Teledermatology: Moving bytes not bodies

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Teledermatology Moving bytes not bodies

• A study to identify and measure the effects of
  enhanced accessibility to specialist
  consultations for remote Australian military
  populations
• AMMA Conference, Hobart
• 17 October 2008

SGT Anthony Hopcraft MeHlth
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Acknowledgements

• Firstly, thank you to all of the study
  participants
• The research staff and the support staff
• Dr Bert Pruim LCDR Steve Pullman
• LTCOL Peter Nasveld CAPT Richard Delo
• LCDR Bob Curtis CAPT Robert Kennedy
• LTCOL Di Elson FLTLT Michael Clements
• PROF Cate DEste FLTLT Andrew Pearson
• PROF Peter Soyer FLGOFF Hamish Crisp
• A/PROF Susan Treloar Dr Ann-Maree Berrill
• Dr Ruth McLaughlin Ms Robyn Davies
• Mr Michael Waller Ms Elaine Gill Nick Duff

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Introduction

• Dermatological conditions accounted for 45,272
  years lost to death and disability (DALYs) in
  Australia in 20031
• Can account for 25 of presentations to primary
  care in ADF2
• Dermatologist access is pivotal to management of
  complex conditions3
• Information and Communications Technology (ICT)
  may facilitate access to specialist
  dermatological support
• Begg, S., Vos, T., Barker, B., Stevenson, C.,
  Stanley, L., Lopez, A. D. (2007). The burden of
  disease and injury in Australia 2003 (Vol. PHE
  82). Canberra Australian Institute of Health and
  Welfare.
• Lim, D. S. (2005). Dermatology in the military
  an East Timor study International Journal of
  Dermatology, 44(4), 304311
• Perednia, D. A. (2002). Foreword. In Oakley A
  Wootton R (Eds.), Teledermatology (pp. xiii-xv).
  London Royal Society of Medicine Press Ltd.

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Teledermatology a Primer

• Telemedicine Health information delivery via
  ICT
• Teledermatology Telemedicine facilitated
  Dermatology
• Real-time communications (Video Teleconferencing)
  expensive and time-critical
• Store-and-Forward communications
  economy and convenience

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Background

• Lack of equitable access to dermatology in the NT
• Progressive thoughts
• Use of technology
• to fill this void
• Moving bytes
• not bodies
• Saw an opportunity
• in an identified area of need
• Darwin
• Pilot Study

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Research Question

• Does Store-and-forward teledermatology
• increase accessibility to specialist support
• reduce the time to a definitive diagnosis
• for
• remote Australian military populations?

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Literature Review

• Store-and-Forward Teledermatology could
• Treat 80 of subjects
• Avoid 49 of face-to-face consultations
• Intervene in 20 of the usual waiting time
• However, findings not generalisable to ADF

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Methods

• Study Design

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Materials
Digital Camera
Referral template
Dermatoscope using cross-polarised
non-polarised light
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Deployment Training

• Recruitment of clinical champions
• Appreciation of scope of project
• Familiarity with technical aspects of equipment
• Demonstration and practice at dermoscopy
• Distribution of photographic guides
• Integration of referral mechanisms with site SOPs

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Process
1. Examination and image acquisition
(Image used with permission)
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Process
(Image used with permission)
2. Consented Referral and image(s)

(Image used with permission)
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Process
3. Email (after 24 hour cooling-off period)
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Process
4. Telediagnosis (hopefully!)
(Digitally manipulated fictitious image)
(Digitally manipulated fictitious image)

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Image acquisition
(Image used with permission)
? 1. Examination by Dermatoscope
(Image used with permission)
2. Scouting Image ?
(Image used with permission)
? 3. Dermatoscopic image
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Results

• Usage and Efficacy

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Time to definitive diagnosis
Comparison of conventional treatment with
Teledermatology
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Case demographics

• Gender
• Teledermatology (n18) 72 Males
• Conventional dermatology (n234) 82 Males
• Average Age
• Teledermatology 33 (range 19-53)
• Conventional dermatology 26 (range 17-58)
• gt 30 years old
• Teledermatology 61
• Conventional dermatology 58
• Rank (grouped)
• Teledermatology 61 Other ranks, 22 SNCOs, 17
  Officers
• Conventional dermatology 58 Other ranks, 23
  SNCOs, 19 Officers

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Distribution of cases

• Types of Lesions

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What worked What didnt?

• PROs
• Timely and cost effective
• Enhanced Clinical Decision Support
• CME / CPD value
• CONs
• De-identification made the system clunky
• Poor quality of photos delay in diagnosis

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Lessons learnt

• Clinician recruitment
• Quality of clinical photographs
• De-identification of information
• There is room for improvement

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Conclusion

• This study proved the concept
• Recommendations
• We adopt this technology and progress it
• Further research required
• Needs engagement from the coalface and
  endorsement by senior consultative groups

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Want to know more?

• www.uq.edu.au/cmvh
• LCDR Steve Pullman
• e-Health Officer, CMVH
• s.pullman_at_uq.edu.au
• [phone]
• SGT Anthony Hopcraft
• e-Health / Research
• Conjoint IT Officer, CMVH
• anthony.hopcraft_at_uq.edu.au

Image courtesy of Department of Dermatology,
Uniformed Services University of Health Sciences