NHS England has published a roadmap with the aim of accelerating the roll-out of teledermatology, by setting out practical steps that systems can take to ensure implementation of a “efficient, safe and effective” teletermatology service, including opportunities to improve integration and prepare for the introduction of artificial intelligence in skin lesion pathways.
Steps to implementing a teledermatology pathway
The first step is identifying the role of teledermatology within the local dermatology pathway, reviewing existing patient pathways, reviewing referral guidelines and identifying capacity to redesign pathways to implement teledermatology services. Specialist advice and guidance, supported by images, with the option of converting to a referral, is the recommended front door to teledermatology services. Although GPs with extended roles or special interest in community dermatology services can triage skin lesions, they should not review urgent referrals for suspected skin cancer.
The second step is in the design of teledermatology services, which includes the identification of an “appropriate setting” for the capturing of high quality images, which may be captured by GPs or advanced clinical practitioners if they have capacity. Acceptance of patients’ own images should be agreed on a local basis, considering the potential for image quality to vary. Images should be transferred using systems which comply with GDPR, and GDPR compliant apps can be commissioned to allow images to be securely uploaded to e-RS. Clear information needs to be available on where and how images are stored and retrieved, and capacity modelling should be undertaken to identify appropriate clinicians with capacity to review images and communicate outcomes to patients.
Step three involves identifying resources including funding, which will be required to set up and maintain the service. The roadmap states that ICSs “will fund teledermatology services using existing locally agreed funding arrangements, usually as part of block contracts”. Time should be set aside, including short-term project management, for those involved in setting up the service, requiring the collecting of baseline data, the identification of a model of teledermatology services, and the completion of an initial pilot. The appropriate space should be equipped with cameras or smart phones, lighting, laptops and internet access, and systems or apps for storage and transferral of images will need to be set up.
Step four of the roadmap is training and development, with continuous training and sharing learning highlighted as “necessary to maintain teledermatology pathways as part of a sustainable, integrated multidisciplinary dermatology service”. Training on teledermatology processes should be regularly refreshed, and training should be provided on taking and uploading high quality images.
The final step in the roadmap is in auditing and quality assurance. Metrics should be agreed at the start of the roll-out, and baseline metrics collected prior to implementation should include patient satisfaction, number and type of teledermatology interactions, outcomes of interactions, clinician time, impact on waiting lists, and effect on overall referral rates. The roadmap suggests that audits review the quality of referrals and images from teledermatology pathways, the effectiveness of communication between healthcare professionals and patients, and the organisation, storage and retrieval of data.
With regards to the incorporation of artificial intelligence, the roadmap emphasises to the need to establish high quality image taking services so that they will be “AI ready”, and so that systems can “take advantage of AI solutions to upscale at pace”. It notes that there are “over 60 commercially available AI technologies in the UK focused on skin cancer diagnostics/triage, with variable and often limited published and independently verifiable data supporting their safety and effectiveness”.
The successful deployment of artificial intelligence as a medical device (AIaMD) in teledermatology will require them to have a clearly defined use, for information to be provided to the patient about their intended purpose, and a pilot study to enable the validation of performance.
To read the roadmap in full, please click here.
We previously covered NHSE’s plans to expand and accelerate roll-out of the teledermatology programme here, with NHS chief exec Amanda Pritchard commenting that “championing the use of digital technology and new ways of working is key to reducing waits and is exactly why we are accelerating the use of teledermatology – it is a small piece of kit that has the potential to speed up diagnosis and treatment for tens of thousands with skin cancer.”
In last month’s panel on delivering remote care at scale, we heard an update on progress around teledermatology in north-west London, where there is a “month-on-month growth in submissions from patients in that region, and we’re expecting to see 100,000 submissions by June – that’s very exciting because we didn’t start the project too long ago. It’s great to see the impact.”