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Getting under the skin of cancer diagnosis

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Open Medical is a clinician-led company developing digital workflow solutions for the healthcare sector. Its Pathpoint database adapts to the needs of each specialty, improving efficiency and patient outcomes.

Mr. Piyush Mahapatra, Director of Innovation at Open Medical, Orthopaedic Surgeon, and NHS Clinical Entrepreneur, discusses how Pathpoint eDerma is improving the skin cancer landscape by acting as a secure platform that facilitates efficient teamwork and communication between departments, trusts and regions for ICS models.

Where does the Open Medical story begin?

Our first solution, Pathpoint eTrauma, was modelled on the trauma board used in most UK hospitals.

One day, a rather overzealous cleaner rubbed the trauma board clean, as you can imagine the pursuing chaos this caused to a busy orthopaedic team.

Clinical and administration teams were left searching through paper documents trying to find out which patient was waiting for what surgical procedure.

When we launched version 1.0 of the eTrauma platform, and started to demo the platform, we received a lot of local interest, as it addressed many of the challenges being faced by orthopaedic departments.

We re-architected everything, built a forward-looking cloud-based solution and really tried to focus around pathway management.

What is driving the current cancer backlog?

One of the major issues with dermatology in particular is workforce pressure. There just aren’t enough Consultant Dermatologists in the UK. Meanwhile, the referral volumes are going up.

Before the pandemic, there were about half a million skin cancer referrals. There is a rising skin cancer incidence, but not to that extent. GPs themselves are very stretched and overworked and they might not be able to see as many people as they’d like.

A lot more people who could have been managed fairly early on end up getting referred to a specialist.

Then there’s a missing cohort of patients who we would have expected to diagnose with cancer during the pandemic. They’re now getting diagnosed much later, potentially leading to more advanced cancers, which necessitate more aggressive, more expensive treatment.

How is the eDerma platform addressing this?

With our initial model, a patient with a concerning lesion sees their GP who then refers them to a specialist. This takes about 20 minutes per appointment.

At the specialist appointment, a medical photographer takes high quality images, or a nurse does the same using a dermatoscope. The images are then uploaded and some brief history is taken.

The dermatologist then assesses for risk factors such as skin type, smoking history and family history before making a decision. That decision can either lead to further investigation such as a biopsy, or they can make a definitive diagnosis using just that image.

The advantage is that, rather than spending 20 minutes, the dermatologist can effectively triage a referral within five. So you increase that capacity by up to four times.

The strength of our technology is the flexibility and adaptability to match the clinical pathway.

The technology doesn’t dictate the pathway, which can often be the case. Here, the clinicians decide which pathway is going to fit best with local processes. The technology just augments that flow. So it becomes a technology-enabled pathway.

We’re looking to move that photography information-gathering element right into the community. So locally, tackling areas of health inequality, trying to reduce patient travel, really fitting in with a lot of key NHS agendas, including things like net zero.

Can patients submit their own smartphone images?

There can be an element of that. But really, it’s about them attending an appointment for high quality dermoscopic photography, which is the investigation of choice for cancer.

NHS England and the cancer alliances are fairly clear that you can’t discharge any suspected skin cancer based on a smartphone image alone. It has to be through dermoscopy.

It’s about making access to high quality imaging as easy and local as possible so that patients don’t have to travel for hours to get to a specialist centre.

How is this being facilitated in your clinical diagnosis centres?

The community diagnostic centre is an NHS initiative. Professor Sir Mike Richards wrote a report about how best to tackle the cancer backlog. One of the main methods was to ensure that we diagnose patients earlier.

That has huge knock-on implications, for not just the patients themselves, but for the whole system.

Richards suggested that we should create community diagnostic centres, where you have extensive cancer diagnosis facilities.

Mr. Piyush Mahapatra discusses skin cancer

Mr. Piyush Mahapatra

These could feature MRI, a CT scanner, endoscopy, or whatever is needed to determine, with a reasonable degree of accuracy, whether a patient has cancer.

We wanted to tackle that from a skin cancer perspective directly. Our technology can facilitate any cancer assessment.

It doesn’t have to specifically be skin cancer. But we were already doing it with our eDerma system so we thought it would be a natural progression to fit in with that model.

The good thing about skin cancer pathway is that the investigation of choice doesn’t require large facilities or expensive machines. Just a small clinical facility and a handheld dermatoscope.

We knew we could effectively deploy these very quickly across wide geographies to tackle this backlog as quickly as possible. In time, we may set up more facilities optimised for skin cancer and other cancers.

Where have you implemented so far and what impact have you had?

We have implemented it across East Kent and are now conducting a large scale independent evaluation. We’re also commissioning a health economic evaluation to understand the implications of this pathway.

Our initial pilot data has revealed a full pathway optimisation time of about 10 days, from referral to diagnosis. We’re able to reduce face-to-face and clinic appointments by up to 90 per cent simply by saying, actually, you don’t need to see a dermatologist face-to-face.

About 50 percent of the time, the lesion requires a biopsy. And about 30 percent of the time, you can make a definitive diagnosis that there is nothing to worry about.

The platform itself can also dispatch advice and guidance to the patient and give them some things to look out for. So you cover a huge proportion of patients through those two pathways alone.

What’s next for Open Medical?

We’re working very closely with NHS England on a number of projects.

We’re looking to scale this particular eDerma project across a number of geographies.

In order to do that, we need to have as diverse an area coverage as possible. We need to be in different parts of the country where there are different pressures, different populations and population mixes. So we’re hoping to roll the project out across a few counties.

We’re also doing an NIHR-based project around clinical decision support to help augment dermatology decision making with artificial intelligence.

The next phase is about delivering care at a regional level.

That’s the exciting thing about moving into these community-based settings. It’s the first foray into being a fully end-to-end solution from GP referral all the way through to complex plastic reconstructive surgery.

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