Archiving images: Cataloging techniques are key to record keeping

November 1, 2008

Photography plays a valuable role in dermatology for improving patient care, but the usefulness of archived images depends on how they are stored.

Key Points

Speaking during a focus session on electronic health records (EHRs) at the summer meeting of the American Academy of Dermatology, Dr. Bhatia discussed photography from the perspective of integrating pictures into the ambulatory EHR. He noted that as clinicians investigate and compare available EHR systems, image-cataloging capabilities might be a feature of interest.

In fact, as one of its criteria, the ideal EHR would have an integrated photography-management function matching that of a good image-cataloging software program. At present, however, there is no Nirvana in terms of an integrated EHR-photography option, Dr. Bhatia says.

"However, dermatologists researching different EHR systems should be sure to ask what is being done to integrate robust image cataloging. Any vendor that would like to focus on dermatology in the future will have to consider this issue, and perhaps may be pushed by user interest to develop a better system," Dr. Bhatia tells Dermatology Times.

Image-cataloging software

Although there is debate over the downside of photographic documentation with respect to medicolegal risks, most dermatologists agree that visual documentation with photography has a valuable role for improving patient care. In addition, it offers a useful lecturing tool.

With the goal of optimizing image use for clinical or educational purposes, saving the photographs with image-cataloging software is far superior to simply storing them onto the hard drive in a file based on patient name.

"Image-cataloging software allows photos to be identified by multiple variables in addition to patient name, including visit date, anatomic location, diagnosis or procedure. Complex searches are easily achieved to help find the images you need.

"These programs also provide better image-manipulation tools to enhance viewing, as well as security and privacy features for tracking if the image is altered," Dr. Bhatia says. Currently, there are good image-cataloging software programs that are tailored to medical imaging, as well as some that are general-use software.

Digital-asset-management software offering some expanded features also exists. However, the latter technology, which is geared more toward libraries or museums that catalog large archives, tends to be more cumbersome to use.

Application service provider

As another option, there is application service provider image-cataloging software. In this Internet-based model, photographs are stored remotely and accessed over a Web interface. This option has pros and cons.

"The benefits include being able to access the images from anywhere - work, home or your cell phone. In addition, the data may be safer because it is stored remotely. However, as an important weakness, your access is susceptible to Internet connection failures," Dr. Bhatia says.

Transactions are likely to be secure, he adds.

"While the technology exists for secure transactions, there are no guarantees that a picture won't be stolen. On the other hand, there are no 100 percent safeguards against someone removing a chart from your office," Dr. Bhatia says.

Limitations

As a disadvantage, saving images to a cataloging software program may limit the ability to integrate them with the EHR. However, most photography-management systems that are part of an EHR program are an add-on feature and have minimal capabilities. Scanned or digital images can be attached to the file, but there is little versatility for accessing and using them.

"You can't easily look at serial images as you can with a paper chart or dedicated image-cataloging software, and you can't search for pictures based on criteria more specific than patient name or visit. These systems also don't offer advanced image-enhancement and viewing options," Dr. Bhatia says.

Benefits

Still, there are some benefits for these systems. When properly saved, the pictures are permanently attached to the virtual chart. Therefore, it becomes easy to find the pictures associated with a particular visit, and they won't be lost or misplaced as can occur with hard-copy files.

Disclosures: Dr. Bhatia is an unpaid evaluator and adviser to Through The Lens, Canfield Scientific, Fotofinder, and most photography software and hardware companies.