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 – 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 Telecare Team joined, becoming SCTT, working with European partners (RTM), now integral part of NHS 24 – (reengagement with dermatologists) – 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

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: NameRoleOrganisation/region Julia SchofieldProject lead, DermatologistBAD Janet McLellandDermatologist Veronique BatailleDermatologist Carol BlowGPRCGP Carolyn CharmanDermatologist David DeberkerDermatologist Stephen FosterNational Clinical LeadPharmacy Saul HalpernDermatologist Liz OgdenDermatologist Stephen KownackiGPPCDS Stephen LockSenior Policy ManagerDH Helen McAteerChief ExecutivePsoriasis Asociation Colin MortonDermatologistNHS Scotland

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

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 easy- to-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, medico- legal, 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

Web Interaction Social Web site Mexican Study

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 1Mental Health 2Infections 3Dermatology

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?