Evidence generation plan for artificial intelligence (AI) technologies for assessing and triaging skin lesions referred to the urgent suspected skin cancer pathway
2 Evidence gaps
This section describes the evidence gaps, why they need to be addressed and their relative importance for future committee decision making.
The committee will not be able to make a positive recommendation without the essential evidence gaps (see section 2.1) being addressed. The company can strengthen the evidence base by also addressing as many other evidence gaps (see section 2.2) as possible. This will help the committee to make a recommendation by ensuring it has a better understanding of the patient or healthcare system benefits of the technology.
2.1 Essential evidence for future committee decision making
Resource and care pathway impact
More data is needed about how using DERM affects the care pathway, compared with teledermatology alone, including:
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referral rates to dermatology from primary care
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impact on workload (for example, number of face-to-face appointments and biopsies, referrals to non-urgent pathways, patients discharged)
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time to diagnosis or discharge
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general costs related to the use of the technology
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proportion of lesions eligible for assessment by DERM.
Ideally, information about the impact on system indicators such as waiting times could also be collected.
This information will help provide a better understanding of whether the technology can help improve efficiency and provide benefits to the NHS.
Data should be collected when the technology is implemented as an autonomous tool and when it is used with healthcare professional review. This data will support a better understanding of how effective the technology is when used in routine NHS practice.
Accuracy of DERM in people with black or brown skin
Collecting more information on the accuracy of DERM in people with black or brown skin (Fitzpatrick skin types 5 and 6) is necessary to assess the effectiveness of the technology across different skin tones.
2.2 Evidence that further supports committee decision making
Comparative analysis of the accuracy of DERM and teledermatology
It is important to understand how DERM performs compared with teledermatology. More information about the accuracy of teledermatology is needed to support this comparison and further data about the accuracy of DERM will enhance future analysis.
Understanding how well DERM or teledermatology discharges non-urgent cases from the suspected skin cancer pathway while maintaining diagnostic accuracy for detecting high-risk lesions will inform an understanding of the impact on the workload for dermatology services.
Subgroup analyses of the accuracy of DERM when it is implemented as an autonomous tool and with healthcare professional review will support a clearer understanding of the effectiveness of the technology.
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