Ed. Note: the mPOWEr team is delighted to welcome our first guest blogger, Dr. Kristy Kummerow Broman, general surgery resident at Vanderbilt University Medical Center, and VA Quality Scholars Fellow in the Tennessee Valley Healthcare System. We’ve been admiring her work on post-discharge care coordination for surgical patients using mHealth solutions for some time. It’s a pleasure to share her thoughts here on the growing use of clinical photography in patient care – something clearly dear to our hearts here at mPOWEr.
The October Bulletin of the American College of Surgeons featured an insightful article on ethical issues surrounding sharing clinical photographs, which are increasingly used by patients and surgeons to facilitate clinical decision-making. The article highlights important ethical issues, but the authors fail to address a more fundamental assumption – that images taken by patients and surgeons are adequate for clinical decision making. When used in this way, clinical photographs essentially become a diagnostic tool. But unlike laboratory tests or radiographs, which are procured and evaluated by trained professionals using standardized techniques, these images may be of variable quality. Despite this, surgeons may be expected to incorporate this additional information into clinical decision-making.
We have learned from our research experience at Vanderbilt that image quality ranges widely. One can only evaluate the portion of the patient that is included in the image, and a viewer may not be aware that additional information (eg. an additional wound, a stoma adjacent to an incision) even exists. Further, we have observed significant variations in scale, contrast, and focus of images submitted by patients. Patients have varying degrees of experience with digital photography and may have physical impairments such as poor vision or tremor which impair their ability to capture a focused imaged suitable for clinical diagnosis.
Despite these challenges, we remain enthusiastic about the potential to increase access to patient-centered care and improve outcomes using clinical photography. Further, we recognize that digital images will continue to be used irrespective of quality standards. Patients and providers have become accustomed to using smartphones and digital photography in many aspects of life, and they will continue to expect the same digital accessibility in receipt and provision of health care services. As a surgical community we have an opportunity – perhaps even a responsibility – to establish standards for transmission, assessment, and documentation of digital images used to provide surgical care.
– Kristy Kummerow Broman, MD, MPH, Vanderbilt University Medical Center