Considerations for a Successful Teledermatology Application

Adrian BowlingCEOMoleMap NZ Ltd

Introducing Mole Map

• Over the last 13 years MoleMap has secured an international reputation for delivering the

most comprehensive melanoma surveillance programme in the world.

• We have developed an exclusive portfolio of proven, proprietary technologies including

digital imaging devices, software applications and a telemedicine platform for use by

physicians, health systems, hospitals and centres of excellence.

• Our technology has been applied to melanoma surveillance, skin cancer diagnosis for

rural health and triage programmes for hospital systems

MoleMap is a global leader in the development and provision of integrated imaging and teledermatology health solutions for the early and accurate detection of skin cancers

Pioneering Early Melanoma DetectionMoleMap was formed in 1997 by a group of NZ dermatologists with a shared vision for developing a world leading melanoma detection programme combining innovative imaging technology with the expertise of skin specialists.

Why?

They recognised that melanomas were not always being picked up in routine skin checks

because doctors did not always have the technology or skills to recognise melanomas,

particularly at the early stage.

What was needed?

Imaging technology to provide new information - dermoscopy

Digital storage to aid in serial monitoring

Skilled dermatologists

The outcomes?

To improve the quality of melanoma diagnosis

To provide equity of access to experts in the field

To reduce the cost burden of melanoma

Pioneering Early Melanoma Detection – First Steps

Launch

Purchase off-the-shelf technology – combined POC and POD

Establish 6 clinics across New Zealand

Two reading centres

Move data around on physical media

Transcribe reports manually

Lessons learned

Not scalable

Insecure data transport and storage

Inefficient

Unreliable equipment

Dubious image quality – video based

BUT IT WORKED

Pioneering TeleDermatology – What was needed?Scalable Imaging Technology - many, anywhere

Simple to use, reliable

Provided suitable image quality for remote diagnosis

Cost effective

Easily deployable

Reading Centres – few, anywhere

High end graphic work stations

Efficient software systems – ergonomics, heuristics

Well trained readers – dermoscopists

Database Management

Central repository – store and forward due to asynchronous nature of structure

Data/image security – millions of images

Auditable

Able to handle access from low tech clients

Pioneering TeleDermatology – Implementation

Point of Care

Customised digital cameras

with proprietary lighting

systems

Point of care software to

guide operation and collect

supporting clinical

information

Training programmes – the

nurses become the eyes, the

ears and the fingers of the

physician

Point of care recording

Pioneering TeleDermatology – Implementation

Reading CentresHighly iterative development – maximise diagnostic accuracy whilst maintaining efficient workflow

High quality, high resolution screens optimised for image viewing

Automated as much as possible

Pioneering TeleDermatology – Implementation

Database ManagementBroadband became the enabler

In the early days speed, data charges and reliability were major technical and business challenges – system evolves as technology overcomes these challenges

Integrate with standard systems and gateways, including PACS, DICOM, HL7 and EMRs

Provide a portal for the patient for self-management and authorised providers to assist in the management of the disease or for monitoring purposes.

The MoleMap Teledermatology System

New Zealand (1997-2010) 22 clinics ; 16,500 patients/year

Australia (2006-2010)15 clinics; 6,500 patients/year.Occupational skin cancer programme screens 10,000 patients per year at 50+ locations

United States (2008-2010) 6 clinics; 1500 patients/year

Dermatologists5 in New Zealand6 in Australia2 in USA

MoleMap’s Network

MoleMap’s Statistics

• 115,000 unique patients

• 200,000 patient visits

• 1.8 million lesions recorded for assessment and serial

monitoring

• 3.2 million images (body, clinical and dermoscopy)

• > 2,000 melanoma identified - ?250 lives saved

• 30,000 unnecessary excisions avoided

• Effectively added 20,000 dermatologist visits with no increase

in physician capacity

Where is TeleMedicine Today?

• The Texas State Prison System – largest real-time in USA - 150,000 per year

• Estimated total reimbursable funds spent on telemedicine in the USA = $6 million, Australia ???, NZ ???

• Barriers to adoption:• Difficult regulatory environments• Health policy and practice • No reimbursement• Inconsistent or no standards• Conflicting evidence – does it work or does it not?• Paradigm shift for physicians• Not cost effective with current focus on real time solutions

Outside radiology MoleMap is one of the largest store and forward telemedicine systems in the world – 99% private pay

What can make Teledermatology Successful?

A System

• Imaging technology – fit for purpose• Relevant clinical information – images are not enough• Simple, robust, cost effective equipment• Adequately trained and certified personnel at point of care and

point of diagnosis• Protocols, audit, quality control systems• IT systems that protect patient privacy, provides for traceability,

is secure, provides access anywhere, anytime and can account for costs and revenues

• A business case that makes sense

The Waikato Virtual Lesion Clinic- better, sooner and more convenient

Dr. David Lim, Dr. Amanda Oakley, Dr. Marius RademakerWaikato District Health Board

Where to next – Virtual Lesion Clinic?

Where to next – MoleMap Diagnostics?• Our MoleCam imaging device now makes it feasible to move tele-dermatology directly into

primary care

• Currently only really 2 options for a doctor presented with a lesion of concern:⁃ Excise/biopsy and send it to the pathologist for their opion⁃ Refer the patient to a dermatologist

• MoleMap’s telemedicine approach can allow the doctor to provide a tele-dermatology consultation directly to their patient

MoleMapSecure

TeleDermatology

Database

Encrypted, SecureInternet TeleDermatology VPN

Education and

Research

Audit andQuality Control

MoleMap Dermatologist

Diagnosis

• Patients are happy – expert opinion without cost and health aspects of biospy/excsion

• Doctors are happy:⁃ confident reassurance to their

patients⁃ fewer investigative, invasive

biopsies or excisions⁃ feedback and learning

opportunities ⁃ a visual documentation system

for audit and follow-up