Mobile devices aren't just for on-the-go access to images and other healthcare information. It's also important to account for their use in capturing photos of patients at the point of care, according to a January 26 webinar sponsored by the Society for Imaging Informatics in Medicine (SIIM).
As a result, healthcare organizations need to develop mobile device programs that address the clinical use cases for acquiring these photographs, including identifying workflow considerations and ensuring that these images are accessible within the electronic medical record (EMR), said Louis Lannum, director of enterprise imaging at the Cleveland Clinic.
"Mobile [device imaging] programs have to take into consideration that all of your physicians and other healthcare professionals are walking acquisition devices capturing images," Lannum said.
Lannum and Kim Garriott of Logicalis Healthcare Solutions discussed the issues surrounding mobile device image acquisition during the SIIM webinar.
Challenges
Using mobile devices to acquire images comes with a number of important challenges, including the need to secure the device and any protected health information (PHI).
"You don't want all of that information going up into the cloud when the system is backed up," Lannum said. "What you also don't want to do is have your physicians and other caregivers cut and paste the images or photographs that they've taken ... and email or message them to another physician. That's not securing the PHI on a device."
In addition, the image capture event needs to be associated with the specific patient, encounter, and order metadata, Lannum said. The report, encounter, or operative note must also be associated with the image in the electronic health record (EHR), and naming convention standards are also important, he added.
Other issues include the need to align the mobile imaging program with existing "bring your own device" policies to ensure that physicians are not walking out the door with PHI on their phone or backing up PHI in the cloud, Lannum said. Image quality assurance is also an important topic.
"Just taking a photograph without understanding the field-of-view, without understanding measurements, and without putting something there to calibrate that image is an issue," he said. "A lot of organizations when they start taking photographs actually put a ruler in the field of vision to give that some type of measurement."
Use cases
Mobile devices have a number of imaging capture clinical use cases, such as in wound assessment programs, surgical wound follow-up, dermatology, caregiver collaboration, home healthcare documentation, and support of eHealth initiatives, Lannum said. Each of these clinical use cases has a specific and slightly different workflow.
"But at the end of the day, what you really want to do is develop a secure way for all of your caregivers to use their mobile devices as an acquisition device to visually document a patient condition, and to have that image sent to your enterprise imaging repository, so that the image is displayed inside the EMR and shared across the continuum of care," he said.
In a caregiver collaboration use case, for example, physicians often take pictures of patients on their mobile devices and send the images to colleagues for their opinion, he said.
"If you don't have a program that secures the mobile device, you've got PHI and exposure of patient information all over your enterprise," he said. "Physicians will use this device as a communication tool, and they will communicate with each other by exchanging photographs. You have to start a program where you start to control that collaboration effort; you don't want to stop the collaboration, but you want to ensure that it's secure and HIPAA-compliant and is documented very well."
In fact, it's a good idea to encourage that collaboration, Garriott said.
"You can imagine a use case where a patient presents to their family care physician with a rash, and that physician is a little stumped by that," she said. "If they are able to acquire a photo and almost in real-time collaborate with a dermatologist or an infectious disease specialist to determine the appropriate path of care right then -- when the patient is in their office -- that's much better patient care, much more timely care delivery than not being able to take a photo and actually having to refer a patient to dermatology or infectious disease. So this is a really strong point when we talk about value-based care and the alignment of enterprise imaging."
Program design strategies
When thinking about implementing a mobile image acquisition program, it's important to first prioritize the use cases that you're going to pursue, Garriott said.
"That may mean proactively going out and talking to some areas," she said. "Not all areas are going to raise their hand and say, 'Hey, I have a need for this.' You may need to go out and do an assessment of your organization to understand those use cases."
The next step is to identify the requirements needed to implement the acquisition and management of these digital photos, such as clinical workflow, technical, security, and other issues, she said. It's also important to account for metadata needs now and in the future.
"As we start to be able to leverage analytics more and more, it's even more important now that we really pay attention to what level of data is being captured with every clinical piece of information that's acquired on a patient, especially for digital photos," she said.
It's also important to consider how the images will be presented within the EHR for viewing by the care team, she said. Finally, organizations will need to determine how the mobile imaging program fits within the organization's enterprise imaging strategy, Garriott said.
