MAUI, HAWAII An online digital photography management service may improve dermatologists' use of patient photos, Dr. Ashish C. Bhatia said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.
To make good use of photos taken of patients, software is needed that allows for easy cataloging, rapid retrieval, and viewing features such as the ability to zoom in for a close-up examination.
Both local software, which is used only on an office computer, and software accessed through an application service provider (ASP) can do this, but there are disadvantages to local software, said Dr. Bhatia of Northwestern University, Chicago.
Drawbacks of local software include up-front costs, the need to update it periodically, and the vulnerability of the photo database to computer crashes. With an ASP, services are provided for a monthly payment, eliminating higher up-front costs.
Since the provider is responsible for continuously upgrading the software, "you don't have to worry about all that," he said. The database is accessible anywhere there is Internet access, and is safer. "If your computer crashes, all your data are not on your local computer," he said.
Secure transactions can be conducted over the Internet, he said. The photos can be shared more readily with referring physicians while complying with HIPAA.
ASPs can also be limited by the Internet. Access may be temporarily lost because of server downtime or power outages, he said, though, "this can happen even with your regular office solutions." Plus, the photo database is stored outside the office, so "they have your data. But most ASPs will send you a hard copy of all your data or send it on a DVD," he said.
There have been significant improvements in ASPs. In the past, it was difficult to access ASP systems from offices with electronic medical record systems or practice management software, "but now most of these companies are making communications conduits to interface with those," Dr. Bhatia said. With his current system, the log-in is done with user names and passwords, which allow different access levels for various people. Dr. Bhatia said that his ASP has enabled him to show before and after pictures to referring physicians by sending them links by e-mail. Access is secured through an encrypted link. The photos cannot be copied or downloaded.
Dr. Bhatia disclosed his meeting expenses were reimbursed by Through the Lens Inc. He is an unpaid consultant to several digital imaging hardware and software companies.
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Photography Tips
Dr. Bhatia offered these tips to better use photography.
Take consistent photographs.
Make sure positioning is consistent to compare photos over time and confirm the results of procedures. Teach staff how to position a patient. Basic views include:
▸ Frontal view.
▸ Oblique (45 degree) view. Put dots on the wall and instruct the patient to stare straight at the different dots for positioning.
▸ Full lateral view, from the top of the head to the collarbone.
Backgrounds are important. Try a portable background or a black or blue box painted on a wall. Distractions should be eliminated by covering up clothing, necklaces, etc. Use a room with no window or a shade.
To maintain a consistent distance, "we actually have markings on the floor for where the patient is supposed to sit," he said. Marks also show the photographer where to stand.
Catalog the photos.
List the patient's name, date, location, and diagnosis for easy retrieval.
Share with patients and referring physicians.
"Before and after" shots may be set up at kiosks. Label these clearly, explaining the procedure.