Research and Background

First-Derm-research-background

Teledermatology is at the forefront of this digital health revolution, and First Derm uses innovation and quality healthcare to drive this revolution forward.

Today, our population faces serious health related threats as the baby-boomer generation becomes elderly, viruses such as Zika spread throughout the world, and chronic diseases such as cancer develop without a cure.

At the same time, technology has advanced and found its way to the pockets of vast segments of society through mobile devices. The intersection between health related threats and accessible technology presents us with the perfect opportunity to improve the lives of many, at a fast rate. This is the digital health revolution that can improve not only patient outcomes, but also the efficiency of our healthcare system. Teledermatology is at the forefront of this digital health revolution, and First Derm uses innovation and quality healthcare to drive this revolution forward.

 

The Beginning

 

The idea behind First Derm was not thought up overnight – it is the product of years of development and scholarly research. First Derm was founded by Dr. Alexander Börve, a medical doctor and an academic in the field of teledermatology. Since 2008, he has published 4 peer-reviewed scholarly articles demonstrating the success of teledermatology:

Academic research focusing on the impact and accuracy of teledermatology began in 2009 when Dr. Alexander Börve and his colleagues conducted a pilot study in Swedish primary care centers. This pilot study, driven by iDoc24 Inc., illustrated the convenience of an app which provides medical information services through a mobile device. Individuals and/or physicians were able to take a picture of a skin ailment, send the picture anonymously to a dermatologist, and receive a response within 24 hours for an affordable price.1 Dermatologists provided the user with a suggested diagnosis and a recommended treatment. This business to consumer (B to C) model eventually developed into the First Derm app, which the consumer can download for free and anonymously (no registration or e-mail necessary) under HIPAA. Meanwhile, the business to business (B to B) model evolved into the iDoc24 PRO app, allowing healthcare professionals to register for an account with the app with HIPAA compliance.

Using the Tele-Dermis ® platform, the first study conducted by Dr. Börve was a small pilot of 51 patients referred from family doctors to dermatologists. In 80% of the cases, family doctors wanted a second opinion for suspected skin cancer lesions. In 90% of those cases, the dermatologist wanted to further inspect lesions with a dermoscope.2

With the remaining 20% of referrals that were not suspected to be (classified as) skin cancer, the family doctor did not need to send in the patient for a dermatologist visit for further inspection, but were given a skin treatment recommendation.2 However, suspected skin cancer lesions were difficult to diagnose due to low image resolution of the cell phone camera.

 

Building on the Studies: The Dermoscope

 

With the diagnostic accuracy to be comparable to face-to-face visits on suspected skin cancer lesions, teledermoscopy offers the patient less time waiting for a suggested diagnosis and treatment option.

One of the first studies comparing teledermoscopy images and mobile images was done by Dr. Kroemer, an avid researcher and member of the Medical University of Graz teledermatology project. This mobile teledermatology study affirmed that the teledermoscopy images were superior when juxtaposed to standard mobile images.3 Following this study, the dermoscope was redesigned as an iPhone attachment, and Dr. Börve and his team further tested the accuracy this technology in their 2013 study, “Mobile teledermoscopy- there is an app for that!” Overall, this study affirmed the accuracy of teledermoscopy images and suggested that using the teledermoscopy image and the mobile image together will prompt a better dermatological response.4

Each progressive study allowed Dr. Börve and his team to refine the methodology of teledermatology. The main flaw in early studies was the low picture quality to assess possible skin cancer lesions, which in turn affected the accuracy of diagnosis and triage decisions. This prompted the innovation of the dermoscope to improve accuracy across the board. Teledermoscopy has demonstrated a very comparable diagnostic accuracy to a face to face appointment with a dermatologist.4 With the diagnostic accuracy to be comparable to face-to-face visits on suspected skin cancer lesions, teledermoscopy offers the patient less time waiting for a suggested diagnosis and treatment option. Less time spent waiting means less time cancer can grow deeper into the skin.

 

HÜD | Dermoscope (Dermatoscope)

 

As a result, 93% of patients in the sample had treatment on the first visit compared to 82% in the traditional referral method.

12,000 people die of skin cancer every year in the USA. Unlike most cancers, skin cancer has a very high survival rate if detected early enough. Studies from Australia show that education and proactive screening can save people from skin cancer deaths. Today we introduce HÜD, the first dermoscope designed for the home.

A dermoscope is a magnifying glass with LED lighting that is used in everyday practice in the dermatology practice. As a consumer, you can screen worrisome lesions that you think are potentially skin cancer and receive an opinion from a board certified dermatologist that is educated in reading dermoscopy images within hours.

If you have more than 3 possible skin cancer lesions that you want examined, we recommend you to see a dermatologist for a full body skin examination. However, our service is well-suited to check out one off lesions that may be worrying you between regular checkups. You can use the dermoscope on yourself, your partner, your parents or your kids.

From our experience date to date, suspicious skin lesions are difficult to assess with only a smartphone camera. With a dermoscope, such as HÜD, our scientific studies have shown results comparable with an face-to-face visit to the dermatologist.HUD | Dermoscope | Dermatoscope

Images taken with a smartphone camera VS smartphone camera and dermoscopeTeledermatology vs teledermoscopy dermoscope dermatoscope

Image quality of four different lesions included in the study. Clinical and dermoscopic images of (1a, 1b) a spitzoid nodular melanoma; (2a, 2b) a seborrheic keratosis; (3a, 3b) a basal cell carcinoma; and (4a, 4b) a dysplastic nevus. [Copyright ©2013 Börve et al.]¹

 

Dr. Börve’s latest study connects family doctors with dermatologists by utilizing dermoscope technology with the iDoc24 PRO app platform. This pathway allows healthcare professionals that are not experts in dermatology to triage their patients with suspected skin cancer concerns by a dermatologist. This one-year study which included over 1500 patients, found that skin cancer lesions could be triaged to a dermatologist in an accurate, timely fashion. If properly used, this technology could save several weeks in referring the right patient at the right time for final diagnosis and treatment. As a result, 93% of patients in the sample had treatment on the first visit compared to 82% in the traditional referral method. Over 40% of the dermatology visits could have been prevented using teledermatology.5

 

Costs and Benefits

 

Telehealth, particularly teledermatology, can save the healthcare system several million dollars by accurately and time efficiently diagnosing and triaging patients.

To further explore the benefits of this technology, a cost-minimization report is being drafted to reveal the preliminary findings of the iDoc24 PRO system. Telehealth, and specifically teledermatology, can save the healthcare system several million dollars by accurately and time efficiently diagnosing and triaging patients.

On a macroscopic scale, teledermatology has demonstrated a higher accuracy of triage referrals compared to paper referrals. Furthermore, this technology has the capability to filter cases that can be managed outside the hospital for a fraction of the cost. First Derm (a consumer driven app) and iDoc24 PRO (a physician driven app) are not a replacement for dermatologists, but rather a tool to acquire an expeditious response from a dermatologist.

It is a technology designed for the purpose of connecting doctors with patients to provide pertinent medical information. On average there are about 3 dermatologist per 100,000 people in the US (fluctuating with population density).6 With this shortage of dermatologists, teledermatology and teledermoscopy provides a selective screening of cases unparalleled in our current healthcare system. 70% of the cases First Derm receives have been recommended treatment with over-the-counter medications, while only 30% are advised to seek a face-to-face visit.7 First Derm promotes a more efficient use of resources, time and money for doctors and patients via telehealth.

Since our population is living longer, our healthcare system needs to evolve to serve more people more efficiently. A recent study estimates that 1 in 5 Americans will develop skin cancer within their lifetime, demonstrating the importance of diagnostic accuracy, triage management, cost and convenience.8 On average, primary care physicians only have an estimated 50% pretest examination and management accuracy of skin ailments, while teledermoscopists via First Derm are 90+% accurate and dermatologist face-to-face (FTF) are 98+% accurate.4,9 First Derm offers diagnostic accuracy comparable to a dermatologist FTF. Additionally, the technology enables swift triaging of patients through the convenience of a mobile phone.

 

The Future of Telehealth

 

Ultimately, First Derm is efficiently and conveniently bridging the information gap between dermatologists and patients. Within hours accurate treatment recommendations and triage decisions are delivered to patients. First Derm is offering a research supported product employing accredited dermatologists that respond quickly to anonymous cases for an affordable price.

As technology evolves, features of this app have the potential to progress as well. Upgrading the dermoscope further will improve picture quality, in turn increasing the accuracy of dermatologists’ assessment. Even though technological advances shows promise for the future, all telehealth will have to overcome the slow-moving government policies and overall reluctance of change by doctors and the healthcare industry as a whole. In the face of adversity, First Derm is merging healthcare and technology to provide an efficient, convenient, and affordable product.

 

References

  1. Börve A., and R. Molina-Martinez. “A Pilot Study of a Medical Information Service Using Mobile Phones in Sweden.” Journal of Telemedicine and Telecare 15.8 (2009): 421-22. Web.
  2. Börve A., Holst A., Gente-Lidholm A, Molina-Martinez R., and Paoli J. “Use of the mobile phone multimedia messaging service for teledermatology.” Journal of Telemedicine and Telecare (2012): 18- 292. Web.
  3. Kroemer, S., J. Frühauf, T.m. Campbell, C. Massone, G. Schwantzer, H.p. Soyer, and R. Hofmann-Wellenhof. “Mobile Teledermatology for Skin Tumour Screening: Diagnostic Accuracy of Clinical and Dermoscopic Image Tele-evaluation Using Cellular Phones.” British Journal of Dermatology 164.5 (2011): 973-79. Web.
  4. Börve, A., Terstappen K., Sandberg C., and Paoli J. “Mobile Teledermoscopy—there’s an App for That!” Dermatology Practical & Conceptual 3.2 (2013): n. pag. Web.
  5. Börve A, Dahlén Gyllencreutz J, Terstappen K, Johansson Backman E, Aldenbratt A, Danielsson M, Gillstedt M, Sandberg C, Paoli J. “Smartphone Teledermoscopy Referrals: A Novel Process for Improved Triage of Skin Cancer Patients.” Acta Derm Venereol (2014). Web.
  6. Yoo, J. Y., and D. S. Rigel. “Trends in Dermatology: Geographic Density of US Dermatologists.” Archives of Dermatology 146.7 (2010): 779. Web.
  7. Buhr, Sarah. “An App That Detects STDs In The Privacy Of Your Own Home.” TechCrunch. TechCrunch, 19 June 2014. Web. 10 July 2014.
  8. Robinson, JK. Sun exposure, sun protection, and vitamin D. JAMA 2005; 294:1541-43.
  9. Ramsay, D. L., and A. B. Fox. “The Ability of Primary Care Physicians to Recognize the Common Dermatoses.” Archives of Dermatology 117.10 (1981): 620-22. Web.
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