Many dermatologists believe that photographic images will increase in use and importance for practicing dermatology in the future. Already, most dermatology residencies have some form of medical photography in place.1 There are many camera systems presently available for taking dermatologic photos.2 However, one of the important keys to widespread use of dermatology photographs is the efficient storage and retrieval of the medical images. The increase use of electronic medical records (EMRs) has enhanced and in other ways complicated the storage and retrieval of dermatologic images. This article provides a synopsis of the goals and deficits with some of the image storage options for dermatologists.
Home photographers may attest that taking the photographs is often the easy part. Categorizing and then being able to easily retrieve the photographs in the future can be more challenging. In a medical setting, the storage of photographic images is complicated by a number of issues including volume, possible need for retrieving multiple images from several dates simultaneously, Health Insurance and Portability and Accountability Act (HIPAA) security, storage capacity, clarity, speed of retrieval and possible integration with an office EMR.
The underlying goal of an image storage and retrieval system would be for the practitioner or assistant to have quick access to the images with minimal delay and minimal steps required to display the images. In addition, the system should allow an easy method for labeling the photographs with categorizing what identifies the different dates of the stored photographs. The provider will want to be able to look at the screen and quickly bring up 2 or more photographs taken at different dates of the same lesion. Ideally, the images would be seen side by side to allow comparison of lesion changes.
Evaluating a clinic’s needs for a new or auditing an existing imaging system can be difficult and time consuming. Important factors in the decision-making process are information technology (IT) infrastructure, workflow efficiency and cost of ownership.
IT Infrastructure
Here are 3 components to consider when evaluating a clinic’s IT infrastructure.
Network Bandwidth — The internal network must accommodate electronic health records, practice management data and the medical image traffic. Adequate bandwidth is critical for all types of image storage systems. The bandwidth usage from an image retrieval system and storage system may slow other network traffic significantly affecting the practice workflow and system response time.
Internet bandwidth — Cloud image storage systems need higher Internet bandwidth to store and retrieve the images. Often the bottleneck in sending or retrieving images via the Internet is due to the reliability and integrity of the Internet connection at the end user.
Storage — The amount of storage needed should also be considered though prices have dropped and cost is less of a factor. Consider the amount of storage needed for many years and do not forget about backup storage.
Hardware
To ensure proper throughput of traffic to the imaging server or Internet, the hardware switches need to be evaluated to make certain the switches are not the cause of a bottleneck. Imaging systems will typically have requirements for hardware that should be followed in order to reduce future problems.
There are many types and brands of camera technology that can be utilized. High-resolution cameras may need to be adjusted to a lower setting to weigh the quality of image versus the amount of storage needed.
IT Support
After an imaging system is in place, dealing with the vendor after the contract has been signed can be challenging. IT support can be in-house or contracted with an outside vendor depending on practice specifics. Incorporating an IT team from the beginning including selection and contract negotiation can mitigate future problems.
HIPAA Security
The security associated with acquisition and retrieval will always be the responsibility of the end users. In-house and cloud systems have different approaches to HIPAA security. Generally, the hardware-managing provider maintains the storage and safekeeping of the images. If the images are stored in-house, then IT and the medical practice are responsible. With a cloud-based system, the imaging vendor is responsible.
Workflow Efficiency
Patient care and workflow efficiency should be the driving force behind selecting an imaging storage system. Documentation and comparison of medical images theoretically should enhance the dermatologists’ ability to treat their patients.
Image Acquisition
The first step in the workflow is image acquisition. The photographer will need to be consistent with camera type, lighting, focal length and lens type to help make future image comparisons valid. This can be done internally or several medical camera systems are designed to systematize these variables.
Image Transfer to Queue
After images are taken and saved in a camera, they need to be sent to a queue, or holding location for further processing. This is usually a shared network location that can be accessed by the programs to which the indexed images will be saved permanently.
Depending on the type of integration, image transfer can be done by manually moving an SD card or using Wi-Fi enabled cameras or cards to transfer the images. Usually the best practice is to attach the images to the specific patient and put into the storage system with identifiers shortly after the image was taken.
Image Processing
This step involves indexing and can be time consuming. Indexing will attach a specific image to a specific patient. It may also identify the target area of the body and document any other relevant information about the image.
Image Transfer to Storage
Some image systems have a built-in queue and the image processing can be done after transfer to storage. Indexes can be added at this time to make retrieval easier and more efficient.
Image Retrieval
The final step is retrieving the image so that the provider can use the images to improve patient care. Attaching the image to the chart note or displaying before and after images for the provider, and possibly the patient will document care, assist decision-making and increase patient satisfaction.
Cost of Ownership
The total cost of ownership should be weighed against improved patient care and increased workflow efficiency. A high-resolution photograph should provide more details than manual drawings and descriptions of lesions.
Meaningful Use
Stage 2, menu measure 3, indicates that diagnostic images need to be accessible in the patient’s EMR chart. Non-integrated systems may need an interface or change in workflow to get the image into the EMR chart. Both of these will have a cost that hopefully will not significantly affect workflow efficiency.
Licensing
Many in-house systems and EMR integrated systems are subject to licensing restrictions. Licensing is less of a problem with cloud-based systems. Often, a practice will buy a block of concurrent licenses or per-computer licenses. These additional expenses should be anticipated.
IT Costs
Many of the IT expenses were identified previously. An imaging system uses significant amounts of bandwidth, storage and hardware, which should be factored into the total cost of ownership.
Useful Life of System
A well-supported imaging system will last many years. However, new technology makes it difficult for many systems to keep up-to-date. An imaging system that is adaptable to new technologies and methods is ideal.
Cost of Changing Systems
If changing imaging systems, several factors should be considered. First, the metadata attached to the patient record is important to keep and should be converted to the new system. Converting often is difficult and it can be costly to transfer the images and more importantly, the indexes. In a cloud imaging system one should know how easy or difficult it is to export the images out for conversion.
Many imaging systems use proprietary systems that can make changing systems difficult and cost prohibitive. It is very important to have a clause in the original contract and all renewal contracts that allows the data out at a reasonable cost.
Image Storage Systems
Three models for medical image storage and retrieval systems exist: cloud, third-party in-house storage systems that may or may not be accessed from the clinic’s EMR and image storage systems that are integrated into an EMR (
Table).
In the Cloud
Cloud image storage systems have an advantage of having a low cost of initial ownership. The imaging vendor manages the technology so there are low IT infrastructure costs. The only IT infrastructure variables that need to be considered are the hardware and the Internet bandwidth.
These systems often compress the images before sending to the cloud. The presentation of the images may also be compressed not allowing full resolution. To remedy this potential problem, some image vendors allow the picture to be downloaded or select to be viewed at full resolution.
The workflow may still require software in order to process the images and get them to the cloud provider. Most often, the workflow is the same as all other methods of storage. High-volume practices need to be aware of the quality and amount of the images uploaded. A cloud imaging provider may have a volume storage surcharge that could impact final costs. In addition, cloud storage systems that are not part of an EMR may require an interface to the EMR that is being used by the dermatologist.
In-House
In-house systems can be the most reliable of all the imaging models if the proper IT infrastructure is in place. Image retrieval will not be dependent on the integrity of the Internet connection. Often, full fidelity images can be displayed quickly. The reliability of the system is directly related to the quality of the IT infrastructure.
Some in-house imaging systems are Picture Archiving and Communication System (PACS) enterprise image distribution systems. A PAC system might be more robust than what many practices require. They are usually stand-alone systems that require more IT and cost of ownership resources including interfaces to an existing EMR.
Integrated Into an EMR
Some EMR systems are in the cloud and others are in-house. The considerations for each system need to be weighed against the factors discussed earlier.
An image retrieval system that is integrated into the EMR simplifies the process and possibly saves some up-front expenses. However, depending on the EMR there could be some loss of functionality with less detail and fewer display and comparison options. The office workflow might realize improved efficiencies when images are directly imported into the patient’s chart.
Summary
Here are some key points to keep in mind as you explore image storage options for your practice:
- Images are used for documentation to support diagnosis and patient care.
- All imaging systems will have minimal requirements for the acquisition, storage and retrieval of the images.
- Storage space is becoming more inexpensive.
- Patient care and workflow efficiency are the driving force behind the decision process.
- Identifying the best solution will be more successful with early participation of the providers, the employees and IT.
- Every practice needs to make a decision based on their workflow and experience.
- Use these considerations to audit your current system.
Ms. Sutton, is a fourth year medical student at the University of Nebraska Medical Center in Omaha, NE.
Dr. Sutton is a PGY3 dermatology resident with Baylor Scott & White in Dallas, TX.
Mr. Lenners is an IT analyst at Lincoln Surgical Hospital in Lincoln, NE.
Disclosure: The authors report no relevant financial relationships.
References
1. Swary JH, Stratman EJ. Practice gaps in patient safety among dermatology and their teachers: A survey study of dermatology residents. JAMA Dermatol. 2014;150(7):738-742.
2. Witmer WK, Lebovitz PJ. Clinical photography in the dermatology practice. Semin Cutan Med Surg. 2012;31(3):191-199.
Many dermatologists believe that photographic images will increase in use and importance for practicing dermatology in the future. Already, most dermatology residencies have some form of medical photography in place.1 There are many camera systems presently available for taking dermatologic photos.2 However, one of the important keys to widespread use of dermatology photographs is the efficient storage and retrieval of the medical images. The increase use of electronic medical records (EMRs) has enhanced and in other ways complicated the storage and retrieval of dermatologic images. This article provides a synopsis of the goals and deficits with some of the image storage options for dermatologists.
Home photographers may attest that taking the photographs is often the easy part. Categorizing and then being able to easily retrieve the photographs in the future can be more challenging. In a medical setting, the storage of photographic images is complicated by a number of issues including volume, possible need for retrieving multiple images from several dates simultaneously, Health Insurance and Portability and Accountability Act (HIPAA) security, storage capacity, clarity, speed of retrieval and possible integration with an office EMR.
The underlying goal of an image storage and retrieval system would be for the practitioner or assistant to have quick access to the images with minimal delay and minimal steps required to display the images. In addition, the system should allow an easy method for labeling the photographs with categorizing what identifies the different dates of the stored photographs. The provider will want to be able to look at the screen and quickly bring up 2 or more photographs taken at different dates of the same lesion. Ideally, the images would be seen side by side to allow comparison of lesion changes.
Evaluating a clinic’s needs for a new or auditing an existing imaging system can be difficult and time consuming. Important factors in the decision-making process are information technology (IT) infrastructure, workflow efficiency and cost of ownership.
IT Infrastructure
Here are 3 components to consider when evaluating a clinic’s IT infrastructure.
Network Bandwidth — The internal network must accommodate electronic health records, practice management data and the medical image traffic. Adequate bandwidth is critical for all types of image storage systems. The bandwidth usage from an image retrieval system and storage system may slow other network traffic significantly affecting the practice workflow and system response time.
Internet bandwidth — Cloud image storage systems need higher Internet bandwidth to store and retrieve the images. Often the bottleneck in sending or retrieving images via the Internet is due to the reliability and integrity of the Internet connection at the end user.
Storage — The amount of storage needed should also be considered though prices have dropped and cost is less of a factor. Consider the amount of storage needed for many years and do not forget about backup storage.
Hardware
To ensure proper throughput of traffic to the imaging server or Internet, the hardware switches need to be evaluated to make certain the switches are not the cause of a bottleneck. Imaging systems will typically have requirements for hardware that should be followed in order to reduce future problems.
There are many types and brands of camera technology that can be utilized. High-resolution cameras may need to be adjusted to a lower setting to weigh the quality of image versus the amount of storage needed.
IT Support
After an imaging system is in place, dealing with the vendor after the contract has been signed can be challenging. IT support can be in-house or contracted with an outside vendor depending on practice specifics. Incorporating an IT team from the beginning including selection and contract negotiation can mitigate future problems.
HIPAA Security
The security associated with acquisition and retrieval will always be the responsibility of the end users. In-house and cloud systems have different approaches to HIPAA security. Generally, the hardware-managing provider maintains the storage and safekeeping of the images. If the images are stored in-house, then IT and the medical practice are responsible. With a cloud-based system, the imaging vendor is responsible.
Workflow Efficiency
Patient care and workflow efficiency should be the driving force behind selecting an imaging storage system. Documentation and comparison of medical images theoretically should enhance the dermatologists’ ability to treat their patients.
Image Acquisition
The first step in the workflow is image acquisition. The photographer will need to be consistent with camera type, lighting, focal length and lens type to help make future image comparisons valid. This can be done internally or several medical camera systems are designed to systematize these variables.
Image Transfer to Queue
After images are taken and saved in a camera, they need to be sent to a queue, or holding location for further processing. This is usually a shared network location that can be accessed by the programs to which the indexed images will be saved permanently.
Depending on the type of integration, image transfer can be done by manually moving an SD card or using Wi-Fi enabled cameras or cards to transfer the images. Usually the best practice is to attach the images to the specific patient and put into the storage system with identifiers shortly after the image was taken.
Image Processing
This step involves indexing and can be time consuming. Indexing will attach a specific image to a specific patient. It may also identify the target area of the body and document any other relevant information about the image.
Image Transfer to Storage
Some image systems have a built-in queue and the image processing can be done after transfer to storage. Indexes can be added at this time to make retrieval easier and more efficient.
Image Retrieval
The final step is retrieving the image so that the provider can use the images to improve patient care. Attaching the image to the chart note or displaying before and after images for the provider, and possibly the patient will document care, assist decision-making and increase patient satisfaction.
Cost of Ownership
The total cost of ownership should be weighed against improved patient care and increased workflow efficiency. A high-resolution photograph should provide more details than manual drawings and descriptions of lesions.
Meaningful Use
Stage 2, menu measure 3, indicates that diagnostic images need to be accessible in the patient’s EMR chart. Non-integrated systems may need an interface or change in workflow to get the image into the EMR chart. Both of these will have a cost that hopefully will not significantly affect workflow efficiency.
Licensing
Many in-house systems and EMR integrated systems are subject to licensing restrictions. Licensing is less of a problem with cloud-based systems. Often, a practice will buy a block of concurrent licenses or per-computer licenses. These additional expenses should be anticipated.
IT Costs
Many of the IT expenses were identified previously. An imaging system uses significant amounts of bandwidth, storage and hardware, which should be factored into the total cost of ownership.
Useful Life of System
A well-supported imaging system will last many years. However, new technology makes it difficult for many systems to keep up-to-date. An imaging system that is adaptable to new technologies and methods is ideal.
Cost of Changing Systems
If changing imaging systems, several factors should be considered. First, the metadata attached to the patient record is important to keep and should be converted to the new system. Converting often is difficult and it can be costly to transfer the images and more importantly, the indexes. In a cloud imaging system one should know how easy or difficult it is to export the images out for conversion.
Many imaging systems use proprietary systems that can make changing systems difficult and cost prohibitive. It is very important to have a clause in the original contract and all renewal contracts that allows the data out at a reasonable cost.
Image Storage Systems
Three models for medical image storage and retrieval systems exist: cloud, third-party in-house storage systems that may or may not be accessed from the clinic’s EMR and image storage systems that are integrated into an EMR (
Table).
In the Cloud
Cloud image storage systems have an advantage of having a low cost of initial ownership. The imaging vendor manages the technology so there are low IT infrastructure costs. The only IT infrastructure variables that need to be considered are the hardware and the Internet bandwidth.
These systems often compress the images before sending to the cloud. The presentation of the images may also be compressed not allowing full resolution. To remedy this potential problem, some image vendors allow the picture to be downloaded or select to be viewed at full resolution.
The workflow may still require software in order to process the images and get them to the cloud provider. Most often, the workflow is the same as all other methods of storage. High-volume practices need to be aware of the quality and amount of the images uploaded. A cloud imaging provider may have a volume storage surcharge that could impact final costs. In addition, cloud storage systems that are not part of an EMR may require an interface to the EMR that is being used by the dermatologist.
In-House
In-house systems can be the most reliable of all the imaging models if the proper IT infrastructure is in place. Image retrieval will not be dependent on the integrity of the Internet connection. Often, full fidelity images can be displayed quickly. The reliability of the system is directly related to the quality of the IT infrastructure.
Some in-house imaging systems are Picture Archiving and Communication System (PACS) enterprise image distribution systems. A PAC system might be more robust than what many practices require. They are usually stand-alone systems that require more IT and cost of ownership resources including interfaces to an existing EMR.
Integrated Into an EMR
Some EMR systems are in the cloud and others are in-house. The considerations for each system need to be weighed against the factors discussed earlier.
An image retrieval system that is integrated into the EMR simplifies the process and possibly saves some up-front expenses. However, depending on the EMR there could be some loss of functionality with less detail and fewer display and comparison options. The office workflow might realize improved efficiencies when images are directly imported into the patient’s chart.
Summary
Here are some key points to keep in mind as you explore image storage options for your practice:
- Images are used for documentation to support diagnosis and patient care.
- All imaging systems will have minimal requirements for the acquisition, storage and retrieval of the images.
- Storage space is becoming more inexpensive.
- Patient care and workflow efficiency are the driving force behind the decision process.
- Identifying the best solution will be more successful with early participation of the providers, the employees and IT.
- Every practice needs to make a decision based on their workflow and experience.
- Use these considerations to audit your current system.
Ms. Sutton, is a fourth year medical student at the University of Nebraska Medical Center in Omaha, NE.
Dr. Sutton is a PGY3 dermatology resident with Baylor Scott & White in Dallas, TX.
Mr. Lenners is an IT analyst at Lincoln Surgical Hospital in Lincoln, NE.
Disclosure: The authors report no relevant financial relationships.
References
1. Swary JH, Stratman EJ. Practice gaps in patient safety among dermatology and their teachers: A survey study of dermatology residents. JAMA Dermatol. 2014;150(7):738-742.
2. Witmer WK, Lebovitz PJ. Clinical photography in the dermatology practice. Semin Cutan Med Surg. 2012;31(3):191-199.
Many dermatologists believe that photographic images will increase in use and importance for practicing dermatology in the future. Already, most dermatology residencies have some form of medical photography in place.1 There are many camera systems presently available for taking dermatologic photos.2 However, one of the important keys to widespread use of dermatology photographs is the efficient storage and retrieval of the medical images. The increase use of electronic medical records (EMRs) has enhanced and in other ways complicated the storage and retrieval of dermatologic images. This article provides a synopsis of the goals and deficits with some of the image storage options for dermatologists.
Home photographers may attest that taking the photographs is often the easy part. Categorizing and then being able to easily retrieve the photographs in the future can be more challenging. In a medical setting, the storage of photographic images is complicated by a number of issues including volume, possible need for retrieving multiple images from several dates simultaneously, Health Insurance and Portability and Accountability Act (HIPAA) security, storage capacity, clarity, speed of retrieval and possible integration with an office EMR.
The underlying goal of an image storage and retrieval system would be for the practitioner or assistant to have quick access to the images with minimal delay and minimal steps required to display the images. In addition, the system should allow an easy method for labeling the photographs with categorizing what identifies the different dates of the stored photographs. The provider will want to be able to look at the screen and quickly bring up 2 or more photographs taken at different dates of the same lesion. Ideally, the images would be seen side by side to allow comparison of lesion changes.
Evaluating a clinic’s needs for a new or auditing an existing imaging system can be difficult and time consuming. Important factors in the decision-making process are information technology (IT) infrastructure, workflow efficiency and cost of ownership.
IT Infrastructure
Here are 3 components to consider when evaluating a clinic’s IT infrastructure.
Network Bandwidth — The internal network must accommodate electronic health records, practice management data and the medical image traffic. Adequate bandwidth is critical for all types of image storage systems. The bandwidth usage from an image retrieval system and storage system may slow other network traffic significantly affecting the practice workflow and system response time.
Internet bandwidth — Cloud image storage systems need higher Internet bandwidth to store and retrieve the images. Often the bottleneck in sending or retrieving images via the Internet is due to the reliability and integrity of the Internet connection at the end user.
Storage — The amount of storage needed should also be considered though prices have dropped and cost is less of a factor. Consider the amount of storage needed for many years and do not forget about backup storage.
Hardware
To ensure proper throughput of traffic to the imaging server or Internet, the hardware switches need to be evaluated to make certain the switches are not the cause of a bottleneck. Imaging systems will typically have requirements for hardware that should be followed in order to reduce future problems.
There are many types and brands of camera technology that can be utilized. High-resolution cameras may need to be adjusted to a lower setting to weigh the quality of image versus the amount of storage needed.
IT Support
After an imaging system is in place, dealing with the vendor after the contract has been signed can be challenging. IT support can be in-house or contracted with an outside vendor depending on practice specifics. Incorporating an IT team from the beginning including selection and contract negotiation can mitigate future problems.
HIPAA Security
The security associated with acquisition and retrieval will always be the responsibility of the end users. In-house and cloud systems have different approaches to HIPAA security. Generally, the hardware-managing provider maintains the storage and safekeeping of the images. If the images are stored in-house, then IT and the medical practice are responsible. With a cloud-based system, the imaging vendor is responsible.
Workflow Efficiency
Patient care and workflow efficiency should be the driving force behind selecting an imaging storage system. Documentation and comparison of medical images theoretically should enhance the dermatologists’ ability to treat their patients.
Image Acquisition
The first step in the workflow is image acquisition. The photographer will need to be consistent with camera type, lighting, focal length and lens type to help make future image comparisons valid. This can be done internally or several medical camera systems are designed to systematize these variables.
Image Transfer to Queue
After images are taken and saved in a camera, they need to be sent to a queue, or holding location for further processing. This is usually a shared network location that can be accessed by the programs to which the indexed images will be saved permanently.
Depending on the type of integration, image transfer can be done by manually moving an SD card or using Wi-Fi enabled cameras or cards to transfer the images. Usually the best practice is to attach the images to the specific patient and put into the storage system with identifiers shortly after the image was taken.
Image Processing
This step involves indexing and can be time consuming. Indexing will attach a specific image to a specific patient. It may also identify the target area of the body and document any other relevant information about the image.
Image Transfer to Storage
Some image systems have a built-in queue and the image processing can be done after transfer to storage. Indexes can be added at this time to make retrieval easier and more efficient.
Image Retrieval
The final step is retrieving the image so that the provider can use the images to improve patient care. Attaching the image to the chart note or displaying before and after images for the provider, and possibly the patient will document care, assist decision-making and increase patient satisfaction.
Cost of Ownership
The total cost of ownership should be weighed against improved patient care and increased workflow efficiency. A high-resolution photograph should provide more details than manual drawings and descriptions of lesions.
Meaningful Use
Stage 2, menu measure 3, indicates that diagnostic images need to be accessible in the patient’s EMR chart. Non-integrated systems may need an interface or change in workflow to get the image into the EMR chart. Both of these will have a cost that hopefully will not significantly affect workflow efficiency.
Licensing
Many in-house systems and EMR integrated systems are subject to licensing restrictions. Licensing is less of a problem with cloud-based systems. Often, a practice will buy a block of concurrent licenses or per-computer licenses. These additional expenses should be anticipated.
IT Costs
Many of the IT expenses were identified previously. An imaging system uses significant amounts of bandwidth, storage and hardware, which should be factored into the total cost of ownership.
Useful Life of System
A well-supported imaging system will last many years. However, new technology makes it difficult for many systems to keep up-to-date. An imaging system that is adaptable to new technologies and methods is ideal.
Cost of Changing Systems
If changing imaging systems, several factors should be considered. First, the metadata attached to the patient record is important to keep and should be converted to the new system. Converting often is difficult and it can be costly to transfer the images and more importantly, the indexes. In a cloud imaging system one should know how easy or difficult it is to export the images out for conversion.
Many imaging systems use proprietary systems that can make changing systems difficult and cost prohibitive. It is very important to have a clause in the original contract and all renewal contracts that allows the data out at a reasonable cost.
Image Storage Systems
Three models for medical image storage and retrieval systems exist: cloud, third-party in-house storage systems that may or may not be accessed from the clinic’s EMR and image storage systems that are integrated into an EMR (
Table).
In the Cloud
Cloud image storage systems have an advantage of having a low cost of initial ownership. The imaging vendor manages the technology so there are low IT infrastructure costs. The only IT infrastructure variables that need to be considered are the hardware and the Internet bandwidth.
These systems often compress the images before sending to the cloud. The presentation of the images may also be compressed not allowing full resolution. To remedy this potential problem, some image vendors allow the picture to be downloaded or select to be viewed at full resolution.
The workflow may still require software in order to process the images and get them to the cloud provider. Most often, the workflow is the same as all other methods of storage. High-volume practices need to be aware of the quality and amount of the images uploaded. A cloud imaging provider may have a volume storage surcharge that could impact final costs. In addition, cloud storage systems that are not part of an EMR may require an interface to the EMR that is being used by the dermatologist.
In-House
In-house systems can be the most reliable of all the imaging models if the proper IT infrastructure is in place. Image retrieval will not be dependent on the integrity of the Internet connection. Often, full fidelity images can be displayed quickly. The reliability of the system is directly related to the quality of the IT infrastructure.
Some in-house imaging systems are Picture Archiving and Communication System (PACS) enterprise image distribution systems. A PAC system might be more robust than what many practices require. They are usually stand-alone systems that require more IT and cost of ownership resources including interfaces to an existing EMR.
Integrated Into an EMR
Some EMR systems are in the cloud and others are in-house. The considerations for each system need to be weighed against the factors discussed earlier.
An image retrieval system that is integrated into the EMR simplifies the process and possibly saves some up-front expenses. However, depending on the EMR there could be some loss of functionality with less detail and fewer display and comparison options. The office workflow might realize improved efficiencies when images are directly imported into the patient’s chart.
Summary
Here are some key points to keep in mind as you explore image storage options for your practice:
- Images are used for documentation to support diagnosis and patient care.
- All imaging systems will have minimal requirements for the acquisition, storage and retrieval of the images.
- Storage space is becoming more inexpensive.
- Patient care and workflow efficiency are the driving force behind the decision process.
- Identifying the best solution will be more successful with early participation of the providers, the employees and IT.
- Every practice needs to make a decision based on their workflow and experience.
- Use these considerations to audit your current system.
Ms. Sutton, is a fourth year medical student at the University of Nebraska Medical Center in Omaha, NE.
Dr. Sutton is a PGY3 dermatology resident with Baylor Scott & White in Dallas, TX.
Mr. Lenners is an IT analyst at Lincoln Surgical Hospital in Lincoln, NE.
Disclosure: The authors report no relevant financial relationships.
References
1. Swary JH, Stratman EJ. Practice gaps in patient safety among dermatology and their teachers: A survey study of dermatology residents. JAMA Dermatol. 2014;150(7):738-742.
2. Witmer WK, Lebovitz PJ. Clinical photography in the dermatology practice. Semin Cutan Med Surg. 2012;31(3):191-199.
