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.
GP’s benefit fromaccess to timely advice from experienced secondary care clinicians, which enables more patients to be managed out of hospital, where that is safe and appropriate, and reduces pressure on NHS hospitals whilst helping to prevent burnout for staff.
The project has led to an increase in efficiency by:
saving hours previously spent on manual data re-entry and admin as Cinapsis integrates seamlessly into EMIS, TPP and e-RS
maximising time and efficiency with complete remote access
ability to search for patient by NHS number, through theintegration with NHS Spine
increasing usability with no limit on file size of images taken
call recordings and photos automatically filed in the patient record
monitoring live referral and associated pathway and outcometracking with full BI data and analytics suite
accessibility of using mobile / dermatoscope compared to thetraditional alternative
dictation within the platform allows clinicians to transcribe spoken words into text
The project has led to improved experience and improved outcomes by:
reducing the pressure on secondary care in order that they canfocus on critical and specialist services, through managing over 49% ofpatients, in the trial, within primary care (who would have routinely beenreferred to secondary care.)
an average of 26hrs 30min turnaround time for specialistmanagement plans were achieved in the first year
reducing the number of benign moles and skin lesions beingreferred into secondary care via the Two Week Wait (2WW) cancer pathway. Thiswas not only a drain on resources, but was causing needless worry for thousandsof patients.
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
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