Working with Images
Images, diagrammatic or photographic, offer a great way to record important clinical observations. A picture of a pressure ulcer, for example, best communicates about the evolution of a wound and its response to treatment.
Connect Care mobility apps support secure capture of clinical images at the bedside, with automated attachment to the "Media" section of a patient's chart. Additionally, the Media Manager can be used to import and attach external images (acquired outside of Connect Care) to the chart. Any images attached to the patient's chart can be incorporated into documentation either directly (image inserted) or indirectly (link inserted).
Direct - Embedding Images
Images embedded within documentation are immediately visible to the reader. The note author can change the image size and can insert as many images as needed within one note. In this way, for example, the progress of wound healing can be documented by facilitating direct comparison of images taken on different days.
Embedded images can also take the form of diagrams, such as a body outline, annotated to indicate the location of cited findings.
Embedded images can significantly add to the file size of a documentation object, and so must be used with care. This is especially true for summative documentation shared with external systems (see Shared Documents) where no more than 2 small embedded images should be used.
Indirect - Linking Images
Links to images can be embedded within clinical documentation. The reader can then select (click on) the link to get a quick pop-up display of the image of interest.
Note that image links may not be resolvable (and so not viewable) in summative documentation (e.g., consult, discharge summary) viewed in external health information systems, such as the Alberta Netcare Portal. This is because documents are converted to .pdf files before sharing and the document is exported alone. It is not packaged with materials that appear as links within the document.
Documentation Image Norms
We recommend use of image links (as above) for progress documentation (e.g., progress notes), unless the reader would benefit from comparing a few fully embedded images. Progress documentation remains within Connect Care, embedded links are easy to use, and the resulting notes are easier to read. This practice also aligns with Connect Care Copy-Paste Norms.
Clinical image links should not be added to summative documentation (History & Physical, Consult, Discharge Summary, Transfer Note, Procedure Note), as these documents are shared with external systems that may not be able to view the links. If it is clinically important to include high-value images, then embed no more than 2 and size each to the smallest dimensions adequate to the documentation need.
Capturing Images using Connect Care Mobile Apps (Haiku, Canto, Rover)
Clinical image capture is initiated when Haiku, Rover or Canto are opened to a specific patient chart.
Haiku
Tap the patient portrait image at the top left of the Haiku chart display and use the "Capture Clinical Media" button that appears. Once an image is captured and approved, it becomes available via Media Manager in Hyperspace and also via "Insert Image" buttons in clinical documentation tools.
It is also possible to capture an image directly into a note started with Haiku by using the "Notes Entry" tool within an opened chart and then selecting the camera icon to take a photo that is immediately incorporated into the note. In this way, a draft progress note can be initiated using Haiku (with clinical image(s) included) that is later edited and finalized in Hyperspace.
A "Media" tool within a patient chart opened in Haiku allows captured images to be further managed, including the deletion of those that are no longer wanted.
Canto
Access to the "Capture Clinical Media" tool parallels actions in Haiku. Select the patient portrait image at the top left of an opened chart. Image capture directly into notes is also supported within the "Notes Entry" tools, and basic image recovery and management is possible using the Canto "Media" activity within an opened chart.
Uploading Images to Media Manager
Inserting Images using Note Insert
As described above, Haiku and Canto support direct capture of images from a mobile device camera into a draft documentation note.
Similar capabilities exist in Hyperspace when a note is being edited, except that the inserted image is pulled from either chart media or a file on the local computer.
With a note opened in editing mode, select the "Insert Image" button or menu command.
By default, the user is presented with encounter-specific images already attached to the chart. These may have been captured using Haiku or Canto. Any image can be incorporated into clinical documentation.
In addition, a "Browse" button at the top of the Image Selector pop-up allows browsing of the local computer file stores so that an external image can be inserted into the note. Supported image formats include: Windows bitmap (.bmp), fax and scanner images (.tiff), JPEG (.jpg), Graphic Interchange Format (.gif) and Portable Graphics Format (.png).
Linking Images using Copy Link
Images can be "linked" into progress notes using the same method promoted for referencing laboratory reports, other documentation or external documents.