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The Inside Story of Open Medical's Successful Skin Cancer Project

Have you ever wondered what pushes innovative projects to succeed? Dr. Piyush Mahapatra, Chief Innovation Officer at Open Medical and the driving force behind the Skin CDC (Community Diagnostic Centres) grant's accomplishments, shares his insights into what drives effective implementation, the importance of collaboration, and presents real-world evidence.

The Skin CDC grant, funded by NHS England through the Small Business Research Initiative, was born from the need to improve early cancer diagnosis in healthcare. The programme focused on just that, diagnostic efficiency and enhancing service accessibility.

We designed our project to catalyse the NHS’s initiative to enhance community-based diagnostics, aligning with the teledermatology roadmap issued centrally. Using our cloud-based platform, PathpointⓇ eDerma, we architected a project that would put all these elements together.

Expect the unexpected

In any big healthcare project, you’re bound to face challenges and you need to be prepared. It’s all about having good mitigation strategies and being able to adapt quickly to get good results.

Our project covered 4 regions and 4 ICSs, reaching nearly 9 million people, so we bumped into quite a few challenges. Sometimes, the problems came from the provider's side. There were areas where the systems weren't quite ready to handle big projects because the ICSs were dealing with a lot, such as the merge into the new system or highly-pressured services. So we started by downscoping and picking an area, starting small, and scaling up that way.

Flexibility is really important here. Knowing how to navigate through challenges, being responsive to feedback, and adapting it accordingly—that's how you arrive at an optimal solution. For example, we were using a model with specialist nurses, but that proved difficult because of staffing and resource constraints. To optimise available resources, we looked into other models that involved photographers and got the patient to deliver a thorough clinical history rather than a nurse.

Collaboration breeds innovation

Before rolling out any innovation, you need to make sure it addresses the problem. In such a complex environment as healthcare, it really has to be done in a co-design partnership with the provider organisation. That's exactly what we did for this project—we worked closely with our clients to understand their needs and develop a solution that fit.

But it's not just about the providers; you need to factor in the patients as well. We designed a lot of patient-facing elements to improve patient engagement and allow the pathway to function effectively. Our in-house Patient and Public Involvement and Engagement team was instrumental in helping to guide and shape a lot of that work. As a result, eDerma’s questionnaire has a 99% completion rate and positive feedback.

I strongly believe that co-designing with both providers and patients is key, and I think it’s been a huge contributor to our success.

Real-world evidence

When you put all those elements together, from adapting to challenges to involving organisations and patients, the success of healthcare projects can skyrocket. We’ve seen this first-hand with the Skin CDC grant, where we’ve achieved incredible success.

At the start of this project, the 2-Week-Wait (2WW) served as the main benchmark, which mandated that patients be seen by a specialist within 2 weeks of referral. One organisation was extremely pressured, with 2WW times of 8 to 10 weeks, but in less than a month after launch, we turned them around with a 2WW mean of 5.6 days. That was a huge accomplishment, and it contributed to saving a number of lives in the process.

In East Kent, we were able to provide access where previously there wasn't. We are live across 5 imaging hubs serving 700,000 people, and we placed those hubs in specific areas of high need, notably coastal communities. We found that people from more deprived areas found the service very beneficial. Our findings also showed no significant difference in referral-to-diagnosis across different Index of Multiple Deprivation Decile groups. This means that those who, for example, wouldn't have been able to take time off work to travel hours to the nearest clinic can now access care closer to home. Essentially, we were able to remove the barriers that once prevented equitable access to care.

We’ve also saved dermatologists’ time; assessments with eDerma take on average 5.5 minutes, nearly 4 times faster than in-person appointments. This increased capacity by 79.7%. We are also in the process of finalising our health economics from this project, and so far it’s shown that even after factoring in eDerma's cost, it was £32 cheaper compared to face-to-face consultations. All the time and costs saved—these extremely valuable and limited resources—become available for redirection to areas where they are more urgently required.

The future is here

Technology has a huge role to play in addressing some of these challenges, but while there is a lot of good tech out there, it needs to be scaled with the best evidence accompanying it.

That real-world validation in clinical settings is something that helps to scale. Providers often have resource and capacity constraints, so the research and evaluation components often end up being deprioritised. With additional funding, it really helps unlock that and we can provide resources to ensure it happens. There hasn’t really been that support structure in place, but this Skin CDC grant project has brought it. It has allowed eDerma to reach a population of 8.8 million people, and we’ve been accepted on the NHS Innovation Accelerator, which will allow us to provide eDerma to even more people across the country.

We want the best innovations to be encouraged to scale; it’s cliché, but it’s like what Bill Gates said: “The future is already here; it’s just unevenly distributed.”


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