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Lai EK, Slavik E, Ganim B, Perry LA, Treuting C, Dee T, Osborne M, Presley C, Towbin AJ. Implementing a Photodocumentation Program. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01236-1. [PMID: 39174733 DOI: 10.1007/s10278-024-01236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
The widespread availability of smart devices has facilitated the use of medical photography, yet photodocumentation workflows are seldom implemented in healthcare organizations due to integration challenges with electronic health records (EHR) and standard clinical workflows. This manuscript details the implementation of a comprehensive photodocumentation workflow across all phases of care at a large healthcare organization, emphasizing efficiency and patient safety. From November 2018 to December 2023, healthcare workers at our institution uploaded nearly 32,000 photodocuments spanning 54 medical specialties. The photodocumentation process requires as few as 11 mouse clicks and keystrokes within the EHR and on smart devices. Automation played a crucial role in driving workflow efficiency and patient safety. For example, body part rules were used to automate the application of a sensitive label to photos of the face, chest, external genitalia, and buttocks. This automation was successful, with over 50% of the uploaded photodocuments being labeled as sensitive. Our implementation highlights the potential for standardizing photodocumentation workflows, thereby enhancing clinical documentation, improving patient care, and ensuring the secure handling of sensitive images.
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Affiliation(s)
- Eric K Lai
- Department of Radiology, Tufts University School of Medicine, Boston, USA
| | - Evan Slavik
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, USA
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Bessie Ganim
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Laurie A Perry
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, USA
| | - Caitlin Treuting
- Division of Dermatology, Cincinnati Children's Hospital, Cincinnati, USA
| | - Troy Dee
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Melissa Osborne
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Cieara Presley
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, USA
- Information Services, Cincinnati Children's Hospital, Cincinnati, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, USA.
- Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, USA.
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Schulte AG, Ricci LR, Melville JD, Brown J. Emerging Trends in Smartphone Photo Documentation of Child Physical Abuse. Pediatr Emerg Care 2022; 38:464-468. [PMID: 36040467 DOI: 10.1097/pec.0000000000002559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Photo documentation of injuries on children is universally recommended in cases of suspected child physical abuse. As technology improves, the ability to document physical examination findings through smartphone photography is increasingly accessible and practical. The quality of images captured on smartphones now rivals traditional photography and the integration of photo capture within the electronic medical record has led to a variety of fields adopting smartphone photo documentation for diagnosis, consult, and follow-up. However, in cases of child physical abuse, practitioners have been hesitant to adopt smartphones as a primary means of photo documentation because of concerns around image quality, privacy, and security. In this article, we discuss the technology of available smartphone cameras and current evidence regarding their use for photo documentation, use existing guidelines to propose a workflow to improve the yield of smartphone photo documentation in child physical abuse, and discuss common medicolegal concerns.
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Affiliation(s)
- Ansley G Schulte
- From the Office of Medical Education, Columbia University Medical Center, New York, NY
| | | | - John D Melville
- Division of Child Abuse Pediatrics, Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jocelyn Brown
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, NY
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Petersilge CA, McDonald J, Bishop M, Yudkovitch L, Treuting C, Towbin AJ. Visible Light Imaging: Clinical Aspects with an Emphasis on Medical Photography-a HIMSS-SIIM Enterprise Imaging Community Whitepaper. J Digit Imaging 2022; 35:385-395. [PMID: 35146611 PMCID: PMC9156602 DOI: 10.1007/s10278-022-00584-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022] Open
Abstract
Photodocumentation is a subset of visible light imaging and is an important growing segment of enterprise imaging. Medical videography is another subset of visible light imaging that shares many of the challenges of photodocumentation. Medical photographs are used to document clinical conditions, support diagnosis, guide, and document procedures and to enable collaboration among colleagues. They also play a significant role in patient engagement and are a mechanism for patients to share information with their provider without the need for a clinical office visit. The content of medical photographs raises issues for acquisition, management, storage, and access. Medical photographs may contain protected health information, and these images benefit from the standardized, secure processes inherent in any enterprise imaging program. The ability to securely acquire images on mobile, and sometimes personally owned devices, is a necessity. In addition to containing protected health information, photograph content can be sensitive or gruesome or the images may be used for forensic purposes. These types of images require additional protections. Access to these images should be role-based and auditable. To properly identify photographs and to convey information about their acquisition parameters new metadata requirements and mechanisms for its association with the imaging files are evolving. Institutional policies need to be developed to define the organization's requirements for medical photography, including consent processes. Existing policies such as those defining the designated record set and legal health record should address the management of medical photography.
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Affiliation(s)
- Cheryl A Petersilge
- UPMC Department of Radiology, 200 Lothrop Street, UPMC Montefiore, Room NE 538, PA, Pittsburgh, 15213, USA.
| | | | - Matthew Bishop
- Enterprise Solutions Architect - Imaging, UnityPoint Health, Bettendorf, IA, USA
| | | | - Caitlin Treuting
- Clinical Photography, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 5013, Cincinnati, OH, 45229, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 5013, OH, 45229, Cincinnati, USA
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A Standardized Peer Review Program Improves Assessment and Documentation of Child Sexual Abuse. Pediatr Qual Saf 2022; 7:e522. [PMID: 35071959 PMCID: PMC8782112 DOI: 10.1097/pq9.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022] Open
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Improving Physical Abuse Documentation and Photography through a Remote Peer Review Intervention. Pediatr Qual Saf 2021; 6:e477. [PMID: 34589651 PMCID: PMC8476058 DOI: 10.1097/pq9.0000000000000477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/03/2021] [Indexed: 12/03/2022] Open
Abstract
Supplemental Digital Content is available in the text. Child Abuse Pediatrics is a small and geographically dispersed specialty. This article reports on an intervention to improve written and photodocumentation quality and uniformity in suspected child physical abuse cases, using a remote, de-identified case review system.
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Petersilge CA. Fundamentals of Enterprise Photodocumentation: Connecting the Clinical and Technical-a Review of Key Concepts. J Digit Imaging 2019; 32:1052-1061. [PMID: 31011957 PMCID: PMC6841903 DOI: 10.1007/s10278-019-00212-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Photodocumentation is an invaluable tool in many specialties, including dermatology, facial plastic and reconstructive surgery, and wound management. As digital cameras and camera-enabled smartphones have become omnipresent in our society, they have brought photodocumentation to all corners of healthcare organizations including the emergency department as well as family medicine and pediatrics. Simultaneously, enterprise imaging programs have evolved enabling access to all medical images for all providers throughout these organizations. Through their unique perspective, enterprise imaging teams have an opportunity to guide development of high quality, ethical programs that are compliant with legal and regulatory requirements. Clinical and technical standards for photodocumentation are not fully evolved and thus establishing an enterprise photodocumentation program will require communication and education. Development of such a program requires an understanding of the clinical, ethical, and technical issues around photodocumentation. This article explores how photodocumentation is utilized, the patient's experience, current quality concerns, tools and technical issues around image acquisition, and the topics of informed consent, privacy, security, and lifecycle and health information management.
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Affiliation(s)
- Cheryl A Petersilge
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 7775 Thistle Lane, Novelty, OH, 44072, USA.
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So N, Waldman R, Waldman S. Professionalism of clinical photography in the pediatric setting. Curr Probl Pediatr Adolesc Health Care 2019; 49:74-78. [PMID: 30981457 DOI: 10.1016/j.cppeds.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Photography has a wide range of use in the medical field, ranging from clinical care to publication and teaching purposes. While photography is more common in certain specialties such as dermatology and plastic surgery, the accessibility to cameras and ease of documentation provides the opportunity for all fields to utilize this technology. In pediatric dermatology, photographs are taken to determine if conditions such as rashes and moles have changed or remained stable. Photos are also taken prior to biopsies to ensure the correct site is biopsied and used for monitoring for post-excisional changes. In surgery, photography is used to capture pre- and post-operative changes. Photography is also used to document trauma and physical abuse, which may be used as legal evidence. Clinical photography has also demonstrated its usefulness in this age of team-based healthcare, where different providers see the same patients over subsequent visits, allowing for new providers to see photographical documentation of conditions at a prior state.
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Affiliation(s)
- Naomi So
- David Geffen School of Medicine at UCLA, United States
| | - Reid Waldman
- Department of Dermatology, University of Connecticut School of Medicine, United States.
| | - Steven Waldman
- Department of Medical Humanities and Bioethics, University of Missouri-Kansas City School of Medicine, United States.
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Photographic Documentation and Hand Eczema Severity Index for Severity Assessment of Hand Eczema. Dermatitis 2017; 28:280-283. [DOI: 10.1097/der.0000000000000306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsokos M. Diagnostic criteria for cutaneous injuries in child abuse: classification, findings, and interpretation. Forensic Sci Med Pathol 2015; 11:235-42. [DOI: 10.1007/s12024-015-9671-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2015] [Indexed: 11/24/2022]
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