Sept. 17, 2010 -- Dr. Neal Sikka, an emergency room physician at George Washington University Medical Center, recalls an eye-opening incident that happened while he was away at a medical conference.
"My son fell and scraped his knee. My wife called, and I told her to take a picture and send it to me. She took a picture with her cell phone," said Sikka. "I looked at it, and told her how to clean it and take care of it."
Someone else Sikka knows once got paint in his eye. He called Sikka, who told him to send a picture of it.
"I was able to look at it and see the foreign body in his eye," said Sikka, who told the man what to do next.
Incidents like these spurred Sikka, who has worked extensively in the areas of telemedicine and remote medical provision, to undertake a six-month study assessing how accurately emergency medicine practitioners diagnose wounds based on photos taken by patients on their mobile phones.
The study involves people who arrive at George Washington University Medical Center's emergency room with non-life threatening flesh wounds. Once they are triaged, research assistants will determine whether they fit the study's criteria. Patients will then take pictures with their own cell phones, complete medical history questionnaires and e-mail the photos through a secure account.
A physician or physician assistant will then look at the photos and determine, based only on the photos, whether the patient needs stitches.
"The patient will then go back into the ER and when they're examined in person, we'll try to see how that diagnosis compares to the virtual diagnosis," said Sikka.
So far, about 100 people have participated in the study. Sikka said he hopes to enroll a total of somewhere between 250 and 500.
The researchers have only done a preliminary data analysis, but so far, Sikka said he's pleased with the results.
"The trends are really positive and the numbers are really encouraging," he said. "Doctors are really very accurate."
Cell Phone Pictures Are a Common Diagnostic Tool, Doctors Say
"This is something that most doctors use to help their families and friends," said Sikka.
"What we have had is a number of our residents or faculty using their cameras or cell phone cameras to take a picture and put it in the medical record to assess whether an injury is getting better or worse," said Dr. Corey Slovis, chair of emergency medicine at Vanderbilt University Medical Center in Nashville, Tenn. "By having a visual, there's no longer a subjective judgment. It's an objective assessment based on the amount of swelling, redness and other characteristics."
It's especially helpful for wound care, doctors say.
"Sometimes a wound can be very dangerous, and you certainly may not want to wait to see a doctor," said Dr. Harold Brem, chief of the Division of Wound Healing & Regenerative Medicine in the Department of Surgery at NYU Langone Medical Center in New York.
Brem has done research looking at how photos of wounds can impact healing.
"We established through a study that using photos of wounds can decrease amputations and prevent bed sores from progressing," he said.
Mobile technology also helps patients stay in better contact with doctors.
"Patients can be more continuously in touch with a provider," said Sikka.
Photos Also Educate Patients and Protect Practitioners
"It helps put a patient in a better educated position," said Slovis. "When a patient returns and says a wound isn't healing, we can show them the photos and explain what it looked like before."
"The more a patient knows about his or her health, the better they do as patients and as health care advocates for themselves," Slovis added.
Photos also help protect health practitioners from potential liability.
"The more you know about a patient's past visit and the more you can document what you saw at the time of evaluation, the more empowered you'll be to defend your actions," said Slovis.
Brem added that photos have become a standard of care, like a call to a doctor, but it must be used properly.
"Any good communication can decrease liability, but you have to make sure it's analyzed by the right person," he said.
Pictures Have Cost-Cutting Potential As Well
"It would cut down on costs and unnecessary trips to the doctor," said Brem.
"We can e-mail a picture of a rash to our dermatologists who are off-site, adn they're able to do a consult via photograph and talk to us over the phone," said Slovis.
That would save patients a trip to another doctor, thereby saving them out-of-pocket medical costs as well as helping them potentially avoid having to take time off from work.
Slovis hopes that continued advances in telemedicine can help cut down on more expensive specialty care and focus on something he thinks is sorely lacking.
"Hopefully, we can also spend more time on basic primary care," he said.
Pictures Also Have Pitfalls
"There are huge issues with privacy. If a patient is sending it, they're acknowledging it can end up in the wrong hands," said Brem. "Doctors know not to send a picture unless it's over a secure network, but patients have to make sure it's going to the right place," he added.
While doctors agree that using photos for wound care is very helpful, that's not the case with all medical care.
"It wouldn't be very effective with specialties requiring a physician's touch or the use of lasers," said Slovis.
The photos also have to be accurate to be an effective diagnostic tool.
"It's possible to not get an accurate picture and be led to believe that something is more serious than it really is," Slovis added.
Doctors say it also helps to have an existing relationship with a provider if people want to send photos of injuries.
"In a big city, there's a great liability of diagnosing and treating without ever seeing a patient," said Slovis. "Most of us would never want to do it."
Research Very Promising
Despite the potential problems with using cell phone photos, experts are excited about Sikka's research. Sikka said it's very preliminary, and the study methods aren't necessarily reflective of real-life emergency room treatment situations. But he said his study could mark the beginning of a whole new avenue of research.
"This is the tip of the iceberg to show that mobile technology allows patients to be much more in touch with the health care system," said Sikka.
"We have great methods of communication, so they should become standards of care," said Brem. "[Sikka] should be congratulated for trying to advance wound care."