AI-Teledermatology: Innovating Skin Cancer Diagnostics
The healthcare system in England and Wales is experiencing unprecedented pressure due to the sharp rise in demand for dermatology services. With one in four individuals seeking consultation for skin, hair, or nail conditions each year, the need for innovative solutions has never been greater. The COVID-19 pandemic exacerbated this strain, causing a 30% drop in dermatology appointments during 2020/21 and a subsequent surge in patient referrals post-pandemic, with suspected cancer referrals rising 13% nationally compared to 2018. Rising volumes of urgent suspected cancer referrals have significant impacts for system sustainability – under a strained system, they correlate with higher volumes of patients breaching care standards, such as the 62-day treatment standard, as explored in a previous piece of work.
The potential of teledermatology, particularly AI-powered teledermatology, has been recognised as a promising solution to expand service capacity and ensure equitable patient access to specialist care. The Skin Analytics AI-Powered teledermatology for Skin Cancer 2-week-wait (2WW) Pathway was pilot tested across University Hospitals of Leicester (UHL) sites starting from March 2022. This collaborative project was designed to respond to the local need for improved patient access to dermatology diagnostics and the achievement of 2WW cancer targets.
Edge Health was commissioned by Health Innovation East Midlands (previously East Midlands Academic Health Science Network) to carry out an independent evaluation of the effectiveness of this pilot initiative. Leveraging our expertise, we gathered both qualitative and quantitative data from staff and patient surveys, as well as existing data from UHL and Skin Analytics.
A Novel Pathway
Our evaluation underscored the potential of AI-powered teledermatology. Despite being in its pilot phase, the AI tool demonstrated its capability to enhance patient access to dermatology services. While the initial benefit-cost ratio stood at 1.05, this figure doesn’t fully encapsulate the unquantified benefits, such as a reduction in biopsies, long-term care costs, and WLI clinics. Workforce costs were also front-loaded prior to capacity being fully utilised, leaving room for a higher benefit-cost ratio.
The current pathway model relies on second-reads to be performed on all AI-screened scans, with a further reduction in the potential benefit-cost ratio as well as increased pressure on clinical teams. In our evaluation, the AI outperformed documented clinical diagnostic standards, but our staff survey highlighted current reservations from consultants in dispensing of the second-reads altogether.
The evaluation also supported the health system through highlighting potential administrative challenges that scaled expansion would need to monitor for. These included timely booking of appointments for patients on the novel pathway, as well as ensuring that commissioning arrangements reflect the true costs of providing an innovative service – and are aware of the prospected savings.
Scenario Modelling for Future Savings
Looking ahead, we conducted scenario modelling to explore the potential for greater savings in the future. These scenarios hinge on reducing or removing the cost associated with the second read of dermoscopy images, leading to a benefit-cost ratio ranging from 1.3 to 1.9.
Our evaluation indicates that this novel pathway could be cost-effective in the long term. It could also offer considerable benefits to the wider Dermatology cohort, healthcare staff, and the health system if implemented at scale, with potential yearly savings across the Midlands ranging between £2.1M and £5.7M, depending on who performs the second read.
Recommendations for Enhancements
As part of our commitment to continuous improvement, we proposed several recommendations. These include streamlining administrative processes, evaluating the best option for lesion second reads and conducting further evaluations as the AI versions improve and more data becomes available.
Our work with Health Innovation East Midlands, UHL and Skin Analytics demonstrates Edge Health’s commitment to pioneering innovative healthcare solutions. Evaluating the effectiveness of new technologies such as AI-powered teledermatology is a fundamental step in improving services so that they are accessible, efficient, and patient-centred.
Our overall experience of working with Edge was very positive, and their analysis and evaluation process was robust and innovative. They handled challenges well and always sought a balanced solution with cross-stakeholder agreement. The Final Report was delivered on track and met the expectations outlined in the original scope and MOU.
Michael Ellis – Senior Innovation Lead, Health Innovation East Midlands
Conducted a comprehensive independent evaluation of the AI-powered teledermatology pilot initiative.
Identified potential for significant future savings through scenario modelling.
Proposed actionable recommendations to enhance the programme’s benefits and ensure long-term cost-effectiveness.
Highlighted the importance of considering administrative implications of implementing novel technologies.
Provided insights to guide future evaluations as AI technology evolves and more data becomes available.
This project was carried out in partnership with Health Innovation East Midlands
 Chuchu N, Dinnes J, Takwoingi Y, Matin RN, Bayliss SE, Davenport C, Moreau JF, Bassett O, Godfrey K, O’Sullivan C, Walter FM, Motley R, Deeks JJ, Williams HC. Teledermatology for diagnosing skin cancer in adults. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No.: CD013193.
Revolutionising Lung Cancer Diagnosis: The Economic and Clinical Impact of ctDNA Testing in the NHS
In 2020, 37,211 people were diagnosed with lung cancer in England. 68% of this population is at an advanced stage and has limited life expectancy. People with advanced lung cancer have complex care needs and often experience high levels of GP appointments, hospital admissions and extended lengths of stay while awaiting diagnosis and treatment.
Timely genomic testing of the tumour can help identify individualised treatments, which can potentially markedly improve the quality and length of life. Delays in identifying specific gene mutations can result in missed opportunities for patients to receive targeted and more effective treatments, ultimately leading to worse outcomes and higher costs for health systems.
Liquid biopsy, a cutting-edge diagnostic method validated through numerous clinical trials, involves testing blood samples for biomarkers like circulating tumour DNA (ctDNA), among others, to detect cancer-related genetic mutations. This less invasive approach offers several benefits, particularly in vulnerable patients with advanced non-small cell lung cancer.
The NHS in England is working towards being a global leader in adopting liquid biopsy testing into a national health service. Recognising the importance of economic assessment and evaluation of the costs and benefits of broader ctDNA testing, Edge Health was commissioned by NHS England to undertake this work to support an ongoing national pilot involving non-small cell lung cancer testing.
Using health economics to understand benefits and costs
Our initial findings in the early phase of the health economics analysis of ctDNA testing combined academic methods with commercial insight and experienced understanding of how the NHS operates to assess the economic implications. This involved collaboration with clinical experts and synthesis of information from various other sources. As a new technology, our analysis considered various clinical scenarios and sensitivities for critical assumptions.
“Implementing ctDNA testing into the routine diagnostic work up of patients with lung cancer is a huge step forward to improving equity of access to state of the art genomic testing for our patients. This will allow patients to receive the best treatment possible for their condition. The input from Edge Health has been invaluable in mapping out a complex pathway, identifying options for ctDNA implementation and their associated cost benefits”.
Professor Sanjay Popat, Consultant Thoracic Medical Oncologist, Royal Marsden Hospital
Outputs from the initial analysis were extrapolated more generally with national data, which helped identify the potential future costs and benefits.
In the context of stage III and IV lung cancer, from early analysis, the application of ctDNA was found to deliver significant benefits relative to its costs. This finding was primarily driven by ctDNA testing enabling earlier blood testing and potentially avoiding tumour genomic testing, which supported patients to access targeted treatments earlier and more consistently – lowering broader system costs. In the next phase of work, pilot data will be analysed to validate these preliminary findings to support the commissioning of the ctDNA test on the genomic national test directory.
Moreover, ctDNA testing is expected to improve equity in genomic testing access substantially, expanding coverage over a broader spectrum of gene mutations and ensuring the inclusion of patients for whom adequate tissue biopsies might not be viable.
Ultimately, incorporating the latest genomics advances into routine healthcare will help deliver the UK government’s vision in “Genome UK: the future of healthcare”.
“The current work of the ctDNA pilot aligns perfectly with the Genomic Medicine Service goals of delivering equitable genomic testing for cancer patients through accessing cutting edge technology and science. This technology will hopefully, if commissioned onto the national test directory, ensure that clinical services can make better-informed decisions faster, have access to precision treatments which will improve patient outcomes, ultimately leading to more efficient use of NHS resources. The work from Edge Health is vital in helping to demonstrate that this advance in care is also economically viable”.
Paul Ryves, Programme Director, North Thames Genomic Medicine Service Alliance.
Contact us to learn more about our approach and how we can help you.
Case study: Evaluating the benefits of integrating chemotherapy patient management apps
Challenges in the Existing Healthcare System for Chemotherapy Patients
Cancer patients undergoing chemotherapy have to navigate a complex healthcare system at a particularly stressful point in their lives. Various patient management apps exist to support both patients and providers with this treatment pathway. However, a lack of a single source of information disadvantages both patients and Trusts.
Integrated Solutions for Patient Management and Prescribing Process
In response to this, the industry leader in electronic chemotherapy prescribing developed a product that integrates all aspects of patient management from referral to discharge and simplifies the prescribing process for healthcare professionals. Additionally, another provider created a patient-facing mobile app that brings disparate pieces of information from across the healthcare ecosystem together and delivers personalized support for cancer patients.
A typical Trust will treat between 1,200 and 1,500 new patients with chemotherapy each year. As such there are significant benefits to integrating these two patient management solutions and offering a bundle for purchase by acute providers. Edge Health was commissioned to deliver a report on the potential impacts of the integration. Through a review of existing literature and clinical engagement, we assessed the wide range of benefits throughout the patient journey. By quantifying some of these benefits, we sought to highlight the potential magnitude of the advantages for both Trust’s finances and patients.
Our Analysis of Impacts and Benefits of patient management solutions
Positive Impacts on Patient Care and Risk Management
Many of the identified benefits are felt by the patients themselves. The integrated app and system facilitate the delivery of optimal patient care and minimise chemotherapy treatment’s risks and side effects. The advantages of this integration appear to be most material for patients who may require changes to their treatment, due to adverse reactions or toxicity, or for the rarer cases of more severe illnesses such as colitis and neutropenic sepsis.
Financial Benefits to the Healthcare System
There are also clear and direct financial benefits to the NHS. Chemotherapy drugs are expensive and waste is a substantial issue, whilst the costs of treating patients who develop more significant illnesses during their treatment can be very large. Through accurate capturing and sharing of patient-reported outcomes, the integration contributes to cost savings by minimising the expenses associated with treating such complications or illnesses.
The integration of chemotherapy patient management apps offers significant benefits to both patients and healthcare organizations. By streamlining the treatment process, improving patient care, and reducing financial burdens, this integrated solution has the potential to enhance the overall quality of care for cancer patients undergoing chemotherapy. Acute care providers can leverage these apps to optimize their treatment protocols and improve resource allocation, ultimately leading to better patient outcomes and more efficient healthcare delivery.
Technology can’t replace GPs (yet), but it can save them time
There has been an unprecedented focus in Primary Care to make better use of digital resources, providing virtual and remote consultations. Changing consultation modes will not provide the answers we need when looking at the growing GP workforce gap, which requires focussed planning on training, retention and addressing demand. We estimate that the benefit of innovation on workforce numbers will be relatively low compared to other strategies and that is by design – innovation should support, rather than replace, the workforce, though there is scope for potential productivity gains.
Closing the 2032 GP workforce gap, aiming for 8.5 % vacancy Number of GPs expressed as Full Time Equivalent (FTE)
With that in mind, we should not put innovation on the back burner, for at least two considerations. One, that discovering new ways of working relies on innovation, which may yet provide us with strategies to tackle need; secondly, that innovative ways of work can have ripple benefits on other areas, such as workforce and patient satisfaction and increase the potential to attract and retain doctors in primary care.
What’s out there?
Innovative solutions are widespread in Primary Care, and some have demonstrated promising changes the way healthcare is provided, particularly through bridging primary and secondary care, and making care more accessible. Consultant Connect, a service developed for North Central London CCG that allowed GPs to directly message specialists for advice and guidance, reduced secondary care referrals in 64% of contacts as specialists could provide advice to be implemented in primary care rather than requiring a referral.
The virtual boost promoted by compelling need during the pandemic has allowed e-consultations to flourish and transform the way time is spent in primary care: e-consultations in North London have allowed non-clinical queries to be directed to staff other than GPs, and GPs were able to deal with e-consultations much faster than in person, reducing face to face consultations by 25%.
Our previous work has highlighted the vast impact of video consultations beyond healthcare savings – such as savings on inpatient travel resulting in lower greenhouse gas emissions as well as £108m savings in lost productivity through avoiding 3m lost work hours.
Productivity gains through harnessing innovation can be very material – virtual consultations have saved PCNs approximately 17,200 hours – scaled nationally, this is equivalent to freeing enough capital to employ 900 GPs –, and eConsult has shown to reduce missed GP appointments by 60%, with large time and cost savings. These strategies could give a substantial boost to our 2032 workforce concerns, though it is important to recognise the technology supports and enables the workforce, it does not (yet) replace it.
How can innovation become a reality?
Innovating does not always equate to revolutionising systems – sharinglearning and making best use of resources in effective and innovative ways can be the best route to having a large impact. Working with Kaleidoscope and Cambridge and Peterborough STP, Edge Health supported the implementation of a digital first pathway for diabetic patients that enabled, through shared priorities and consistent approach to care, to improve care for diabetic patients and increase the uptake of the National Diabetes Prevention Programme without generating more work for GPs. Key to the success of the programme was the sharing of evidence that supported innovation within the STP, as well as the engagement with frontline staff that directly experienced the benefits of the innovative intervention.
We could draw four take home points from this successful implementation of innovation at scale:
Ideas should be generated locally, where need is clearly understood
Successful innovation relies on collaboration across practices – this promotes not only sharing of best practices, but also agreement on care delivery strategies that have the potential to level up working habits
Taking on from the example of practices, collaboration across ICBs will also enable effective innovation to reach other areas through cross-communication; central channels need to be available for this to happen
Innovation must involve frontline staff rather than be exclusively top-down, for effective implementation and longevity
The last consideration is particularly important in the context of workforce – attempting to implement innovative strategies will undoubtedly be a challenge amidst an overstretched, disenchanted workforce. Taking decisive steps towards tackling the workforce gap will be a necessary step to promote further innovation, and in return, innovation could hold the keys to better healthcare that makes best use of resources.
Evaluation of Eye Care Electronic Referral Systems
In 2017/18 ophthalmology outpatient activity was reported to be greater than any other NHS speciality. This high demand has been linked to the aging population, new treatments, eye conditions requiring multiple appointments a year, unwarranted variation in referrals, as well as a lack of discharge pathways for stable and lower risk patients. Demand-driven pressures on ophthalmic services have also risen further in the wake of the COVID-19 pandemic, and have been compounded by services suffering workforce supply challenges, with persistently low ophthalmologists per capita across the UK. It is, therefore, becoming increasingly important that processes to relieve pressure on ophthalmology services are developed and successfully deployed.
There has been growing interest in the potential benefits of using Eye Care Electronic Referral Systems (EeRS) and transfer of full volume scans/images in ophthalmology to improve pathways from primary care optometrists to specialist ophthalmologists in a Hospital Eye Service (HES). Through implementation of EeRS there is the hope that some of the pressures on both primary and secondary care could be alleviated.
Several pilots have been commissioned across the UK to test the use of EeRS, however, there remains a gap in the literature on the real-world benefits of this intervention. With expertise in both qualitative and quantitative research methods, Edge was commissioned to evaluate the use of one EeRS at the 6-month stage in its pilot. Interviews were held with optometrists, consultant ophthalmologists, optometry service delivery managers, clinical commissioners, optometry clinical technology managers and the EeRS provider, to understand the impacts that the technology could have on patient pathways. In parallel, cost data and CCG-level demand data were used to identify the potential cash and non-cash-releasing benefits to the system.
Quantitatively, it appears there have only been marginal cost and time efficiency gains. However, the pilot was in its infancy, and referrals and user sign-ups continued to grow month-on-month. Qualitatively, optometrist and ophthalmologist feedback suggested significant potential with many citing patients were seen quicker at HES, patients were more likely to be sent to the correct clinic for their first appointment, saving patient time and health system resources, as well as patients being less likely to get lost in the referral pathway.
This analysis also identified several next steps for the current pilot as well as key learnings for expansion and further roll-outs. These findings will be used to inform decisions makers on the real-world benefits of EeRS and help ensure future regional or national roll-outs have the data needed to deliver maximal benefit for the NHS.
In 2019, there were 748,000 people living with dementia in England. This population typically has complex care needs, placing considerable strain on the health and social care systems as well as on individuals themselves and their carers/families – at an estimated total cost to the UK of £37.4 billion a year.
Minder is a remote care platform that aims to improve the quality of life for people with dementia and their carers. It uses home sensors to detect an individual’s activity at home, and builds a model of ‘usual activity’ through use of artificial intelligence, allowing any deviations to be detected and flagged for follow-up, enabling early prevention. Minder has been developed by the research team at the UK DRI Care and Research Centre based at Imperial College London and the University of Surrey, in partnership with Surrey and Borders Partnership NHS Foundation Trust.
Recognising the benefits that Minder could have for people living with dementia, the UK DRI commissioned Edge Health to undertake a health economic evaluation of Minder. Through engagement with stakeholders and experts in the field, as well as review of existing evidence and literature, we built an understanding of the impacts that Minder could have on the health and social care systems, as well as on individuals with dementia and their carers. By modelling the costs associated with each of these impact pathways, we were able to estimate the Benefit Cost Ratio of Minder among the dementia population in England.
As part of their translation exercise, the UK DRI realised the need to have cost benefit figures at local population level. Through development of an adjustable model, enabling selection of specific geographies and dementia populations of interest, we were able to provide the UK DRI with a dynamic output demonstrating the value that Minder could bring for local populations, and the return on investment that could be made. This work will facilitate wider rollout of the technology in England, which if successful would allow a range of benefits to be realised across a large population of individuals, with huge benefits for health and social care systems.
“What many people don’t see if that AI is already part of the NHS… AI and other smart platforms are already helping us improve the services we deliver for the NHS, and ultimately, the individual’s patient experience” – fantastic coverage in The Mail on Sunday, featuring the DigitalHealth.London Accelerator and Edge Health! Read on!
”AI in the NHS Artificial intelligence is already being used across the UK. Gina Clarke looks at how it’s being implemented and the benefits to patients and practitioners. […]
SURGERY SCHEDULING: When it comes to planning surgical procedures, in order to minimise cancelled appointments, AI is helping NHS trusts such as South Tees to reduce waiting times. By using SpaceFinder, a product from Edge Health that can be implemented into existing software, the technology estimates how long a procedure will take and fits other surgeries accordingly â€” similar to the game Tetris. On average, up to two hours of operating time per theatre per day is currently unused, whereas this software can maximise the time. It also works to eliminate weekend procedures, which tend to cost more. However, it’s important to note that with the majority of today’s technology, humans still get the final say.”
Press release: Edge Health joins cohort 4 of the DigitalHealth.London Accelerator
Press release: Edge Health joins cohort 4 of the DigitalHealth.London Accelerator
Edge Health is proud to announce that it joins cohort 4 of the DigitalHealth.London Accelerator programme. The DigitalHealth.London Accelerator is a programme aimed at speeding up the development and scaling of digital innovations across health and care and pioneer their adoption by the NHS.
Across England, over 5 million people are waiting for an operation – almost as many people as there are in London. At the same time, hospital operating theatres often go unused due to poor scheduling. The complexity of modern scheduling requirements is not being met by the systems currently available in hospitals.
SpaceFinder is a software developed by Edge Health that uses advanced analytics to accurately predict operating times and propose optimal operating lists tailored to local conditions. These lists take account of all available information so that valuable theatre operating time is used effectively every day.
South Tees NHS Foundation Trust implemented SpaceFinder to put more activity into its core operating time. This allowed it to turn off weekend working. As well as being safer for patients, less frustrating for staff, it helped save £3 million. This innovative use of technology was well received by the CQC as “outstanding practice”.
Through DigitalHealth.London, Edge Health is looking to sped up the development and roll-out of SpaceFinder so that no patient ever must sit on a waiting list longer than needed.
Our software, Space Finder, has been shortlisted for the HSJ workforce efficiency award.
Many hospitals are not delivering planned care activity to plan. This is impacting their patients, who are waiting longer, their performance (RTT), and their finances. It also means that workforce is stretched further as theatres need to be operated for longer.
Increasing throughput in core hours is hard and often runs into resistance: “theatres are busier than ever”, “case-mix is more complex”, “staff are new”, “turnaround times are longer”, “there aren’t enough beds”. This can mean scheduling out of hours theatre sessions and running weekend lists.
Space Finder is a tool that uses AI to help organisations access more of their core capacity. It does this by providing visibility of where the space exists on future lists, so that additional cases can be booked. At the same time, it considers local constraints or rules that impact list planning, so fewer operations need to be rearranged or cancelled due to a lack of equipment.
When delivered, Space Finder means workforce is used more efficiently, reducing pressure on staff and hospital finances without patients suffering from longer waits.