Incorporating photograph in an routine exam room visit

I've been incorporating photographs in PowerNotes for nearly 2 years and after a wide variety of experiments am now refining the process to where nearly 50% of my notes have images in them without adding any time to the documentation at the point of care in the exam room. This blog reports on the technique and methods that allow this value added process in a primary care ambulatory setting using existing tools, devices, features and functions in PowerChart 2007.19 code.

Basically the process involves using virtually any camera, transmitting the images in real-time to a secure network folder that is accessible by PowerChart running on Citrix application servers, loading those images into the Multimedia Manager, Clinical or PowerNotes during the visit.  Here's what it looks like:

We've been testing a variety of cameras to determine whether there is an optimal camera and have concluded that virtually any image capturing device will work and the one chosen should be dictated by the nature of the image and potential downstream use.  The iPhone works as does the inexpensive point-and-shoot cameras, mid-level and high end cameras.  All have their advantages and disadvantages but they all work (more about this later).

The critical component for fast, secure and seamless incorporation of images in the point-of-care documentation process is a wireless SD card.  We found that physically having to connect the cameras using USB cables and/or removing the SD memory cards and inserting them into the local device was problematic on two major levels.

1. First, the active of manipulating the camera, cable or chip detracted significantly from the patient-physician interaction and interrupted the flow of the encounter as well as added time to the encounter. 
2. Second, enabling USB and SD imports increased the security risk of the in-exam room computers unnecessarily.
3. There's an Eye-Fi app for the iPhone so smart phones can be used securely as well and this allows the smart phone to direct the photographs in a secure fashion to the same secure as the cameras with the Eye-Fi cards although it seems to take marginally longer (1-2 minutes at most).

We are having significant success using wireless Eye-Fi SD cards widely available at different price ranges ~$40 - $100 primarily dependent on size and speed.  These cards look like any SD camera memory card except they have wi-fi capability in which images are encrypted and routed wirelessly to the desired location.  The cards come with an Eye-Fi Center application that installs on any PC or Mac allowing the user to specify which Wireless Access Points to connect to (up to 32 private/secure SSIDs may be specified for each card) and the target network folder to which the pictures will be routed. All of the cards can be managed by the same application as shown below:

Net result:  A picture is taken in the exam room > camera begins immediately to transmit the picture without any intervention by the physician > physician and patient continue their interaction without being disturbed > image is usually available to PowerChart's drawing tool within 30 - 120 seconds (there are many variables that vary the copying of the image from the camera to the network folder).  The physician can then incorporate the image in the note that (in our case) is being compiled at the point-of-care in front of the patient.

We're using images for anything that is difficult to describe or will need to be followed (rashes, lesions, wounds, physical findings like edema, varicose veins, etc.).

It's fun, the patient's love it and it has certainly enhanced the physician/patient/exam room experience without adding time to the visit or taking attention away from the clinical condition/event that prompted the visit.