实施摄影记录计划。

Eric K Lai, Evan Slavik, Bessie Ganim, Laurie A Perry, Caitlin Treuting, Troy Dee, Melissa Osborne, Cieara Presley, Alexander J Towbin
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引用次数: 0

摘要

智能设备的普及为医疗摄影的使用提供了便利,但由于与电子健康记录(EHR)和标准临床工作流程的整合存在挑战,医疗机构很少实施摄影记录工作流程。本手稿详细介绍了一家大型医疗机构在所有护理阶段实施全面摄影记录工作流程的情况,强调效率和患者安全。从 2018 年 11 月到 2023 年 12 月,我们机构的医护人员上传了近 32,000 份照片文档,涵盖 54 个医疗专科。在电子病历和智能设备上,拍照存档过程只需点击 11 次鼠标和按键。自动化在提高工作流程效率和患者安全方面发挥了至关重要的作用。例如,使用身体部位规则自动对面部、胸部、外生殖器和臀部的照片贴上敏感标签。这种自动化非常成功,50% 以上的上传照片文件都被贴上了敏感标签。我们的实施凸显了照片文档工作流程标准化的潜力,从而增强了临床文档的质量,改善了病人护理,并确保了敏感图像的安全处理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Implementing a Photodocumentation Program.

Implementing a Photodocumentation Program.

The widespread availability of smart devices has facilitated the use of medical photography, yet photodocumentation workflows are seldom implemented in healthcare organizations due to integration challenges with electronic health records (EHR) and standard clinical workflows. This manuscript details the implementation of a comprehensive photodocumentation workflow across all phases of care at a large healthcare organization, emphasizing efficiency and patient safety. From November 2018 to December 2023, healthcare workers at our institution uploaded nearly 32,000 photodocuments spanning 54 medical specialties. The photodocumentation process requires as few as 11 mouse clicks and keystrokes within the EHR and on smart devices. Automation played a crucial role in driving workflow efficiency and patient safety. For example, body part rules were used to automate the application of a sensitive label to photos of the face, chest, external genitalia, and buttocks. This automation was successful, with over 50% of the uploaded photodocuments being labeled as sensitive. Our implementation highlights the potential for standardizing photodocumentation workflows, thereby enhancing clinical documentation, improving patient care, and ensuring the secure handling of sensitive images.

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