Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
J Pediatr Urol. 2022 Dec;18(6):766-772. doi: 10.1016/j.jpurol.2022.04.004. Epub 2022 Apr 22.
Digital photography can be securely stored in the medical record and enhance documentation of physical exam findings and monitor wound healing. A standardized protocol that respects the dignity of the patient and maintains the fidelity of objective documentation is needed for patients with differences in sexual development (DSD) and congenital adrenal hyperplasia (CAH).
The purpose of this study was to evaluate the feasibility, acceptability, and applications of a HIPAA-compliant digital photography protocol in the care of female patients with CAH.
A protocol for standardized digital imaging including consent, permission, data capture, and storage in the electronic medical record (EMR) was implemented. Patients undergoing physical examination during multidisciplinary CAH clinic visits, preoperative evaluation, and postoperative follow-up from October 2020 through May 2021 were included. Male patients with CAH, patients with clitoromegaly or urogenital sinus not from CAH, and patients seen through telehealth were excluded. Consent was obtained from caregivers and permission from patients. Images of the exam were taken during clinic visits or at the time of surgery with no identifying features included. Images were directly uploaded into the patient's chart in the HIPAA-protected EMR separate from other clinical documentation and not stored on personal devices.
There were 17 patients with CAH seen with median age 6 years (range 2 weeks-18 years). There was a median of 3 photos per patient during the study period with cooperation from both the patient and their caregiver. Amongst the patients seen, 6 patients underwent reconstruction with a median of 10 photos per patient. Images were available and used for preoperative planning and counseling. Patients with previous images did not require repeat examinations and were subjected to fewer genital examinations. Fewer providers were present during exams. Images taken by providers and caregivers during the postoperative period were used to monitor wound healing and surgical outcomes.
Protocol implementation improved patient care by reducing the number of exams and number of providers present, enhancing clinical documentation, and providing a means of tracking the physical exam over time. This was in concordance with guidelines for limiting exams for patients with DSD and CAH. Implementation of best practices for medical photography was important in respecting patient dignity and confidentiality.
Implementation of standardized digital photography was feasible and acceptable to patients and caregivers. Digital images reduced the need for repeat physical examination and provided a visual means of enhancing clinical documentation.
数字摄影可以安全地存储在病历中，增强体格检查结果的记录，并监测伤口愈合情况。对于性发育障碍（DSD）和先天性肾上腺增生（CAH）患者，需要制定一种尊重患者尊严并保持客观记录真实性的标准化协议。
本研究旨在评估符合 HIPAA 标准的数字摄影协议在 CAH 女性患者护理中的可行性、可接受性和应用。
实施了标准化数字成像协议，包括同意、许可、数据采集和存储在电子病历（EMR）中。纳入 2020 年 10 月至 2021 年 5 月在多学科 CAH 诊所就诊、术前评估和术后随访期间接受体格检查的患者。排除 CAH 男性患者、阴蒂肥大或非 CAH 尿生殖窦患者以及通过远程医疗就诊的患者。获得了照顾者的同意和患者的许可。在诊所就诊或手术期间拍摄检查图像，不包含任何识别特征。图像直接上传到患者的图表中，在 HIPAA 保护的 EMR 中与其他临床文档分开，不存储在个人设备上。
共纳入 17 例 CAH 患者，中位年龄 6 岁（范围 2 周至 18 岁）。在研究期间，每位患者平均有 3 张照片，患者及其照顾者均合作。在接受手术的患者中，6 例患者接受了重建手术，每位患者平均有 10 张照片。图像可用并用于术前计划和咨询。有既往图像的患者无需重复检查，生殖器检查次数减少。检查时在场的医生减少。术后由医生和照顾者拍摄的照片用于监测伤口愈合和手术结果。
协议的实施通过减少检查次数和减少在场医生数量、增强临床记录以及提供随时间跟踪体格检查的方法来改善患者护理。这与限制 DSD 和 CAH 患者检查次数的指南一致。实施医学摄影最佳实践对于尊重患者尊严和保密性非常重要。
标准化数字摄影的实施对患者及其照顾者来说是可行且可接受的。数字图像减少了重复体格检查的需要，并提供了增强临床记录的视觉手段。
