Medical Model

Use Tablets to Share External Eye Photos with Patients

By Robert L. Bass, OD, FAAO

January 14, 2015

SYNOPSIS

A tablet makes it easy to take—and share–external photos of a patient’s eyes to provide a learning experience in the exam room. Tips on being HIPAA compliant.

ACTION POINTS

USE CREDITS. Where possible, useinsurance company lab points to acquire tablets at no cost, or have doctors use personal tablets.

CAPTURE EXTERNAL IMAGES. Photography of the eyelids and ocular adnexa such as subconjunctival hemorrhage, foreign bodies, eyelid papilloma and blepharitis.

STORE PHOTOS IN EHR. To remain HIPAA-compliant, immediately transfer photos to EHR after viewing with patient–then delete them from the tablet.

When a patient in the exam room has a condition that is easily observable, I use a tablet I keep to take a photo. I show the patient an image of their own eyes as we discuss their condition, so that education becomes much more impactful.

Use Credits forTablets

We have four iPads specifically for the office; three in use and one always charging as a backup since somebody always forgets to charge theirs. My iPads were purchased with VSPone lab points and credit card points. Note, you do not need a powerful iPad; all you use is the screen and the camera; nothing is stored on it. If you don’t want to invest in iPads for the practice, each doctor also can bring in their own tablet to use with patients since no patient images are saved or stored to the device, but rather, immediately transferred to the EHR after viewing.

What Kinds of Images Can Tablet Capture?

I use the iPad in my exam room to take external photos of the eye, meaning photography of the eyelids and ocular adnexa. Conditions that I would photograph include subconjunctival hemorrhage, foreign bodies, eyelid papilloma and blepharitis.

Dr. Bass takes an external photo of a patient’s eye with a tablet to help explain an eye condition. To remain HIPAA-compliant, Dr. Bass says to always immediately transfer photos to the office EHR, and then delete, so no patient-related information or photos are stored on the tablet.

Use Photos to Track Condition

Photographs document changes in a condition over time more accurately than drawings or description with words. My software, Eyefinity EHR, allows you within the record to take a photograph, add notes and resume or continue with the exam without having to leave the EHR.

Have Conversation with Patients

For a patient with blephartis, I might say as I showed them the picture taken of their eyes with the iPad: “You have blepharitis, which is inflammation that affects the eyelids. Blepharitis usually involves the part of the eyelid where the eyelashes grow. Blepharitis commonly occurs when tiny oil glands located near the base of the eyelashes malfunction. As you can see in your picture, your eyelid is red and swollen around your eyelashes with flakes of skin attached to the lashes.”

Store Photos in EHR; Not on Tablet

The photos are saved and stored in the patient record inside our EHR, and never on the iPad. These images are not even temporarily saved to the iPad. Instead, they are immediately transferred to our EHR system after the patient and I are finished with our conversation. It is important to note that storing photos of patients’ eyes in any place other than a secure EHR would not be HIPAA-compliant.

To keep the photos secure at all times, it is best to have interested patients access the images using your EHR’s secure patient portal. We have trained our staff to educate patients on how to use their patient portal, including for viewing photos of their eyes taken during exams. For those without computers, we will print out the record and FAX to a private machine, or mail the record to them.

Robert L. Bass, OD, FAAO, is the owner of Optometric Associates, PC, in Manassas, Va. To contact: idr.bass@verizon.net

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