People seem obsessed with taking photos these days. Recent news articles have highlighted the fact that, for the first year ever, selfies took the lives of more people than sharks did. It seems like no matter where you go, somebody wants a photo – even at the doctor’s office. For some, it feels like an intrusive process. After all, if they’re visiting the doctor to have something visual corrected, having that flaw or defect highlighted by photography can stir emotions. They want the defect corrected, not put on display. In a plastic surgeon’s office, a desire for modesty can also be of concern. While these are understandable worries, clinical photography serves several very important purposes, and sometimes understanding the logic behind them can help set your mind at ease.

1. It documents your starting point, so you can compare later.

Sometimes it can be hard to gauge results without having before and after photos. When you have the two images to compare side by side, the changes are much more apparent. If your treatment involves a sequence of procedures, assessing the gradual changes can help your doctor determine a more accurate timeline as well.

2. It enables your doctor to educate you about the procedure and anticipated results better.

No two people are alike, so models and sketches don’t always accurately represent your personal anatomy. Photos serve as a valuable aid when your doctor is explaining how a procedure will work and what changes you can expect to see.

3. When patients allow the doctor to share them, they can help educate others and showcase the doctor’s skill.

It’s incredibly likely that you examined photos of your doctor’s actual patients before you began treatment. While review websites and personal recommendations may help guide an individual’s decision to choose a doctor, nothing demonstrates his capabilities quite like photographs do.

Generally speaking, medical professionals don’t share any of your information, including photos, with the public, without your written permission. However, if you’re still worried about privacy, and don’t want images of you shared, let your doctor know.

4. Insurance companies tend to pay for procedures more easily when they can see visual evidence of why treatment was needed.

Many insurance companies will only cover treatment if it’s of medical necessity, rather than for aesthetic reasons. Other companies will determine coverage levels based on their own assessment of a condition. In either case, photographs provide them with the visual evidence they require in order to be able to process your claim.

There are lots of reasons why both you and your doctor benefit from clinical photography, but the biggest reason is that they can help you receive better care overall. In fact, most plastic surgeons are actually required to learn how to take quality clinical photographs as part of their studies, simply because it enables them to assess their own work to a greater degree. If you have questions or concerns over having your photograph taken, let your doctor know. He’s probably heard similar concerns before, and he’ll be able to set your mind at ease.

Camera stability is essential to taking good medical photos.  In our “Guide to Better Clinical Photography” we lists a number of tips and tricks for improving camera stability when capturing patient photos.  Recently, one of our users shared this photo with us and we wanted to pass it along.  As you can see, the physician has placed his iPad on a small tripod inside his exam room.  Our first question was obvious “How did you get the iPod on to the Tripod”?

As it turns out, Amazon offers an inexpensive attachment for an iPad which will allow you to affix the device directly to any Tripod.  In this case, the physician was using a Jellyfish Mini Tablet Tripod Mount which can be purchased for $17.95:  http://amzn.to/1lVmATg

If you are using a full sized iPad, iStabilizer offers a similar product for $19.95:  http://amzn.to/1uPNUYu

Whoever said that a picture is worth a thousand words must have been a dermatologist. Patients truly look at and even study those photos on your website of before and after the procedure. They use these photos to evaluate your skills as a dermatologist or a plastic surgeon. If you want to truly be successful in this business, then your photos must be top-notch. You can scrimp and cut corners in some areas, but the clinical photographs should be of highest quality.

Staying Competitive

It’s no small task to stay competitive these days in the world of medicine. Regardless of what kind of practice you have, there may be hundreds or even thousands of similar practices in your city. The before and after pictures provide the necessary data for potential patients to “visualize” their procedure and expected results.

Once a patient has decide to take the plunge and get the work done that they’ve been considering, then these clinical photos will also serve as a reminder or where they were prior to the procedure and what kind of changes were made. Though most practices do use them for surgical procedures, often they are not utilized for non-surgical procedures. The reasons are varied:

• It’s too expensive.
• Patients don’t really need them anyway.
• It’s time consuming.

The truth is that a practice that does take before and after photos of any procedure is often viewed by patients as more exclusive or high-end. And who doesn’t want to go to the best dermatologist or plastic surgeon in town?

Choosing Your Equipment

Most doctors like to boast about having the most advanced machines and medical devices but what about your photo equipment? There are a few options when considering how to best capture and catalog your photos. A traditional digital camera is sufficient for taking medical photos, but the process of managing the clinical photos after they have been captured is often cumbersome. Users must manually upload the photos to a computer, label them, and then integrate them directly into the EMR.

Companies like Canfield and Fotofinder provide more streamlined photo capture and management. Many physicians find that these solutions are very bulky and expensive and more than what they actually need.

AppwoRx is a newer clinical photography solution that utilizes mobile and cloud technology to streamline the process of capturing and cataloging photos. Because AppwoRx is a software platform and no equipment purchase is necessary, the cost is typically more palatable.

Training

Clinical photography training is essential for any practice who intends to use medical photos for marketing, collaboration or insurance reimbursement. There are procedures for clinical photography that must be adhered to when capturing medical photos. Lighting, positioning, shadow and background can all have dramatic effects on the quality of a patient photo. To learn more about how to improve the quality of your medical photography, you can review this free whitepaper: http://www.myappworx.com/whitepaper

Excellent before and after pictures can take your practice to a whole new level and draw in a more affluent crowd. Make an investment in better equipment and better trained employees to maximize the potential of photographs.

Medical imaging is of paramount importance in the field of plastic surgery. Many years ago, it started out as a helpful tool, but today it is an essential part of any practice. A few other medical fields also utilize photography these days and it can be a valuable aid to any physician’s practice. As more and more doctors begin to incorporate photography into their day-to-day practice, many questions arise.

Getting Consistent Quality

One of the major concerns of plastic surgeons, dermatologists and others is consistent quality. In order to get uniformity, the conditions must be the same for before and after pictures or a series of photos.

For facial plastic surgery, it’s important that all conditions be exactly the same for pre-op and post-op photos. The patient should be wearing dark clothing, similar cosmetics, and the background and lighting must be matched. All camera specs must be the same as well: the lens, film, focal setting, and F-stop.

Consistent Positioning

Though all these factors may seem like common sense to some, peer-reviewed articles on this topic show that many unintentional inconsistencies were found. Patient positioning was one major factor that seemed most difficult to replicate at each photo shoot. Even a small degree of head retrusion or neck flexion made a significant impact on the photodocumentation.

For lateral facial photographs, many photos were observed that had not been taken in the true lateral position. Even a slight over-rotation of the head caused skewed results. Since digital photography has become so inexpensive, one method recommended for coping with these various issues, is simply to take several photos in each position. Of course, every effort should be made to replicate the exact lighting and conditions for pre-op and post-op photos.

Conclusion

With the field of medical imaging growing and the need for reliable medical photography in advertising, teaching and diagnosis, achieving standardized quality is essential. Whether mistakes are made through carelessness, lack of knowledge or through equipment failures, poorly taken photographs can diminish the value of using photographs altogether. They can also provide misleading or incorrect information.

To address these numerous issues, many physicians are training one or two employees that handle only the photography itself. Another helpful solution is the use of better or easier to operate equipment. Several companies do provide medical imaging equipment but it can be very expensive, cumbersome and difficult for employees to operate. The future of medical imaging will most likely steer toward easy-to-use programs that can be utilized with iPhones and iPads, making it much more versatile and convenient for the busy medical professional.

We’ve put together a new marketing video for AppwoRx which will give you a sneak peek at the new look and feel of the application, along with some of the new features. You can view our new marketing video here:

AppwoRx For Clinical Photography from Chris Cabell on Vimeo.

Photo Gallery Enhancements –

We’ve added a number of enhancements to the image gallery to make it easier to view and manage your photos from your iPad or iPhone. Additionally we’ve made some changes under the hood that will make the speed of the gallery much faster than in previous versions of the application.

Image Tags –

The applications new interface will make it easier to add diagnosis and treatment tags to your patient’s record. We have provided a number of standard tags including CEAP classifications. You will also be able to create and manage your own custom diagnosis and treatment tags through the AppwoRx website.

Patient Marketing & Education –

The biggest change to our application will be seen by our iPad users. The new version of AppwoRx will have a “Patient Education Portal” that will give the user access to a wealth of vein related images, diagrams, videos, before & after photos and much more. This content will help you and your staff market services and educate your patients at the point of care. We’ve provided you with a wealth of content, but you may also customize the application with your own personalized content.

Health-VU –

In addition to the patient education functionality in the mobile application, AppwoRx will also be rolling out a new patient engagement tool called Health-VU.COM. Health-VU will allow you to create a patient education portal directly from your iPad device. As you share content with patients in your office, you will also be able to share that content to a secure patient portal. In addition to marketing and education content, clinicians can share the patient’s clinical photos so they may view them in the privacy of their own home best weight loss tablets. Patients can log into Health-VU through a HIPAA compliant gateway and re-live their consultation with family or key influencers.

We are very excited about these new features and we are looking forward to speaking to you about them. If you are interested in learning more about the Health-VU platform we will be doing personal webinars in the coming weeks to help you learn how you can use this service to market your practice. To schedule one of these webinars, please email me directly at chris@myappworx.com

New Features Coming to RxPhoto – AppwoRx is pleased to announce the addition of several exciting new features to RxPhoto, our popular clinical photography tool. Users will begin to see some of these enhancements in the coming weeks, with the majority becoming available by the new year. Here are a few of the new features you can expect to see:

Diagnosis & Treatment Cataloging – At the request of a number of our physicians, we are giving users the ability to add treatment types and diagnoses to the patient’s record. The diagnosis or treatment can be chosen from a list of hundreds of options, or you can create a custom tag. This feature will help clinicians easily find and reference patient images that are relevant to specific treatments, streamlining the process of collecting before and after photos for marketing or reviewing results for training purposes.

Custom Marketing Reports – Current users will note that this feature has recently been implemented. Users may now use pre-defined blocks of content to create in-depth marketing reports for their patients or referring physicians. Users can either generate their own original content or select from the wealth of content provided by AppwoRx, including information on diagnosis, treatment descriptions, and post-treatment care instructions, and modify as desired. Users are also encouraged to add physician bios or custom fields of data. Additionally, some physicians have used the content manager to create custom forms for streamlining insurance per-authorizations.

Enhanced Image Gallery – iPhone and iPad users will soon be able to navigate more easily through a patient’s previous photos by utilizing an enhanced image gallery. Users will be able to quickly reference previous photos or show before and after images.

Draw& Annotate – This feature will allow users to mark and annotate photos with brushes, drawing tools and custom shapes. This will help providers to illustrate services or create a record for later discussion.

Secure Collaboration –   The AppwoRx secure collaboration feature will allow our users to coordinate care in real time from their computer or mobile device. Images and video can be sent to individuals or groups utilizing a staff directory. Recipients are notified via email, SMS or Push Notification. Delivery receipts can be sent back to the sender to alert them that the messages were received, read or responded to.

EMR Integrations–  AppwoRx is now fully integrated with Streamline and Greenway EMRs.  This means your images are pushed directly to the patient record.

As always, the AppwoRx team is eager to hear your feedback on how we can improve our products. Please don’t hesitate to reach out to us with your comments and recommendations!

How to Improve Your Clinical Photography

Written By:

Christopher Cabell

Co-Founder & CTO – AppwoRx

Part 1 –  Taking Better Photos

Struggling to capture perfect before and afters with your iPhone? Turn your mobile device into a HIPAA compliant medical photography system with RxPhoto. Check it out here.

In 2011, Dr. Ari Soffer and I formed AppwoRx with the intention of revolutionizing the field of clinical photography.  We developed a software platform, RxPhoto which is used daily by hundreds of physicians and clinicians.  Our mobile application and cloud based photo management tools streamline the process of capturing, cataloging and managing clinical photos.    I have been involved in all aspects of the development, training and implementation of our software.   These efforts have given me a unique perspective on the subject of clinical photography.

When I began training physicians to use the AppwoRx, the focus was strictly on how to use the features of the software.  The trainings did not include any advice on how to stage a photo, because I naively assumed that clinical photography technique was something taught to clinicians by their respective medical or nursing schools.

As I worked with more of our customers, I noticed that many of the clinical photos were of poor quality.  Often the photographers were not giving much thought to lighting, positioning, shadow or background.  I interviewed a number of support staff who seemed to look at the photography process begrudgingly, as an additional step that was necessary in order to get the patient out the door. The importance of taking quality photos had never been instilled in or taught to them, and there were no consequences or repercussions if their results were less than optimal.

With this I realized that AppwoRx would need to do more than educate our users on how to use our clinical software.   We would also need to teach them how to take a good picture.

This is the first in a series of articles relating to clinical photography.   The intention is to share knowledge gained from working wide range of practices, each with their own set of unique needs.  The goal is to not only help reader’s take better photos, but also to help them optimize work flow while marketing and illustrating their services.

The first article is simply entitled “Taking Better Photos”.  Below I summarize of some of the techniques I share with my users to help them improve the quality of their photos.

Accountability

The most effective means I have found to improve photo quality quickly and across an entire organization is to make individuals accountable for the quality of the photos they take.  This can be best accomplished by reviewing actual photos with the photographer in an individual or group setting. This will allow you to coach your team based on actual photo sets, not concepts.

It is best to review existing patient photos and create an agenda before any training or coaching the photographer. I suggest finding one or two patients with photos taken by the staff member which are of good quality.  Use these high quality photos as an example of the type of photos they should be consistently taking.  Starting with positive feedback will set the tone for the meeting so that the photographer is not defensive.

Next, move on to patient photo sets which have been identified as having areas requiring improvement. Choose specific photos as examples and show the photographer what could have been done differently to achieve a better result.

This exercise will show your team that there are only a handful of variables that they must keep in mind when taking a quality clinical photo.  If your staff is educated on the core principles of clinical photography, the quality of their photos will greatly improve.  This education becomes more effective when the user is aware that their photographs will be periodically reviewed and they will be held accountable for the quality.

Photography Basics

We’ve discussed some techniques for coaching and training, but what types of opportunities for improvements are we looking for?You don’t have to be an expert photographer to take great clinical photos, but there are a handful of items the photographer should be conscious of before taking a photo.  When training your team to capture quality photos, it is important to instill in them the basic principles of photography.  Obviously there are entire books written on the subject, but for practical clinical photography I have narrowed the list down to the six most important items to remember when taking your photos:

• Lighting
• Positioning
• Shadow
• Background
• Stability
• Consistency

After training your team, you may want to post a note in your exam rooms with these items bulleted.  Each time your staff takes a picture, they should be thinking about each of these points.  This will help them remember these techniques and they will eventually become second nature to the photographer.

Let’s look at each of these items and examine how they translate to real world clinical photography:

1.       Lighting – Naturally, lighting is one of the most important aspects of photography.  It is also very commonly misunderstood. In general, most exam rooms have sufficient lighting for clinical photography.  Standard halogen or fluorescent lights typically provide more than enough light so long as the wattage of the bulbs is sufficient.   Incandescent lights are not optimal for clinical photography, just as they are not optimal for an exam room.  If you must use incandescent light, you may want to look at the wattage of the bulbs you are using.  120W Soft White bulbs are a great alternative to standard bulbs and will provide a better spectrum of light for your photographs. 

Many photographers feel that their exam rooms do not have enough light, when in fact the issue is that they are not cognizant of where the light source is in relation to the subject they are photographing.  When taking a picture of a patient, one must be sure that the light is shining on the subject area being photographed.  If your patient is sitting on an exam table, and the room’s light source is behind you, then you are likely blocking your light source.  Before taking a photo you should always make sure there is a direct path between the light source and the subject area.

2.      Shadowing –  You may have sufficient light in a room, but if you aren’t positioning your subject correctly or your camera is not angled correctly to take advantage of the light, you can get shadow.  At times, shadow may not be noticeable with the naked eye, but is much more pronounced in the photo.  That is why it is important to always review the photo after you take it to ensure that your subject area is clearly visible. 

3.      Positioning – Positioning is critical for taking good clinical photos.  Part of a clinical photographer’s job is to instruct the patient how to position their body to enable the best quality photo.  The highest quality photos I typically see are taken by clinicians who have a pre-defined series of photos that they take for every patient.  Each patient’s photos are taken in the same position, often using props such as step stools or tape on the floor to show where feet should be positioned for each shot.  By walking into each photo session with a plan, clinicians are able to streamline the process and take better photos.

Positioning the patient is not, however, the only thing to be conscious of when taking your photo.  The photographer must also be aware of how the camera is positioned. The best rule of thumb is to always keep the camera flat and pointed directly at the subject area.  You should never hold your camera at an angle when taking a clinical photo.  Any type of offset angle will distort your photo and detract from overall quality.

4.      Background – One of the biggest areas for improvement I typically see is in the use of backdrops.  I cannot stress how critical it is to have an appropriate backdrop behind your subject whenever possible. Taking a photo of Caucasian skin against a two-toned beige wall, for example, will always provide less than optimal results.

If you want to use something around the office to serve as a backdrop, my recommendation is blue medical drapes.  If you don’t have these handy, you can purchase a few yards of material at any fabric store.  Dark or navy blue fabric will provide the best results.  You can either hang it in your exam room, or you can find a way to make a “prop” background that is versatile but will not get in the way.  Some of my more creative users have taken a large section of poster board and affixed blue material to it with spray adhesive.  Such a prop can be positioned as needed and easily moved between exam rooms. 

5.      Stability – Holding a camera steady is essential when taking a clinical photo.  This should go without saying, but surprisingly this is an area we have to coach on quite often.  Whenever possible, you should use some type of prop to help steady your camera.  Exam stools and exam tables work great, but you can also use your other hand to help stabilize the hand holding the camera.  Be creative with your props, but more importantly, be aware of the need to have a steady hand when taking your photos.

6.      Consistency – Consistency is critical when taking clinical photos. Your before and after photos are a key component of marketing and illustrating your services.  Anyone visiting your website will surely be viewing the work that you have done to assess the results they can expect. Even the best results are less than impressive if the before and after photos were taken from a different angle, a different distance, or with a different background. These photographs are your professional portfolio and they should be treated as such. 

Having a standardized process for taking photos is a great way to ensure photo consistency.  However, utilizing your previous photo as a guide for your new photo is the best way to ensure that you take the same picture every time.  The AppwoRx platform has a photo “Ghosting” feature that allows the user to overlay a previous photo onto a new photo to be used as a guide for framing the new image. Ghosting ensures that no matter who took the previous photo, the current photographer can render a consistent new photo.

Summary:

I sincerely hope that these tips help you and your staff to take better photos.  I’m very passionate about helping individual practices improve their clinical photography, because it creates a better user experience with our software.  For the next article in this series, I will discuss how to use clinical photos to better market your practice.