Subscribe to RSS
DOI: 10.1055/s-0039-1700870
Use of an EHR-Integrated Point-of-Care Mobile Medical Photography Application in a Pediatric Emergency Department
Funding This study was funded by the National Institutes of Health, (Grant/Award Number: “UL1TR002377”); Mayo Clinic Department of Emergency Medicine.Publication History
15 July 2019
26 September 2019
Publication Date:
20 November 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035026/201905/lookinside/thumbnails/10-1055-s-0039-1700870_190159ra-1.jpg)
Abstract
Background Mobile applications allow health care providers to capture point-of-care medical photographs and transfer them to the electronic health record (EHR). It is unclear how providers use these photographs or how they affect clinical care.
Objectives We aimed to understand the content, purpose, and outcomes of point-of-care medical photography performed in the pediatric emergency department (ED) at large academic medical center.
Methods A retrospective chart review was conducted of patients <21 years of age who were seen in the ED and photographed between March 29, 2015 and July 1, 2017 using a secure smartphone application integrated with the EHR. Inter-rater agreement and reliability between the two reviewers was assessed for the first 50 charts, and any discrepancies in interpretation were resolved before proceeding with the remaining data abstraction. The documented rationale for photography, content of photographs, and outcomes were recorded.
Results We identified 619 clinical encounters involving photographs of 605 patients who were eligible for inclusion. Skin was photographed in 499 (81%). The most common finding was rash (N = 177; 29%). Photos were of acceptable quality, with 569 (94%) achieving a score between 4 and 5 out of 5. The primary use of photography was documentation (N = 334; 54%), though teleconsultation was noted in 38 (6%). Nearly one-third (N = 187; 30%) of patients were seen in the ED or outpatient clinic for any reason within 2 weeks, and in 25 (13%), clinical notes explicitly referenced the initial photograph(s). In 53 (9%) cases, patients were photographed at a clinical visit in the subsequent 2 weeks, suggesting that photography was used to track changes over time.
Conclusion Documentation of findings using mobile point-of-care photography allows for high-fidelity documentation and facilitates continuity of care.
Keywords
medical photography - photography - emergency medicine - mobile application - pediatric emergency medicineProtection of Human and Animal Subjects
This study was conducted in accordance with the Declaration of Helsinki and was approved by the Mayo Clinic Institutional Review Board.
-
References
- 1 Wilson GM. Early photography, goitre, and James Inglis. BMJ 1973; 2 (5858): 104-105
- 2 Cheung A, Al-Ausi M, Hathorn I, Hyam J, Jaye P. Patients' attitudes toward medical photography in the emergency department. Emerg Med J 2005; 22 (08) 609
- 3 Sandler J, Gutierrez RJ, Murray A. Clinical photographs: the gold standard, an update. Prog Orthod 2012; 13 (03) 296-303
- 4 Morse GA, Haque MS, Sharland MR, Burke FJ. The use of clinical photography by UK general dental practitioners. Br Dent J 2010; 208 (01) E1
- 5 Aveta A, Filoni A, Persichetti P. Digital photography in plastic surgery: the importance of standardization in the era of medicolegal issues. Plast Reconstr Surg 2012; 130 (03) 490e-491e
- 6 Kunde L, McMeniman E, Parker M. Clinical photography in dermatology: ethical and medico-legal considerations in the age of digital and smartphone technology. Australas J Dermatol 2013; 54 (03) 192-197
- 7 Accetta JL, Schoenfeld J, Bitar C, Murina A. Smartphones in dermatology: acceptance of smartphone photography by the informed patient. Dermatol Surg 2019 . Doi: 10.1097/DSS.0000000000001976
- 8 Chan N, Charette J, Dumestre DO, Fraulin FO. Should ‘smart phones’ be used for patient photography?. Plast Surg (Oakv) 2016; 24 (01) 32-34
- 9 Kameda-Smith MM, Iorio-Morin C, Winkler-Schwartz A. , et al; Canadian Neurosurgery Research Collaborative (CNRC). Smartphone usage patterns by Canadian Neurosurgery Residents: a national cross-sectional survey. World Neurosurg 2018; 111: e465-e470
- 10 Li MK, Howard DP, King R. “A picture tells a thousand words” smartphone-based secure clinical image transfer improves compliance in open fracture management. Injury 2019; 50 (07) 1284-1287
- 11 Services USDoHH. Summary of the HIPAA security rule. 2013 . Available at: https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html . Accessed August 9, 2019
- 12 Ai AC, Maloney FL, Hickman TT, Wilcox AR, Ramelson H, Wright A. ; The Use of Clinical Images in Electronic Medical Records. A picture is worth 1,000 words. Appl Clin Inform 2017; 8 (03) 710-718
- 13 Landman A, Emani S, Carlile N. , et al. A mobile app for securely capturing and transferring clinical images to the electronic health record: description and preliminary usability study. JMIR Mhealth Uhealth 2015; 3 (01) e1
- 14 Wyatt KD, Willaert BN, Pallagi PJ, Uribe RA, Yiannias JA, Hellmich TR. PhotoExam: adoption of an iOS-based clinical image capture application at Mayo Clinic. Int J Dermatol 2017; 56 (12) 1359-1365
- 15 Pecina JL, Wyatt KD, Comfere NI, Bernard ME, North F. Uses of mobile device digital photography of dermatologic conditions in primary care. JMIR Mhealth Uhealth 2017; 5 (11) e165
- 16 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 17 Uebersax J. Raw agreement indices. 2018 . Available at: https://www.john-uebersax.com/stat/raw.htm . Accessed September 17, 2019
- 18 Kottner J, Audigé L, Brorson S. , et al. Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J Clin Epidemiol 2011; 64 (01) 96-106
- 19 Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37 (05) 360-363
- 20 Services USDoHH. Individuals' right under HIPAA to access their health information 45 CFR § 164.524. 2016 . Available at: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html . Accessed August 9, 2019
- 21 Abbott LM, Magnusson RS, Gibbs E, Smith SD. Smartphone use in dermatology for clinical photography and consultation: current practice and the law. Australas J Dermatol 2018; 59 (02) 101-107
- 22 Miller MW, Ross RK, Voight C. , et al. Patient-generated digital images after pediatric ambulatory surgery. Appl Clin Inform 2016; 7 (03) 646-652