Last year I posted about storinig Clinical Photos electronically, and got some interesting feedback (see link below for post).
I’m interested to know what systems are in use (if any) to capture and store clinical videos, and either share them securely or link them to the Electronic Health Record such as Orion Clinical Portal.
Is anyone doing this yet? Do any of the photo storage systems discussed in the previous post (below) include video storage as an option?
Hi @damon - I am doing a piece of work that required me to find out this same info. What I have established is that a number of DHBs are using formal clinical photography systems, while others are managing this in various semi-formal ways. I can only speak for Waikato DHB’s solution - we use the Wabalogic Medical Image Manager application. 3 DHBs use the Silhouette Imaging Solution in their Community practices, a couple of DHBs are using the Medtasker Mobile Communication solution to send and receive images as well as to upload them to DHB storage, and so on. From what I have established, only Wabalogic and one other solution link the images to the clinical record automatically when images are taken in patient context - the rest require manual manipulation after the image is taken. Wabalogic also captures patient context, and does both video and image capture + management.
Welcome to the #nz-forum, Peter! Your answer is a great example of the value of dialogue between clinical informaticians and those with a deeper technical knowledge.
We’d love to see more of your assessment of video solutions if possible, but understand that employers vary in how supportive they are of this type of work being disseminated.
@NathanK - thanks, great to be here!
@damon - just to address the storage part of the question:
Storage IS going to be a massive issue for all DHBs when clinical video storage goes mainstream. Most DHBs have generally adopted a ‘see no evil’ approach to Clinical Photography, and the result is a privacy nightmare: DHB Clinicians appear, generally, to be using their personal mobile devices to capture patient images and video. These media files are mostly not subjected to any governance or oversight while on those devices. While researching these solutions, I heard several anecdotes of this variety: Clinician is viewing their photos with a friend, swiping through their photos on their iPhone, when a Clinical photo pops up that clearly shouldn’t be there…the shocked friend is then told, “we have no choice, as we have no solution to store these in, so the images remain on our devices.”
Patient privacy is a big problem, and there will be literally thousands of cases where patient privacy has been breached without the concerned DHB being any the wiser.
When DHBs do decide to do something about this, they will be shocked by the costs involved. Images are easy to store, and they are not very heavy on storage - but videos are a different story altogether. In our case at Waikato DHB, typical patient videos (say, involving post-medication behaviour observation of a MH patient) can be up to 30 minutes long, sometimes longer. If this is HD video - which it tends to be, else it is not very useful diagnostically - then, uncompressed, it takes up about 1,540 MB per minute of video. Your typical 30-minute video is thus consuming at least 46 GB uncompressed.
Multiply this by the number of services needing to capture HD video - eg Language Therapy, MH, Child Development, etc - and the scale of the storage required becomes clear. For many DHBs, such files are currently stored on storage devices stuck under the Clinical Photography Manager’s desk - dash over to PBTech, buy an external hard disk with 10TB capacity, and you’re fine for a couple of years if you diligently keep deleting old video files.
Where there is formal DHB storage to be considered, this does not become as readily apparent a problem for those with on-premises hardware: they have their own servers, they can buy storage as and when they need it as part of BAU, so no biggie.
The problem becomes unavoidable when a DHB moves to cloud storage for its systems. The video files then quickly become one of the more expensive systems to store in the cloud - and, given the cloud’s opex billing model, IT departments begin looking for alternative storage options.
Some DHBs have negotiated deals with cloud providers for special storage: at least one DHB has a deal with IBM’s Spectrum Scale bulk storage cloud service for clinical video and images.
Others are considering options such as Microsoft Azure Cloud’s Azure Cool Storage,a long-term, low-cost storage option for items that are not accessed frequently.
All this is at a formative stage, though, because most DHBs do not quite know - yet - the scale of the clinical video storage “problem” they’re sitting on.
Damon - Waikato is using Waba-Logic for doing this combined with a mobile App. The mobile phone app allows patient to consent via phone, then deletes the data off the phone as soon as consent provided , uploading into clinical record into CWS. We have re-labeled/renamed product as CM3 (meaning clinical multi media management).
Hey Damon
Nothing clever in HBDHB - we currently don’t store and video data against the patient record, adopting the “hear no evil, see no evil” strategy outlined above. The biggest concern is the enormous volumes of data and requirement for storage for long periods and some ambiguities of the legislation.
Have a look at section 5 of the 1996 legislation on retention of health data.
http://legislation.govt.nz/regulation/public/1996/0343/latest/whole.html#DLM225653
In the status quo, when a surgeon performs a laparoscopy procedure, the recording exists. Right now it just fizzles into the ether and nobody knows any different.
If we upload that video against the patients medical record, we are now obliged to keep that data for 10 years from the date of last contact we have with the patient. e.g. if we store an appendectomy video today, then see the person 9 years later for a mental health issue, then another 9 years later for a heart attack, we believe we are obliged to store the appendectomy video for 10 years after the date of the heart attack.
While it’s an enormous volume of data, the value of that data is (generally) pretty low. In the example above, the chance that anybody actually wants to go back over the entire video of a historical appendectomy are very low. If we allow unfettered proliferation of vidoes, the time required to review all the clinical record and find items of relevance becomes prohibitive.
I think that this is a line we should not go down outside of very specific use cases, at least until we develop a clever way to summarize and extract meaning from the video.
A post was merged into an existing topic: Clinical Photos stored electronically - does anyone have a good system for this?
Oops. I just reread it - we don’t sore video… I note that Babylon app keeps a recording of the consult that you can playback
And waba incorporates patient consent and is mobile as well as desk bound…
I’ve raised this topic on the UK based “Open Forum” section on Discourse and got this interesting response about PACS systems doing the job - it makes sense really, but I’m wondering if any of the PACS in NZ have this potentially capability:
Here’s the link to the Open Forum discussion thread on this:
Photo and video sharing - link to post on UK based Open Forum