Adrian Bowling CEO, MoleMap NZ Ltd (4/11/10, Illott, 10.00)

1. Considerations for a Successful Teledermatology Application Adrian Bowling CEO MoleMap NZ Ltd

2. 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

4. To improve the quality of melanoma diagnosis

5. To provide equity of access to experts in the field

7. 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 United States (2008-2010) 6 clinics; 1500 patients/year Dermatologists 5 in New Zealand 4 in Australia 1 in USA

9. 165,000 patient visits

10. 1.5 million lesions recorded for assessment and serial monitoring

11. 3.2 million images (body, clinical and dermoscopy)

12. Average 32 lesions imaged per patient (range 1 – 269)

15. Relevant clinical information

16. Adequately trained and certified personnel at point of care and point of diagnosis

17. Protocols, audit, quality control systems

22. Patient history

23. Lesion history

25. 14 Point of care recording

27. Patient history

28. Lesion overview

29. Lesion images and history

31. 17

32. 18

33. 19

35. Am I at risk?

36. If so what needs treatment?

37. What is it and where is it?

38. Patient’s doctor needs the same information

39. For treatment

40. For their EHR

42. Training, Accreditation, Audit Our training progammes are comprhensive, tested and validated by key opinion leaders in our field. Melanographer training: 80 hours of clinical, technology, patient care 40 hours one to one supervision Certification by written and practical examination Practice controlled by systems and protocols Continuing supervision by tele-audit Dermatologist training: Must show competency in dermoscopy Complete 150 patient training set Complete independent online assessment Benchmarked against peers on regular basis

43. Quality Control Maintaining safe practice is about managing our quality systems and embracing a continuous improvement philosophy. Quality Control: Clinical supervision Dermatologist feedback Tele-audits Continuous Improvement Our knowledge is limited to what we know today We are dealing with biology which doesn’t aways follow the rules we know today Any adverse event is an opportunity to add to the rules we know today

44. Information Security Protecting health information is always a critical issue. When your information contains images of semi-naked patients it is even more so.

45. Information Security Protecting health information is always a critical issue. When your information contains images of semi-naked patients it is even more so. Clinical Control: Password protected access Encrypt images asap Move them off the client systems asap Transport Control Password protected access Certificate authentication SSL transport Server Control 3rd party management Audit record of access to database

46. Validated Telemedicine Programme Diagnosing melanoma earlier (Breslow thickness): Results from audit of 13,000 patient visits, 200 melanomas Diagnosing more accurately: Results from analysis of 79 referrals (for suspected melanoma) MoleMap dermoscopists recommended only 9 of these for excisions/biopsies 5 were confirmed as melanoma (benign/malignant <2) 70 lesions were saved from excision.

48. 30% of patients are GPs referrals

49. ~200 melanomas diagnosed per year (>5% of all melanomas in New Zealand)

50. Accurate Diagnosis (sensitivity):

52. Where to next – Patient Portal? Patient Portal

53. 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

55. Currently only really 2 options for a doctor presented with a lesion of concern:

56. Excise/biopsy and send it to the pathologist for their opion

57. Refer the patient to a dermatologist

58. MoleMap’s telemedicine approach can allow the doctor to provide a tele-dermatology consultation directly to their patient

59. Patients are happy – expert opinion without cost and health aspects of biospy/excsion

60. Doctors are happy:

61. confident reassurance to their patients

62. fewer investigative, invasive biopsies or excisions

63. feedback and learning opportunities

64. a visual documentation system for audit and follow-upEducation and Research Audit and Quality Control MoleMap Dermatologist Diagnosis

66. Blair Stewart

67. www.molemap.co.nz

68. enquiries@molemap.co.nz