Award-winning Tele-triage pathway helps to maintain first-class dermatology patient care in Cornwall

Among the winners at this year’s HTN Now Awards is Isla Health. Isla was awarded Health Tech Case Study of the Year for their collaboration with the Dermatology team at the Royal Cornwall Hospitals NHS Trust.

Described as ‘a powerful digital platform for healthcare providers to support patients throughout their care journey,’ Isla aims to give clinicians and patients better insights and visibility across care pathways, enabling quicker decision making, reducing admin pressure, and freeing up clinical time.

Already in use across several NHS hospitals, Isla’s platform has enhanced patient care in Cornwall through low-cost ‘Community Lesion Imaging Clinics’, or CLICs. These CLICs provide triaging skin cancer referrals, reducing face-to-face consultant appointments by 50 percent, and creating an AI-ready database of several thousand dermoscopic images.

Speaking about the use of Isla and how the collaboration came about, Dr Sandy Anderson, Consultant Dermatologist for RCHT, explains:

“Across the country, skin cancer demands have doubled over the last decade, with hospitals receiving over 10,000 potential skin cancer referrals a year from GPs. When you combine this with a national shortage of dermatologists – with around 150 consultant posts nationally that we haven’t been able to recruit – it became apparent that we needed to find a new pathway and new solutions.”

The Dermatology team collaborated with Isla to develop a Tele-triage platform for hosting CLIC outputs and patient-submitted data. Between August and November 2023, 438 patients (489 lesions) were reviewed. Of these, 27.9 percent were discharged directly from triage with advice to the referrer. 20.8 percent were listed directly for biopsy or simple excision. While 49.8 percent were managed without the need for face-to-face appointments altogether.

Clinicians spent around 3 minutes per patient on the CLIC pathway, compared to 20 minutes for traditional face-to-face appointments. This increased specialist capacity for CLIC patients by 50 percent. This has enabled faster care and reduced unnecessary travel and hospital visits for patients. The department now lists patients directly for surgery when appropriate. This has streamlined the pathway and creates more time to manage the increased level of demand for their expertise.

“We’ve held CLICs across four or five different sites in community hospitals and community settings around Cornwall,” Dr Anderson explains. “The CLIC comprises two healthcare assistants with iPads and a skin cancer imaging device called a dermatoscope. They ask the patients a standard questionnaire and then take a high-quality digital image of the skin lesion. Then, we’re able to review these images and data online, providing a much quicker response than if we were seeing the patient face to face.”

Dr Anderson had the idea to approach the team behind Isla, which is a cloud-based platform. He then worked to adapt and develop the new pathway in collaboration.

“We looked for a provider who we could work with to develop a flexible, bespoke service. We worked together to produce the patient questionnaire, and we’ve also developed training packages for the healthcare assistants who lead the CLICs. We’ve essentially designed the whole thing from the ground up.”

“The improved service is much more efficient,” Dr Anderson continues. “We can consult with patients much closer to home and the increased speed means we’re managing our 200 referrals a week. This is giving us more capacity to treat other, non-cancerous dermatology conditions, such as inflammatory rashes like psoriasis.

With funding from the Royal Cornwall Hospitals NHS Trust, the service has expanded to five hubs across Cornwall. The team is now developing a pathway for inflammatory dermatology conditions and advancing an AI-ready research database.