Teledermatology using the Advice and Guidance Choose and Book service
The teledermatology service can be used to:-
obtain diagnosis or management advice from a Consultant Dermatologist
-
triage patients with basal cell carcinomas for skin surgery (patients will be sent preoperative
information in the post and booked directly onto a surgical list if appropriate, avoiding the
need for a dermatology clinic appointment.)
Exclusions:
-
2-week wait skin cancer referrals (suspected melanoma and squamous cell carcinoma)
-
pigmented lesions (please refer to the pigmented lesion clinic for dermatoscopic evaluation).
Prior to taking the image ensure the camera settings are set as follows (refer to camera
handbook):
1.
The date and time are correctly set; you may need to change to and from BST.
2.
The size of the image is set to ‘fine’ or equivalent.
3.
The ISO is set to AUTO.
4.
The flash is set to ON, this will ensure a consistent light source.
5.
The White Balance is set to Auto or Flash.
6.
The Auto Focus is on.
Then:
7.
Complete Patient Consent Form ensuring that you have explained the reason for the photograph,
what the benefits of an image are, how it will be stored and ask if they mind that it be used for
teaching in the future. Tick the relevant box to indicate if consent is given for teaching or not.
8.
Place the consent form on a flat surface such as the floor and photograph the whole form directly
from above, making it as big as possible in the viewing area.
Photographing the Patient:
9.
Take a locating photograph of the patient’s moles/lesions/rash/bump eg for a toe nail image
photograph the whole foot.
10.
Then photograph the area of interest filling the viewing area of the camera as much as possible.
If the area is small your camera may not focus that close, move back until it is in focus.
11.
Ensure the camera flash fires when taking the photographs (see 4)
12.
Review the image on the replay screen (refer to camera handbook), and if not clear take another
image.
13.
A maximum of 5MB of attachments can be uploaded to Choose and Book, each attachment with a
maximum file size of 1MB. One of these attachments must be the consent form.
HannSa
Version: 2014/06/1
Review date: June 2016
P a g e |1
Author/Owner: Dr S Hann, Consultant Dermatologist
14.
Connect the camera to the computer using the camera lead (the lead can be left connected to the
computer at all times for easy of use) or remove the camera card and insert into a camera card
reader (these can be purchased for a few pounds and left attached to a Computer)
15.
Upload the images either directly into ‘Choose and Book’ by attaching the image file by navigating
to the camera card via ‘My Computer’, or upload to an area on your computer for attaching to
‘Choose and Book’ at a later time.
16.
Once the Images are uploaded then delete the images from the camera; this is best done by
formatting the card in the camera (refer to camera handbook). Format instead of deleting is
recommended as it will increase the life of the camera card and ensure the image is completely
deleted.
HannSa
Version: 2014/06/1
Review date: June 2016
P a g e |2
Author/Owner: Dr S Hann, Consultant Dermatologist
Teledermatology using the Advice and Guidance Choose and Book service
The Royal Cornwall Hospital Dermatology Department runs an ‘Advice and Guidance’ service via
Choose and Book, with the option to attach photographic images (teledermatology). This service
provides an alternative to out-patient referral for selected patients. The service offers a significant
reduction in standard out-patient tariff, with rapid diagnosis and management advice provided by
a Consultant Dermatologist, usually within 48-72 hours.
Clinical photographs can be taken in the consultation using a home or practice digital camera or
smartphone (> 3 mega pixel, with flash and ‘close up’ function), then uploaded to choose and
book when convenient, before deleting. A maximum of 5MB of attachments can be uploaded,
each attachment with a maximum file size of 1MB. One of these attachments must be the
consent form. Patient images should be deleted from the camera after submitting the referral; a
permanent record will be held on the C&B system. Photographic advice and the consent form are
available on Choose and Book.
The teledermatology service can be used to:-
Obtain rapid diagnosis and management advice from a Consultant Dermatologist
Triage patients with basal cell carcinomas for skin surgery - patients will be sent preoperative
information in the post and booked directly onto an appropriate surgical list, avoiding the need
for a dermatology clinic appointment.
Please remember that low risk BCC’s should be managed by GPSIs in the community (low
risk = well defined BCC, not on nose and lips (including nasofacial sulci and nasolabial folds), or
around the eyes (periorbital) or ears, < 2 cm in diameter below the clavicle or < 1 cm in diameter
above the clavicle, patients > 24 years, not immunosuppressed ). If you are unsure please send
teledermatology images or refer to Dermatology Department.
Exclusions:
- 2-week wait skin cancer referrals (suspected melanoma and squamous cell carcinoma)
- Pigmented lesions (please refer to the pigmented lesion clinic for dermoscopic evaluation).
Contacts for Further Information:
Teledermatology and Dermatology Service information
Dr Samantha Hann, Consultant Dermatologist
01872 252841
Choose and Book Advice and Guidance information:
Emma Wheeler
01872 253068
Dermatology Service Lead:
Hannah Donoghue
HannSa
Version: 2014/06/1
Review date: June 2016
01872 252413
P a g e |3
Author/Owner: Dr S Hann, Consultant Dermatologist