title: A mobile app for securely capturing and transferring clinical images to the electronic health record: description and preliminary usability study.
abstract: BACKGROUND
  Photographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking.
  
  
  OBJECTIVE
  The aim of this study is to describe the implementation of a secure application for capturing and storing clinical images in the electronic health record (EHR), and to describe initial user experiences.
  
  
  METHODS
  We developed CliniCam, a secure Apple iOS (iPhone, iPad) application that allows for user authentication, patient selection, image capture, image annotation, and storage of images as a Portable Document Format (PDF) file in the EHR. We leveraged our organization's enterprise service-oriented architecture to transmit the image file from CliniCam to our enterprise clinical data repository. There is no permanent storage of protected health information on the mobile device. CliniCam also required connection to our organization's secure WiFi network. Resident physicians from emergency medicine, internal medicine, and dermatology used CliniCam in clinical practice for one month. They were then asked to complete a survey on their experience. We analyzed the survey results using descriptive statistics.
  
  
  RESULTS
  Twenty-eight physicians participated and 19/28 (68%) completed the survey. Of the respondents who used CliniCam, 89% found it useful or very useful for clinical practice and easy to use, and wanted to continue using the app. Respondents provided constructive feedback on location of the photos in the EHR, preferring to have photos embedded in (or linked to) clinical notes instead of storing them as separate PDFs within the EHR. Some users experienced difficulty with WiFi connectivity which was addressed by enhancing CliniCam to check for connectivity on launch.
  
  
  CONCLUSIONS
  CliniCam was implemented successfully and found to be easy to use and useful for clinical practice. CliniCam is now available to all clinical users in our hospital, providing a secure and efficient way to capture clinical images and to insert them into the EHR. Future clinical image apps should more closely link clinical images and clinical documentation and consider enabling secure transmission over public WiFi or cellular networks.
authors.affiliation: Brigham and Women\'s Hospital, Department of Emergency Medicine, Boston, MA, United States. alandman@partners.org.
authors.forename: Adam
authors.identifier: http://orcid.org/0000-0002-2166-0521
authors.initials: A
authors.lastname: Landman
authors.forename: Srinivas
authors.identifier: http://orcid.org/0000-0002-6217-5792
authors.initials: S
authors.lastname: Emani
authors.forename: Narath
authors.identifier: http://orcid.org/0000-0002-6601-6035
authors.initials: N
authors.lastname: Carlile
authors.forename: David I
authors.identifier: http://orcid.org/0000-0001-9033-6349
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Simon
authors.identifier: http://orcid.org/0000-0001-6445-2960
authors.initials: S
authors.lastname: Semakov
authors.forename: Daniel J
authors.identifier: http://orcid.org/0000-0002-8517-9702
authors.initials: DJ
authors.lastname: Pallin
authors.forename: Eric G
authors.identifier: http://orcid.org/0000-0002-7251-5842
authors.initials: EG
authors.lastname: Poon
keywords: electronic health records; mobile phone; photographs; telemedicine