Teledermatology technology has been rolled out across Cheshire and Merseyside as part of an ICS-led initiative to streamline the triaging and referral of dermatology patients.
With backlogs and record service demand placing high pressure on the region’s primary and secondary care services, this initiative has been launched by the Cheshire & Merseyside ICS and four acute trusts in Liverpool, Wirral, and Cheshire to support 228 GP practices in the delivery of timely, effective, and collaborative dermatology care.
Made possible by National Teledermatology Investment Programme (NTIP) funding and a partnership with Cinapsis SmartReferrals, the powerfully-simple solution consists of a smartphone-compatible Dermatoscope, a connected app, and integrated digital platform.
The 228 participating GP practices have all been provided with Heine dermatoscopes, with a universal adaptor that attaches to any smartphone camera.
GPs are then able to use their own phones to safely capture high-quality clinical images of moles and other skin lesions in a data-compliant manner.
These images can be easily attached to dermatology referrals or advice and guidance requests made through the Cinapsis SmartReferrals app.
Historically, my GP colleagues and I had to waste hours wrestling with clunky, poorly-integrated photo-sharing technologies if we were able to attach photos at all in a data-compliant manner
On the desktop or mobile platform, a secondary care specialist is able to review the case and suggest the best course of treatment or next steps for the patient; whether that be an outpatient clinic appointment, primary care management, or self care.
The images, and the outcomes of the referral or advice and guidance, are automatically updated in the patient record via an NHS ERS and EMIS integration.
A key advantage of this initiative is that it is reducing the previously-high number of benign moles and skin lesions being referred into secondary care via the Two Week Wait cancer pathway.
This was not only a drain on resources, but was causing needless worry for thousands of patients.
Prior to the technology rollout 30% of dermatology Two Week Wait referrals were being referred unnecessarily, amounting to approximately 7,000 unnecessary referrals every year, at a cost of over £1m.
However, since the Cinapsis technology and services were launched in the region 49% of cases submitted on the platform are successfully managed with advice and guidance alone.
And all patients entering the cancer-suspected, Two Week Wait pathway are correctly referred.
In addition, patients who do have clinically-worrying lesions are being redirected into the appropriate clinic earlier on, while those with benign lesions are screened out and need not make the journey to hospital.
Dr Stephanie Gallard, a GP and primary care lead for elective dermatology within Cheshire and Merseyside Health & Care Partnership, said: “Historically, my GP colleagues and I had to waste hours wrestling with clunky, poorly-integrated photo-sharing technologies if we were able to attach photos at all in a data-compliant manner.
“Aside from the heavy burden it was placing on our time, this was leading too many dermatology referrals to be made without high-quality images.
“This meant that patients were often called in for a face-to-face specialist appointment when they did not need special treatment, or when they could have been more appropriately managed in primary care.
The system is simple but effective and can be adapted in a bespoke way for local service nuances and this is saving me time that I can put towards helping patients and reducing care backlogs
“Now that I can use the Cinapsis SmartReferrals platform to manage patient referrals and access specialist second-opinions within days, I’ve been able to work more efficiently and treat patients more effectively.
“The entire referral process is now faster and more accurate: and this means that my patients receive the right care, first time around. And because all the information and actions are automatically synced to the ERS, it’s easy for me to monitor the patient’s condition and make sure that nothing slips through the net.”
Dr Richard Azurdia, consultant dermatologist at Liverpool University Hospitals NHS Foundation Trust, adds: “Receiving high-quality images attached to every patient referral and advice and guidance is incredibly helpful as I can quickly review all the necessary information and make an informed, collaborative decision with the referring GP, without the endless email chains.
“With the Cinapsis SmartReferrals platform available on my phone, laptop, iPad, and PC, I can manage all referrals and requests through a single, integrated interface - whether in my office or on the wards.
“The system is simple but effective and can be adapted in a bespoke way for local service nuances and this is saving me time that I can put towards helping patients and reducing care backlogs.”