A picture is worth a thousand words: The role of photography in patient care – Part 1

Assessments in patient care are vital. The more descriptive each written assessment, the better every professional can deliver specialized treatment to the patient.

There are caveats, however. A physician may document a wound as reddened, for example. However, what’s red to one physician may be pink to a colleague.

“Findings in areas such as wound care or dermatology might look very different on the patient who has aging, fragile skin versus someone with young, denser supporting tissue,” said Julie McDonald, senior customer advisor, Hyland Healthcare. “So it’s important to know that when we’re describing findings that we’re comparing like-to-like.”

Visible light imaging, of which clinical photography is a component, could mark a sea change in how patient assessments are completed.

“When that written word is supported by visual images, the patient story is instantly much richer,” said McDonald. “And those supportive images can put all stakeholders in patient care on a more level field of understanding.”

McDonald, along with Matt Bishop, enterprise-imaging architect at Unity Point Health, spoke during SIIM 2020, the Society for Imaging Informatics in Medicine’s annual conference, held virtually this year. The two tackled the benefits and challenges of using images in patient care from both a clinical and technological perspective, as well as how to jumpstart a visible light imaging strategy.

The benefits of a clinical photography strategy

Clinical photography lends visual support to written assessments and stands as one of the biggest benefits of the practice.

“It’s really important when determining if ongoing treatment is effective, especially if the clinician ordering that treatment is not physically in the presence of the patient at every visit,” said McDonald. “Or if assessments might be occurring at different locations, like some via homecare or at outpatient clinics and others during inpatient stays.”

The ability to compare similar impairments on a diverse population provides an almost unparalleled educational opportunity. Imaging presents a less-biased look at data, and ensures that caregivers are prepared to assess, treat and create protocols developed for all patients and not just some.

“And when we’re collaborating with senior clinicians or more specialized providers, it helps ensure that we’re getting really efficient, specific teaching moments and collaborative interactions between our clinical staff,” said McDonald.

Perhaps most importantly, it lifts patient engagement. While patients may not fully comprehend all medical terminology and test results, before-and-after photos tell a story almost any person can understand. This also often leads to more pertinent follow-up questions and a better understanding of ongoing care.

“With images, patients feel connected,” said McDonald.

Challenges and risks associated with the discipline

With telehealth rapidly becoming the normal way patients and providers are connecting, due in great part to the 2020 novel coronavirus pandemic, patients are sharing digital images with doctors more frequently and the need to understand the challenges clinical photography presents is paramount.

“It’s important to understand that there have been rapid changes to the ways we provide care,” said McDonald. “And those changes will continue to foster new and creative care processes going forward. For that reason, we have to prepare to accommodate all those changes as safely and efficiently as we can.”

McDonald outlined a handful of challenges stakeholders will want to understand before moving forward comprehensively with a clinical photography plan.

Those challenges include:

  • Image capture

Unlike radiology, the capture of many clinical images is not scheduled or predetermined, so flexibility is necessary for all involved. And patient privacy must be of utmost importance.

We must also realize that not all images are captured by the same clinical role. Physicians, nurses, mid-level providers and clinical photographers may all capture images, and workflows that respect each of those roles – from capture to access and image manipulation – must be accommodated.

  • Device type

Whether smart devices or digital cameras capture images, even endoscopic images, those devices do not share the same capabilities to store, share, apply metadata and safely transmit images to the right storage archive. And certainly none of them is inherently DICOM.

“When you have inconsistency in capture, inconsistency in that metadata application or transmission or storage methods, that can dramatically limit how useful those images are downstream,” said McDonald. “And this prevents consistency in the continuum of care.”

  • Metadata standardization

Metadata standardization is critical, and language around body parts is one area of metadata standardization that the HIMSS SIIM enterprise-imaging community is actively discussing, noted McDonald. Beyond that, she suggests an internal metadata standardization plan as a goal every organization should adopt.

  • Image sensitivity

While image sensitivity is not a new challenge for healthcare organizations, the increased use of clinical photography brings the issue to the forefront. Image sensitivity is subjective and ever-changing, and providers will always need to handle some images carefully.

But there are new sensitivities to consider, as well. Tattoos and body jewelry, for example, could reveal a patient’s identity, making what was once a non-sensitive image now sensitive. Graphic imagery and pediatric photographs will also always play a role in image sensitivity.

  • PHI exposure

McDonald notes that the risk of personal health information exposure exists at nearly every part of the photo documentation process.

  • Image loss

Even when an organization properly follows all steps, the loss of clinical photography is possible. This might be due to technological and workflow failures. It could also happen when an image capture device fails or is lost, taking recent images with it.

  • Patient consent

Patent consent is why health delivery organizations should create clear policies and procedures around the capture of images, particularly with smart devices. Organizations should clearly define what consent it is requesting for each use case and create an opportunity for patients to consent to those individually.

Governance: The final step

In order to take on these challenges and reap the benefits of clinical photography, healthcare organizations must create a strong, inclusive and ongoing governance committee.

“That’s really imperative to make sure that you’re creating relevance for all of your images,” said McDonald. “Whether that’s access, lifecycle management, internal and external compliance, procedural guidelines or all of the regulations that may be applied to certain types of images. The governance team needs to include all stakeholders, including clinical, IT and your HIM and risk management stakeholders, to ensure that all image management issues are considered and appropriately meet the organizational goals, as well as guidelines and compliance standards.”

Ready to read part 2?

Tom Tennant has expertise in content creation and content services and has been a contributor to the Hyland blog.
Tom Tennant

Tom Tennant

Tom Tennant has expertise in content creation and content services and has been a contributor to the Hyland blog.

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