Integrating Captured Clinical Images into the EHR - Results of a Usability Study

Background

Electronic Health Records are traditionally limited towards text based data, and if you are lucky, that data may extrapolated into useful figures. Nonetheless, one topic of interest has been the inclusion of images collected by providers that can be uploaded into the EHR for others to view.

One example I could easily think of would be status improvement on wound care patients, that could be captured by physicians, nurses, and other health aides that could then upload their data and updates for others to see and analyze. 

Personally, in my practice setting of Transitions of Care & Heart Failure management, I would like to see how much their edema has improved, from their admission to discharge and throughout their outpatient follow-up. Questions I ask myself and can never quite get answers to by reading the chart alone range from, "is this the worse they been?" to "were they better in the past?" Images can offer a snapshot (no pun intended) at different timeframes for patients. 

The issue of course, is how do we standardize capturing said images, frame it in a clinical sense, and upload it with due diligence into the EHR for others to see? With those questions in mind, I was pleasantly to see a recent study titled " A Mobile App for Securely Capturing and Transferring Clinical Images to the Electronic Health Record: Description and Preliminary Usability Study" published in JMIR.

The Study

The study was based upon the design of an iOS app that could take images and then be uploaded into the EHR. The app developed was named 'CliniCam' which incorporated "...user authentication, patient selection, image capture, image annotation, and storage of images..." (as PDF files) (Landman, 2015). In a manner similar to Snapchat, no image is permanently stored on the device once taken and transmitted. Up to 6 images can be taken at a time for a patient, whereupon the user then must annotate the image prior to transmission to the EHR. All users and colleagues then had access to those images in the EHR. Twenty-eight residents from the departments of EM, IM, and Derm were involved with the study for one-month of evaluation (between July - September, 2012), whereupon they completed a survey on their impression of the app. 

Nineteen physicians completed the survey, however, only 9 actually used the app in practice. Within that small sample, 8/9 found the app highly beneficial for clinical practice and was easy to use, and would continue its use. Issues present during the course of research demonstrated that the app would have significant lag and had lost one image, which the investigators attributed towards WiFi capabilities of the research site as interference. The users also indicated their preference that the images be connected with the clinical note instead of separate in their individual files. 

Takeaway Points

• The study was relatively small, and can be regarded as a pilot of user experiences in a home-brewed institution attempt at creating an app to capture images and incorporate into their own EHR.
• Of those that did use the app, most seemed to find it beneficial. Information lacking includes who these users were (for instance, did Derm find it more useful than EM?)
• Additional information lacking that would have been useful would be their colleagues or other providers stance on the use of captured images in patient care. For example, Did attendings find the images captured by their residents beneficial in understanding the patient workup and care? How often did other users look at the images? This information would be very beneficial to know, in order to understand the implication of integrating such information into the EHR.
• Overall, interesting pilot project that should encourage others to explore such a project (and addressing the above concerns), as well as identify that infrastructure support is needed to ensure the best use of the app from a user standpoint. Future researchers could benefit from incorporating design features in CliniCam, and considerations the investigators put into patient privacy concerns.

Citation

Landman A, Emani S, Carlile N, Rosenthal DI, Semakov S, Pallin DJ, Poon EG. A Mobile App for Securely Capturing and Transferring Clinical Images to the Electronic Health Record: Description and Preliminary Usability Study JMIR mHealth uHealth 2015;3(1):e1 [Link]