Talking HealthTech: 310 – How technology can democratise dermatology. Philip Tong, Dermscreen

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Two out of every three Australians will develop skin cancer in their lifetime. Regarding skin cancers per capita, Australia and New Zealand rank first and second in the world, respectively. Skin cancer is low risk and low cost to treat if detected early. If detected late, it has a higher mortality rate and costs the healthcare system significantly more in treatment.

Our routine health checks have gone out the window in the past few years. So, how many skin cancers are there in people now that they are unaware of? When was the last time you had a skin check?

The traditional skin check procedure is as it sounds: you go into a clinic, strip down, and the clinician examines all the spots on your body for any areas of concern. However, that process is fraught with ambiguity and inconsistency for both the patient and the clinician. As a result, there is an opportunity for technology to improve how it works to help prevent unnecessary deaths caused by undetected skin cancers.

Dr Philip Tong, the founder and CEO of Dermscreen, joins Pete in this episode to discuss digitising the skin check workflow, using technology to address shortages of specialists and improving affordability and accessibility so more patients can access the care they need.  

About Dr Philip Tong and Dermscreen

Dr Phil is an Australian dermatologist embracing digital technologies, artificial intelligence (AI), and the web. His vision is to improve dermatologist access throughout Australia, including rural and remote communities.

Dr Phil’s early training began in the lab, where he discovered that translating ideas and discoveries into clinical practice took a very long time in this setting. Imaging was an early part of his research training, and he has now taken this to the next level with the Dermscreen platform, which champions digital imaging for skin cancer and skin check.

During his training, Dr Phil discovered that very few of them train as dermatologists, and the training takes a long time—some 10 to 15 years. After that, the problem is that there aren’t enough dermatologists, particularly in rural and remote areas, to meet the needs of all Australians. This is how Dr Phil came up with the idea for Dermscreen to see how digital technology can solve some of healthcare’s most pressing issues.

One of Dermscreen’s partners is MetaOptima, which helped develop a transformative platform that will allow healthcare professionals such as general practitioners (GP) and nurses to photograph and take a brief clinical history of lesions of concern. They can then send the photographs to Dermscreen, where dermatologists will review them, who will then provide an opinion to the healthcare professional within 48 hours via telehealth. This significantly reduces the time between seeing a GP and referring a patient to a dermatologist. 

Dermscreen wishes to shorten that time in order to provide more equitable access to dermatological services where necessary, as well as to synchronise the need for care. Synchronising the demand for and delivery of clinical services is critical, especially when skin cancer must be removed as soon as possible.

Addressing the referral pathway

Several companies are attempting to address the convoluted referral process, ranging from faxing issues to companies championing digital referrals. Dermscreen believes that the entire referral pathway should be disrupted—you should no longer have to wait to see a dermatologist when you can have a digital dermatologist in the palm of your hand, courtesy of your GP. This is what they want to do for the community’s patients.

There have been examples of similar healthcare initiatives overseas where general practitioners have received consultative advice, whether over the phone or via video conferencing with specialists, and that has been able to save healthcare both at the federal and state level, quite a significant amount of money whereby we can actually address problems at the point of care with the general practitioner and save hospital visits or specialist referrals that may not have otherwise been necessary.

Dermscreen in practice

Dermscreen’s customer discovery revealed that they needed to collaborate with the general practitioner and practice nurse, for example, to ensure that Dermscreen adds value to the clinic. There is a type of GP who truly values Dermscreen, and that is the motivated GP who wants to care for their patients and keep them within their practice while doing so safely. It’s helpul in continuing medical education because they believe that the reports they receive from Dermscreen help to empower them to care for their patients while also learning on the run. Because they are in charge of the consultation, they remember some of the management strategies for patients so they can use them for future reference. The Dermscreen platform is helping general practitioners improve their dermatology expertise.

It demonstrates the importance of general practitioners in the healthcare landscape regarding skin cancer; policymakers recognise that GPs are the primary caregivers in skin cancer diagnosis and management. A referral should be initiated only when they believe their expertise requires the additional assistance of a specialist, such as a surgeon or a dermatologist. Unfortunately, there is so much to learn in general practice training that the emphasis on dermatology may only be a small part of their overall training, and only those general practitioners interested in doing more skin work will be able to pursue it. They will then pursue additional qualifications, courses, and so on.

Dermscreen is now attempting to level the playing field so that all GPs, regardless of whether they routinely perform surgery or not or have completed these skin cancer courses, can potentially be involved in skin checks. As a result, the entry barrier has been reduced, allowing GPs to become more skilled in managing patients with skin cancer or suspicious lesions.

Dermscreen’s ultimate customer is the clinic. The clinic must see value in skin cancer and skin cancer checks as part of its value proposition and offering. Dermscreen enables practices, particularly those without a dedicated skin cancer GP, to take on skin cancer work with the help of Dermscreen.

Making a diagnosis out of photographs 

Dermscreen provides clinics with hardware and software to ensure that the images they send are standardised and of high quality. This ensures that Dermscreen dermatologists have the best images possible to make an accurate assessment. If the patient moves, for example, Dermscreen dermatologists will contact the clinic and request another photograph if artefacts appear. This is not always the case with the clinic training provided by Dermscreen; this is where the practice nurse can help. They saw the practice nurse as crucial in COVID-19, such as immunisation delivery. The practice nurse, and thus the doctor can be involved in the photography in this case. The time-pressed GP is not required to take a photograph themselves. They only need to notify the practice nurse, who is adequately trained to take a photograph from a distance and then up close, using the special attachment on Dermscreen’s hardware device.

Collaboration in skin cancer management

Having a workflow and utilising individuals such as melanographers or nurses is critical. The GP does not always need to take the images and run the whole thing from start to finish. 

Healthcare, particularly concerning skin cancer management, is a collaborative process. Having involvement from a melanographer or a specialty trained nurse is coming out as a new career pathway for nurses. 

Dermscreen recently exhibited at the Australian Dermatology Nurses’ Association meeting in New South Wales. They received much interest from local delegates who wanted to know how to collaborate with Dermscreen to explore skin cancer checks as an alternative pathway.

The problem with GPs is that the barrier to entry requires much education; however, having Dermscreen as a backup and clinical decision support allows them to enter this space (with the appropriate training) feeling comfortable in their ability to do their job. 

National Skin Cancer Action Week

Summer is when many patients get skin checks, whether before or after the summer. Many patients simply want to be reassured about their skin, and it just so happens that National Skin Cancer Awareness Week is in November. In line with this, Dermscreen has collaborated with Skin Check Champions to assist and supply nurses performing skin checks on Bondi Beach.

The value of Dermscreen

Dermscreen is an absolute bonus for the health consumer. Dermscreen provides consumers with an alternative pathway for accessing services via digital means, while dermatologists now have an alternative method of practising dermatology. 

Due to the COVID-19 pandemic, some dermatologists have had to close their practices because they could not see any other way to practice. Dermscreen enables dermatologists who must be at home for extended periods to log in to Dermscreen and report on cases, thereby continuing to support the demand for dermatology services through telehealth.

Dermscreen has championed the spot check examination with their hardware effectively with the size of a tablet. Next year, they will have a total body solution that can scan the entire body’s surface area. Currently, what they do is that often the lesions that patients come in with aren’t necessarily the lesions that dermatologists worry about. Only when they do a complete skin examination, do they find this. This is where the next iteration of Dermscreen will transform into a total body digital skin check which they hope will be well-received by both doctors and consumers.

_{Source talkinghealthtech.com}