Considerations for a

Successful Teledermatology
Application

Adrian Bowling
CEO
MoleMap NZ Ltd
Introducing Mole Map
MoleMap is a global leader in the development and provision of
integrated imaging and teledermatology health solutions for the early
and accurate detection of skin cancers

• Over the last 13 years MoleMap has secured an international reputation for delivering the

most comprehensive melanoma surveillance programme in the world.

• We have developed an exclusive portfolio of proven, proprietary technologies including

digital imaging devices, software applications and a telemedicine platform for use by

physicians, health systems, hospitals and centres of excellence.

• Our technology has been applied to melanoma surveillance, skin cancer diagnosis for

rural health and triage programmes for hospital systems

Pioneering Early Melanoma Detection
MoleMap was formed in 1997 by a group of NZ dermatologists with a
shared vision for developing a world leading melanoma detection
programme combining innovative imaging technology with the
expertise of skin specialists.
Why?
They recognised that melanomas were not always being picked up in routine skin checks
because doctors did not always have the technology or skills to recognise melanomas,
particularly at the early stage.
What was needed?
Imaging technology to provide new information - dermoscopy
Digital storage to aid in serial monitoring
Skilled dermatologists
The outcomes?
To improve the quality of melanoma diagnosis
To provide equity of access to experts in the field
To reduce the cost burden of melanoma
Pioneering Early Melanoma Detection – First Steps

Launch
Purchase off-the-shelf technology – combined POC and POD
Establish 6 clinics across New Zealand
Two reading centres
Move data around on physical media
Transcribe reports manually

Lessons learned
Not scalable
Insecure data transport and storage
Inefficient
Unreliable equipment
Dubious image quality – video based
BUT IT WORKED
Pioneering TeleDermatology – What was needed?
Scalable Imaging Technology - many, anywhere
Simple to use, reliable
Provided suitable image quality for remote diagnosis
Cost effective
Easily deployable
Reading Centres – few, anywhere
High end graphic work stations
Efficient software systems – ergonomics, heuristics
Well trained readers – dermoscopists
Database Management
Central repository – store and forward due to asynchronous nature of structure
Data/image security – millions of images
Auditable

Able to handle access from low tech clients

Pioneering TeleDermatology – Implementation
Point of Care
Customised digital cameras
with proprietary lighting
systems Point of care recording
Point of care software to
guide operation and collect
supporting clinical
information

Training programmes – the

nurses become the eyes, the
ears and the fingers of the
physician
Pioneering TeleDermatology – Implementation

Reading Centres
 Highly iterative
development – maximise
diagnostic accuracy whilst
maintaining efficient
workflow
 High quality, high
resolution screens
optimised for image
viewing

 Automated as much as
possible
Pioneering TeleDermatology – Implementation
Database Management
Broadband became the
enabler
 In the early days speed, data
charges and reliability were
major technical and business
challenges – system evolves
as technology overcomes
these challenges

 Integrate with standard

systems and gateways,
including PACS, DICOM, HL7
and EMRs
 Provide a portal for the
patient for self-management
and authorised providers to
assist in the management of
the disease or for monitoring
purposes.
The MoleMap Teledermatology System
MoleMap’s Network

New Zealand (1997-2010)

22 clinics ; 16,500 patients/year

Australia (2006-2010)
15 clinics; 6,500 patients/year.
Occupational skin cancer
programme screens 10,000 patients
per year at 50+ locations

United States (2008-2010)

6 clinics; 1500 patients/year

Dermatologists
5 in New Zealand
6 in Australia
2 in USA
MoleMap’s Statistics

• 115,000 unique patients

• 200,000 patient visits

• 1.8 million lesions recorded for assessment and serial

monitoring

• 3.2 million images (body, clinical and dermoscopy)

• > 2,000 melanoma identified - ?250 lives saved

• 30,000 unnecessary excisions avoided

• Effectively added 20,000 dermatologist visits with no increase

in physician capacity
Where is TeleMedicine Today?
Outside radiology MoleMap is one of the largest store
and forward telemedicine systems in the world – 99%
private pay
• The Texas State Prison System – largest real-time in USA - 150,000
per year

• Estimated total reimbursable funds spent on telemedicine in the

USA = $6 million, Australia ???, NZ ???
• Barriers to adoption:
• Difficult regulatory environments
• Health policy and practice
• No reimbursement
• Inconsistent or no standards
• Conflicting evidence – does it work or does it not?
• Paradigm shift for physicians
• Not cost effective with current focus on real time solutions
What can make Teledermatology Successful?

A System
• Imaging technology – fit for purpose
• Relevant clinical information – images are not enough
• Simple, robust, cost effective equipment
• Adequately trained and certified personnel at point of care and
point of diagnosis
• Protocols, audit, quality control systems
• IT systems that protect patient privacy, provides for traceability,
is secure, provides access anywhere, anytime and can
account for costs and revenues
• A business case that makes sense
Where to next – Virtual Lesion Clinic?

The Waikato Virtual Lesion Clinic

- better, sooner and more convenient

Dr. David Lim, Dr. Amanda Oakley, Dr. Marius Rademaker

Waikato District Health Board
Where to next – MoleMap Diagnostics?
• Our MoleCam imaging device now makes it feasible to move tele-dermatology directly into
primary care

• Currently only really 2 options for a doctor presented with a lesion of concern:
⁃ Excise/biopsy and send it to the pathologist for their opion
⁃ Refer the patient to a dermatologist

• MoleMap’s telemedicine approach can allow the doctor to provide a tele-dermatology

consultation directly to their patient
• Patients are happy – expert opinion
without cost and health aspects of
biospy/excsion

• Doctors are happy:

⁃ confident reassurance to their Encrypted, Secure MoleMap
Secure
patients Internet TeleDermatology VPN TeleDerma
⁃ fewer investigative, invasive tology
Database
biopsies or excisions
⁃ feedback and learning
opportunities
⁃ a visual documentation system Education Audit and
MoleMap and Quality
for audit and follow-up Dermatologist Research Control
Diagnosis