Clinical photography in dermatology
Answers in Practice
By Swapna Pachauri, MPH, Manager, Health Technology & Informatics, February 1, 2022
Each month, DermWorld tackles issues “in practice” for dermatologists. This month, practice management staff offer tips on clinical photography in dermatology.
Photography plays an increasingly significant role in dermatology, particularly in the way it can be used for diagnosing a patient’s condition or understanding the progression of a current skin condition. These photos can be integrated within the electronic health record (EHR) or used during teledermatology visits. With advances in technology, dermatologists can use mobile devices or digital cameras to take high-quality photos even if they have minimal experience. But these advances in technology have also led to ethical challenges and security concerns, especially when it comes to capture, storage, and submission of photos. HIPAA-compliant storage, proper protocols for transfer and removal of photos, and safe retrieval of files during teledermatology visits are some of the specific technical challenges. Also, determination of when and how to ask the patient for consent can be ethically challenging, due to the multitude of use cases for images/photos in an evolving technical landscape.
Since the COVID-19 public health emergency began, many dermatologists have been utilizing teledermatology more in their practice, some even for the first time. In some areas of the country, patient volume for in-person appointments have decreased, and audio-only or video appointments have increased. Learning the basic skills of how to take a photo to submit for clinical use can aid in developing and implementing a standard policy for capturing high-quality photos. This is particularly helpful because while dermatologists are typically the primary photographers in a practice, sometimes non-physician clinicians will also help.
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If engaging in photo capturing, begin by:
Obtaining patient consent, especially when using it for educational use or publications. Ask your malpractice carrier for a model consent form.
Developing clear, easy-to-follow guidelines for patients when submitting photos.
Outlining under which circumstances photos should be standard of care in the practice. For example, to identify progression of acne.
Then, follow some best practices for consistently and safely capturing high-quality photos in a dermatology practice or at home by a patient.
Make sure the setting is well-lit, preferably with natural light.
Focus the photo by touching the phone screen and ensuring the focal point is not blurry.
Take multiple photos at different angles of the area(s) of skin being captured.
Hide or remove any distractions, such as jewelry or wallpaper. If possible, use a simple, solid-colored background.
Get help from someone in your practice (or at home, if it is a patient) to capture photos of areas you cannot reach yourself.
Do not include any patient identifiers.
When it comes to sharing and storing photos during a teledermatology visit, take advantage of utilizing the EHR and patient portal for submitting and storing patient photos in a secure manner. If your EHR does not have that function, reach out to your EHR vendor to see if there is an option to add that feature. This could also be an opportunity to identify areas for improvement in photo capture and storage with your vendor. To learn more, visit our resources for EHR and patient portals.
Regardless of what device you use to capture the photo, the Academy highly recommends that you and your patients submit and store photos via HIPAA-compliant sources to uphold patient confidentiality and to avoid accidental sharing of any personal health information. A HIPAA-compliant cloud server could be an option as well so that photos are automatically uploaded from your device and stored right away through a secure Wi-Fi network. If a patient or physician texts/emails you photos to review, you should always reply with standard language asking them to submit them via a HIPAA-compliant cloud server and delete the unsecured message. For additional ways to submit photos electronically in a secure manner, check out the Academy’s resource on HIPAA Checklist for Electronic Messaging that offers examples on utilizing HIPAA-compliant texting or email software for you and your patients.
Preparing patients for a telemedicine appointment
Did you know the Academy has online guidance for patients on telemedicine visits? Direct patients to staging.aad.org/teledemedecine.
Currently, there are no standard ethical criteria or guidelines for capturing or storing photos, but the Academy continues to work on creating additional educational resources to help standardize the process in the future. To that end, the Academy recently conducted a survey called Dermatology Photo Capture & Storage. The survey focused on evaluating dermatologists’ photo capture and storage perspectives and behaviors as well as identifying how different practice settings approached photo capture and storage. The results of this survey are being tabulated and will be made available to Academy members later in 2022.
The Academy also offers an educational module on Clinical Photography for Skin of Color. This educational module was developed by the Academy’s Skin of Color Workgroup and is worth 0.5 CME credit.
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