1. Purpose
Teledermatology, assessing skin remotely from images, is convenient and often effective, but a remote view has limits: an image can miss a lesion, hide a worrying feature, or be too poor to judge. This policy sets out when the Service assesses skin remotely, the standards the images must meet, and how it makes sure a patient who needs to be seen in person is seen.
The Service must verify this policy against current British Association of Dermatologists teledermatology guidance and GMC guidance on remote consultations before adoption.
2. Sources to verify before adoption
- British Association of Dermatologists, teledermatology guidance: https://www.bad.org.uk/
- GMC, guidance on remote consultations and prescribing: https://www.gmc-uk.org/
- Data Protection Act 2018 and the UK GDPR (clinical images and remote-consultation data): https://www.legislation.gov.uk/ukpga/2018/12/contents
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
3. Scope
This policy applies to:
- skin assessment carried out remotely from images or video
- the decision to manage remotely or to bring the patient in
- the clinicians who assess remotely and the staff who support the service
4. When remote assessment is appropriate
- the Service assesses remotely only where it can reach a safe decision from what it can see
- where the images are inadequate, the history raises concern, or the lesion may be cancer, the patient is brought in for a face-to-face assessment rather than judged on a poor remote view
- a remote consultation is not used to avoid an examination that the patient needs
5. Image quality and what is captured
- the Service sets the standard for the images it needs, including a clear overview, a close-up and, where used, a dermoscopic image, with the lesion site identified
- where the images do not meet the standard, the patient is asked for better ones or brought in
- the clinician records what they could and could not see, so the limits of the assessment are clear
6. Identity, consent and the record
- the patient's identity is confirmed before a remote consultation
- the patient consents to the remote consultation and to the images, and the consent is recorded
- the remote consultation, the images relied on, the assessment, the decision and the advice are recorded as fully as a face-to-face consultation
7. Safety-netting
The patient is told, in a form they can keep:
- the outcome and any uncertainty in it
- what to watch for and what to do if the lesion changes
- how and when to come in if needed, and how to reach the Service
The Service does not close a remote case where the assessment was uncertain without arranging the next step.
8. Protecting remote-consultation data
- images and consultation data are handled on secure systems, not personal phones or unprotected apps
- patient images are linked to the right record and protected as sensitive personal data
- any loss or exposure of remote-consultation data is treated as a possible data breach and reported at once
9. Training
Clinicians assessing skin remotely are competent to do so and understand the limits of remote assessment, and are refreshed on a stated cadence. The Service records who is competent and the next refresher date.
10. Audit cadence
The Service checks, on a stated cadence, that:
- remote assessments were made only where a safe decision was possible, with patients brought in where needed
- images met the standard and their limits were recorded
- identity and consent were confirmed and the consultation fully recorded
- safety-netting and next steps were given, and remote-consultation data was handled securely
The Registered Manager and the clinical lead review the results and record the improvement actions that follow.