Frequently Asked Question: FAQ:

How do I get photos into the medical record?

Other FAQs

There are four options here.

1. Send To Yourself

Anecdotally, many doctors simply take a photo on their phone, email it to themselves, and then upload it to the medical record system that they use. The problem with this is, email is sending patient data via email is insecure, and there are many security issues with using the default camera app on your phone.

PicSafe has been designed to encrypt photos on your phone, before sending them. This means they can be emailed "normally" while remaining secure. If you send a "report" to yourself, you can go to my.picsafe.com and drag and drop the encrypted .picsafe file to decrypt it and view the contents. This is all done in the browser, and no patient data travels over the internet unencrypted. From here, you can simply get the photo you want to include to the medical record system and upload it like any file sitting on your system.

Steps
  1. Take a photo in the PicSafe app, enter the patient's details and get consent.
  2. Tap on the Send to row and select Email.
  3. Tap the Send button and email the report to an email address you can access on your computer.
  4. Sign in to my.picsafe.com.
  5. Open the email with the PicSafe report attached and Drag and drop the .picsafe file into the box.
  6. Tap on the Save button at the bottom of the report.
  7. Import the saved image into the Medical Record system you are using.

2. Send To Box/Dropbox

Requires PicSafe PRO

If you can't get your medical record system or clinic management software to integrate initially, PicSafe makes it much easier to get photos from your phone to the medical record than if you were to use the default camera app on your phone.

Getting photos from your phone to your desktop (where it is often possible to import to medical record systems of clinic management software) is generally painful. You should not email photos to yourself as that is considered insecure. If you are using an iPhone and a Mac, you can AirDrop them, but Bluetooth connections are often flaky. Plugging your phone into your computer and transferring the files across is secure but is tedious.

One solution we have found that works quite well is by using PicSafe's ability to send to Box and Dropbox (PRO version only). Upload your photos to Box or Dropbox and have your computer automatically sync your files. You can use Box or Dropbox as a repository where you store the clinical photos, or you can import the photos into the medical record or clinic management software manually.

Box and Dropbox are considered the most popular cloud storage services available. Both Box and Dropbox offer a HIPAA-compliant secure storage option, and while HIPAA is a US-based standard for protecting patient privacy, it is viewed by many around the world as the gold standard in patient privacy regulation. Both Box and Dropbox, however, are US companies and, hence, raises the issue of data sovereignty for those outside the US.

Box & Data Sovereignty

In November 2106 Box, fortunately, announced "Box Zones in Australia” which enables Australian customers to store their data locally. Box says that by storing customer data in-country, it “can help address Australian Privacy Principles for organisations with data residency concerns and help companies meet the Australian Signals Directorate's strong recommendation that cloud providers handling sensitive data be located in Australia”.

Unfortunately, you must have a Box Enterprise account to use Box Zones. The Box website asks that you contact them to get a quote. Expect to pay around $35 per month for this service. There are Box Zones set up for other countries too.

Dropbox & Data Sovereignty

According to Dropbox's VP of Enterprise Strategy, Ross Piper, “Dropbox stores its Australian customer files in Amazon Web Service's Sydney data centre”. Technically speaking, then, it sounds like you can use Dropbox. However, they state that they hold related metadata in the US, thereby raising the accessibility spectre once again. The fact that this issue is conspicuously not addressed on its website raises some doubt about using Dropbox here in Australia.

The “Dropbox Basic” free plan, may be all you need. That gives you 2GB of storage which should be enough for roughly 4,000 photos. If you require more storage space, you can upgrade to various paid plans starting at AU$11.60 a month.

Steps
  1. Tap on the Settings button in the top left of the PicSafe app to link your Box or Dropbox account.
  2. Tap on either the Box or Dropbox rows and follow the prompts to link your account.
  3. Take a photo in the PicSafe app, enter the patient's details and get consent.
  4. Tap on the Send to row and select either Box or Dropbox.
  5. Tap the Send button.
  6. Install {link_to "Box Drive", "https://www.box.com/resources/downloads"} or {link_to "Dropbox", "https://www.dropbox.com/install"} on your computer. This will sync files you add to your account
  7. Open the file explorer to the PicSafe folder within the Box or Dropbox directory on your computer and locate the file you just added.
  8. Import the saved image into the Medical Record system you are using.

3. FHIR

Requires PicSafe PRO

FHIR stands for Fast Healthcare Interoperability Resources. It is "the" emerging standard for exchanging health information to and from electronic health records. In short, this means that third-party applications that also support FHIR, like PicSafe, can integrate with EMR/EHR systems often without any work from IT. Most, if not all, progressive EMR and EHR software vendors support FHIR (or are planning on doing so).

PicSafe allows PRO and Enterprise users to "link" to their EMR/EHR account within the app. Reports sent "via FHIR" will be placed in the patient's medical record along with documentation of consent. PicSafe's FHIR integration even allows you to pick which patient's record a report should be added too if there is some ambiguity (e.g. if there are entries for a James Smith, Jim Smith, or Jimmy Smith all with the same date of birth). For more details on how FHIR works, please see the FHIR Documentation.

Steps
  1. Tap on the Settings button in the top left of the PicSafe app.
  2. Tap on the FHIR row and follow the prompts to link your account. You will need the URL to be provided by your IT department.
  3. Take a photo in the PicSafe app, enter the patient's details and get consent.
  4. Tap on the Send to row and select FHIR.
  5. Tap the Send button.

4. Custom Integration

Requires PicSafe PRO

If your practice, clinic, or hospital is using a third-party medical record system or clinic management software, that is not FHIR compatible, to fully automate the process, you may have to lobby the vendor or your IT department to provide access. Understandably, access is locked down by default. It takes two to tango, just as it takes two to integrate into third-party software. PicSafe will work with software vendors or your IT department to help integrate.

Integration with a medical record system is obviously more relevant for those that operate the IT department of an institution (hospital, clinic, etc.). If you want to integrate PicSafe reports into a patients medical record, PicSafe provides a simple API to allow you to do so.

Ultimately, you will need to set up a private "Endpoint", and we also recommend you set up a private "Key Server". PicSafe provides a turnkey Docker image for hosting a private Key Server. PicSafe also provides a sample Endpoint application. You will need to write middleware to take reports uploaded to the endpoint and move them into your medical record system (PicSafe does not perform this integration).

For more details, please see the "How do I set up a private Endpoint?" FAQ. For even more detail on how endpoints work and how to integrate PicSafe into medical record systems, please see the Integrations Section of this website.

Steps

We will assume a custom integration has been set up. These are the steps for a user.

  1. Take a photo in the PicSafe app, enter the patient's details and get consent.
  2. Tap on the Send to row and select the custom integration.
  3. Tap the Send button, and the report is sent!