Estonian digital health company Dermtest has big plans. What started as a melanoma early detection service providing a suite of digital tools to Estonian healthcare providers has widened to cover other indications and geographies.
The company also has a subsidiary in Germany — without a doubt the largest market in the European Union — and has been piloted in Lithuania and Moldova, with plans underway to expand into other European markets.
The ongoing COVID-19 pandemic prompted the business to innovate in new ways earlier this year, resulting in the development of a new application. Dermtest is also involved in a large retrospective study to gauge the impact its service has had on users’ health since it rolled out.
All of this is being accomplished with a tightly-knit team of half a dozen core employees.
The story so far
The method underlying Dermtest was first implemented at the Dermato-oncology Clinic, a private center in Tallinn, and then spun out as an independent company. Priit Kruus, the CEO and co-founder, has been guiding the firm since 2014. The initial concept was to enable family physicians to make images of suspicious moles on patients and then relay them to specialists for assessment. This allowed both a decentralization of the process of evaluating patients for skin cancer and an opportunity to improve the ease and speed of diagnosis and, thus, treatment.
A digital toolbox for skincare
Today, the service consists of a digital toolbox for managing skincare and other image-heavy specialties, such as wound care, orthopedics, dermato-venerology, ophthalmology, and others. It includes an application for imaging patients, a software platform for clinicians to manage those images and interact with colleagues, options for integrating data with electronic health records, as well as a means for clinicians to tele-consult with patients with high photo quality. The solution is widely in use in Estonia today, with uptake at more than 50 hospitals, general practitioners’ offices, and clinics.
Better quality of care
“Since we introduced it six years ago, Dermtest has enabled the management of more than 150,000 clinical cases, including capturing skin images and enabling more than 15,000 remote skin cancer checkups,” says Kruus. “Hundreds of early-stage melanomas have been discovered,” he says. “If you discover melanoma at an early stage, the treatment cost is 15 to 40 times lower, and the survival rate is also higher.”
It’s not just about skin cancer, though. The Dermtest offering can also support the assessment of wounds, burns, psoriasis, allergies, and other skin issues, enabling patients to be evaluated from a distance, such as from rural locations, so that they don’t need to travel to a specialist for a checkup. “Instead of waiting in line to see a dermatologist, your doctor can just send a photo to the hospital for evaluation,” says Kruus. “Our tool enables a better quality of care and access.”
Within the digital framework
Dermtest’s success in its home market is not just due to its location. Its digital toolbox was constructed by experts well-versed in the Estonian digital society framework, making use of the same principles regarding security, ethics, and privacy that support its e-health and e-governance systems. “We built our solution in collaboration within the Estonian digital framework,” notes Kruus. “We have people on our team who understand the digital health experience very well and who understand how the digital landscape has developed,” he says.
An experience that is helpful in other countries, too
While one could assume being entrenched in the Estonian e-health system might be a limitation to exporting its tools to other markets, Kruus says Dermtest’s experience has been quite the opposite. “Our experience is helpful in other countries,” he says. “It has helped us advance faster in Estonia because we already have some e-governance frameworks in place,” he adds. “In some countries, we have to build these ourselves or adapt to the local standards.”
A tailored approach
Indeed, Europe is a hodgepodge of healthcare systems, with varying degrees of coverage, digitalization, and processes for the adoption of new technologies. This means that Dermtest has to tailor its approach for every market it attempts to enter. “Every country’s healthcare environment is different, the financial incentives are different, not to mention the financing framework, the clinical culture,” he says.
The company’s response has been to work on its onboarding process so that new users can easily understand and adopt its tools. Dermtest also works with local hospitals and healthcare authorities to meet their specific needs. “All countries are very different, and that makes exporting healthcare solutions harder,” says Kruus. “You need a good understanding of the healthcare environment you are going into.”
The COVID experience …
Like all technology companies, Dermtest was impacted by the ongoing COVID-19 pandemic. As GPs use a special camera to image suspicious moles, and physician visits declined due to lockdown measures, the number of cases using the service declined significantly at first.
The company quickly turned around a new application called Dermtest Telehealth, which enabled patients to send photos directly to physicians and receive telehealth consultations related to their cases by video or phone. “We built this solution, which helps, for example, Tallinn Central Hospital in providing remote care,” says Kruus.
The product is now integrated into the company’s complete photo management toolkit. According to Kruus, COVID-19 has benefited the company so that there is a broader understanding of the need for digital health solutions. “We have found several new clients,” he notes, “and next year we will expand even further and faster.”
… and a new study
The European Union’s Regional Development Fund is also funding a two-year study involving Dermtest and its solutions. The project, which commenced this year, has a budget of €81,000. Dermtest Chief Medical Officer Christian Koop is leading the project with the support of Tartu University Hospital. The study also involves the Estonian Insurance Database and the Estonian Health Information System Database.
According to Koop, the project is a retrospective study of data collected during the past seven years that Dermtest’s service has been available within one national health system, a sizable cohort for the teledermatoscopy space – “a study of a unique depth and magnitude to show the impact of using medical photos in a clinical setting in a productive way,” he says.
“This study focuses on melanoma, but with our clinical partners we are planning other studies in the medical spheres, in which our medical photo management system is used, including allergy, psoriasis, and orthopedics,” Koop notes.
“The team believes that simple-to-adopt and powerful digital tools should also contribute to better clinical research and the development of new care models,” says Koop. “These will help to make our health system sustainable, accessible, enable remote care, and increase the quality of care.”