Use of a teledermatology platform to reduce dermatology referrals to secondary care

In Ipswich and East Suffolk, patients often waited several weeks or months to be seen and had to travel long distances to a hospital for appointments.

At the height of the COVID-19 pandemic it was necessary to reduce in-person outpatient appointments because of the risk of infection while maintaining care and support for patients.

Aspiration

The service commissioned by Ipswich and East Suffolk Clinical Commissioning Group (CCG) wanted to:

• reduce outpatient attendance for patients with skin lesions.
• enable GPs to supervise and treat patients with remote support from specialist consultants
• reduce waiting times for the diagnosis and treatment of patients’ skin conditions

Solution and impact

The Vantage team worked with GPs, hospital consultants, the Trust’s IT team and commissioners to introduce Rego teledermatology.

Rego allows GPs to make structured, relevant referrals to consultants. Images support them to make a meaningful assessment of a patient's skin conditions.

Vantage’s Rego teledermatology system was installed in 38 GP practices in East Suffolk and is launched from SystmOne or Emis. Accompanying images can be taken by the patient or in the practice and can be uploaded onto the system via a secure smartphone App.

The local hospital consultants review the cases usually within 1-2 working days and send their response back to the GP.

Functionality

Rego teledermatology allows electronic referrals to be made without paper or manual intervention.

The referral is digital so images of skin conditions can be sent from a GP directly to the dermatology specialist at the hospital. This means that the consultant can give advice and guidance to the GP without the patient attending hospital.

The whole process is automated so the GP does not have to manually check referrals against complex pathway guidance.

Capabilities

Rego teledermatology is an innovative solution on several levels.

It’s launched directly from primary care record systems. It automatically captures patient demographics and medical history from the clinical record into the form.

New technology means patient images can be uploaded remotely onto Rego. Images can be uploaded through Vantage’s mobile app. Practices can also upload images they receive through other virtual consultation platforms such as eConsult and accuRx.

Scope

The platform analyses patient data and records, helping clinicians to make better-informed referral decisions.

Key figures and quotes

• 47% of patients did not require a hospital appointment.
• 12% of patients found to have suspected skin cancer were fast-tracked.
• GP practices have made over 800 advice and guidance requests for skin lesions through Rego between June 2020 and November 2021.
• 85% of requests received a response from the consultant dermatologist within 3 working days.
• 39% of patients needed a routine hospital appointment.
• Waiting times for dermatology outpatient appointments reduced from 28 weeks in February 2020 to 17.5 weeks in December 2020.
• Patients travel 13,360 less miles.
• Patients saved a total of 2,100 hours.

User feedback shows the system is effective.

• 100% of respondents agreed that the system improved access to care for patients with skin lesions during the pandemic.
• 95% of respondents were pleased with the response time and the quality of advice and guidance.
• 78% of respondents felt that the system supported earlier detection and intervention of undetected cancerous lesions.

User feedback and testimonials

“Telederm has been literally transformational for how primary care can safely manage patients with skin lesions where there is uncertainty. Prior to this, a patient may have waited many weeks, if not months, for assessment leaving both patient and clinician in the limbo of doubt which causes anxiety. Now within a week we receive advice as to whether the lesion is of concern, needs referring in, or can be managed in primary care.”

Dr Crockett, GP at Peninsula Practice

“By triaging the routine referrals we can pick up more than 10% of skin cancers otherwise waiting to be seen as non-urgent, have been able to create a bond of trust and strengthen the interface between primary and secondary care and improve patient care by providing guidance on further management within 2 days through digital advice to GPs.”

Dr Labinoti, Consultant Dermatologist at Ipswich Hospital

Find out more

Read more on the Vantage Health website

The service received a commendation in the Dermatology Quality in Care Awards 2021

Key contact

Caroline Wells, Transformation Project Manager, Ipswich and East Suffolk CCG

caroline.wells@suffolk.nhs.uk