- Community health centers in eastern and central Massachusetts will soon be using a teledermatology platform designed to improve the initial diagnosis of a skin lesion and cut wait times for an appointment that often takes weeks.
The telemedicine system designed by 3Derm uses a handheld scanner to capture three different views of the lesion in the doctor’s office – an overview, a 2D and 3D image and a polarized and magnified dermatoscope image – then uploads those images and necessary patient information to a cloud server for review by a specialist. The specialist can then determine whether the patient needs follow-up care, and notify both patient and primary care provider within 48 hours.
Typically, a PCP or clinic doctor will take a look at a lesion and refer the patient to a dermatologist if there is any visual cause for concern, a process that takes, on average, 29 days but could take months. Of the 14 million “new issue” dermatology appointments scheduled each year, studies estimate that only 20 percent actually require an in-person visit with a specialist and less than 1 percent result in a positive melanoma diagnosis.
“It’s a much more efficient to take these images and have a dermatologist interpret them than it is to schedule an office visit,” says Tom Scornavacca, MD, a family practice physician and Senior Medical Director of UMass Memorial Health's Office of Clinical Integration and Population Health program in Worcester, Mass. “Until now, there hasn’t been a good way to filter out who they see and who they don’t.”
Scornavacca and Mary Maloney, MD, chair of the University of Massachusetts Medical School’s Dermatology Department, presented the results of their study of the 3Derm platform at the American Telemedicine Association conference this past May in Minneapolis. According to the study, the teledermatology platform identified cases of skin cancer with the same rate of success as an in-person visit, while reducing the number of cases referred from a PCP or clinic to a specialist by some 57 percent.
Over all, they reported, some 70 percent of patient with benign skin conditions could be diagnosed at the doctor’s office or clinic rather than in the dermatologist’s office several weeks later.
“This platform is designed to replicate what a dermatologist would see in person,” says Liz Asai, 3Derm’s CEO, part of a team of Yale University engineers who developed the platform and began marketing it earlier this year. “What we’re trying to do is give (PCPs and other front-line doctors) the technology they need to help make that diagnosis. You can’t do that with an iPhone.”
Asai says dermatologists are often overworked because a primary care physician will often refer patients to them just to be safe. They often don’t have the technology in their office to do a good examination, or they don’t have the expertise. And while the market is flush with consumer-facing solutions that promise to detect skin lesions via a smartphone and app, those platforms aren’t reliable and could very well be dangerous.
“Doctors need validated technology,” she says.
The 3Derm platform is now being rolled out to 22 locations at seven community health centers in Massachusetts, part of a program to bring needed healthcare services to resident below the poverty line. Many of these patients lack access to a doctor due to financial or transportation issues, and they certainly wouldn’t be able to visit a dermatologist if asked to make an appointment.
Scornavacca expects that teledermatology platforms like 3Derm’s will become popular quite rapidly. They enable PCPs and their patients to connect with a specialist within days, rather than months, and either put to rest the fears over a skin lesion or enable the patient to more quickly begin treatment. Imagine a serious case of melanoma that’s spotted in 48 hours and can be treated quickly, instead of waiting three months for the dermatologist to become available.
Such a platform also enables specialists to concentrate their energies on those cases that need treatment, rather than seeing patients who don’t need to be seen.
“It’s a huge win for a primary care doctor to have that capability,” he says.