The role of photography in patient healthcare

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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 a patient who has aging, fragile skin versus someone with young, denser supporting tissue,” said Julie McDonald, a senior customer advisor at 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,” McDonald said. “And those supportive images can put all stakeholders in patient care on a more level field of understanding.”

McDonald, along with Matt Bishop, an enterprise imaging architect at UnityPoint Health, spoke at the Society for Imaging Informatics in Medicine conference in 2020.

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.

Benefits of a point-of-care imaging 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 for all patients.

“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,” McDonald said.

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

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

Challenges and risks associated with patient photography

With telehealth becoming a normal way patients and providers connect, patients are sharing digital images with doctors more frequently.

“It’s important to understand that there have been rapid changes to the ways we provide care,” McDonald said. “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 address before moving forward comprehensively with a clinical photography plan.

7 patient photography challenges to address

1. Image capture

Unlike radiology, the capture of many clinical images is not scheduled or predetermined, so flexibility is necessary for all involved (though patient privacy must remain paramount).

We must also realize that not all images are captured by the same clinical role. Physicians, nurses, midlevel 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.

> Read more | An enterprise imaging strategy in this new era of connected care

2. Device type

Even the smartest cameras (even endoscopic) don’t have all the capabilities to store, share, apply metadata and safely transmit images to the right storage archive. And importantly, none are 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,” McDonald said. “And this prevents consistency in the continuum of care.”

3. 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 suggested an internal metadata standardization plan as a goal for every organization.

4. 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 more carefully than others.

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 nonsensitive image now sensitive. Graphic imagery and pediatric photographs will also always play a role in image sensitivity.

5. Protected health information (PHI) exposure

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

6. Image loss

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

7. Patient consent

Patient consent is why health delivery organizations need 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 of photography in healthcare

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,” McDonald said. “Whether that’s access, life cycle 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.”

Tips for launching an effective healthcare imaging strategy

“My approach has always been to create technology that enables the clinical side and not vice versa,” Bishop said. “This is a clinical problem, not a technical problem, but technology needs to be there to help solve it.”

Bishop shared a number of ways healthcare organizations can use technology to get a jump on a clinical photography plan:

Take advantage of existing tools

Although some healthcare organizations may not have a complete enterprise imaging suite, most of them have some of the underlying components necessary to begin building one.

“Most organizations have a radiology PACS or cardiology PACS or other tools,” Bishop said. “You can begin using the existing tools you have and start enabling these technologies and clinical workflows to feed a future enterprise imaging strategy.”

> Read more | Why your PACS isn’t a VNA

Acquire the right devices

There are a number of devices on the market that healthcare organizations should investigate and acquire, said Bishop.

Organizations should consider how patients might react to certain devices.

Personal cameras, or “bring your own” devices, tend to trigger a negative reaction whereas digital devices purchased and owned by the hospital system provide more peace of mind — and are often much easier to secure.

Avoid image-capture silos

Dedicated image acquisition devices put patients at ease, especially when they are used in what seems like a standardized clinical setting. However, they can also create image silos, so it is imperative that all devices are included in the organization’s overall enterprise imaging infrastructure.<h3>Prepare for different imaging formats</h3>

As patients become more accustomed to sharing their images, providers will encounter more and more imaging formats. File formats, especially container files, could include multiple images as well. Some of those images may not be pertinent to the provider, and providers will need to figure out the best way to handle these images.

“Leverage your infrastructure, leverage governance, leverage the processes you already have in place,” Bishop said. “You can modify most of those file formats to match photo documentation.”

Enable workflows

The bottom line, according to Bishop, is to ensure you have a connected environment with the proper workflows.

“If you’re doing an encounter-based workflow, you need to get demographics and you need to get the metadata,” Bishop said. “And usually, you’re querying some system to get patient-level metadata. You’re creating the system to get some exam-level metadata. You may be putting annotations on the drawing. All those things need to happen in a connected environment.”

Put a premium on metadata

Everything from properly indexing images to comparing images side by side relies on a solid metadata methodology. You just need to take the time to do it.

“Most of the systems that are out there already have methods for adding the appropriate metadata,” said Bishop.

Content services: A key to organizing patient photography

Bishop concluded by talking about the myriad ways technology can handle the transmission and storage of images, from the number of industry vendor formats in the market to the benefits and challenges of DICOM images.

“There are some limitations to DICOM, especially as it relates to photography, but if you’re using JPGs, and you’re doing basic photography, DICOM can be great,” he said. “And if nothing else, it’s a great start for a program that you can then expand with more technology and more tools as you go.”

More than half of U.S. hospitals use Hyland Healthcare solutions

Up to 75% of unstructured content is stored and managed outside the EMR. What if you could access that content right from within the EMR? With Hyland Healthcare, you can.

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Learn more about Hyland’s enterprise imaging solutions.


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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.

... read more about: Tom Tennant