Target, triage, treat: how telederm pathways are improving wait-times and outcomes in skin cancer referrals
Half of all cancers in England and Wales are skin cancer, with over 16,000 cases of melanoma diagnosed every year, increasing 8% annually. Skin cancer is the second most common suspected cancer referred on cancer pathways in England with 509,668 referrals in 2019/20, representing around 21% of all urgent suspected cancer referrals. The NHS is looking to technology to assist in safely and effectively managing the huge volume of suspected skin cancer referrals, and to be able to effectively triage and treat the patients with the most concerning lesions.
Isla is a secure cloud-based storage platform that has been adopted in over 30 NHS Trusts across over 40 specialties, including many dermatology services from urgent diagnosis cancer pathways to psoriasis and eczema.
Reducing time to diagnosis for skin cancer
Isla has been implemented to support Dermatology across North West London ICB where an evaluation calculated that the Telederm model is saving £1.3m annually across the patch. To provide a high level summary, of those patients who were referred into Chelsea and Westminster’s 2 Week Wait skin cancer service (this NHS standard has recently been amended to “28-day Faster Diagnosis Standard” or FDS):
- 42% were discharged
- 27% were given a routine appointment
- 5% were given an urgent appointment
- 17% were triaged for urgent biopsy
- 9% were triaged for routine biopsy
Patients triaged for biopsy were done so without the need to physically attend a consultant-led outpatient appointment. As we set up Plastics and Dermatology in the same collaborative teams on Isla, both services had access to the same images in real time.
For London North West Hospital Trust, implementing Telederm through Isla reduced by 70% the average time-to-review for 2 Week Wait patients. Whether aiming for the previous goal of two weeks or the FDS target of 28 days, Isla drastically reduces the time to diagnosis for potentially cancerous lesions. This reduction was achieved through two methods, digital forms and high resolution image sharing. Patients are sent their assessment questionnaires via SMS the day before their appointment, which they complete digitally and upload directly into their medical record on Isla. Medical photographers are then able to review a patient’s questionnaire with minimal waiting time. The patients attend and have photos taken and securely uploaded in high resolution onto the same medical record, which can then be reviewed by the consultants.
In North West London ICB, the sending of assessment forms in advance of Medical Photography appointments is entirely automated which has reduced Medical Photography time by 50% as over 75% of patients complete their clinical forms at home before attending the hospital, making the appointments more efficient.
High resolution images, high confidence clinical decision making
Due to Isla’s capacity for large sized image files, meaning that the files do not need to be compressed or degraded in any way, there has been a twofold increase in the quality of images presented to clinicians to inform diagnosis and triage, contributing to a 25-50% reduction in clinician time taken to make decisions and communicate findings to patients.
Interoperability and Integration- EPRs and eRS
As well as integrating with several major EPRs (Electronic Patient Records) native to the NHS Trusts, Isla also supports eRS referrals, with the ability for primary care teams to send detailed images along with referrals giving vital information from the first instance. Isla also excels at caseload management with automated communications to patients, requesting forms or photos prior to appointments or delivering advice documentation. Isla created a shared and ongoing medical record across primary and secondary care systems, allowing for the most efficient and effective care pathways to be realised.
Consultants can also be presented back live data on their service which includes patient outcomes and this builds confidence in discharging inadequate referrals remotely.
