Exploring artificial intelligence and mobile health in skin cancer care: From development to implementation

This thesis explores the use of artificial intelligence (AI) and mobile health (mHealth) in skin cancer care using quantitative and qualitative research. In Part I, the diagnostic landscape of skin cancer during the COVID-19 pandemic is explored by performing an epidemiological population-based study of skin cancer diagnoses and tumor characteristics in the COVID-19 pandemic, during which access to in-person care was severely restricted in the Netherlands. Part II of this thesis starts with the exploration of developing an AI algorithm to identify individuals at high-risk of skin cancer in the general population based on facial photographs (Chapter 3). Next, in Chapter 4, an mHealth app which uses an AI algorithm for skin cancer detection is prospectively validated in a multi-center study. Part III qualitatively explores the factors surrounding the successful implementation of AI and mHealth in skin cancer care as perceived by key stakeholders. Chapter 5 focuses on the perspective of the general population and elucidates their views toward mHealth apps for skin cancer screening and identifies perceived barriers and facilitators. Chapter 6 explores the views of healthcare providers (HCPs) toward using mHealth apps for skin cancer screening among the general population. Chapter 7 further explores the views of HCPs and focuses on the successful implementation of AI in assisting HCPs in skin cancer care. Part IV concludes the research of this thesis with a first exploration of the actual implementation of an mHealth AI app for skin cancer detection among the general population. Chapter 8 evaluates the uptake, performance and user-reported skin cancer diagnoses following the implementation of an AI mHealth app in 2019 by a large health insurer in the Netherlands. Chapter 9 delves further into this first implementation program of an mHealth app by conducting a health claims analysis to identify the impact of AI and mHealth on dermatological care consumption in the Netherlands.