than replacing patient visits with a specialist clinician&#46; However&#44; what TD can reliably replace &#40;and is replacing&#41; are the traditional referral procedures&#44; and in this context it achieves better results than traditional methods&#46; Before the implementation of the current TD programs&#44; patient referrals to a different level of care &#40;primary&#44; secondary&#44; etc&#46;&#41; were made through written requests from the primary care physician or referring specialist&#46; These traditional procedures have been shown to be clearly inadequate in terms of the appropriate prioritization of patients according to the seriousness of their clinical condition&#44; even when the model of care prioritizes patients who may have cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In various forums&#44; we have expressed our opinion that the principal achievement of teledermatology in our country has been to improve the quality of the healthcare processes managed with information and communication technologies&#46; In order to make such an assertion we need to refer to some of the many characterizations that have been used to define quality in healthcare&#46; One of the most pragmatic and specific definitions of quality in healthcare was issued by the Department of Health in the United Kingdom in 1997&#58; &#8220;Doing the right things&#44; at the right time&#44; for the right people&#44; and doing them right the first time&#8230; the quality of the patient&#39;s experience as well as the clinical result&#44; quality measured in terms of prompt access&#44; good relationships and efficient administration&#46;&#8221; However&#44; we must recognize that the principle of &#8220;doing the right things&#44; at the right time&#44; for the right people&#44; and doing them right the first time&#8221; has not been applied fully in the practice of conventional clinical dermatology&#46; We must ask ourselves whether&#44; applying this definition of quality&#44; we would consider adequate and efficient the care provided in hospital dermatology clinics to patients with common skin lesions &#40;common warts&#44; acrochordons&#44; lipomas&#44; etc&#46;&#41; or mild and transient skin conditions &#40;acute urticaria&#44; seborrheic dermatitis&#44; etc&#46;&#41; Similarly&#44; the fact that the same standards and waiting time targets are applied to all requests for a consultation with a specialist dermatologist&#44; irrespective of the seriousness of the patient&#39;s condition&#44; represents a failure to fulfill the criteria embodied in the concept of quality healthcare&#46; Finally&#44; TD improves the process of referring the patient to a specialist or directly to a surgeon &#40;presurgical teleconsultation&#44; for example&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> and even offers the possibility that patients who have reduced mobility or are confined to bed can be assessed by a specialist without having to leave their own homes&#46; These advantages also reflect a level of care that meets the standards of quality which should apply from the patient&#39;s first contact with the healthcare system&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; despite the obvious potential of TD&#44; reports published by the WHO and other organizations recognize the existence of barriers which&#44; in recent years&#44; have hindered the more generalized implementation of TD programs in routine care settings&#46; Among the barriers cited by the WHO are budgetary considerations &#40;particularly in developing countries&#41;&#44; legal issues arising from the delivery of telemedicine services in different countries&#44; and cultural factors associated with physicians as well as patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In Spain&#44; we have encountered the same barriers and difficulties&#44; which have been the result of multiple factors&#46; Contributing factors range from the current configuration of Spain&#39;s health services to the view of TD held by medical professionals and the health services in the country&#39;s different autonomous communities&#46; The division of Spain&#39;s healthcare system into 17 separate health services &#40;one for each autonomous communities governed by a regional government&#41; has made it impossible to implement common telemedicine strategies&#44; the approach recommended by the WHO&#46; This fragmentation gives rise to significant variability in how and why we use TD in dermatology departments across the country&#46; The fact that some health administrations view TD as a short-term and less expensive solution to the age-old problem of waiting lists has been one of the principal obstacles to the full incorporation of TD into our services&#46; The presentation of TD as an alternative to face-to-face consultation with a dermatologist triggered very strong resistance within our own community because dermatologists viewed the introduction of TD into the system as a threat to jobs in the field of dermatology&#46; In many cases&#44; TD programs were put in place with little or no input from the dermatologist during the development phases of the project&#44; even to identify needs&#46; The lack of a clear legal and regulatory framework for telemedicine has in recent years been another reason for insecurity and even anxiety among medical professionals&#44; particularly in teleconsulting projects involving different territories&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">After 10 years of debate on TD&#44; we have reached a situation in which the threats to the profession have dissipated&#44; the strengths of the new systems have been observed&#44; and the areas of dermatological care improved through telemedicine have been identified&#59; and the Spanish dermatologist now occupies a privileged position&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> Spain is the third country worldwide in scientific production on the subject of TD&#44; only surpassed by the United States and the United Kingdom &#40;according to a search using the term <span class="elsevierStyleItalic">teledermatology</span> in the <a href="http://www.gopubmed.org/">www&#46;gopubmed&#46;org</a> search engine&#41;&#46; Furthermore&#44; the number of TD programs in our country tripled in only 5 years from 21 in 2009 to 68 in 2014 &#40;survey carried out by the AEDV&#39;s eDermatology and Imaging Group coordinated by Dr&#46; Guillermo Romero and Dr&#46; Diego de Argila&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This privileged position should translate into a more settled scenario in which we can start to develop a framework for working with TD that will provide guarantees of safety for both patients and professionals and ensure the quality of telemedicine services&#46; Three basic principles are fundamental to the formulation of such a framework and objectives and should underpin all future development of TD services&#58; the dermatologist must play a leading role in the design&#44; development&#44; implantation&#44; and coordination of all TD programs&#59; all TD activity must be integrated into the portfolio of services authorized by the health services&#59; and scientific associations and working groups must develop guidelines and standards for the practice of quality TD&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The teams involved in the development and implementation of TD programs are necessarily multidisciplinary &#40;primary care physicians&#44; technicians&#44; decision-makers&#44; etc&#46;&#41; and&#44; in this context&#44; the leadership of the dermatologist will make it possible to identify from the outset the problems that can be improved through the intensive application of information and communication technologies&#46; In other words&#44; it is essential to avoid at all cost situations in which TD programs are launched in response to an instruction received from a health agency or administration without first identifying the target area that can be improved by TD&#44; and this analysis must be done by experts in the field&#44; namely&#44; dermatologists&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">TD activity must be integrated into the portfolio of services authorized by hospitals and health services&#46; After completion of the preliminary phase involving analysis and validation&#44; all TD activity should be integrated into the system in the form of an official and authorized program recognized by the hospital and the health authorities&#46; Moreover&#44; like other official programs&#44; TD systems should be assigned specific resources &#40;the necessary working time and appropriate equipment&#41;&#46; This integration of TD activity into the hospitals&#8217; official portfolio of services carries with it implicit recognition of the organization&#39;s responsibility for the appropriate legal coverage required by the medical professionals involved&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Since the beginning of this debate&#44; professionals involved in TD programs have lacked proper guidelines to help them rationalize and optimize the use of this tool&#46; In recent years&#44; however&#44; a number of scientific societies and related organizations&#8212;<span class="elsevierStyleItalic">American Telemedicine Association&#44; British Teledermatology Society&#44; American Academy of Dermatology</span>&#44; etc&#46;&#8212;have published standards and recommendations on the practice of quality TD &#40;<a href="http://www.americantelemed.org/">http&#58;&#47;&#47;www&#46;americantelemed&#46;org&#47;</a>&#44; <a href="http://www.bad.org.uk/healthcare-professionals/specialist-groups/british-teledermatology-society">www&#46;bad&#46;org&#46;uk&#47;healthcare-professionals&#47;specialist-groups&#47;british-teledermatology-society</a>&#44; <a href="http://www.aad.org/forms/policies/uploads/ps/ps-teledermatology.pdf">www&#46;aad&#46;org&#47;forms&#47;policies&#47;uploads&#47;ps&#47;ps-teledermatology&#46;pdf</a>&#41;&#46; These documents&#44; which are of great interest&#44; are serving as the basis for the work currently being undertaken by the recently created Grupo Espa&#241;ol de e-Dermatolog&#237;a e Imagen &#40;GEDEI&#44; the Spanish eDermatology and Imaging Group&#41; at the request of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41;&#46; The aim of this work is to create a framework for TD activity that can guarantee standards of quality in care that would be difficult to achieve without the rational application of current information and communications technologies&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; after a decade of intense debate about TD&#44; we are sailing into calmer waters&#46;</p></span>"
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