Medical photography in corporate imaging
Organizations are rapidly extending their enterprise imaging architecture to accommodate imaging generated outside of radiology and cardiology. Point-of-care and bedside imaging is a growing concern in our industry, along with medical photography. Each of them brings its own complexity related to workflow, compliance and levels of integration. I am pleased to see the Healthcare Information and Management Systems Society (HIMSS)/Society for Imaging Informatics in Medicine (SIIM) task force taking charge of developing thought leadership and standards on how best to manage these data and bring lessons learned from years of image management into the conversation.
An article was recently published in the Diagnostic Imaging Journal titled “Visible Light Imaging: Clinical Aspects with an Emphasis on Medical Photography — a HIMSS-SIIM Enterprise Imaging Community Whitepaper,” written by Cheryl A Petersilge, MD, et.al. This article discusses some important considerations in incorporating clinical photos into the patient record. The purpose of this article is to describe and expand on some important standards for how images are managed within the enterprise imaging architecture. We have learned many lessons in this industry related to the slow adoption or drift away from standards and the impact this has on how images are viewed, displayed, stored, identified and retained, as well as as well as their place in the patient’s file. This article does a great job of listing some of those important considerations.
Medical photos are taken for a number of reasons and some of them are very sensitive in nature. Content in these photos may include pediatric data, sensitive body parts, may be gruesome, or may be used for forensic or forensic purposes. Due to the nature of this content, according to the document, patient consent is essential to determine how these images are incorporated into the patient’s record and to whom they are made available. As the document states, “A patient’s privacy and psychological safety should be the primary concern of organizations when implementing medical photography programs. Patient consent that addresses every potential use case of medical photography is the cornerstone of patient, provider, and organizational protection. This requires that we as organizations develop strong governance around the management of these photos as well as the necessary policies and agreements to ensure the privacy and trust of our patients.
Due to the ubiquity of cameras, it is difficult to ensure that the data generated provides the necessary metadata to ensure that the photos are contextualized in the patient file. Great work has been done recently in creating categories for labeling photographs taken either by clinicians or patients. The document outlines four categories of metadata that will be important in how photographs are identified and labeled. These categories include patient level, encounter level, procedure level, and object level. A list of data elements for each of these categories can be found in the whitepaper and provides a great starting point for organizing metadata. And while many devices used for photography aren’t at a point where they can support automatic metadata generation, as the article states, “The aim of this list is to be provocative and ambitious. This should stimulate discussion within each organization when selecting technology and establishing workflows and policies for their medical photography programs.The document alludes to a companion document that will address some of the technical aspects of this.
Life cycle management
Because photographs have historically resided in departmental systems or even on the specific clinician’s devices or computers, there has not been a corporate approach to lifecycle management of these image objects. While I suspect that these discussions will continue to determine whether it is retained in accordance with implemented policies regarding Terms-Generated Studies, there are things we can do to ensure that we are technically prepared to maintain data integrity. The article highlights the importance of processing these images as part of the patient record with a robust infrastructure, including redundancy and high availability, as well as leveraging HL7 interfaces to ensure that all information updates of the patient are reflected in the metadata of the photograph.
Much remains to be decided, and the implications of those decisions, as we continue to expand the enterprise imaging landscape. The considerations listed in this article are just a few of the considerations discussed in this important white paper. I would urge anyone considering the adoption of medical photography in your enterprise imaging solution to read and distribute this document as a decision-making guidance document that will have a significant impact on every aspect of this part of the patient’s medical record.
Jef Williams is Managing Partner of Paragon Consulting Partners LLC, a health informatics consulting group based in Sacramento, California.