Teledermatology comes of age via medical devices and secure iCloud

Teledermatology is a subspecialty of dermatology that offers an effective way – at a distance from the patient – of addressing inflammatory skin conditions and life-threatening tumours of the skin. With COVID-19 restrictions and clinic closures, it becomes a necessity to transition to virtual care, eliminating the need for an in-person assessment.

However, consumer-facing apps assessing skin cancer risk are generally unproven and have poor performance. Most of them have not been adequately evaluated or regulated. Indeed, there are a number of new and existing platforms to transmit skin surface images taken by a cell-phone or digital camera to connect with specialists which are not PIPEDA compliant (https://www.priv.gc.ca/en/privacy-topics/privacy-laws-in-canada/the-personal-information-protection-and-electronic-documents-act-pipeda/) and put patients’ privacy at risk.

To enable dermatologists to conduct a secure and qualifiable teledermatology consultation, particularly for lesions, you need high-quality imaging that is not affected by the light or angle of exposure and that can scan not only the surface of the skin, but deeper into the skin at various wavelengths to reveal pathological changes.

The compliant technology platform developed by MedX Health Corporation (www.medxhealth.com) is a two-part system that includes SIAscopy (Spectrophotometric Image Analysis), an advanced optical scanning technology, approved class II medical device, here in Canada and in several other countries.

SIAscopy is a non-invasive scanning technique where a handheld device shines near infrared and visible spectra light through the skin (600-2000 nm). The image (surface to 2 mm deep) shows collagen and haemoglobin content of the papillary dermis, and melanin content of the epidermis and papillary dermis that can indicate pathological changes. The skin-contact surface view can be used for the analysis of many and various skin diseases (e.g., psoriasis, etc.).

The second part is cloud-based DermSecure. It is appropriate for widespread use and scalability, is hosted/served in Canada, and has been extensively audited by ISO and privacy certification committees.

It allows the patient’s health information and images to be sent securely from an “ease of access” location to a trained dermatologist for assessment. The dermatologist receives an email notification that a new patient has been forwarded for assessment.

The dermatologist opens the patient’s profile on his/her laptop and receives a high quality dermascopic view of the patient’s suspicious mole or lesion.

Ontario does have store-and-forward teledermatology platforms such as www.otn.ca/providers/telederm/, a service of the Ontario eConsult Program, which is open, secure, with e-Consult fees for dermatologists. But it does not offer a solution for more in-depth assessment and documentation of skin lesions. Many other Canadian provinces do not even have access to an appropriately vetted platform.

Don’t expect “back to normal” after coronavirus. The pandemic has accelerated the transformation of healthcare, and there will be no “back to normal” when it is over. Responses will include adoption of a contemporary service mindset, technologies that allow remote work and monitoring, telehealth, predictive analytics, informational chatbots, and innovative care models.

Teledermatology is here to stay, and a safe and proper augmented tool like SIAscopy and DermSecure will contribute to a more rigorous and effective method of triage and first assessment network for dermatology referrals from family health teams considering wait-time referral to assess pigmented skin lesions, from emergency departments, and to aid the rapid discharge of patients with skin disease from hospital. Then, potential skin cancers, especially melanoma, will be dealt with at an early stage, more appropriately, discarding suspicious moles or lesions as benign (or vice-versa), freeing the remaining in-person resources for biopsy, excision, and ultimate management.

Competing interests: Both authors are members of MedX Medical Advisory Board and declare no financial gain. Provenance and peer review: Commissioned; not peer reviewed.

Dr. Bruno Battistini is a Senior Consultant, Member of Scientific Advisory/Board of Directors, Chairperson and former National Co-Chair in Quebec and all of Canada. Dr. Trevor Champagne is an Assistant-Professor, Dermatology/Medicine, U of T and Toronto’s Women’s College Hospital, Clinician in Quality and Innovation, Division of Dermatology.