There were about 3 million dermatology outpatient appointments in England in the year to 2022 and dermatology services receive more urgent referrals for suspected cancer than any other speciality. About half of the one million dermatology referrals are for urgent suspected skin cancer referrals with about 8% being diagnosed with melanoma and squamous cell carcinoma.
Teledermatology is the use of digital images to triage, diagnose, monitor or assess skin conditions without the patient being physically present. A service must provide high-quality timely care for the right patients.
There are several models of teledermatology including:
- Advice and Guidance whereby a response is sent back digitally to the referring practitioner with advice on diagnosis and management. It is a useful alternative to a face-to-face clinic referral for selected patients
- Support the virtual urgent suspected skin cancer pathway and where appropriate, a teledermatology interaction can replace face-to-face appointments
- Used as a tool to triage Dermatology referrals
When a patient presents with a mole or lesion that looks suspicious, GPs can obtain a rapid diagnosis and management plan with the use of teledermatology. Sending your patients’ photos, with their permission, via a secure messaging app can save significant amounts of time and speed up access to a diagnosis and treatment.
The NHS have created a video, showing general practitioners how to take high-quality images through a secure App on a mobile device and how to securely transmit the images from the App, and upload them to clinical systems in primary care.
We also have information for patients on teledermatology that can be found here.
The NHS England Teledermatology Roadmap for 2023 supports NHS systems to accelerate the roll out of teledermatology to help safely manage the demand of dermatology services and reduce unnecessary outpatient appointments. Opportunities to utilise teledermatology in new and innovative ways to deliver better integrated care, whilst preparing for the introduction of artificial intelligence within the pathway as appropriate. It is aimed at clinicians, managers and transformation leads working at a local, integrated care system (ICS) or regional level to support planning and delivery of transformation of dermatology services.
The roadmap states two key principles for delivery:
1. Patient centred care – a teledermatology service must provide high-quality timely care for the right patients. People must be given clear information about their care
2. Teledermatology should avoid creating additional burden
Currently in England, all referrals must be made via the electronic Referral System (e-RS) or alternative commercial platforms which can link to e-RS. All systems must comply with General Data Protection Regulations (GDPR), including cloud data storage systems. There should be clear processes for the capture and storage of any data alongside the images. Specialist advice and guidance; A&G with images is advocated as the main route to specialist opinion for primary care healthcare professionals. Specialist A&G can be requested via e-referral system (e-RS) or alternative commercial platforms, which can link to e-RS pathways should conversion to referral be required. GDPR compliant apps to support image sharing can be commissioned as standalone apps to allow images to be securely uploaded to e-RS, or alternatively as part of a potential alternative commercial A&G pathway. These allow images to be captured securely with personal mobile phones and transferred safely to e-RS or other clinical systems. Further information can be found in the dermatology digital playbook and on the British Association of Dermatologists website.
Other points of note: There may be limitations to the file size and number of images that can be attached. Some commercially available GDPR compliant photo apps can automatically adjust the file size and resolution to support attachment to e-RS. Application-programme interfaces (APIs) have been developed that allow external applications to initiate referrals on e-RS and can be used to deliver similar functionality. System suppliers will need to develop their systems against these APIs.