Evaluating AI Implementation in the NHS: Skin Analytics AI-powered Teledermatology

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[1], 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

Key Successes

• 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

Full Report

The evaluation report can be accessed on the Health Innovation East Midlands website, as well as previewed below.

[1] 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.