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. 

AppwoRx is a company that realizes opportunities for developing new mHealth apps, content, products, and services are emerging daily. We believe mHealth will play a ubiquitous role in transforming the U.S. and global health systems, expanding access to decision support that permit consumers to engage effectively with their systems of care.
The evolu

tion of mobile technology in the past twenty years has revolutionized every aspect of industries across the board in the way they conduct business and communicate with their customers, and healthcare is no exception. The rapid growth and advancements in the technical field have compelled investors to reevaluate their current methods of commerce to determine how they can employ these advancements to better service their clients in the digital age.

Industry professionals have acknowledged the significant role that the field of healthcare plays in the mobile market. In a 2012 survey of senior executives in the US mobile sector, 78% of respondents said that the healthcare/life sciences market had the greatest potential for benefiting from emerging technologies and subsequently generating revenue. Further, data from this study indicated that the healthcare/life sciences market was the industry most likely to see high rates of growth in its business model over the next five years.
The demand for mobile apps will largely be driven by challenges encountered throughout the lifecycle of the population using them. Current and continuing healthcare reforms and rising costs of coverage as well as the natural aging processes and developing illnesses encountered by mobile users, along with the population’s increased awareness and desire to take a proactive stance on their health, will all propel growth in the mHealth field substantially.

As integral as mobile devices have become to the average user’s daily routine, the market is rife with opportunity for healthcare to emerge as a leader in mobile app revenue. Technologies currently available allow the user to view their own medical records on-demand instantly as well as to connect with providers in order to take active part in their own healthcare. There also exists the potential in the expanding global market to allow providers to connect with patients and caregivers in remote areas to assist in diagnostics and recommendations for treatment, which will in turn facilitate the provision of accessible and affordable healthcare worldwide.
As a company dedicated to reinventing the way patients and physicians engage, AppwoRx realizes opportunities for developing new mHealth apps, content, products, and services are emerging daily. We believe mHealth will play a ubiquitous role in transforming the U.S. and global health systems, expanding access to decision support that permit consumers to engage effectively with their systems of care.

It’s easy to see that G. Daniel Martich, M.D., chief medical information officer at the University of Pittsburgh Medical Center (UPMC), like many of his cohorts at the large integrated healthcare system and elsewhere in the industry, can see the big picture.

Dr. Martich, who is also a member of the Healthcare Informatics editorial advisory board, is focused squarely on accountable care, and better yet, he has an idea on how to get there. At HIMSS13, on the same day that was officially themed after “patient engagement,” Martich spoke with HCI Associate Editor Gabriel Perna on why this year at the annual conference he has really zeroed in on patient engagement and mobile health (mHealth).

“How we engage the patient in their own care ties into accountable care because we can’t continue to deliver the same care at hospitals, critical care units, and in emergency departments as we used to, because we can’t afford to,” Martich says. “So how do we care for those patients in a better, if not equal setting, moving them first to the outpatient center then the home? We need patients to engage. How do they do that? They can engage with a laptop or a desktop, but the reality is patients are engaging more and more with mHealth.”

At UPMC, Martich says the organization is attempting to extend this concept in a mobile fashion to their patient base in the ambulatory setting. The organization, he says, is working on a marketing effort that attempts to get patients to sign up for their shared personal health record. This means the patient sees what the doctor sees in terms of medications, upcoming appointments, and prescriptions.

Already, Martich says, the organization has gotten 150,000 patients on board. Furthermore, UPMC will be extending this mobile app to those who use the organization’s insurance product. Half of those patients don’t have a UPMC physician. But that doesn’t matter, as the organization is essentially an accountable care organization (ACO), he notes.

G. Daniel Martich, M.D.

“We have an insurance arm, we have a hospital division, and we have a physician division. Tying all of those together and going out beyond that is obviously a big step. And [it’s about] developing the tools and strategies around that, so you can do virtual care collaboration using the camera on a laptop and the camera on an iPhone. If you want to see the [practitioner], you can see the [practitioner],” Martich says.

ACOs, Martich says, are about access, quality care, and reasonable cost. Both UPMC and the UPMC Health Plan in this regard are incentivized to reduce costs, and one of the best ways to do that is to keep the patient out of the hospital. The mHealth is one way to do that, as is UPMC’s electronic visits (eVisits), a growing online platform at which has actually integrated with the mobile app. There are also non-technology answers, he says, such as extended hours clinics, which can keep a patient out of the emergency department.

“We still want to admit people to the ER, if they need to go. But we don’t want a system where people say, ‘My doctor is not available, so I’m defaulting to the most convenient option.’ That option happens to be the most expensive option. In reality, the most convenient option should be the least expensive option,” Martich says.