Product Case Study – Clinical Uploader App Integration at the Royal Wolverhampton Hospital

Product Case Study – Clinical Uploader App Integration at the Royal Wolverhampton Hospital

Service Provision The Clinical Illustration Department provides clinical photography and illustration services on site in the hospital wards, theatres, outpatient clinics and photographic studio for the purposes of monitoring and assessing patient’s medical conditions, assisting treatment planning and providing educational material for medical and surgical students and staff. Due to the diverse geography of community patients and to provide a total care pathway, the photography of wounds and pressure ulcers needs to be carried out by the community nursing teams in the patient’s homes. Canon Ixus cameras were provided for these teams by the Clinical Illustration department and were equipped with Wi-Fi cards so images could be transferred into the centralised FotoWare image management system via a secure server where they were processed by the Clinical Illustration department and made available in the EPR system to all.

Problems! This introduction of this process provided huge improvement from a patient care perspective and although essential, created a number of new technical, governance, safety and practical issues:

  • The Community nursing team shared cameras so wounds may not be photographed at the time of the initial visit which is critical for accurate monitoring and reporting.
  • Paper photography consent forms were often not being completed fully or not at all which rendered the images unusable unless this was obtained again and rectified at a later date.
  • Illegible entries on the photography consent form led to incorrect NHS numbers being supplied for patient identification. These data entry mistakes had to be manually identified and corrected due to the lack of an automated verification process, creating an additional administration burden. Failure to identify mistakes could potentially lead to images being filed under the incorrect patient record.
  • Blurred or unacceptable images were often taken due to lack of photographic skills and it could also be very difficult to ascertain which part of the body had been photographed.
  • Images often did not get transferred for processing via wi-fi due to the cameras being turned off after use.
  • When the cameras were switched on, the images were all transferred to the FotoWare database as per protocol, however staff regularly forgot to delete previous images causing duplicate entries and confusion when correlating data and images. This created an administration headache which could only be solved by the Clinical Photography team travelling to the site of the camera to identify and delete the images or the community team making additional journeys to bring the camera to the department for cross referencing and formatting. This also created the potential for the incorrect images to be filed under a patient record risking actual harm to the patient.

“Patient identifiable information was being stored on unencrypted mobile devices, causing serious governance risks with potential of loss, theft or inappropriate viewing”

The Solution A decision was made to employ the use of the Clinical Uploader App produced by Medialogix. The Clinical Uploader App provides a comprehensive and secure solution for clinical photography using mobile devices and has the following features:

  • An intuitive step by step process guides users through all of the required elements of clinical photography so that a complete ‘job package’ enters the central system ready for viewing or sending directly to the electronic patient record.
  • Patient identification verification to ensure accurate data entry and patient records.
  • A comprehensive consent model to ensure images can be processed in line with governance guidelines including electronic signature and documentation.
  • Body part documentation to ensure correct record keeping and accurate assessment and treatment planning.
  • Offline capability for remote working.

“The easy to use App provides end to end control of the photographic procedure with full auditability, assurance of correct patient identification and consent and a secure transfer process to improve your workflow and minimise governance risks within your organisation”

Outcomes and benefits Following a trial period where users were encouraged to test the application in a variety of environments, significant improvements were noted:

  • All users have access through their existing iPads so don’t need additional hardware or to share devices, ensuring timely photography of wounds.
  • Consent is now established with the patient and documented electronically before the images can be uploaded, ensuring processing can only be carried out within the terms agreed by the patient. There is also a process for documenting a ‘best interests’ decision’ made on behalf of a patient who lacks mental capacity for decision making.
  • A simple or advanced search entry is made to identify the patient, the user confirms that it is the correct patient and it is automatically verified against the hospital record prior to upload.
  • Using a mobile device to take photographs is a familiar and instinctive process which has resulted in better quality images. The app enables the user to document the body part/s and check the quality of the photograph prior to upload.
  • The images are transferred via internal wi-fi or 4G using a VPN connection and immediately deleted from within the App upon successful transfer.
  • Images are only transferred once, with the ID and consent metadata embedded in the file, removing the risk of image duplication or incorrect data entry.

“Images are stored in the App container on the encrypted device until connectivity is established for download– avoiding the gallery or camera roll completely, preventing the risk of losing or exposing sensitive patient data”

Feedback Feedback from the community nursing team has been very positive due to the simplified but comprehensive ‘one stop’ process. Administration tasks have been reduced significantly and so have the risks associated with the issues originally identified. Due to the success of this trial period, full roll out to the community team is imminent. Standard cameras are currently still in use within other clinics, such as Dermatology, Podiatry, Breast Clinic, Orthodontics and Cardiothoracic surgery. The plan is to further expand the use of the Clinical Uploader App to these areas to further improve the governance and security of clinical photographs within the Royal Wolverhampton NHS Trust.

Conclusion Hospitals that have a requirement for medical staff to take clinical photographs outside of the scope of the Clinical Photography services should consider employing the use of the Clinical Uploader App to ensure the secure and efficient correlation of patient identification, consent and photographs from multiple different locations and different users into a centrally managed location.

Reference Site The Clinical Illustration Department at the Royal Wolverhampton Hospital have kindly agreed to provide a reference site for the Clinical Uploader App. If you are considering employing a mobile App for clinical photography in your hospital  or are looking at ways to improve your clinical photography cover out of hours or off site, you can see the Clinical Uploader App in action by arranging a site visit to view the improved workflow at the Royal Wolverhampton Hospital by arrangement with Lisa Fisher lisa@medialogix.co.uk                      

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Modernising the Workflow of Clinical Photography: Digital Asset Management in Healthcare

Modernising the Workflow of Clinical Photography: Digital Asset Management in Healthcare

Clinical photographs play a major role in the healthcare industry and are widely used in areas such as clinical documentation, research, publication and education. Hundreds of thousands of clinical photographs are produced each year in the health sector and it’s increasingly crucial to manage these images effectively and safely to assure effective governance of often highly sensitive, clinical photographs of patients.

Medialogix have many clients in the healthcare industry

Our NHS clients are currently all Medical Illustration departments, where FotoWare Digital Asset Management (DAM) is employed for the management and viewing of clinical photographs taken by professional clinical photographers, doctors and allied health staff. Clinical photographs of patients are routinely taken to assist with diagnosis, monitor progress, plan treatment and provide educational material. Hundreds of thousands of clinical photographs are produced each year and the requirement for effective management of these images continues to increase with the development of technology and the General Data Protection Regulations (GDPR). There are many opportunities for centralising image management resources for other departments using ‘standalone’ storage and image capture devices and also within the Private Sector.

FotoWare DAM has solved the problems with management of clinical photographs

Prior to using DAM, clinical photographs were managed via manual processes which stemmed from traditional film photography procedures used prior to the advent of digital photography. Patient details were documented in paper books, spreadsheets or job databases and kept separate from the photographs. Digital photographs were printed out and inserted in paper case notes with very ineffective (if any) controls in place to prevent unauthorised access, copying and distribution. There were multiple margins for error and loss to occur and quite often, prints were missing from patient notes and were either unavailable for patient care or filed after patients had been discharged. With the growth and availability of digital photography, timely availability of clinical photographs often did not meet requirements, a problem exacerbated due to reduced staffing and increased workload pressures.

Employing FotoWare DAM has completely modernised the workflow of clinical photography and has enabled strict governance procedures to achieve legal compliance in terms of Data Protection and GDPR. Due to improved workflow, photographs are now available at the point of care, risks are minimised through proper control of access and the availability of full audit trails of activity. Printed photographs are only rarely required which minimises the risk of loss and unauthorised viewing. Patient details, diagnosis and consent provide useful metadata as the basis for processing images.

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Common problems that prospective customers in the healthcare sector are experiencing without a DAM:

Without a DAM, customers are still employing labour intensive systems in an attempt to manage digital assets using manual processes. Proper control over access to images cannot be achieved and many photographs are still unavailable at the point of care. There are many ‘halfway systems’ in place where digital photographs are being printed, then scanned back into Electronic Patient Records (EPR’s) – literally doubling the workload! When photographs are required for teaching, doctors are putting them on USB sticks and taking images home to process and import into documents – there is no audit trail!

It is well known that many doctors and allied health staff are taking photographs on personal mobile phones which poses many security risks due to images being stored on personal cloud services outside of the EEA which breaches the GDPR and DP laws. This also causes significant governance issues around the use, storage and availability of images. Image sharing via WhatsApp is also a growing problem. In response to this, many hospitals are now employing mobile devices for doctors and nurses in huge volumes of 300-500 at a time or allowing Bring Your Own Device (BYOD) systems with camera functions enabled. This requires the use of a DAM to ensure that resulting images and metadata are managed securely and centrally, making them available to those that are authorised to view them.

Some hospitals have decided to employ EPR’s or radiology systems as a means of image storage. Although they do at least provide an image repository, they do not provide image management functionalities or the specialist access controls required and sadly, the workflow process often generates additional work in an environment already under pressure.

Risk is the single biggest problem for organisations that do not have a proper solution in place – risk of significant financial fines due to breach of GDPR & DPA, risk of poor organisational reputation, risk of negative effect on patient care, risk due to the lack of centralised resources…

 

The main uses of DAM in the healthcare industry:

FotoWare Digital Asset Management ensures full auditable control of clinical photographs via the configuration of several different control mechanisms based on: the medical specialty caring for the patient; the sensitivity of the images; the consent the patient has given regarding the use of their images. This configuration ensures that images are viewed on a ‘need to know basis’ and are processed in accordance with the patient’s permission.

FotoWare also supports the upload of images from a variety of different sources, enabling integration with mobile phone Apps to ensure that even staff working in remote community locations have the same resource available to them. Medialogix have recently developed a secure Clinical Uploader App which can be integrated with FotoWare DAM so that images and metadata are imported and processed automatically, ensuring they are managed securely within the centralised DAM process.

The DAM solution can be the primary image viewing interface, or it can be used in conjunction with an EPR to provide seamless availability with the proper access controls in place. The workflow for image processing is immediate, intuitive, automated where appropriate and reduces the administration burden of clinical photographers and clinicians alike.

Which organisations in the health sector need a DAM solution?

If they take clinical photographs, they need a solution!

How can organisations in the health sector determine what the return on investment is for a DAM system?

The return on investment is both quantitative and qualitative. Images are available at the point of care, enhancing the patient pathway. Workflow efficiencies make better use of staff resources. Proper governance reduces the risk of significant financial penalties relating to breaches of legislation-the cost of a DAM solution is a fraction of a potential penalty!

 

About the author:

Lisa Fisher has been part of the Medialogix team since April 2018 in her role as Business Development Manager, working primarily within the health sector. Previously she worked as a Clinical Photographer within the NHS for 19 years, the last 9 years of which, were as the manager of a Medical Illustration Department. Therefore she is very familiar with the challenges and requirements of image management and the governance of highly sensitive clinical images. Having always been an advocate of secure and effective workflows within her previous role and within the wider clinical photography profession she is now able to influence this further through promotion of DAM and Medialogix products to provide a comprehensive solution to NHS and health sector clients.

If you would like to discuss the content of this article or would like more information about healthcare solutions please contact lisa@medialogix.co.uk

A related article was also published here.