👩⚕️Teledermatology to triage between primary care and specialists (research and start-ups)
👩⚕️Teledermatology to triage between primary care and specialists (research and start-ups)
When we think telemedicine, we think online consults between patients and providers. Teledermatology shows us it can be so much more.
Hello and welcome to Careviser by Marie Loubiere, the weekly newsletter that cuts through the healthcare noise with a single focus: productization of the latest research and tech breakthroughs.
This week, I focus on Teledermatology and how it can reduce wait-time to specialists in a world of shortage of dermatologists!
Teledermatology reduces dermatology referrals and improves access to specialists in the Lancet by Mara Giavina-Bianchi, Andre P. Santos and Eduardo Cordioli is a study performed in a public health system in São Paulo city which implemented a year-long program to triage patients asking for a dermatology consultation.
🗝️ Why it matters: Triage of patients between primary doctors and specialists isn’t optimized when patients are left to decide whether they need access to a specialist. Patients tend to go straight to a specialist, even when a primary care physician could treat them. We see it with the example of dermatology where the main causes for consultation (e.g., acne) could be fully treated by a GP. The fact that patients go to a specialist for minor issues means that there is a long wait to access specialists. Patients with acute needs have to wait to access the care they need.
⌛ Why now: Telemedicine enables specialists to review patients data without doing a consultation with them. GPs can rely on specialist’s advice and fully handle patient care.
📚 Context: The WHO doctrine is that GPs need to be the main point of contact for most care beyond every-day diseases and that includes dermatology, gynecology etc.. For instance at the EU-level, there are almost no medical gynecologists trained anymore, because the EU considers that regular gynecology follow-up should be done by GPs and that ob-gyn should focus on high-risk pregnancy, fertility issues and surgery.
🔎 Findings: Patients who requested a dermatology appointment were referred to a mobile app where they uploaded photos of their skin lesions and basic information about their health history. Then, they had an in-person appointment with a technician who asked more questions and took pictures. A team of dermatologists reviewed each medical case remotely and triaged patients between sending them to 1/ a GP, 2/ a specialist, 3/ biopsy. Half of the patients (53%) were sent to a primary care physician with preliminary diagnosis performed by the tele-dermatologist, 43% were referred to in-person dermatologists and 4% directly to biopsy. The waiting time for in-person appointments with a specialist decreased 78% which could potentially lead to earlier detection of deadly diseases (skin cancer) and save lives! It is also interesting to note that sending patients directly to biopsy also leads to time-savings. Once the biopsy results are out, they meet with the specialist who is then able to make a diagnosis on the spot. These findings are significant as they were observed over a sample of 30,976 individuals over a full year.
✅ Implications: GPs need to receive extra training on most common dermatology diseases so that they can address patients. Such trainings can be customized based on the demographics of the area where they are based. They can also receive support for a remote specialist when needed as seen in this study. In the context of a shortage of specialist physicians, this approach seems very promising.
I struggled to find very early-stage start-ups (less than two years old) in teledermatology with a first release out of their product. Probably because the GTM is mostly B2B and it takes time to sell or even do pilots with providers and health systems.
🤩 Founded by a surgeon in the UK in late 2016, Cinapsis is a triage and referrals software. I am excited by its potential. They are already an approved NHS supplier which is a great start for their go-to-market. They enable health systems to triage patients between primary care physicians and specialists. Patients can access care online through video consultations and messaging. Primary care physicians receive guidance from specialists through messaging and calls reducing drastically the number of unnecessary referrals to specialists. 70% of dermatology referrals are managed without a face-to-face appointment with a specialist at One Gloucestershire Integrated Care System. The potential to generate cost savings and improve quality of care through reduced wait-times is huge. Covid-19 has made that need even more acute, and they have launched a dedicated program. They were incubated with the govtech incubator Public in 2019 and by the DigitalHealth.London programme. They raised a small round with Hicom, a UK healthcare software business.
📱 Miiskin started out with a B2C angle. It launched as a mobile app in 2015 with a freemium model ($25 a year to unlock advanced features). It enables users to store pictures of their skin, highlights moles and compares changes over time prompting the user to visit a provider when needed. I like that they stay away from making flashy claims such as using AI or that they will ever be able to diagnose diseases. They aim to reinforce the relationship between providers and patients. They have had a slow but constant growth over the past few years (500k downloads). They recently launched a B2B offer. Miiskin Pro allows providers to access patients' images over time, schedule appointments and integrate with their EHR. It would be hard to get Miiskin reimbursed as a self-monitoring app so it makes sense to monetize the software with providers. The benefits for providers are: enhanced video consultations, increase in frequency of consultations and referral of B2C users to providers using Miiskin Pro. They charge $100 per provider monthly. Seems reasonable, don’t you agree?
📺 DermatologistOnCall and Snapmed are two teledermatology platforms. DermatologistOnCall covers the US and Snapmed Europe (the Nordics and UK). Building on the fact that most dermatology consultations can be based on pictures, they enable patients to upload pictures and receive a diagnosis and a prescription from a board-certified dermatologist within days. Like most telemedicine partners, they save a lot of time for both the provider and the patient. However I am not convinced that specialized telemedicine platforms will win compared to the ones that cover all practices. There aren’t that many differences between a dermatology remote consultation vs. an ob-gyn one for instance. At the end of the day, you need to enable users to submit their data (pictures, lab results if any etc…) and have a video-conferencing solution. Platforms like hims in the US and Zavamed in Europe have won a very specific niche. They cover use cases that patients were ashamed to talk to their provider about, with a strong differentiated branding (for hims). I don’t see that happening for mainstream dermatology yet.
That’s a wrap for today! I wish you a happy & healthy festive season. I will see you in 2021 with a special covid-19 edition. Which start-up would you like to be included?