There were two principal and longstanding issues that created the opportunity for
teledermatology to offer a solution to systematic diagnostic challenges in
Cheshire and Merseyside.

Firstly, historically poor IT integration meant the taking, transferring, and storage of
digital images was cumbersome, time consuming and unreliable for primary care
practitioners. For secondary care, the quality of images received was in most
circumstances insufficient to make any form of medico-legally sound clinical
assessment without first seeing a patient face to face in an outpatient setting.

The second issuewas the high level of inappropriate and benign moles and skin lesions

being referred by primary care to secondary care via the Two Week Wait (2WW) cancer
pathway, creating a significant pressure on trust dermatology departments.

Prior to the project roll-out:

• 30% of dermatology 2WW referrals were being referred unnecessarily
• this amounted to approximately 7,000 unnecessary referrals every year, at a cost of over £1 million.

The aspiration was to identify a smartphone/tablet app and software solution that could

easily take images, with the ability to attach a dermatoscope. These images required
safe storage and transfer into primary care systems and full integration with the patient

record before further processing and transfer into the NHS e-Referral Service system (e-RS)

for flow into hospital systems and secondary care opinion.

• provide Advice and Guidance on moles and lesions in less than 48 hours
• support better outcomes for patients by ensuring patients receivetreatment sooner;
• allow care closer to home and avoid the need to travel to hospital;
• reduce the need for face-to-face appointments;
• use the principle of 'dialogue first' to enable the retention ofa significant proportion of conventional secondary care outpatient activity in
  primary care, digitally supported by secondary care specialists
• establish an educational programme to improve the standards ofcare across care settings
• to reduce the pressure on secondary care in order that they canfocus on critical and specialist services, through managing patients in primary
  care (who would have routinely been referred to secondary care).
• monitor live referral and associated pathway and outcome tracking