Today I had a chance to meet with a provider that uses images of patients heavily in his practice.  His specialty practically requires that he have simple, powerful access to photos that he takes in office with a digital camera.  We actually work with several groups that this is important to.

Stop for a minute and think about specialties that would benefit from photos of patients.  Certainly Dermatology, for use in tracking before and after of cosmetic treatment, treatment of acne or other skin disorders, tracking growth sizes for skin tumors an lesions, and on and on.  Plastic and Cosmetic surgery is another specialty that needs to be able to document via photo.  Practically any instance where an outcome can be documented and tracked photographically needs a powerful tool to manage those photos.

EMR is not that tool.  EMR is important, and the photos should absolutely be imported and included in the patient chart, for a number of reasons, but EMR is clumsy and clunky when it comes time to actually review and compare those images.

PACS may be an option, particularly since every EMR was required to be able to link directly to PACS data for a now defunct Meaningful Use measure, but PACS is designed around DICOM, and these images are not DICOM.  They can be imported to a DICOM database as JPG and we can back into the DICOM spec, but it’s not native, and it’s clunky.  There are some significant benefits, like the ability to change hanging protocols which have long allowed Orthopedic and other XRay heavy specialties to compare before and after or even compare different patient studies.  There are built in measurement tools, and standardized scale indicators.  Add a robust medical support community, and PACS may be the best existing option.  The biggest issue, then, is that a digital camera is NOT a PACS recognized modality.  There is not a simple way to import images.

Consumer tools, “free” applications like iPhoto or Google Picasa are useful and helpful, but there are no collaboration tools that will stand up to HIPAA rigor, and no collaboration tools that allow for multiple users/viewers of data.  Image acquisition is beyond simple, and tagging and naming files, for later search, is very powerful.

There are also very powerful and robust business class image database tools that have long been used by the graphic design industry.  They offer versioning, check-in and -out, multi user capabilities, collaborative tools, etc.  The weak point is that they don’t tie to health records without exporting a version and importing to the patient chart.  Cumbersome and duplicative.

What is the best solution?  A PACS system that is built to import JPG and other common image format natively and without having to “trick” a system into thinking a digital camera is a modality?  A business grade image management database with the relatively simple added task of export and import into EMR?

Is there an EMR out there that is built to manage images?  That includes a fast, easy to use image catalog?  I haven’t seen it…