Help with your referral


The information on this page is intended for referrers.

Please refer to your organisation for alternative care options. There should always be a back-up plan for specialist referral or management.

Get help with images ...

Create a new referral

Screen 1

When you create a referral, you are first asked some demographic details ( see top image on the left ). Do NOT tell us the patient's name; use your practice ID number or other anonymised system. You are asked to select from a list of "primary reasons". If none of these fit, or you have a general nonspecific inquiry, select "Other" and summarise your query. For Type of referral, select "Dermatology", then select "Next".

Screen 2

To provide you with useful advice, there are some important details you should add to the referral. The dermatology referral template ( see second image left ) prompts you to remember to include at least:
  • Presenting complaint
  • History of presenting complaint
  • Past medical history
  • Physical examination
  • Investigations
  • Working diagnosis
  • Current management/treatment

See below for more about referral details .

Attach files

High quality clinical images are nearly always essential. These can be obtained using any suitable camera, including those on mobile smartphones. Please ensure patient consent; explain that their images are being uploaded to a secure portal for clinical purposes. Sometimes these clinical images are also useful for education or publication. We will endeavour to specifically ask for written consent for such purposes.

More about clinical images ...

It is often very helpful to have original laboratory test results as uploaded documents or PDF files. To upload images and documents (see uploading file images, left or download tutorial (PDF file)):

  1. Click on the "Attach file(s)" button at the bottom of the referral form. This opens up a new window headed "Upload a file relating to (your case)".
  2. Click on the 'Browse" button.
  3. Find and select the file you wish to upload. Click on "Open" to upload the file.
  4. The name of the file you have selected appears to the right of the Browse button. Type in the Contents box to describe the file (eg "left arm" or "lab results")
  5. Press Upload. Repeat the process if you have another file to upload.
  6. When you have uploaded all the files, press Finished to return to the case.

File uploading takes a variable time depending on the size of the file and the speed of your internet connection. Smaller files will load more quickly.

Screen 3

Confirm your email address ( see third image left ).

Choose from a menu of options for who the case should be sent to, if this is available to you (options vary depending on the organisation). Note. The default is "Co-ordinator", but direct-to-dermatologist options may result in a faster response.

Having obtained consent from your patient, check the box and select Refer Case.

List my cases

Select item 1, "List my cases", which you will find on the Main menu (Referrer) page. The "All cases" page lists your cases ( see fourth image left ). The main thing to note is the colour of the Status box.

  • Red means the case has not yet been allocated to a dermatologist.
  • Yellow means the dermatologist has been allocated but has not yet responded to the latest message.
  • Green means the dermatologist has responded.

Patients with suspected skin cancer

Our dermatologists will advise you whether skin lesions are suspicious of malignancy and should undergo biopsy or excision. They are expert in dermatoscopic diagnosis. The following information/images are required for each lesion.

  • Anatomic/location views to reveal site on body and if relevant, normal naevus pattern for that patient
  • Close-up (macroscopic) views of the lesions
  • Dermatoscopic images – if available, it is useful to have both polarised and non-polarised views.

Refer to local Map of Medicine pathways for melanoma and non-melanoma skin cancer.

Patients with widespread rashes

  • It may take up to 3 days to respond to NZT cases, so if the case is urgent, use your usual channels for acute referral.
  • “Urgent” referral might include a sick patient, widespread blistering, mucosal involvement, acute erythroderma etc.
  • Images submitted to NZT should be representative of all sites affected. Please include both anatomic and close-up views.
  • We may request additional images of sites that may be unaffected by the rash, for example, when considering the differential diagnosis of a rash on the hands, we may require images of the feet.

Informed consent

Teledermatology consultations require the patient's consent, preferably in writing. You should explain the consultation process, why it may be helpful, and its limitations. Document what was said.

The patient may still require face-to-face consultation. Tell your patient:

  • You are seeking the help of a dermatologist based elsewhere in New Zealand, because of problems accessing dermatology locally (or as applies).
  • The information about the patient is stored on a secure website specially designed for telemedicine consultations.
  • The referring doctor/practice, the responding specialist, and co-ordinators have access to the messages and images about the patient. They are not visible to other users of the website.
  • That there may be a difference in diagnostic accuracy between teledermatology and a face-to-face consultation, and that they still may need a face-to-face consultation.
  • That you can provide them with a copy of the messages, if required.
  • Images can be used for all sorts of purposes. For example we may wish to use a particular clinical image for teaching or publication on the DermNet New Zealand website. It is our intention to get specific consent for this, particularly if patients may be identifiable.

A suitable consent form is found on Page 50 of the British Association of Dermatologists' Quality Standards for Teledermatology (Appendix C).

Referral details

It's best to select the dermatology standardised referral template. However, please include, where relevant:

1. Patient demographic data:

  • Geographic location
  • Date of birth or age
  • Gender
  • Ethnicity / ancestry
  • NHI number.

2. Teledermatology referral for skin lesions:

  • Date of onset/duration
  • Whether single or multiple
  • Location/s on body
  • Changes in size, shape, colour
  • Any bleeding and/or ulceration
  • Symptoms
  • Any personal and/or family history of skin cancers
  • Other risk factors, ie excessive sun exposure, fair skin, large number of naevi, immunosuppression, outdoor occupation etc.
  • Repeat and recent medications
  • Other medical conditions.

3. Teledermatology referral for inflammatory dermatosis:

  • Date of onset/duration
  • Location/s on the body (you can upload an annotated body map if you wish)
  • Symptoms
  • Previous treatment for this condition and its response to medications
  • Personal and family history of skin disease
  • Personal and family history of atopy
  • Relevant medical history
  • Known allergies
  • Repeat and recent medications
  • Recent overseas travel
  • Active problem list.

Images

High quality imaging is essential. The specific camera, and the number of pixels is much less important than focus, lighting, background and the clinical relevance of the images. Poor quality images are irritating to our specialists. Smartphone cameras available in 2015, such as iPhone 6, Galaxy 6, HTC One M9 and Sony Experia Z3 are ideal.

Refer to guidelines in the reference list below.

  • Aim for image dimensions 1280 x 1024 px (or thereabouts) and file size 100–500 kB
  • Use flash if indoor lighting is insufficient

More about clinical images ...

PicSafe™

If you use iPhone, iPad or Android device, consider downloading a safe mobile medical imaging system from https://picsafe.com/medi . This application includes:

  • Patient consent
  • Cloud-based image storage
  • Free and paid-for options

Other documents

If relevant, please upload copies of investigations such as biopsy results. Make sure all documents have fully uploaded before logging out.

Saving as PDF file

Click the "View as PDF" button at the top right hand corner of each case to download all the messages as a single file. This can be added to the practice's electronic clinical record or provided to the patient.

References



Referral template for Collegium Telemedicus Create referral. Screen 1

Referral template for Collegium Telemedicus Dermatology template. Screen 2

Referral template for Collegium Telemedicus Confirm consent. Screen 3

Referral template for Collegium Telemedicus All cases page

Referral template for Collegium Telemedicus Uploading file 1

Uploading file for Collegium Telemedicus Uploading file 2

Uploading file for Collegium Telemedicus Uploading file 3

Uploading file for Collegium Telemedicus Uploading file 4

Uploading file for Collegium Telemedicus Uploading file 5

Uploading file for Collegium Telemedicus Uploading file 6

Please note, New Zealand Teledermatology does not provide a direct-to-patient consultation service. Please see your own General Practitioner or other healthcare professional to find out how you can access a dermatologist. New Zealand Dermatologists are listed on the New Zealand Dermatological Society's website .
For further information about skin diseases and their treatment, refer to DermNet New Zealand at www.dermnetnz.org .