A Project to Enhance Dermatology E-consultations in Primary Care Centers Using Artificial Intelligence Tools.
Conditions: Skin Condition, Skin Abnormalities, Malignancy, Melanoma (Skin Cancer), Skin Cancer
Sponsor: AI Labs Group S.L

 
 
 
Sponsor: Instituto de Investigación Sanitaria Puerta de Hierro 
 
STUDY PROTOCOL 
Project to enhance Dermatology E-Consultations in Primary Care Centres using 
Artificial Intelligence Tools. 
 
Protocol version and date 
Version: 1.0. Date: 29/06/2022 
Protocol code 
LEGIT.HEALTH_DAO_Derivación_PH_2022 
Sponsor 
 
Instituto de Investigación Sanitaria Puerta de 
Hierro 
Calle Manuel de Falla 1, 28222, Majadahonda 
Research Coordinator 
Dr. Gastón Roustan Gullón  
Dermatology Service 
Puerta de Hierro Majadahonda University 
Hospital 
C. Joaquín Rodrigo, 1, 28222 Majadahonda, 
Madrid 
Principal Investigator 
Dr. Gastón Roustan Gullón  
Dermatology Service  
Puerta de Hierro Majadahonda University 
Hospital 
C. Joaquín Rodrigo, 1, 28222 Majadahonda, 
Madrid 
This Study Protocol is the property of the Puerta de Hierro Health Research 
Institute and is a confidential document. It may not be copied or distributed to 
other parties without the prior written authorization of the Puerta de Hierro 
Health Research Institute. 
 
 
 
 
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Sponsor: Instituto de Investigación Sanitaria Puerta de Hierro 
 
 
 
1. Resumen​
4 
2. Marco teórico. Planteamiento del problema​
6 
Antecedentes y justificación​
6 
Preguntas de investigación​
8 
Las preguntas que persigue responder el presente estudio son las 
siguientes:​
8 
Hipótesis​
8 
3. Objetivos generales y específicos​
8 
4. Métodos​
9 
Diseño del estudio​
9 
Población de estudio. Criterios de inclusión, exclusión​
9 
Criterios de inclusión:​
9 
Criterios de exclusión:​
10 
Definición de variables​
10 
Tamaño de la muestra previsto​
11 
Control de calidad​
12 
Limitaciones del diseño, de la fuente de información y de los métodos de 
análisis​
12 
5. Plan de trabajo (tareas, hitos y cronología del estudio)​
12 
Reclutamiento de médicos​
12 
Identificación de los pacientes.​
13 
Procedimientos a realizar por el médico de atención primaria​
13 
1. Consulta​
13 
2. Cumplimentación de los cuestionarios​
14 
Procedimientos a realizar por el médico especialista​
14 
1. Consulta​
14 
2. Cumplimentación de los cuestionarios​
14 
6. Aspectos éticos​
14 
Consideraciones éticas, sobre información a los sujetos y consentimiento 
informado​
14 
Consideraciones sobre el tratamiento de las muestras biológicas​
15 
Confidencialidad de los datos​
15 
Interferencia con los hábitos de prescripción del médico​
15 
7. Plan de difusión de los resultados​
15 
8. Modificaciones del protocolo​
15 
9. Consideraciones prácticas​
16 
Informes de inicio, seguimiento y final​
16 
10. Bibliografía​
16 
11. Anexos​
17 
 
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Sponsor: Instituto de Investigación Sanitaria Puerta de Hierro 
 
Anexo I - Cuestionario de Utilidad Clínica y Satisfacción​
17 
 
 
 
 
 
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Sponsor: Instituto de Investigación Sanitaria Puerta de Hierro 
 
1.​ Abstract 
Sponsor Identification 
Instituto de Investigación Sanitaria Puerta de 
Hierro 
Calle Manuel de Falla 1, 28222, Majadahonda 
Study Title 
Project to enhance Dermatology E-Consultations in 
Primary Care Centres using Artificial Intelligence 
Tools. 
Protocol code 
LEGIT.HEALTH_DAO_Derivación_PH_2022 
Protocol version and 
date 
Version: 1.0. Date: 29/06/2022 
Research Coordinator 
Dr. Gastón Roustan Gullón  
Dermatology Service  
Puerta de Hierro Majadahonda University Hospital 
C. Joaquín Rodrigo, 1, 28222 Majadahonda, 
Madrid 
Principal Investigator 
Dr. Gastón Roustan Gullón  
Dermatology Service  
Puerta de Hierro Majadahonda University Hospital 
C. Joaquín Rodrigo, 1, 28222 Majadahonda, 
Madrid 
Collaborating 
investigators 
Dra. Esther Minguela 
Majadahonda Health Center 
Dr. Fernando León 
Pozuelo Health Center 
Dr. Ángel Rosell Díaz 
Dermatology Service 
 
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Sponsor: Instituto de Investigación Sanitaria Puerta de Hierro 
 
Puerta de Hierro Majadahonda University Hospital 
Investigational centers 
Puerta de Hierro Majadahonda University Hospital 
Majadahonda Health Center 
Pozuelo Health Center 
Ethics Committee 
Research Ethics Committee of the Puerta de 
Hierro Majadahonda University Hospital 
Primary Objective 
The main objective of this study is to validate the 
clinical utility of the Legit.Health platform developed 
by AI LABS GROUP SL in the management of 
patients with skin pathology by primary care 
physicians and dermatologists of the Puerta de 
Hierro Majadahonda University Hospital involved in 
the project.  
Design 
Prospective observational analytical study of a 
series 
of clinical cases with a longitudinal 
character. 
Disease under study 
Patients 
suspected 
of 
having 
the 
following 
pathologies in Primary Care: tumor pathology, 
inflammatory pathology, and infectious pathology 
Study Population and 
Total Number of 
Subjects 
100 adult patients attending their primary care 
center 
with 
tumor 
pathology, 
inflammatory 
pathology, or infectious pathology. 
Calendar. Planned 
Duration of the Study  
The study will last 5 months, with 4 months of 
recruitment time and 1 month for data analysis. 
Ethical Considerations 
The development of the study will comply with 
international 
Good 
Clinical 
Practice 
(GCP) 
guidelines, the Declaration of Helsinki in its latest 
active amendment, and applicable international 
 
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and national rules and regulations. The study will 
not begin until approval has been obtained from 
the Ethics Research Committee of the Hospital 
Universitario Puerta de Hierro Majadahonda. 
 
2.​ Theoretical framework. Problem statement. 
Background and rationale 
Skin-related diseases are a frequent reason for consultation in primary care 
(PC)1; some studies estimate this at approximately 5% of all consultations, 
mainly among the working population. 
This represents a considerable consumption of resources and makes an 
efficient approach to these conditions a key step in optimizing the functioning of 
primary care. 
Numerous studies show discrepancies in opinion between primary care 
physicians and dermatologists2, with agreement rates in their diagnoses 
ranging from 57% to 65.52% depending on the study. In general, primary care 
physicians do not demonstrate adequate knowledge about skin diseases, their 
diagnosis, and their treatments. 
This human limitation when evaluating skin diseases is also reflected in the 
effort and time required to estimate the degree of involvement in a patient or the 
stage of the pathology. So much so, that it ends up being a very unrewarding 
task and can lead to poor adherence to the protocol and inappropriate referrals. 
Time consumption is especially concerning given that the number of medical 
professionals, particularly in dermatology, is insufficient to meet the existing 
demand. Access to a dermatology specialist for the general population is 
complicated due to the low number (3 dermatologists per 100,000 inhabitants)3, 
a situation that is even more difficult in small population centers. Because of 
this, screening for dermatological lesions must be carried out by primary care 
physicians, whose diagnostic capacity is even lower and which may increase 
the risk of misdiagnosis. 
In this regard, the literature shows a discrepancy of between 55% and 65% 
between primary care physicians and specialists, and studies confirm several 
expected characteristics: common dermatological diseases are often not 
recognized or are misdiagnosed by non-dermatologists due to the particular 
profiles of common diagnoses in this field (drug-induced rashes, fungal 
infections). 
In addition to these inherent limitations, when the preliminary examination is 
performed by the patient, the possibility of bias arises. This is especially true 
 
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when the patient knows that the treatment they receive will be determined by 
the information they provide. Furthermore, the medical team lacks the means to 
verify the accuracy of the values ​reported by the patient, preventing external 
verification. 
For several years, and as part of the objectives of utilizing new information and 
communication technologies (ICTs), healthcare information systems have been 
adapted to record certain Primary Care (PC) activities. Since June 2020, an 
asynchronous e-consultation for Dermatology has been available, allowing the 
transmission of clinical information and images generated in Health Centers to 
the Dermatology Department of Puerta de Hierro Majadahonda Hospital, 
integrated within the hospital's own information system (Selene). 
 
The gradual implementation of teledermatology within the strategic plan of the 
Community 
of 
Madrid 
has 
culminated 
in 
the 
development 
of 
the 
teleDERMADRID project. Led by Pilar Sánchez Pobre Bejarano and Manuel 
Grandal Martín (GAOAIO), in coordination with DGASA, this project enables a 
new, non-face-to-face consultation modality adapted to the current social and 
technological reality. This new modality includes an image acquisition 
management (IAM) tool, accessible via a QR code on the mobile device, which 
improves and streamlines the e-consultation. This tool is directly linked to the 
integrated request system (SIPE), ensuring rapid and generally satisfactory 
access to and response to the health problems of the target population, thus 
avoiding diagnostic delays, unnecessary travel, and expediting the therapeutic 
requirements available in our service portfolio. 
 
The reduction of pressure on in-person hospital consultations directly 
contributes to lower costs for conventional care. All of this is achieved without 
compromising the humanization of patient care, another key objective for 
improving health-related quality of life. In addition to the image management 
tool, a clinical form is associated with the necessary items to complement the 
image. 
Advancing the development of ICTs, the emergence of Artificial Intelligence in 
medicine has enabled the automation of a wide variety of processes, such as 
patient triage, allowing for faster care for those suffering from more serious 
conditions. The use of these types of systems by primary care physicians can 
increase their diagnostic capacity by up to 12%, proving highly useful in 
appropriate referrals for patients with skin conditions. 
Therefore, this study aims to clinically validate a novel artificial intelligence tool 
to increase the appropriateness of referrals from primary care to dermatology. 
 
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Research Questions 
The questions this study seeks to answer are the following: 
●​ Does dermatological artificial intelligence help primary care physicians 
treat patients with skin problems? 
●​ Does Legit.Health's cutaneous artificial intelligence contribute to 
appropriate referrals? 
●​ Do primary care physicians value the incorporation of dermatological 
artificial intelligence into their routine clinical practice? 
Hypothesis 
The hypothesis guiding this study is that the Legit.Health platform, developed by 
AI LABS GROUP SL, significantly increases the appropriateness of referrals to 
dermatology. 
This hypothesis is based on the notion that artificial intelligence introduces 
several significant changes to the diagnostic process: 
●​ Greater sensitivity and specificity than a primary care physician in 
diagnosing skin conditions, especially in differentiating between 
malignant and benign lesions. 
●​ It provides the security of a clinically validated second medical opinion. 
3.​
Primary and secondary objectives 
The main objective of this study is to validate the clinical utility of the 
Legit.Health platform, developed by AI LABS GROUP SL, in the management 
of patients with skin conditions by primary care physicians and dermatologists 
at the Puerta de Hierro Majadahonda University Hospital involved in the project. 
Secondary objectives include: 
●​ Reduce and correct the referral of patients with skin conditions from 
primary care to dermatology. 
●​ Personalize and improve continuing education for primary care 
physicians in the field of dermatology. 
●​ Offer healthcare adapted to technological innovations. 
●​ Measure the satisfaction of primary care physicians with the Legit.Health 
platform. 
●​ Measure the satisfaction of dermatologists with the Legit.Health platform. 
 
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4.​
Methods 
Study design 
This is a prospective, observational, analytical study of a series of clinical 
cases. 
It is a longitudinal study. 
Study population. Inclusion & exclusion criteria 
Adult patients (≥ 18 years) with skin pathologies. 
Inclusion criteria: 
●​ Patients with suspected of having the following pathologies in Primary 
Care: 
o​ Tumor patholohy 
▪​
Benign 
●​ Histiocytoma 
●​ Seborrheic keratosis 
●​ Angiomas 
▪​
Precancerous 
●​ Actinic Keratosis 
▪​
Suspected malignancy: 
●​ Basal cell carcinoma 
●​ Squamous cell carcinoma 
▪​
Pigmented lesions 
●​ Melanocytic nevus 
●​ Malignant melanoma 
o​ Inflammatory pathology 
▪​
Psoriasis 
▪​
Atopic dermatitis 
▪​
Urticaria 
 
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▪​
 Hidradenitis suppurativa 
▪​
 Lichen planus 
o​ Infectious pathology 
▪​
Viral warts 
▪​
Molluscs 
▪​
Herpes simplex 
●​ Patients aged 18 years or older. 
●​ Patients who have signed the informed consent for the study. 
Exclusion criteria: 
●​ Patients under 18 years of age. 
●​ Pregnant patients. 
●​ Patients who, in the researcher's opinion, will not comply with the study 
procedures. 
Variables 
The main variable aims to determine the clinical utility of the platform developed 
by AI LABS GROUP SL in the management of patients with skin pathology by 
primary care physicians and dermatologists of the Puerta de Hierro 
Majadahonda University Hospital involved in the project. 
For this purpose, clinicians will complete the Clinical Utility and Satisfaction 
Questionnaire (Annex I). 
In addition, the following secondary variables will be collected:: 
●​ Patient demographics:  
○​ Sex 
○​ Age 
●​ Teleconsultation data: 
○​ Response time 
○​ Response label (follow-up in primary care, shared follow-up, 
dermatology follow-up, insufficient or inadequate information) 
●​ Data from the in-person consultation: 
 
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○​ Duration of an in-person dermatology appointment to respond to 
an online primary care consultation. 
○​ Waiting time until being seen in a specialized dermatology clinic. 
●​ Diagnosis 
○​ Diagnostic correlation between primary care and dermatology. 
○​ Number of patients referred by pathology. 
○​ Diagnostic correlation between primary care, dermatology, and 
dermatopathology (if applicable). 
○​ Time elapsed between the day of the primary care visit and the 
day of the histopathological diagnosis (if applicable). 
●​ Primary care physician satisfaction using the Clinical Utility and 
Satisfaction Questionnaire (Appendix I). 
●​ Dermatologists satisfaction using the Clinical Utility and Satisfaction 
Questionnaire (Appendix I). 
Expected sample size 
This study will recruit 100 patients. This study is designed as a proof-of-concept 
pilot study in which the sample size has been estimated based on the number 
of primary care physicians who treat patients diagnosed with skin diseases who 
can be seen in the primary care services of the following centers: 
1.​ Majadahonda Health Center 
2.​ Pozuelo Health Center 
During the study recruitment period, all patients diagnosed with skin diseases 
who meet the selection criteria will be included. 
To ensure that all primary care physicians participating in the study have 
sufficiently interacted with the tool, a minimum of 50 patients per primary care 
center is required. 
The data collected from these patients during the study period will be analyzed, 
and based on the results, an assessment will be made as to whether it is 
necessary to expand the sample size to include more patients. 
Quality control 
The researcher will guarantee the accuracy and integrity of the data, as well as 
all required reports. Data included in the Data Collection Booklet (DCB) that are 
derived from source documents will be consistent with those documents; 
otherwise, any discrepancies will be justified. 
The investigator will retain the study documents for at least five years after the 
study's completion. 
 
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Upon request from the monitor, auditor, Ethics Committee, or health authority, 
the investigator will make all study-related files available, allowing direct access 
to the source data or documents for monitoring, auditing, Ethics Committee 
review, and trial inspection by the competent authorities. 
Limitations of the design, the information source, and the analysis 
methods 
The main limitation of machine learning lies in the quantity and quality of the 
images collected. Variability in lighting, color, shape, size, and focus are crucial, 
as is the number of images per patient. This means that high variability within 
the same patient and an insufficient number of images to reflect that variability 
can result in lower-than-expected accuracy. 
5.​ Work plan (tasks, milestones and study timeline) 
Recruitment of practitioners 
The Principal Investigator and/or the collaborating researchers assigned to this 
task will explain to the primary care physicians what their participation in the 
study will entail. The physicians will then be able to ask any questions they 
deem necessary to clarify any doubts they may have regarding the study. 
Likewise, all physicians participating in the study will receive specific information 
on the use of the artificial intelligence tool, provided by an expert in the field. 
If the physician wishes to participate in the study, they will sign the Informed 
Consent form and will be assigned a study code. After signing the informed 
consent form, the data collection process begins. 
The Principal Investigator and/or the collaborating researchers assigned to this 
task will collect demographic data (age, center, years in practice) and explain to 
the physician the steps they must follow as part of the study. 
Patient identification.  
The primary objective of this study is to evaluate the clinical utility perceived by 
physicians; therefore, patients' clinical variables are not the focus of the study. 
Patients will be identified in the tool solely for the purpose of enabling its use, 
and their data will not be analyzed or processed in any way. 
The primary care physician will explain the study to the patient using the Patient 
Information Sheet. The patient will then be able to ask any questions they may 
have to clarify any doubts regarding the study. 
If the patient wishes to participate, they will sign the Informed Consent form and 
will be assigned a study code. Data collection begins after the informed consent 
form is signed. 
 
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The Principal Investigator and/or the collaborating researchers assigned to this 
task will enter demographic data (age, sex) and data related to the diagnosis, 
characteristics, and treatment of the pathology into Legit.Health platform. 
Procedures to be performed by the primary care physician 
1.​ Consultation 
Primary care physicians will need to take photographs showing the areas 
affected by the condition. These photographs will be taken with their own 
smartphone or using a mobile dermatoscope if its use is clinically relevant. 
Primary care physicians will upload the photographs to the Legit.Health 
platform. 
Primary care physicians will assess the patient's condition through direct 
observation and guided by the results from the platform. They will enter the 
diagnosis into the Legit.Health platform by selecting the condition if it is among 
the first 5 or by using a drop-down menu that displays a wide range of 
conditions. 
In addition to the most likely diagnoses, physicians will have access to referral 
criteria, the clinical referral questionnaire, and basic treatment advice. When 
they deem it necessary, they will refer the patient in their Selene system, as 
they normally would; not through Legit.Health. 
2.​ Completion of the questionnaires 
Primary care physicians will complete the Clinical Utility and Satisfaction 
Questionnaire (Annex I) twice during the study, the first time at 2 months and 
the second time at 4 months from the start of the study. 
Procedures to be performed by the specialist physician 
1.​ Consultation 
The Principal Investigator will see patients while maintaining their standard 
clinical routine. In the Data Collection Document (DCD), they will note the 
appropriateness of the patient referral. If they deem the referral to dermatology 
inappropriate, this will also be recorded. The initial diagnosis provided by the 
primary care physician, as well as their own diagnosis, will be documented. If 
relevant, the pathology diagnosis will also be included. 
2.​ Completion of questionnaires 
Dermatologists will complete the Clinical Utility and Satisfaction Questionnaire 
(Annex I) twice during the study, the first time at 2 months and the second time 
at 4 months from the start of the study. 
 
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6.​ Ethical considerations 
Ethical considerations, regarding information to subjects and informed 
consent 
The study will be conducted in accordance with international Good Clinical 
Practice guidelines, the Declaration of Helsinki in its latest amendment, and 
applicable international and national rules and regulations. It will not commence 
until it has received approval from the Research Ethics Committee of the Puerta 
de Hierro Majadahonda University Hospital. Any modification to this protocol will 
be reviewed and approved by the Principal Investigator and must be evaluated 
by the Ethics Committee for its approval before enrolling subjects in a modified 
protocol. 
The study will be conducted in accordance with European Regulation 2016/679 
of 27 April, on the protection of natural persons with regard to the processing of 
personal data and on the free movement of such data, and Organic Law 3/2018 
of 5 December, on the Protection of Personal Data and Guarantee of Digital 
Rights, with regard to data processing. No data that allows for the personal 
identification of subjects will be included, and all information will be managed in 
a coded manner. 
Patients will be informed orally and in writing about all aspects of the study, 
adapted to their level of understanding. Patients will be given a copy of the 
informed consent form and information sheet. The investigator must allow 
patients sufficient time to ask questions about the details of the study. 
The preparation of the informed consent form is the responsibility of the 
Principal Investigator. This form must include all elements required by the 
International Conference on Harmonisation (ICH), current regulatory guidelines, 
and comply with Good Clinical Practice (GCP) guidelines and the ethical 
principles derived from the Declaration of Helsinki. 
The investigator, or a person designated by the Principal Investigator, will keep 
the original signed informed consent form in a secure, restricted-access area, 
under the custody of the Principal Investigator. This form will never leave the 
facility, and a copy of the original signed form will be given to the patient. 
Considerations on the treatment of biological samples 
Biological samples will not be collected in this study.  
Data confidentiality 
Regarding the confidentiality of the study data, the provisions of Organic Law 
3/2018, of December 5, on the Protection of Personal Data and Guarantee of 
Digital Rights and Regulation (EU) General Data Protection Regulation 
2016/679 will be followed. 
 
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Interference with the practitioner's prescribing habits 
The clinical management of patients will be adapted to the treatment standards 
of the Dermatology Service of the Puerta de Hierro Majadahonda University 
Hospital, without the performance of this study influencing such process. 
7.​ Plan for disseminating the results 
Following the completion of the study, the results of the clinical utility and 
satisfaction surveys, conducted according to the model in Annex I, may be 
presented at conferences and scientific meetings with prior authorization from 
both parties. Press releases and communications may also be issued to 
communicate the study results. All publications and communications must be 
accepted and approved by Novartis and the Puerta de Hierro Majadahonda 
University Hospital. 
8.​ Protocol modifications 
Any modification to the study protocol will always take the form of a written 
amendment or addendum. Formalization will require the approval of all 
individuals responsible for the study. In the case of significant modifications, 
express approval from the Clinical Research Ethics Committee will be 
requested. 
9.​ Practical considerations 
Start, progress and end reports 
The ethics committee will be notified of the start of the study. Annual progress 
reports will be submitted subsequently. 
After the study's conclusions are reached, a final report will be prepared and 
submitted to the ethics committee. 
10.​
Bibliography 
1.​ D.L. Ramsay, P.E. Weary. Primary care in dermatology: Whose role should it 
be?. J AmAcad Dermatol, 35 (1996), pp. 1005-1008 
2.​ Berg M. Evaluation of a questionnaire used in dermatological epidemiology. 
Discrepancy between self-reported. Symptoms and objective signs. Acta 
Derm Venereol (Stockh).1991;Suppl 156:13-7 
3.​ Patricia Barber Pérez, Beatriz González López-Valcárcel. “Estimación de la 
oferta y demanda de médicos especialistas. España 2018-2030. 2019, p. 
168. 
https://www.mscbs.gob.es/profesionales/formacion/necesidadEspecialistas/
doc/20182030EstimacionOfertaDemandaMedicosEspecialistasV2.pdf. 
 
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4.​ Jain A, Way D, Gupta V, et al. Development and Assessment of an Artificial 
Intelligence-Based Tool for Skin Condition Diagnosis by Primary Care 
Physicians and Nurse Practitioners in Teledermatology Practices. JAMA 
Netw 
Open. 
2021;4(4):e217249. 
Published 
2021 
Apr 
1. 
doi:10.1001/jamanetworkopen.2021.7249 
 
 
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11.​
Annexes 
Annex I - Clinical Utility and Satisfaction Questionnaire 
Based on their experience, without needing to consult the Medical History: 
1.​ Average weekly number of patients with skin conditions you have seen in 
your practice during the last two months (approximate). 
2.​ Name the conditions for which Legit.Health has been most useful in your 
daily clinical practice. 
3.​ In your opinion, indicate the impact of Legit.Health from 0 to 10 (where 0 
is “no impact” and 10 is “great impact”) on the accuracy of your 
diagnostic decisions for each of the following diseases: 
a.​ Urticaria 
b.​ Psoriasis 
c.​ Hidradenitis Suppurativa 
d.​ Melanoma 
e.​ Atopic Dermatitis 
f.​ Other (add any other diseases where the tool has had an impact 
at this point and rate the impact from 0 to 10) 
4.​ In your opinion, please indicate the impact of Legit.Health from 0 to 10 
(where 0 is “no impact” and 10 is “great impact”) in relation to reducing 
the time to issue your diagnostic decision for each of the following 
diseases: 
a.​ Urticaria 
b.​ Psoriasis 
c.​ Hidradenitis Suppurativa 
d.​ Melanoma 
e.​ Atopic Dermatitis 
f.​ Other (add any other conditions where the tool has had an impact 
at this point) 
5.​ In your opinion, please indicate the impact of Legit.Health from 0 to 10 
(where 0 is “no impact” and 10 is “great impact”) on your therapeutic 
decision-making, thanks to the included management recommendations, 
for each of the following diseases: 
a.​ Urticaria 
b.​ Psoriasis 
c.​ Hidradenitis Suppurativa 
 
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d.​ Melanoma 
e.​ Atopic Dermatitis 
f.​ Other (add any other conditions where the tool has had an impact 
at this point) 
6.​ In your opinion, please indicate the impact of Legit.Health from 0 to 10 
(where 0 is “no impact” and 10 is “great impact”) on monitoring the 
evolution of skin lesions for each of the following diseases: 
a.​ Urticaria 
b.​ Psoriasis 
c.​ Hidradenitis Suppurativa 
d.​ Melanoma 
e.​ Atopic Dermatitis 
f.​ Other (add any other conditions where the tool has had an impact 
at this point) 
7.​ In your opinion, please indicate the impact of Legit.Health from 0 to 10 
(where 0 is “no impact” and 10 is “high impact”) on the efficiency of 
interconsultations/referrals to the dermatology service (in cases where 
referral applies) for each of the following diseases: 
a.​ Urticaria 
b.​ Psoriasis 
c.​ Hidradenitis Suppurativa 
d.​ Melanoma 
e.​ Atopic Dermatitis 
f.​ Other (add any other conditions where the tool has had an impact 
at this point) 
8.​ Please indicate your overall level of satisfaction with the use of 
Legit.Health from 0 to 10 (where 0 is “not at all satisfied” and 10 is “very 
satisfied”). 
Would you recommend Legit.Health to other primary care colleagues? 
In your opinion, please indicate your patients' level of satisfaction with using 
Legit.Health from 0 to 10 (where 0 is "not at all satisfied" and 10 is "very 
satisfied"). 
Would you recommend using Legit.Health to your patients? 
Are there any additional features you would consider relevant to include in this 
tool? Open field 
 
Code: LEGIT.HEALTH_DAO_Derivación_PH_2022 
Version: 1.0. Date: 29/06/2022 
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Sponsor: Instituto de Investigación Sanitaria Puerta de Hierro 
 
Are there any features already included in the tool that you consider irrelevant 
or that do not add value to your clinical practice? Open field 
 
 
Code: LEGIT.HEALTH_DAO_Derivación_PH_2022 
Version: 1.0. Date: 29/06/2022 
- 19 -