Download TeleDermatology Meeting 15/Dec/2011

TDUF Meeting Summary
Tele-Dermatology – SCTT / NHS24, Norseman House, South Queensferry, 28th August
2014
Attendees
Tracey Cunningham, Project Coordinator, SCTT, NHS 24
Dr Stewart Douglas, Director, Skin Conditions Campaign, Scotland
Dr Peter Freedman, Moletest
Dr Girish Gupta, Consultant Dermatologist, NHS Lanarkshire (Via VC)
Dr Mary Harper, Planning & Commissioning Mgr, NHS D&G
Paul Edwards, Assistant General Manager, Medicine, NHS D&G (Via VC)
Jeff McBride, Moletest
Aileen MacVinish, No Delays, NHS Grampian
Dr Colin Morton, Consultant Dermatologist, NHS Forth Valley
Bruce Murray, Moletest
Anne Reoch, Telehealthcare Advisor, JIT/SCTT (Chair)
Sue Scotland, Industry, Health & Care Engagement Manager, DHI
Dr James Vestey, Consultant Dermatologist, NHS Highland
Apologies
Dr Carol Blow, GP, NHS Grampian
Carolyn Chalmers, Service Improvement Coordinator, NHS Orkney
Prof Trish Connelly, Director, Strathclyde Institute of Medical Devices
& CEO, Ohmedics Ltd
Dr David Bisland, Consultant Dermatologist, NHS GGC
Dr Colm Dwyer, Consultant Dermatologist, NHS Ayrshire & Arran
Dr Colin Fleming, Consultant Dermatologist, NHS Tayside
Prof David Gray, Clinical Nurse Specialist, NHS Grampian
Dr Alex Holme, Consultant Dermatologist, NHS Lothian
Dr Daniel Kemmett, Consultant Dermatologist, NHS GGC
Dr Simone Laube, Consultant Dermatologist, NHS Borders
Dr Fiona Macdonald, Consultant Dermatologist, NHS Lanarkshire
Dr Megan Mowbray, Consultant Dermatologist, NHS Fife
Dr Peter Murchie, GP, NHS Grampian
Dr Frank Muller, Consultant Dermatologist, NHS Grampian
Dr Sanjay Rajpara, Consultant Dermatologist, NHS Grampian
Kerry Russell, Asst Dir Clinical Services, NHS Shetland
Dr Ann Sergeant, Consultant Dermatologist, NHS Fife
Dr Siobhan Sinclair, Consultant Dermatologist, NHS Forth Valley
1.
The summary and presentations from this and previous TDUFs will be uploaded to the
following website.
http://www.sctt.scot.nhs.uk/programmes/health/dermatology/tduf/
2.
Digital Health Institute (DHI) – Sue Scotland
Sue gave an overview of the DHI, explaining that it provides an environment to grow the
potential in digital health and support existing businesses and new entrants to the market,
fostering an environment that helps overcome barriers and supports commercialisation of
research-driven innovations, helping to shorten development times, bringing better products
and services on-stream quicker. SG funded, DHI main partners are Edinburgh University,
TDUF Meeting Summary - SCTT / NHS 24
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Glasgow School of Art and NHS 24, all academic institutes had the opportunity to apply to
DHI open funding calls over the last year. Funding can only be paid to Universities, the
maximum budget for research is £90K, with a 9 – 12 month turn around. Now 61 approved
projects -anything new should come through the Engagement Officer. The panel meet
monthly look to review and approve these.
3.
National Update - Dr Colin Morton
Colin provided a National Update advising that the majority of teledermatology activity was in
the Highlands, Western Isles, Lanarkshire and Forth Valley.
NHS Highland -James Vestey receives telereferals several times most days and provides
management advice, tele triage and “full” teledermatology, he has approx 25-30 cases a
week, and looks after the Falklands mainly by telederm (approx 20 pts a year). He can also
provide a teledermatology service from home and whilst he is away.
NHS Lanarkshire - Photo-triage skin lesions, approx 3,600 patients per year, this is not
restricted to moles only. They can also electronically refer to plastic surgery, e-referral
through Trackcare using an outcome code.
NHS Forth Valley -Community-based photo triage for 2 GP surgeries, approx 1500 per
year.
An audit found that only 20% patients require clinic visit.
Looking to increase referral back however Girish advised extreme caution in doing this.
Telemanagement plays a big part in Teledermatology.
NHS Fife - Encourage GPs to attach a photograph with referrals (not for suspicion of
cancer).
NHS Borders - Have been electronic vetting for a couple of years and GPs can attach
photographs. GPs can also email for advice, more useful for management advice.
NHS Tayside - 17% of all referrals arrive with an image (all GPs were given cameras
several years ago). Permits triage or management decisions
NHS Grampian -There is a teledermoscopy clinic between Elgin and Aberdeen, and
sees100 patients per year.
NHS GG and Clyde - N. Argyll, GPs have cameras and are encouraged to use email with
picture.
NHS Lothian, NHS Ayrshire & Arran – No update
Colin explained there is a different structure to healthcare in Scotland, Health Boards
oversee Primary and Secondary care, there is no commissioning process. There is suspicion
of management seeing Teledermatology as a cheap fix to capacity issues, rather than as
part of means of enhancing capacity within an integrated service that permits FtoF
consultations whenever indicated.
In 2010 the SDS position statement on Teledermatology was to use technology in a
cautionary manner. There is frustration at the absence of initiatives to drive teledermatology
forward. Research has shown many pilots, none with true delivery and seeing some
negativity. There have been positives as well but not carried into substantive services in
many areas.
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Clinicians are collaborating to use a peer review in three new specialties (Dermatology,
Opthamology, Gastro) and new patient centered follow up models are currently being looked
at across Forth Valley, Tayside and Greater Glasgow & Clyde. Doing It Once for Scotland is
linking with No Delays.
Stewart Douglas asked if England was doing it better? He stated that according to the
QUIPP reports (pilot in Bristol which has been evaluated and was proved to be productive
and effective). GP investigation.
Some areas of Scotland use medical illustration to take all patient photographs either in
hospital medical illustration department ((Lanarkshire) or in the community (FV),for others it
is GP or practice nurse.. There was debate about potential of patient ‘selfie’ picture or other
party, taking picture for assessment in future. It was agreed technology now so good there
is increasing likelihood that these images will be of good standard for initial assessment.
Girish Gupta advised that there were two groups, pigmented and non-pigmented. If trained
anyone can take these pictures. Perhaps nurses would be better taking them. So long as
trained perhaps one or two centre's could do this.
In Highland ‘amateurs’ (GPs and nurses) take the pictures but they can all have more
training if required. Focused on the management of skin lesions, equip the GPs with the
surgical equipment. Practices refer 70%.
4.
Moletest Update - Jeff McBride
Moletest had presented to TDUF in December 2013, at that time they were keen to find
Scottish clinical sites. A summary of this is on the SCTT website, url noted above.
20 versions of the App were released and evaluated in the last year. Originally
Moletest had used a measure of Asymmetry as this is conventionally used to assess the risk
of abnormality in a skin lesion. Results presented at the last TDUF meeting showed that this
produced poor differentiation. A method has been developed for measuring the irregularity
of the edge of the skin lesion. This is far better a distinguishing characteristics that indicate
malignancy.
A pilot test within a Clinical Environment has been designed with the help of Dr Girish Gupta
and colleagues in NHS Lanarkshire.
The test will measure performance of the iPad Mini as an image capture device.
The test will also calibrate the differential diagnosis capabilities of the Moletest App. 1,200
participants will be recruited from patients referred from Primary Care. The normal clinical
processes will remain unchanged and the output from the App will be anonymous.
In July, Moletest was adopted by the DHI as a ‘Factory’ project, sponsoring a clinical pilot as
a first stage in a process to develop and exploit Moletest for Scotland.
Moletest would welcome involvement from other Scottish regions.
5.
No Delays – Aileen MacVinish
www.nodelays.co.uk
username: demolsdev.co.uk
password: bluesky
Aileen presented ‘No Delays’ to the group. No Delays has been developed in partnership
with Digital Life Sciences. Transforming how patients interact with GPs and specialists. It
TDUF Meeting Summary - SCTT / NHS 24
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provides immediate access for patients to specialist information and helps them prepare for
their specialist consultation by being better informed about conditions and treatment.
It was noted that consultation information was not retained upon leaving the consultant. The
elderly were part of a group who were seen to benefit from repetition and welcomed the
ability to be able replay videos.
No Delays allows the GP or the specialist to prescribe a digital postcard by email to the
patient. This is a personalised package of short videos that explains their condition in detail.
The patient has time at home to review what the GP or specialist has told them, they can
also share this with family members or carers if they wish to. There are also links to support
groups and other approved sources and quizzes that tests the patients understanding and
knowledge of their condition. This can reach patients who are unable to travel in order to
help them self manage and give them guidance on exercise and medicine management. It
was thought that patients would be keen to see the home team, people that they have seen
before.
Cardiology Postcard to be developed. Anne Reoch encouraged Aileen to link with work
already done nationally on small film for angiography and CABG. This information had
previously been sent to NoDelay team but had been unable to open on web. Tracey
Cunningham to send disk. TC
There was discussion re relevance of such local development – would it be more economical
to provide national postcard with local add on?
6.
AOB
Colin noted that iPads were being given out but have been finding out that the cameras are
being blocked. It appears that there has been an agreement in the Health Boards across
Scotland. The existing NHS Scotland imaging requires to be updated to ensure new
technology is included (approx. 7 years old). Can George Crooks change this from a ‘can't
do’ philosophy to a ‘how can we do this?’ Anne to discuss with George AR
Colin and Girish enquired about how can they find out more about initiatives that are going
on. Tracey to send TOPS info TC
Anne advised that there is an Innovation Lead in each Board, who should be disseminating
this type of information and advised all to find out who that is and ensure they are on
dissemination list. All NHS Clinicians
Paul Edwards advised that two new consultants had been recruited in NHS D&G and all
going well would be in post by the end of the year.
7.
Date of Next Meeting
There was desire to keep the TDUF going, CM keen to look at a national conference. Date
and venue of next TDUF to be confirmed.
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