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BCA News: Spring 2019

PhotoExam: A Mayo Clinic-developed App for Securely Capturing Patient Images

Pete Pallagi
Photography Supervisor
Mayo Clinic Arizona

In 2009, in an effort to enable teledermoscopy between Mayo Clinic Arizona Dermatology and two family practice locations—one in Glendale and one in Scottsdale—Mayo Clinic’s Center for Innovation funded a project to pair a point-and-shoot camera with an Eye-Fi card, which enables the wireless transmission of photos to a predetermined secure server on Mayo Clinic’s network.

The card worked some of the time, but when it didn’t, support was very difficult to come by. Around the time we were having issues with the Eye-Fi card, I came across a device made by Canfield called a DermScope, which allows users to insert their iPhone 4 into a cradle and take dermoscopy photos with the iPhone’s camera. The quality was excellent and the rig was very easy to use, which inspired the idea that maybe we could use existing software from Apple’s App Store to perform the image transfer. After some research, we found an app that enabled image transfer in a similar manner to the Eye-Fi card. After coming up with a workflow for differentiating which anatomical sites and lesions were to be photographed, we found that the app worked well most of the time, and that most difficulties were due to user errors.

Though the project was moderately successful, it was cumbersome, and we believed it could be done better. I proposed an idea to my manager: How about we create our own app that allows us to access our patient database, choose the patient, select metadata, and attach photos to the EMR without ever allowing the image to be stored on the iPhone? He was fully supportive and encouraged me to look into it.

After some research, I found that we had an app developer within Mayo Clinic that had just finished working on the Mayo Clinic Patient App. I proposed my idea and he agreed to have his team take it on—I’d just need to design the app screen by screen.

After about a month of working on it alongside project manager Richard Uribe and IT analyst Lindsay Clark, we turned over a plan for the app, and three months after that, we had a fully functioning piece of software.

We implemented the app into our teledermoscopy program and it worked flawlessly. It was intuitive and very reliable.

After using it for dermatology for about a year, I had a chance meeting with the section head of IT while they were visiting the Arizona campus. I proposed that PhotoExam could be used for all specialties when medical photographers weren’t available, as we had multiple sites in the Mayo Clinic Health System that didn’t have medical photographers on staff but still had an enormous need for photographic documentation. One of the arguments was that we had a policy within Mayo Clinic that prohibited the use of personal mobile devices for patient photography, but we believed clinicians would use what was easily available to them, so why not give them an option that’s secure and within policy?

After buy-in from our IT section head, we went through multiple committee approval processes to plan the project. The number of committees from whom we had to obtain approval was daunting, but necessary; overall we received nine different approvals and endorsements, and concluded with an approval to plan from the Clinical Practice Committee, a group largely comprised of physicians and administrators from across the enterprise.

The app was truly an enterprise-wide collaboration between the Arizona, Minnesota, and Florida campuses. It included staff from multiple divisions of the IT department and photography department, and it touched several others, too. Over the course of eight months, we met weekly to discuss and design the app’s functions. Once the deadline had arrived for our proposals, we were able to offer two options for the development process:

  • Write the code internally using on-staff programmers and pre-existing resources. This option would take about a year and had the potential to be interrupted by normal day-to-day activities, but financial costs would be minimal.
  • Hire a vendor to write the code and report back to us weekly. This option would be more costly, but would allow delivery within six months.

The second option was chosen by the committee and work began shortly after. The app was ready for testing in December 2014, and in March 2015 the app went live.

The app, which can only be used when the user is logged onto Mayo Clinic’s internal network, consists of four screens: User Login, Patient Search, Exam Details, and Image Capture. For each anatomical site, up to six images and one sixty-second video can be taken. Up to seven sites can be photographed during an encounter, for a total of up to 42 images and seven videos. These images are then converted to DICOM and attached to the EMR. There is also an optional screen that allows the user to collaborate with another Mayo Clinic physician by automatically sending an email containing hyperlinks to the patient’s images in the EMR.

PhotoExam was a quick success and its adoption has been steadily rising over the past four years. Users upload nearly 20,000 images per month—of around 8,500 studies by over 1,400 users within Mayo Clinic—with the app. Since its release, not only have these numbers grown, but the calls for professional medical photography by our staff photographers across the enterprise have increased. The need for trained medical photographers is still an absolute necessity, but now, with the advent of the app, documentation that would have otherwise never occurred now has a convenient way of being captured.

If you’re interested in reading more about the app’s adoption and uses, please see the following publications in PubMed:

https://www.ncbi.nlm.nih.gov/pubmed/28497467
https://www.ncbi.nlm.nih.gov/pubmed/29117934


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