Outcomes Report
The NHS handles around half a million suspected skin cancer referrals annually. With a shortage of specialists, this has placed significant strain on the healthcare system, leading to delays in diagnosing and treating all skin conditions in secondary care. To address these challenges, Open Medical launched the Skin Community Diagnostic Centre (Skin CDC) project, commissioned and funded by the NHS Cancer Programme, with support from SBRI Healthcare and the NHS Accelerated Access Collaborative.
The Skin CDC project introduced a transformative teledermatology model across three NHS Trusts through Open Medical’s Pathpoint eDerma platform. Teledermatology services aim to reduce the burden on traditional care pathways by enabling remote triaging, diagnosis, and management of skin conditions. These services are designed to manage demand and minimise the need for face-to-face appointments, particularly for patients with low-risk, non-cancerous lesions.
This report highlights the outcomes of eDerma-enabled, community-based skin cancer pathways across the NHS Trusts, using data collected between January 2021 and October 2024. It demonstrates how teledermatology can ease the burden on traditional healthcare pathways and showcases eDerma’s effectiveness in delivering flexible care models tailored to local needs. The report also emphasises the additional benefits of a community diagnostic centre approach, and positions eDerma as a forward-thinking solution for establishing robust teledermatology models to support dermatology services.
Implementing Community-Based Teledermatology for Faster Skin Cancer Diagnosis in the NHS
Challenges in skin cancer pathways
Skin cancer is the most common cancer in the UK, with around 500,000 referrals to dermatology services each year. The healthcare system is struggling to keep up, as traditional pathways for suspected skin cancer are no longer sustainable. According to the National Institute for Health and Care Excellence (NICE), teledermatology should now be regarded as the standard of care and the benchmark against which innovative approaches, like AI tools, should be compared. Teledermatology offers a progressive solution to address both current and future dermatology challenges.
To make safe decisions about patient care, dermatologists need detailed information, such as the GP’s findings, the patient’s medical history, and high-quality images of the skin lesion, including dermoscopic images. However, gathering this information takes time, and many referrals either lack critical details or include irrelevant data. Without the necessary information, dermatologists cannot make remote decisions safely, and need patients to come in for face-to-face appointments.
This process leads to inefficiencies, as patients often need to visit secondary care facilities for imaging and then return later for a consultation. Each of these appointments, which involves documentation and explanation, takes around 20 minutes, adding strain to an already overstretched system. For patients in remote or rural areas, this can be particularly inconvenient, involving long travel times, missed work, and other obstacles that limit their access to timely care. These delays in service not only impact skin cancer patients but also slow down diagnosis and treatment for those with non-cancerous, non-urgent inflammatory skin conditions that require face-to-face assessments.
The Skin CDC project and Pathpoint eDerma
Open Medical launched the Skin CDC project, commissioned and funded by the NHS Cancer Programme, with support from SBRI Healthcare, to implement a teledermatology model through Community Diagnostic Centres (CDCs). This project spanned three NHS Trusts and was powered by Pathpoint eDerma.
Pathpoint eDerma is a cloud-based platform designed to streamline dermatology service coordination. It supports flexible models of care that can be adapted to fit within available resources and meet the unique needs of different communities. eDerma was developed by practising NHS clinicians in partnership with dermatologists and patients, and is supported by the NHS Innovation Accelerator.
Community-based teledermatology model
Under this new model, patients with a skin lesion with potential for malignancy were referred by their GP to one of eight Skin CDCs, each connected to one of the three participating NHS Trusts. At the centres, healthcare professionals took high-quality photos of the skin lesion and additional patient information was collected through a teledermatology patient questionnaire. This questionnaire, developed with input from patient representatives, covered details such as skin type, family history, and sun exposure.
The photo and the GP’s referral, complemented with the patient questionnaire, were then sent to a dermatologist, who reviewed the information and determined the next steps—whether the patient can be discharged, requires further testing, or needs treatment.
The Outcomes of Pathpoint eDerma’s CDC Model on Dermatology Services
An independent evaluation was conducted by Channel3 Consulting. They provided a comprehensive evaluation report that covers stakeholder engagement and staff interviews, staff satisfaction, and an independent assessment and interpretation of the quantitative data provided by Open Medical.
Referral to diagnosis time
The speed of diagnosis using the eDerma-enabled pathway was measured compared to the traditional face-to-face appointments. The evaluation looked at the time from GP referral to diagnosis for both methods.
Key Benefits
Most patients on the eDerma pathway received their diagnosis 14 days faster than those in traditional pathways
On average, patients received a diagnosis more than a week faster using eDerma
A higher number of patients on the eDerma pathway achieved a diagnosis within the 28-day Faster Diagnostic Standard (FDS) even with an 88% increase in referrals
Health economics
Key Benefits
Health Enterprise East (HEE) conducted a health economics assessment. The savings were calculated after factoring in all costs, including the cost of eDerma itself.
£45 lower compared to traditional methods
The average cost of diagnosing a skin lesion using eDerma was £45 lower per patient compared to traditional face-to-face appointments
£18,261 savings in six months
It was estimated that using eDerma could save £18,261 in a six-month period compared to the traditional way of working
18% reduction in unnecessary procedures
With the new care model, patients were 18% less likely to be referred for a diagnostic biopsy and instead diagnosed directly by dermoscopy assessment or booked straight to treatment. For these patients, cost savings could reach up to £135
Patient experience and satisfaction
Open Medical obtained patient experience feedback from all three sites, which showed an overarching positive attitude towards eDerma compared to face-to-face consultations.
Key Benefits
88.9%
of patients found the teledermatology questionnaire easy to complete
74%
were happy to receive results via text or email rather than waiting for a letter
95.8%
felt comfortable having their photos taken
Health inequalities
We evaluated demographic factors in relation to referral to diagnosis times, assessment outcomes, patient reported experience measures (PREM), and travel distances in eDerma and face-to-face clinics. We used the ‘Index of Multiple Deprivation Decile’ (IMDD) and NHS Outcomes Framework methodology, and demographic information as provided by patients through a voluntary questionnaire.
Key Findings
Patients in various IMDD groups experienced no significant difference in referral to diagnosis times
Patients from all IMDD groups provided positive feedback for eDerma, as shown by the PREM results
There is no significant difference in patient experience across various IMDD groups
eDerma is well-received by patients from diverse ethnicities, sexual orientations, genders, and educational levels
eDerma significantly reduces travel distances, particularly for patients from more deprived areas
Carbon emissions
This project looked into the carbon emissions related to the use of eDerma.
Key Findings
Reduced travel distances
Patient travel distances decreased across the three NHS Trusts where eDerma was implemented, particularly in regions with large geographic areas. Patients in these areas also adopted more sustainable transport methods after eDerma’s introduction.
Potential for emissions reduction
In areas where a single hospital serves a large region, eDerma could help reduce emissions by decreasing the need for patient travel and promoting the use of sustainable transport.
Digital vs paper
Digital communication and database use require electricity but this is often offset by the reduction in paper use.
Minor impact on emissions
eDerma’s overall impact on carbon emissions is minor, particularly in urban areas, as high-carbon-emitting devices like dermatoscopes are used in both eDerma and traditional models. However, in rural regions, there is likely to be a more significant reduction in emissions due to minimised patient travel and shorter travel distances.
Sustainable technology
Open Medical utilises carbon-neutral servers and refurbished mobile devices, saving 77.31 kg of CO2e and 77,000 litres of water per device.
Reporting and performance
The three NHS trusts were struggling to document and report on their 2-Week-Wait. With eDerma, the sites can now report structured data quickly, as the platform encourages input using standard data dictionaries such as SNOMED.
Patient and Public Involvement (PPI)
Public and Patient Involvement (PPI) played a vital role in shaping this project’s direction and success. We conducted a thorough public involvement impact assessment using the Public Involvement Impact Assessment Framework (PiiAF) framework, which helped us outline our PPI approach, apply effective intervention strategies, and set clear indicators to measure its impact.
Our approach was built around three key elements:
Applying the involve principles ensuring meaningful collaboration with PPI participants
Recruiting a dedicated committee of patients and members of the public to be involved throughout the research cycle
Prioritising participants’ availability and preferences when organising meetings and gathering feedback
The PPI participants had a positive experience, and their contributions were key to the project’s success. The research team’s responsiveness helped build trust, making participants feel that their input was valued. Participants’ input helped shape the project, with 90% of their feedback being implemented into the final design.
PPI had a direct impact on product development, data analysis, and the creation of patient-facing materials. Their feedback led to wider adoption and improved accessibility of these resources. It also enhanced the quality and relevance of the data, guiding the research team in refining the project based on PPI insights. The active role of the PPI committee in interpreting results helped drive further analysis and fine-tune the project’s outcomes.
Finally, assessing the impact of public involvement was crucial for identifying strengths, limitations, and key takeaways that will be applied in future projects.
In a Year’s Time:
eDerma’s Impact on Waiting Lists
Health Tech Enterprise (HTE) conducted a waiting list simulation to evaluate waiting list scenarios for skin cancer diagnosis within one of the participating NHS Trusts. The simulation evaluated waiting times for diagnosis and treatment over a one-year period, comparing five eDerma pathways to two traditional care pathways. Key focus areas included time to clinical diagnosis, histopathological diagnosis, and final diagnosis communication. The study involved patients referred for skin cancer screening with two or fewer lesions.
Key Findings
Substantial reductions in waiting times
eDerma significantly accelerated all stages of the diagnostic pathway compared to traditional care models:
Diagnosis communication:
54.18 days shorter
Clinical diagnosis:
9.90 days shorter
Histopathological diagnosis:
62.80 days shorter
Improved resource utilisation and patient experience
eDerma streamlined the triage process, reducing the need for in-person appointments without compromising care quality.
By minimising waiting times, eDerma empowered patients with quicker diagnoses, enhancing their experience and reducing anxiety
Exceptional efficiency in care delivery
The most efficient approach was an eDerma pathway where a photography appointment (dermoscopy) at a local GP practice was followed by a teledermoscopy assessment. This pathway demonstrated the highest potential for reducing bottlenecks, minimising delays, and enhancing diagnostic efficiency
Pathpoint eDerma’s Sustainability and Scalability
eDerma has already proven its ability to support multiple models of care across a variety of healthcare organisations and has now been running for nearly a decade in some NHS trusts. By adapting to the specific needs and resources of each provider, it enables flexible, scalable solutions that work for both patients and healthcare teams. It is easily scalable and is interoperabile with existing systems, including AI tools, allowing for wide-scale implementation across regions and healthcare systems.
eDerma’s current footprint
eDerma’s reach continues to grow, with 13 active clients currently using the platform. These clients represent multiple NHS Trusts, two full ICS-wide deployments, and a private healthcare provider.
Future technological advancements
eDerma not only addresses current challenges in dermatology services but also lays the groundwork for future advancements. Its potential to evolve and integrate with other healthcare solutions means the platform can support broader innovation in digital health, such as:
Real-time consultations
Allowing for instant virtual consultations between patients and dermatologists.
Integrated digital solutions
Seamless integration with patient portals and the NHS app to improve patient engagement and access to care.
The platform can also integrate with AI tools if desired to support the assessment process and further increase impact and benefits.
Large-scale data collection and predictive analytics
Leveraging the platform’s capabilities to generate insights that enhance patient outcomes and optimise care delivery.
Queue sharing across regions/ICS
Redistributing workload across ICSs to minimise bottlenecks and improve patient flow.
Predictive machine learning models
Using data from teledermatology questionnaires to predict outcomes, further reduce referral-to-diagnosis times, and improve cost-effectiveness.
With its proven scalability and flexibility, eDerma can transform how dermatology services are delivered on a grand scale.
eDerma has proven to be a highly effective teledermatology solution, significantly enhancing the speed and efficiency of diagnosing skin conditions.
With its ability to deliver earlier diagnoses—often up to 14 days sooner than traditional methods—it has eliminated delays even in the face of increasing referral volumes. In addition to its clinical benefits, eDerma has demonstrated cost-effectiveness, saving hospitals an average of £45 per patient, making it a valuable tool in healthcare delivery.
The platform has also reduced the need for diagnostic biopsies by 18%, relieving pressure on histopathology departments and speeding up decision-making. This has led to shorter waiting times and a more efficient screening process. Furthermore, eDerma promotes healthcare equity, ensuring consistent referral-to-diagnosis times across all socioeconomic groups.
Feedback from patients of diverse demographics has been positive, indicating broad acceptability. Patients from more deprived and rural areas have particularly benefited from the eDerma-enabled community-based care model, with significant reductions in travel time and costs, and an increased use of more sustainable transportation methods.
Additionally, eDerma has streamlined data collection and enhanced referral quality without adding to the workload of healthcare providers. It has also facilitated the collection of Patient Reported Experience Measures (PREMs), further improving the patient care process.
In conclusion, eDerma provides a comprehensive, cost-effective teledermatology solution that transforms patient care while optimising resources. By addressing operational inefficiencies and fostering inclusivity and sustainability, eDerma sets a new standard for healthcare delivery. More than just a tool for today, it lays the groundwork for a future where dermatology is more accessible, efficient, and resilient.