Catch It Early with FHIR
How Updated Teledermatology Systems Assist with Melanoma Detection
Author: Smile Digital Health
Every day, approximately 9,500 people in the US are diagnosed with skin cancer. The cost of treatment is estimated at $8.1 billion: $4.8 billion for non-melanoma and $3.3 billion for melanoma diagnoses. For 2022, it’s estimated that 7,650 people will die of melanoma; 5,080 men and 2,570 women.
Skin cancers are highly curable if detected early. However, the long wait for results and ensuing issues with clinics still relying on antiquated methods (such as faxes and hospital mail systems) means that, no matter how early someone is tested, there may be a delay in learning their diagnosis.
Such was the case with 39-year-old Melvin O'Shaughnessy. After moving to a beach town in early spring of 2018 with his partner, Dr. Eli Simms, Melvin started spending more time outdoors. During their first summer, he took advantage of the warmer weather by going on a beachside run as soon as the sun came out. After work, he’d tend to the garden or go for a swim until the sun went down.
Melvin loved his new routine. Not being accustomed to living in an area that received a lot of sunshine, he wasn’t used to the routine of putting on sunscreen and wearing a hat when outdoors. This resulted in frequent sunburns, making his skin nearly as red as his hair. Much to Eli’s chagrin, Melvin not only continued to leave his skin uncovered while out in the sun, but also didn’t limit his time outdoors.
Towards the end of August, Eli noticed a mole on Melvin’s lower back. Convinced it was nothing more than an existing freckle, Melvin tried to ignore his partner’s suggestion to see a doctor. Eventually he relented.
Within a week, Melvin saw his general practitioner, who performed a physical examination. During his appointment, Melvin told his doctor about the fact that the area surrounding the mole became increasingly itchy, but he did his best to refrain from scratching. The doctor took note of the mole, focusing on its size, shape and color. He also checked the area around the mole to see if there was puss or blood—there was none. The final part of the examination included feeling Melvin’s lymph nodes for signs of growth and/or inflammation, which the doctor noted some minor swelling.
As a precaution, the general practitioner sent a referral for Melvin to see a dermatologist for further testing.
Late Diagnoses Don’t Have to Be the Norm
Unfortunately for Melvin, simply having red hair already greatly increases a person’s risk of developing skin cancer. In fact, the red hair gene mutation is analogous with someone having an extra 21 years of sun exposure. That’s why it’s imperative for someone with fair skin, freckles and red hair to be extra cautious when it comes to protecting their skin from the sun’s ultraviolet (UV) rays.
As a pediatrician, Eli stresses the importance of sun protection to his young patients and was certain that his partner would have heard similar cautionary speeches as a child. This wasn’t the case, as Melvin, who grew up in the northwest with way less opportunities for prolonged sun exposure, didn’t really consider protecting himself from the sun as part of his health regimen.
For the next five weeks, while waiting to see the dermatologist, Eli made sure that Melvin regularly reapplied sunscreen with sun protection factor (SPF) of 50, which only allows two percent of the sun’s UVB rays—the ones that cause skin to burn and lead to the development of skin cancer—to penetrate the skin. He also had Melvin wear a shirt and hat both during his beachside runs and while out in the garden.
At the dermatologist’s office, a biopsy was done on Melvin’s mole. This was done by numbing the area surrounding the mole and removing it for further examination. It was explained to him that the sample would be sent to a pathologist, who would then analyze it in order to determine if it was benign or cancerous. The dermatologist also advised that the results would be rushed and should be expected in about a week.
If detected at an early stage, treatment can result in a 99% chance of survival. This can drop to 30% for a delayed diagnosis. That’s why, when it was over a week since his dermatologist visit, Melvin wasn’t sure if he should be concerned or if this was a “no news is good news” type of situation. So he asked Eli for advice.
Eli was surprised, to say the least. Shortly before Melvin’s appointment, the pediatrician spoke to the mother of a patient of his, Denise. She had a similar situation, where she noticed a dark spot on her leg that she had tested. Unlike Melvin, however, she received a quick diagnosis.
Denise’s dermatologist used a Spectrophotometric Intracutaneous Analysis (SIAscope), which is a non-invasive tool that goes under the skin to take a series of images. The tool probed her skin with visible and infrared lights to take five high resolution images—four of which are two millimeters below the skin’s surface—allowing for suspicious moles or lesions to be assessed by dermatologists. MedX’s SIAscope works in conjunction with their DermSecure® Screening Platform to securely send the images to the cloud-based system. The images are immediately accessible to dermatologists who can accurately diagnose their patients within 72 hours. The images are stored on the cloud for 10 years.
Denise’s results were available in two business days. She was diagnosed with basal cell carcinoma. Because it was caught early, her dermatologist was able to schedule two cryosurgery sessions in order to freeze the affected cells the following week. They also arranged for a follow up appointment to see how effective the treatment was for Denise’s basal cell carcinoma.
Melvin was quick to follow up with his dermatologist. He was told that the results weren’t yet available and to wait on their call. What he didn’t know is that his dermatologist’s office still relied on fax machines to receive test results. They were also unable to follow up with the lab that day, as it was closed early for the Columbus Day long weekend.
Nearly three weeks after sending off the sample, Melvin’s dermatologist’s office requested that the biopsy results be resent, as they had misplaced the original fax. The lab then had to reprint the results from Melvin’s electronic health record and send it to the dermatologist’s office as a fax because they weren’t set up with a cloud-based platform to receive the information. A few days later, the dermatologist had a follow up appointment with Melvin, where it was determined that he was diagnosed with Stage 2 melanoma.
New FHIR-y Face of Teledermatology
Though Melvin’s experience is unfortunate, it’s not uncommon. In fact, men in this situation usually have a worse outcome, hence the sad outcome of almost twice as many men dying from skin cancer as women. When the diagnosis for any form of skin cancer is delayed, the disease spreads and becomes worse. For men, specifically, advanced melanoma grows quickest.
Many clinics in the US still rely on outdated technologies, making matters more difficult. In 2019, it was estimated that 70% of healthcare providers, including nursing homes and facilities, still relied on faxes to send information. This includes facilities that still use them to deliver test results of COVID-19 patients, resulting in one third of global skin assessment appointments being missed and approximately 60,000 undiagnosed melanoma cases in 2020. This figure is expected to be much higher when including other forms of skin cancer.
With regulatory mandates that push to facilitate and streamline the exchange of medical data among clinicians and patients, it’s clear that more providers are embracing interoperability. However, until this becomes commonplace, many patients can expect the possibility of delays in treatment. This becomes increasingly difficult for patients seeing multiple specialists, each using different technologies. Had Melvin’s dermatologist used the same technology as Denise’s, his results would have been immediate.
When developing their SIAscope, MedX Health Corp., a medical device and software company focused on skin health, consulted with multiple medical advisory boards consisting of leading dermatologists. The medical imaging device has allowed dermatologists to screen tissue more efficiently than traditional methods, which not only results in a more painless, prompt test, but also reduces costs while maintaining accuracy in diagnosing skin cancers.
Using teledermatology could eliminate the need for in-person appointments with a dermatologist. With virtual doctor appointments being preferred among many patients, this platform enables practitioners to offer accurate and efficient screening and assessment tools.
Accuracy of this diagnostic tool is one of its uniqueness. The other is the interoperability of the platform, on which SIAscopy is deployed.
The owners of MedX knew that it was essential for their device to be fully interoperable to be successful. That’s why they combined forces with Blanc Labs Inc., a Toronto-based digital innovation firm, and Smile Digital Health, a FHIR-expert based in TO, to help them launch the DermSecure telemedicine platform, on which SIAscopy is deployed . Together, they created a USB connection for MedX’s SIAscope, allowing it to operate on a browser-based, multilingual interface.
They took into account data interoperability, access control and the scale in which the platform was compliant with privacy regulations and governance.
Building DermSecure around the Health Level Seven International (HL7®) and Fast Healthcare Interoperability Resources (HL7®-FHIR®) standard allowed for better patient management systems in clinical settings—especially for dermatological assessments of suspicious moles and lesions on the body. Additionally, this teledermatology platform securely transmits high quality images to be assessed by specialists. Because FHIR enables collaboration through open standards, utilization prevents patients experiencing extended wait times before and during treatment.
Benefits of Open-Source Screening
Fully interoperable screening process is beneficial for both payers and providers. When the technology is put into place and followed correctly, patients like Denise can receive prompt diagnoses and treatment options after testing is complete. Both the patient’s record and SIAscope images are sent to a specialist via DermSecure. From there, the dermatologist is able to assess the images to determine a diagnosis. The patient’s record is then updated with the dermatologist’s assessment report, where it can be easily accessed at any date.
Using this collaborative effort allows for patient peace of mind; it no longer has to take weeks or months in order to receive a diagnosis. When dealing with melanoma, a delayed diagnosis can lead to an advanced form of the cancer, resulting in a greater risk of death.
Teledermatology allows doctors to assess and diagnose suspicious skin conditions quickly and accurately through the platform’s image capture technology. By integrating into cloud-based platforms, clinics can work collaboratively and patients can have peace of mind. Partnerships like the ones between MedX, Blanc Labs and Smile allow the capabilities of the global telemedicine market to expand which means patients can receive the treatment they need when it matters most.
Thanks to the combined efforts of MedX, Blanc Labs and Smile, the global teledermatology platform can greatly improve the detection and survival rates of melanoma. Investing in MedX’s SIAscope and DermSecure solutions allows health providers to offer beneficial solutions for their patients.