Teledermatology is a pathway for obtaining a rapid dermatology opinion on diagnosis and management for patients presenting with skin problems. It involves sending a digital photo together with a clinical history to the Dermatology Specialists.
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
- Used as a tool to triage Dermatology referrals (Referral Assessment Service)
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.
A Teledermatology Roadmap for 2020-21 presents what systems are currently available to optimise teledermatology triage and Advice & Guidance.
The roadmap states two key principles for delivery:
1. Patients need to be kept informed directly about the care pathway they are on, their diagnosis and treatment plan in a clear, compassionate and timely way.
2. Teledermatology workflows should not add burden to primary or secondary care
Currently in England, all referrals must be made via the electronic Referral System (eRS). Images can be attached to referrals in eRS from GP integrated systems up to a maximum of 5MB. Web-based attachments can be 5MB each, with no limit to the number of files attached. Some commercially available GDPR compliant photo apps can automatically adjust the file size and resolution to support attachment to eRS. Application-programme interfaces (APIs) are in development that support the use of eRS referral pathways with images improve the user experience.
Advice and Guidance (A&G) is another route to specialist opinion for primary care, including with images. A&G can be requested via eRS and through other commercial platforms, often combined with GDPR compliant image sharing. A&G services should be used when the referring clinician needs advice on management in primary care or is unsure whether a referral is needed. Clinical responsibility remains with the referrer. The specialist reviewing the A&G request can advise that a referral be made, but it is the responsibility of the requesting clinician to make the referral.
Here is a link to the Teledermatology Roadmap for 2020-21 for further information.
Here are some further useful links for support:
Healthcare Professionals Guide: Taking and uploading photos using secure smartphone apps
How to request advice and guidance in dermatology
Gloucestershire Clinical Commissioning Group have produced a useful video on What is a Dermatoscope and how to use it
How to take dermatoscopic images using a camera or smartphone
Uploading images to the clinical system
BAD teledermatology information
Dermatology digital playbook (NHSX) contains dermatology pathway case studies