Teledermatology Service in Tayside

Dr CJ Fleming

Definition

• Teledermatology is the practice of medicine at a distance which allows access to specialist dermatological knowledge by means of telecommunication and information technology.

Methods

1) Audit on Teledermatology Service2) GP survey3) Data on referrals to our dermatology

department4) Cost/benefit analysis

Audit • - 4 week period (9 Nov 2010 to 3 Dec 2010) was

undertaken to assessed the impact of the digital images on the management process.

• - Total referrals to dermatology- 619

78%

22%

No photographsWith photographs

Quality of photographs

36%

35%

13%

16%

excellentgoodaveragepoor

• - There were between 1 to 8 digital photographic attachments per referral.

• - On average 2 attachments per referral.

Did the image help?

62%

38%

Yes No

Outcome

25%

18%

26%

31%

One Stop Biopsy

Treament institutedprior to clinicAdvice Given, noappointmenturgency upgraded

Telediagnosis vs Final Diagnosis

76%

24%

Diagnosis Correct

Diagnosis notmatched

Diagnosis from photo Confirmed DiagnosisOdd mole Compound naevusAtypical Naevus Benign NaevusSCC Lentigo malignaBCC SCCBCP AKAK/ BCC Bowen’sViral wart Molluscum?Bowen’s BCP?SCC/ BCC Granulomatous rosacea?SCC BCCBCC Inflamed naevusPPD Venous eczema

GP Survey

- A survey monkey was conducted in July 2011 to assess the opinion of primary care users of the system.

- 94 responses out of 68 practices- 80.8% found the service extremely helpful or helpful. - 50% found teledermatology time consuming. The main

obstacles was locating cameras and time to attach images.

Estimated time for each teledermatology referral

70%

23%

6% 1%

1-10 mins

11-20 mins

21-30 mins

31-40 mins

Feedback

- 65 comments- 20 specifically mention that feedback given

was greatly valued as it adds to the educational experience.

Costs Analysis PER ANNUM• - Once off camera costs: 68x£200=£13600

- If cameras last 5 years, annual cost= £2720

- Digital Storage £600- Consultant time £570 - IT staff salary £624

- Total Cost : £1794- (fr secondary care perspective)

Savings PER ANNUM

• Based on our audit, there is a saving of £28 212

• Saving from patient transport= £3 600

• Total savings £31 812

• Cost Savings = £30 018

Summary

- Model based on primary care practitioners acquiring images has proved successful

- Simple system, which is integrated in Tayside general referral system

- High uptake- Patient Journey