National Teledermatology Meeting29 March 2012

Anne Reoch

SCTT C&S Clinical Lead / Service Development Manager

• Welcome and background to SCTT involvement • Teledermatology Standards• Current Service – national paper• Brainstorming around other existing Telederm

services outside Scotland and possible new ones• Identify priorities for Teledermatology in Scotland• Summary

Background to SCTT Involvement• 2006 – 2010 -SCT hosted within NHS Grampian (worked with

FV Teledermatology)• 2010 – SCT became part of NHS 24 the national HB primarily

delivering OOH GMS services via telehealth• 2011- Telecare Team joined, becoming SCTT, working with

European partners (RTM), now integral part of NHS 24 – (reengagement with dermatologists)

• 2012-2015 – Working with Scottish Gov - four year strategy for T&T across Scotland, including potential larger developments that include other areas in UK & Europe

SCTT / NHS 24 Future

Dermatology Standards

Dr Colin Morton

NHS Forth Valley Department of Dermatology, Stirling Community Hospital, FK8 2AU

colin.morton@nhs.net

Quality standards – Draftusing ‘store and forward’ images

Quality standards for Teledermatology

• A reference guide for both commissioners and providers of care regarding the use of ‘store and forward’ digital images in dermatology

• They set out what constitutes a good-quality service and outline the procedures that need to be followed when practising Teledermatology to ensure patient safety and confidentiality of data

• Supplement to Quality Standards for Dermatology: Providing the Right Care for People with Skin Conditions, which was initiated by the British Association of Dermatologists 2011

• Intended as a precursor to, as well as to help inform, any future NICE quality standards on teledermatology. While the standards are intended to be particularly useful in commissioning services in England, it is hoped they will be adopted as good practice in other parts of the UK.

Quality standards Committee include:Name Role Organisation/region

Julia Schofield Project lead, Dermatologist BAD

Janet McLelland Dermatologist

Veronique Bataille Dermatologist

Carol Blow GP RCGP

Carolyn Charman Dermatologist

David Deberker Dermatologist

Stephen Foster National Clinical Lead Pharmacy

Saul Halpern Dermatologist

Liz Ogden Dermatologist

Stephen Kownacki GP PCDS

Stephen Lock Senior Policy Manager DH

Helen McAteer Chief Executive Psoriasis Asociation

Colin Morton Dermatologist NHS Scotland

Quality standards•Standard 1: Selecting patients for Teledermatology •Standard 2: Gaining the patient’s informed consent•Standard 3: Suitable images and patient history •Standard 4: Information governance•Standard 5: Appropriately trained staff•Standard 6: Models of care and links to other services•Standard 7: Audit and quality control•Standard 8: Communication between referrer & specialist

Quality standards – DraftFrom ‘Selecting Patients’

Patients with pigmented lesions for diagnosis

Rationale

Key performance indicator

Quality standards – DraftFrom ‘Models of Care’

This standard outlines the three types of Teledermatology services and explores the benefits and limitations of Teledermatology as a part of the care pathway. Models of care that incorporate the use of ‘store and forward’ digital image referral (or Teledermatology) models should:• be patient-centred• benefit patient care and • ensure patients are seen right place/right person/first time, without unnecessary delays.

Quality standards – DraftFrom ‘Models of Care’

The role of TD should be clearly identified. It will usually fall within one of the following definitions:

•Triage Teledermatology•Full Teledermatology •Intermediate Teledermatology

It is essential that there is clarity about which of these roles the commissioner has chosen to commission and what the Teledermatology service is providing.

Quality standards – Draft

•Final meeting of committee 17th May

•Anticipate sign-off July

•Propose present final to Scottish Telederm users regarding feasibility to adopt in Scotland

Current Service - National Paper

Innovative Ideas in Teledermatology

SCI-ADVICE INTERACTIVE (DERMATOLOGY) PROPOSAL

Dr Colin MortonNHS Forth Valley Department of Dermatology, Stirling Community Hospital, FK8 2AU

colin.morton@nhs.net

Background

• The problem: continued rise in referrals to specialists driven by increased patient expectation, awareness of need to present early with suspected cancer, limitations in expertise of GPs skin cancer diagnosis, etc.

• Can we improve interaction between levels of care?• Previous discussions with Alan Fleming, national PACS

Programme manager, with general agreement that the PACS (both locally and nationally) would be available for dermatology use

• The current advice system as part of SCI-gateway remains limited in functionality and is only in limited use

Proposal• Develop current SCI clinical advice system to enable an easy-

to-use system for requests to specialists

The system should be enabled to permit:• Functionality to convert advice request to formal referral

without further typing/reformatting by referrer• Automatic storage of the advice request, attached image and

response from GP to patient record.• Option to store images on PACS and opportunity for national

access• Ability to return advice comment to GP with attachment to

enable GP to copy responses into an education folder which can be reviewed at intervals

Current SCI Advice ….• The current advice system is not user-friendly and

time consuming to use

• The ability to integrate ‘Advice’ with ‘Referrals’ and enable a feedback with attachment to referrer

• A well developed system that records activity levels of specialists and easily stores the images and records for later access in clinic (if required)

• This innovation should enhance efficiency and avoid unnecessary visits to hospital.

• This type of system could enhance integrated care in several specialties, especially where assessment of an image is likely to alter care pathway. There would be a requirement to develop national guidance around the use of this system – e.g. responsibilities, medico-legal, security, etc, to further enable buy-in.

Next Steps

• Ascertain stakeholder interest – applicability across NHS Scotland?

• Option to proceed as joint collaboration between NHS 24/SCTT, SCI DC, PACS and NHS Forth Valley (?Tayside, ?other HBs)

Digital TV

• http://lookinglocal.gov.uk/digitv/cds/nhsscotland/Netgem/home.html

Web Interaction

Social Web site Mexican Study• http://www.ncbi.nlm.nih.gov/pubmed/21790270

• http://www.justanswer.com/sip/health/dermatology

Smart Phone Applications iTunes & Android

Dr Girish Gupta

iTunes & Android Apps• Free

– Skin of mine– Clickmedix– ClinPix– DemSnapi– ClinPix (Android)– SpotMole (Android)

iTunes & Android Apps• Paid

– Dermocloud– Handyscope– Skin Scanner– Dermscope– Skin Tagger

Smart Phone Applications

So………..Is there a role for apps in NHS derm service?

Prison Developments

Top Referrals from prisons

1 Mental Health2 Infections3 Dermatology

Current/Potential Service

• Tayside• Lothian

Live imaging VC dermatology

• Useful in other areas of medicine

• Several countries in use• Limited use in

dermatology?

Priorities for Dermatology in Scotland?