We compare the process of a GP taking clinical photos when using PicSafe versus when using a DSLR camera. A DSLR (Digital Single-Lens Reflex) is what most people would know as a good digital camera. Spoiler alert. We show that PicSafe is much quicker, easier and doctors are far more likely to comply with practices that keep clinical photos secure.
We recently received an email from an organization that we will not name here. They are looking for a solution that allows GP's to take photos and attach them to the patient's medical record system. We (PicSafe) are seeking to integrate into various medical record systems and clinic management systems, but it takes two to tango. While we are happy and prepared to do the integration, the developers of the medical record systems need to allow us to integrate. Understandably, the developers of these systems have some high barriers to get over before they accept you. Unfortunately, these high walls mean most of the integration work is bureaucratic rather than technical. Nonetheless, we will persist.
Given this organization needed an immediate solution, one of the ideas put forward was giving the doctors a digital camera as they thought it might be easier. We disagree. We have adapted our response to form this article.
The Process Using a DSLR
Here is the process a GP would go through if using a DSLR.
- The doctor explains that they are going to take a picture for medical purposes.
- The doctor pulls out a consent form and hands it to the patient.
- The doctor pulls out their DSLR or compact camera. Is the camera locked away to prevent it from being stolen? Is it stored in another room because doctors in the clinic share it? Has the camera been charged?
- The patient completes the consent form (generally paper consent forms are overly verbose, and the patient never reads). The patient enters their name, date of birth and signs the form. The doctor inputs the patient ID (e.g. NHS number, UR number, etc.).
- The doctor takes the photo. Has the doctor read the camera manual? Do they know how to use it?
- Doctor plugs in a USB cable. Is the cable with the camera? Does the doctor's computer have a USB port? Is it the right type of port for the cable or is an adaptor needed (USB Type C, USB Type A, USB Micro-B 5 pin, USB Mini-B 5 pin, Apple Lightning)? Alternatively, the doctor pulls the memory card out of the camera. What type of memory card is it? Does the computer have a memory card reader? What formats does the memory card reader support? Is it SD (Secure Digital, SDHC (Secure Digital High Capacity), SDXC (Secure Digital Xtra Capacity), CF (Compact Flash), Micro SD, Micro SDHC, xD (eXtreme Digital), Memory Stick Duo, MMC (Multi Media Card), UHS-II, or CFast 2.0 standard? Is the memory card formatted to work on both Mac and PC?
- The doctor waits for the file to copy across. If it is a DSLR, most raw image files will be around 50MB these days. It will take a little while to copy that across.
- The doctor then opens a third party program (e.g. Photoshop, Lightroom, IrfanView, etc.) to compress the raw image file copied from the camera and save it in another format (JPEG). A 50MB file is too big to put in the patient's medical record, and the medical record system (most often) will only allow JPEG files. Does the doctor have such a program on their computer? Do they know how to use this program?
- The doctor has to delete the raw photo from the camera or memory card.
- The doctor uploads the exported JPEG to the medical record system.
- The doctor removes the exported JPEG file from their computer. Ideally, they delete it from their trash/recycle bin too.
- The doctor files the consent. Preferably, it is scanned and added to the patient medical record. When capturing clinical photos, most guidelines recommend getting permission every time and documenting the consent in the patient's medical record.
- We will assume that the doctor now has also to create a referral letter and attach the photo, and the clinic practice software can do this. If they want to use the image for teaching purposes, they should strip the metadata from the photo.
In summary, that process is cumbersome and given doctors are often pressed for time, steps will be skipped resulting in noncompliance with guidelines/laws. Alternatively, if it is too hard, and doctors will not take a photo resulting in poorer patient care.
The Process Using PicSafe
Here is the process if using PicSafe:
- The doctor explains that they are going to take a photo for medical purposes.
- The doctor pulls out their phone and opens the PicSafe app.
- The doctor takes a picture.
- The doctor enters the patient's details. If there is a barcode or QR code used, this very easy (see https://picsafe.com/uk/qr). Otherwise, the doctor has to type in the first name, last name, patient ID, and enter their date of birth.
- The doctor hands their phone to the patient to read the simple consent form and sign their name on the screen. Alternatively, the doctor can record audio of the patient giving verbal consent.
- The app uploads the generated "report" (photo plus a PDF of the patient details and consent) to Box or Dropbox or direct to the patient's medical record (later). The app automatically removes patient data from their phone.
- The doctor opens the file explorer on their computer. Box and Dropbox automatically synchronize, so the recently uploaded file appears in a few seconds. Given reports are compressed, they are only around 5MB, so this does not take long. PicSafe removes all metadata from the photo and converts it to a format that imports easily into the medical record system.
- The doctor uploads the exported JPEG, and the PDF document containing the details and consent, to the medical record system.
- We will assume that the doctor now has also to create a referral letter and attach the photo. Most clinic practice software can do this. If not, PicSafe makes it easy to send a copy via email (encrypted attachment).
Obviously, we would like to get the photos into the medical record direct from the phone, and bypassing the steps of uploading to Box or Dropbox. Avoiding Box and Dropbox will come with more integration, something that is never going to be possible with the DSLR process.
We should note that we are not advocating PicSafe replaces the role of a clinical photography department in a hospital. There will always be a role for that. The quality of image a high-quality DSLR can achieve is superior to that of a smartphone (even if the gap is closing). For the vast majority of cases, the quality of photo that you can achieve on a smartphone is more than adequate for its purpose.
So the winner is...