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National Teledermatology Meeting 29 March 2012 Anne Reoch SCTT C&S Clinical Lead / Service Development Manager • • • • Welcome and background to SCTT involvement Teledermatology Standards Current Service – national paper Brainstorming around other existing Telederm services outside Scotland and possible new ones • Identify priorities for Teledermatology in Scotland • Summary Background to SCTT Involvement • 2006 – 2010 -SCT hosted within NHS Grampian (worked with FV Teledermatology) • 2010 – SCT became part of NHS 24 the national HB primarily delivering OOH GMS services via telehealth • 2011- Telecare Team joined, becoming SCTT, working with European partners (RTM), now integral part of NHS 24 – (reengagement with dermatologists) • 2012-2015 – Working with Scottish Gov - four year strategy for T&T across Scotland, including potential larger developments that include other areas in UK & Europe SCTT / NHS 24 Future Dermatology Standards Dr Colin Morton NHS Forth Valley Department of Dermatology, Stirling Community Hospital, FK8 2AU [email protected] Quality standards – Draft using ‘store and forward’ images Quality standards for Teledermatology • A reference guide for both commissioners and providers of care regarding the use of ‘store and forward’ digital images in dermatology • They set out what constitutes a good-quality service and outline the procedures that need to be followed when practising Teledermatology to ensure patient safety and confidentiality of data • Supplement to Quality Standards for Dermatology: Providing the Right Care for People with Skin Conditions, which was initiated by the British Association of Dermatologists 2011 • Intended as a precursor to, as well as to help inform, any future NICE quality standards on teledermatology. While the standards are intended to be particularly useful in commissioning services in England, it is hoped they will be adopted as good practice in other parts of the UK. Quality standards Committee include: Name Role Organisation/region Julia Schofield Project lead, Dermatologist BAD Janet McLelland Dermatologist Veronique Bataille Dermatologist Carol Blow GP Carolyn Charman Dermatologist David Deberker Dermatologist Stephen Foster National Clinical Lead Saul Halpern Dermatologist Liz Ogden Dermatologist Stephen Kownacki GP PCDS Stephen Lock Senior Policy Manager DH Helen McAteer Chief Executive Psoriasis Asociation Colin Morton Dermatologist NHS Scotland RCGP Pharmacy Quality standards •Standard 1: Selecting patients for Teledermatology •Standard 2: Gaining the patient’s informed consent •Standard 3: Suitable images and patient history •Standard 4: Information governance •Standard 5: Appropriately trained staff •Standard 6: Models of care and links to other services •Standard 7: Audit and quality control •Standard 8: Communication between referrer & specialist Quality standards – Draft From ‘Selecting Patients’ Patients with pigmented lesions for diagnosis Rationale Key performance indicator Quality standards – Draft From ‘Models of Care’ This standard outlines the three types of Teledermatology services and explores the benefits and limitations of Teledermatology as a part of the care pathway. Models of care that incorporate the use of ‘store and forward’ digital image referral (or Teledermatology) models should: • be patient-centred • benefit patient care and • ensure patients are seen right place/right person/first time, without unnecessary delays. Quality standards – Draft From ‘Models of Care’ The role of TD should be clearly identified. It will usually fall within one of the following definitions: •Triage Teledermatology •Full Teledermatology •Intermediate Teledermatology It is essential that there is clarity about which of these roles the commissioner has chosen to commission and what the Teledermatology service is providing. Quality standards – Draft •Final meeting of committee 17th May •Anticipate sign-off July •Propose present final to Scottish Telederm users regarding feasibility to adopt in Scotland Current Service - National Paper Innovative Ideas in Teledermatology SCI-ADVICE INTERACTIVE (DERMATOLOGY) PROPOSAL Dr Colin Morton NHS Forth Valley Department of Dermatology, Stirling Community Hospital, FK8 2AU [email protected] Background • The problem: continued rise in referrals to specialists driven by increased patient expectation, awareness of need to present early with suspected cancer, limitations in expertise of GPs skin cancer diagnosis, etc. • Can we improve interaction between levels of care? • Previous discussions with Alan Fleming, national PACS Programme manager, with general agreement that the PACS (both locally and nationally) would be available for dermatology use • The current advice system as part of SCI-gateway remains limited in functionality and is only in limited use Proposal • Develop current SCI clinical advice system to enable an easyto-use system for requests to specialists The system should be enabled to permit: • Functionality to convert advice request to formal referral without further typing/reformatting by referrer • Automatic storage of the advice request, attached image and response from GP to patient record. • Option to store images on PACS and opportunity for national access • Ability to return advice comment to GP with attachment to enable GP to copy responses into an education folder which can be reviewed at intervals Current SCI Advice …. • The current advice system is not user-friendly and time consuming to use • The ability to integrate ‘Advice’ with ‘Referrals’ and enable a feedback with attachment to referrer • A well developed system that records activity levels of specialists and easily stores the images and records for later access in clinic (if required) • This innovation should enhance efficiency and avoid unnecessary visits to hospital. • This type of system could enhance integrated care in several specialties, especially where assessment of an image is likely to alter care pathway. There would be a requirement to develop national guidance around the use of this system – e.g. responsibilities, medicolegal, security, etc, to further enable buy-in. Next Steps • Ascertain stakeholder interest – applicability across NHS Scotland? • Option to proceed as joint collaboration between NHS 24/SCTT, SCI DC, PACS and NHS Forth Valley (?Tayside, ?other HBs) Digital TV • http://lookinglocal.gov.uk/digitv/cds/nhsscotland/Netgem/home.html Web Interaction • http://www.justanswer.com/sip/health/dermatology Social Web site Mexican Study • http://www.ncbi.nlm.nih.gov/pubmed/21790270 Smart Phone Applications iTunes & Android Dr Girish Gupta iTunes & Android Apps • Free – Skin of mine – Clickmedix – ClinPix – DemSnapi – ClinPix (Android) – SpotMole (Android) iTunes & Android Apps • Paid – Dermocloud – Handyscope – Skin Scanner – Dermscope – Skin Tagger Smart Phone Applications So………..Is there a role for apps in NHS derm service? Prison Developments Top Referrals from prisons 1 Mental Health 2 Infections 3 Dermatology Current/Potential Service • Tayside • Lothian Live imaging VC dermatology • Useful in other areas of medicine • Several countries in use • Limited use in dermatology? Priorities for Dermatology in Scotland?