We want to look at a system for clinical staff to be able to easily store and share clinical photos with other clinical staff.
Due to the lack of this being available many photos are taken on personal devices and shared using non-DHB apps (such as What’s App). Often these never get recorded in the patient’s record.
An ideal system should have the following attributes:
Be easy to use from mobile devices
Upload the photo along with any text based comment (and meta data) to the patient’s electronic record where it can be accessed.
Allow the photo and comments to then be easily accessed by other clinicians, ideally on mobile devices.
Not risk the photo being shared (or stored) inappropriately - eg being inadvertently uploaded into the useres’ personal cloud storage system or saved insecurely to the device’s memory.
Allow uploading of images from other medical equipment devices.
I’m interested if anyone can answer any of these questions: A. Does anyone in NZ have or are considering a good system for this which is good enough to mean clinicians don’t feel the need to use non DHB systems like What’s Ap? B. If you have a system, does it use the DICOM format (which is used for radiology images)? Or does anyone have an opinion if there is any advantage or not in using the DICOM format for non-radiology images? C. Do you agree with the above requirements, or have any further suggestions to add to these?
I can’t speak for anywhere in NZ of course, but our local experience in Birmingham is that we have a home grown app called Secure Clinical Image Transfer (SCIT); this has been sold to other Trusts. It allows photos to be taken securely within the app along with appropriate clinical information; this is then transferred to the appropriate EPR via a semi-automatic workflow. However, its days are numbered due to the emerging clinical messaging solutions.
An example is Medxnote, used in Southampton, which allows photos to be taken a la WhatsApp, which the user then messages to a ‘bot’. The bot ensures that the clinical data is attached and accurate via dialogue with the user, and then the image is automatically uploaded to the EPR.
I think that most clinical photography services use an image management system based on standards (TIFF/JPG) other than DICOM. But using DICOM might work well - perhaps @rhidian_bramley could shed some light on if this is possible / desirable.
We are launching waba logic this month, very exciting. It will upload images into our CWS and enable consenting via app. Not yet on byod but will work on that. It has a break glass function and also totally protected images for our child protection and sexual assault team. It will be used by clinicians and medical imaging
I’d be really interested to see how it handles consent - is this done directly by the patient? I haven’t seen a good example of this yet in a clinical application. SCIT just gets the clinician to confirm that consent has been granted (which is easy).
Hi Nathan. Yes most PACS suppliers now have their own mobile Apps (and integrate with third party Apps) designed to support medical illustration and mobile phone image acquisition. These are designed to support both scheduled and unscheduled workflows, using DICOM and/or XDS standards. Damon, I’d agree it is worth asking your PACS supplier what they can offer to see if it meets your needs.
As discussed there are also a number of instant messaging type Apps that offer to upload the images securely to the EPR (see the separate topic/thread on instant messaging solutions. Ideally you would want these to integrate with your PACS and/or document management solution rather than as a stand-alone archive.
A key consideration is what the image is going to be used for and the subsequent workflow and meta data indexing to enable it to be located correctly in the patient record, with the appropriate consent and access control. From a clinical safety perspective I would feel more comfortable signing off with a defined set of users and scenarios for this at first, agreed with your medical illustration/clinical photography department.
There are many advantages in having a common repository and, for us, having the images in PACS enables us to use our existing systems to view the imaging cross-site and at regional MDTs. For medical illustration department acquisition it is also important to be able to support scheduled workflow and ordercomms functionality. We currently use a third party image acquisition solution integrated with PACS (PACSscan by PACSgear) - other suppliers are available. This info leaflet shows some of the benefits of the modular integration that a standards based approach IHE/XDS/DICOM can enable. This product just deals with the image acquisition part of the scheduled workflow, integrating with the other actors/components. https://www.hyland.com/-/media/Hyland/hyland-healthcare/enterprise-imaging/pacsgear/pacsgear-healthcare-product-summary-pacs-scan-mobile.pdf
Hey Damon,
Wanganui have been using Medtasker to do image upload in context to the patient portal. They have been using Medtasker for much of this year.
My understanding is that this process is still rolling out across DHB, and not all staff have access yet, but that it’s been popular.
I can’t give you specifics about what format images are stored in.
The best person to ask about this is @franrawl. I’ll send you through an email so you have each others email addresses.
Hawkes Bay DHB is probably going to end up using he same product, although we’re a while behind them yet. From what I understand, the in-context integration from Medtasker and Clinical Portal is still a bit clunky, but the developer has been very responsive to requests.
Mat
I’m new to this network gp and I’ve only been involved in a few “IT” projects in CDHB so may not know all the ins and outs of most stuff.
re: apps for photos & consent from patients, we have been strongly encouraged to use Celo for it. i was told that the goal was ultimately be able to link this to the patients records so that we can store patient photos and consent securely. I was told presently, all Celo information is stored in an encrypted state (including images)
@BeckyGeorge might have more updated information than me.
I would be a bit worried about having formal clinical images not attached to a patients record and also concerned about access. However likely to be better than texting and whatsapp!
Wabalogic is the enterprise application deployed in Christchurch. Currently curated by Medical Illustration and it has not yet been integrated into our clinical portal. The ability to capture images by clinicians is a two edged sword. We have decided to use the concept of Point of Care Images when these are incorporated into Wabalogic in the future so that viewers understand the provenance of an image and treat it with some scepticism re quality and accuracy. A comparison would be POC Haemoglobins. If it seems odd you double check, whereas you can trust a lab result a lot more. So an image from Med Illustration is pretty certain to be the correct patient, properly consented, and with the correct body part photographed. A user submitted image is much less reliable.
Celo is a good concept but is still rather immature in my opinion. Its a fair way from being enterprise ready, but has been received well in some services, particularly because of the way it handles images and keeps them out of your Photostream.
I don’t quite understand. Is Wabalogic an image management system with its own app to allow point of care pictures? Or are pictures taken via other sources (eg Celo) handled / stored in it? Or does it do both?
And are you prioritising integrating it with your portal? This seems a key feature to facilitate clinical usability, especially for the occasional photo interested clinicians.
There are many other medical messaging services / apps out there which also separate photos from personal photostreams; it is essentially a key feature. Heck, you can even do this with an email service within a secure container. It is the integration into the image storage and the integration to serve it up to the clinicians which are the keys. The app is just the front end, although good consent capture as @Ruth_Large mentions sounds like a major bonus.
I don’t suppose that you could video it in action and post a link to it? We can’t dump videos in Discourse (and if we can @pacharanero would not be happy with us doing so!) but we can link to one.
I thought webalogic was the store but with a FIHR API there is no reason it couldn’t integrate with the
likes of CELO which has, as I understand it its own separate secure store.
I had done some work around this about 6 years ago. There are a number of issues to contend with and that is even before you start talking about video.
At the end of the day an image/video is only really a snapshot at a point in time. Depending on what the purpose of capturing the image is and the gravity of decisions made from that image should determine whether it is captured in the first place and how it is stored.
There is also the issue of consent for capture and consent for onward usage which is also tricky. These issues are also compounded when you consider what the required format of an image needs to be in. i.e what is the use of a 2hr video shot in 4K format when there are only 20 seconds of useful images.
I had covered some of these issues in a presentation I gave to the regional sector architects hoping to get some consensus on how we should proceed and did not get any clear answers.
Anyway this is a walled garden, and I have attached a PDF of the presentation for your consideration.
That is very sad @darren.douglass. We will try to solve all the problems of the world even in your absence, you can rely on us!
That’s one of the reasons why I love wabba so much as consent and privacy assured. We have launched now with our clinical photography team, soon to release to dermatology and then the world (well, the world that is Waikato DHB…)
Hi. Wabba is an image management product. It doesn’t have an app to collect the images, they have to be uploaded into the system. Its a medium priority to be connected into our portal (HCS) but the issue of making sure that staff are properly credentialed to view different image types needs to be resolved. This works off Active Directory, the contents of which can be a bit flaky with regard to having correct Depts and Grade. In terms of image upload from users via eg Celo, it does slightly give me cold chills that it is relying on a user to correctly enter an NHI into an app and then the image becomes part of that patients record. Hence the suggestion to classify these images as POC Images. We don’t have an integration between CELO and Wabba yet. I’ve suggested to CELO that they can build a portal to allow web access to users photos with the ability to generate a link that can be put in the clinical record and allow access to images by CELO users who are viewing the clinical record.
Richard
Apparently the new Microsoft Teams could be used for secure photo sharing between clinicians and uploading to the clinical record. It seems in theory it may be able to achieve the required functions through the PowerAp tool.
Is anyone aware of anywhere that has tried this in a hospital setting yet? In New Zealand it probably depends on when your local DHB is planning to roll out Office 365 yet.
I’m interested if anyone has explored this and found any challenges or limitations.
It certainly seems an attractive option when the Microsoft guys demo it. Leeds might have it up and running when we visit in July.
Richard, I’ve just been looking at Vocera’s smartphone apps, and was particularly impressed with how they actively associate chats with patients and staff members, integrating with the PAS and AD; they tell me that they are in CDHB too. Perhaps they would fit better for this role.
