Region Stockholm – customer case
Region Stockholm implements Dermicus teledermatology platform for efficient patient management in support of early diagnosis of skin cancer at all their primary care centres for over 2.2 million patients.
From pilot to implementation
Watch video with presentation by Elinor Nemlander and Karina Schultz describing the introduction of Dermicus platform for teledermatoscopy from pilot to implementation in Region Stockholm, International Society of Digital Health in Dermatology YouTube channel, December 3, 2023.
Background
In 2015 the Swedish government initiated a national reform to standardize cancer patient pathways, enable the period from suspicion to start of treatment is made as short as possible – but without compromising on quality. As a part of this initiative, Region Stockholm has gradually evaluated teledermatology technology for efficient diagnosis of skin cancer, funded by RCC Stockholm Gotland (The Regional Cancer Centre).
The evaluation started as a pilot with ten primary care centres 2015, where GPs sent pictures of suspected skin cancer to dermatologists for remote expert assessment and diagnosis. Teledermatoscopy at more and more primary care centres, RCC Stockholm, October 2017.
The project was broadened, and in 2018, 48 primary care centres used Dermicus, Teledermatoscopy – a successful project that enables shortening of waiting times, RCC Stockholm January 2019.
“It takes a long experience to distinguish early malignant melanoma from benign skin lesions. Thanks to teledermatology, we can move the specialist competence to primary care.”
Marie Sedvall, GP in Täby, Mobile solution enables shortening of waiting time for suspected malignant melanoma, RCC Stockholm, 2018.
Agreement in 2020
Region Stockholm is one of Europe’s largest healthcare providers covering a patient population of 2.2 million.
In the autumn 2020, Region Stockholm procured Dermicus to introduce a comprehensive platform that will provide a user-friendly, secure, and modern IT support for teledermatology for over 220 primary care centres. The centres are operated by both Region Stockholm and by private care providers.
Region Stockholm has signed a six-year agreement with Dermicus to deliver a broad introduction of the region’s new care process for teledermatology for more efficient management of patients with suspicious skin lesions.
GPs, in all 220 primary care centres in the region, will be able to document and photograph skin lesions with Dermicus app, a mobile phone and dermatoscope, and send them securely to skin specialists for remote expert assessment and diagnosis.
Ref: Project for wide introduction of teledermatoscopy, RCC Stockholm.
“It’s a fun way to work! The earlier we find cancer, the better the patient’s prognosis. So, it feels very concrete and meaningful to work like this.”
Fedra Amorim, GP, S:t Eriks health centre, Teledermatoscopy provides quick answers to suspected cancer, Region Stockholm, Janusinfo, Evidens No 2, June 2020.
Integration to Take Care – Spring 2021
The knowledge team (CaPrim) at the Academic Primary Care Center (APC) in Region Stockholm have been given the mission to create a web-based training module, launched in the Spring of 2021, Digital “driving license” for assessment of suspected skin cancer, to facilitate the roll-out of teledermatoscopy.
In the middle of May 2021, 60 GP practices in Stockholm started using the new teledermatoscopy process to evaluate cases of suspicious lesions of malignant melanoma.
“We have received more than 1 000 patient cases from the first 60 GP practices and less than 150 cases have been diagnosed as suspicious malignant lesions or required a follow-up. This indicated that by using teledermatoscopy it was possible to avoid further interventions or operations on more than 800 cases. These patients would have otherwise needed to wait for a diagnosis or have been operated unnecessarily.”
Elinor Nemlander, a specialist in general medicine and the project manager of the education section of the project at the Academic Primary Care Center, Region Stockholm, Evidens No 2, September 2021.
During spring 2021, the system was integrated to the patient journal (Take Care) in Region Stockholm, which will enable the roll-out to all 220 GP practices.
“Dermicus solution for efficient patient management in support of early diagnosis of suspicious skin lesions is implemented in Region Stockholm. The solution was possible due to an integration of the patient journal (Take Care) through a creating dedicated referral.
The collaboration between IT, management team, medical professionals and Dermicus has been very positive and solution oriented. We have together delivered a solution on time and with quality. We are now working together to launch the solution in all 220 GP practices in the district.”
Peter Öberg, maintenance object owner, Region Stockholm.
In October 2021, the roll-out of teledermatoscopy started in the primary care in Region Stockholm with the goal to onboard everyone during 2022.
EU conference on cancer
On 1 February 2023, Swedish healthcare was highlighted by Swecare in an exhibition at Conference on Cancer under the Swedish EU Presidency in Stockholm. Region Stockholm and the Dermicus implementation was part of the exhibition.
Elinor Nemlander, specialist in general medicine, at RCC Region Stockholm, talked about the advantages and opportunities of teledermatoscopy, see pdf.
Publications 2023
- Schultz K, Nemlander E. Introduction of new technology and new working methods; from a successful pilot project to a region-wide implementation of teledermatoscopy in primary health care. JMIR Preprints. 29/05/2023:49437.
- Schultz K, Ivert LU, Lapins J, Sartorius K, Johansson EK. Lead Time from First Suspicion of Malignant Melanoma in Primary Care to Diagnostic Excision: a Cohort Study Comparing Teledermatoscopy and Traditional Referral to a Dermatology Clinic at a Tertiary Hospital. Dermatol Pract Concept. 2023 Jan 1:13(1).
Part of the development of the care process for skin cancer
The objective is to facilitate the communication and collaboration between primary and secondary care to enable efficient, safe, and secure diagnosis of skin diseases by efficient patient management.
The contract award to Dermicus (Gnosco) (2 November 2020), for the procurement of the teledermatology platform, was made by the Healthcare Provision in Region Stockholm, the organisation responsible for placing orders for healthcare that is financed by public funds, and stated this about Dermicus:
“Broad introduction of teledermatology is part of the development of the care process for skin cancer and means that the region can offer better care at a lower cost as well as enabling increased safety and accessibility for patients. A prerequisite for the working method is access to adequate IT support.”
Requirement’s specification
The procurement document “Delivery of Teledermatoscopy System, Region Stockholm, 2020-09-12” states that the goal of the procurement is a standardised, comprehensive system that is user-friendly and functional and that meets Region Stockholm’s need for new digital IT support for the care process for teledermatology.
“The system must be able to be integrated with other systems used by the region that are necessary to be able to carry out the region’s mission.”
More on the subject
More about the procurement, objectives, scope, and requirements specification where the system for teledermatology is described in more detail (Appendix 2), see: Delivery of Teledermatoscopy system, 2020-09-12, Region Stockholm, diary/reference number HSN 2020-116.
This extract from the procurement documentation describes the process and how Region Stockholm procured and introduce teledermatology.
More background, tips, advice and guidelines for development and implementation of teledermatology.
Disclaimer: The views expressed in this case study belong to the client mentioned. This is for informational purposes only.
“Doctors at health centres who start using the technology quickly become better at finding skin cancer and more skilled at screening out age-related warts and other benign skin lesions.”
Jan Lapins, MD, PhD, Associate Professor, Department of Dermatology, Karolinska University Hospital, Teledermatoscopy provides quick answers to suspected cancer, Region Stockholm, Janusinfo, Evidence number 2, June 2020.