---
title: 慈濟醫院皮膚科醫師會議
tags: note
---

### :memo: The disscusion : the use of skin lesion image in dermatology department - 221024
#### By: 洪彬彬 Jeshika、莊舒雅 Thalia、王偉恩 Wang Wei En 慈濟醫院皮膚科醫師 (Tzu Chi Hospital Dermatologist)

- #### Discussion:
- Q1: What are the skin captured images used for? Is it for tracking, diagnosis, and education?
A1: For disease tracking record, because curently the condition, observation, diagnosis and treatment plan [(S.O.A.P)](https://www.scmh.org.tw/dept/6409/service.html) are recorded in written form and are less effective for describing skin condition.
Several photos were used for biopsy records (before and after). Photos are also used to publish papers and research (photos without the patient's face)
- Q2: Is the image used in presentations or consultations between doctors?
A2: Yes, used for reports on regarding the development of a particular patient disease in internal department meeting （主治醫師）. Curently neither the report nor the captured image is stored in the medical record.
O1: Internal reports may not need to be linked to the medical record, but captured images during the encounter should be recorded in the medical record.
- Q3: When do general practitioners usually capture a patient's skin condition? for each patient, or patients with certain conditions?
A3: Surgery patients, tumors, special skin conditions
- Q4: When will the image be uploaded to the computer storage, per day / week / month?
A4: There will be a technician to move the photo from camera to computer once a few days
- Q5: Is the storage format year>month>week>patient's EMR number defined by the hospital?
A5: Because curently there is not any system so, it is old format to facilitate the search for patient encounter images.
- Q6: Do general practitioners feel non-standard storage formats also make it difficult to search for images?
A6: Yes, it would be better if there is an application/system that made it easier to record the patient's skin condition during an encounter and manage skin lesion image of a patient.
- Q7: Is the image integrated with EMR or stored individually separately and need to do a manual process of linking the patient/EMR data, the metadata along with the image?
A7: For now, the image is not integrated with EMR, the encounter is integrated with EMR but the practitioner will create one separate excel of encounter to record the encounter information and the image.
- Q8: Is there currently no system or app used to record and integrate skin lesion images with EMR?
A8: Less number of big hospitals have an application/system to manage skin lesion image
- Q9: If there is a system that integrates image, image information (patient, size, time), and pre-diagnosis information and EMR, will it help the general practitioner?
A9： Surely
- Q10： Do general practitioners annotate images to support tracking, education, diagnosis, and future AI research purpose?
A10: Yes, annotate on the patient's skin using a surgical skin marker.

- There are 3 methods of capturing images (Capture the worst part):
- Far distance photos: to see the spread of disease on the body
- Middle and close distance photos： to see the characteristics of the disease (color, depth)
- The image for tracking biopsy use is recorded in excel, clinical special cases will be recorded in a paper based table
- The tumor will be photographed with measurements accompanying the ruler, but inflammation is not necessary.

- Because skin lesion images is not well-integrated with the encounter, to make searching easier, there are 3 kinds of folders to record:
- Biopsy : year>month>week>patient EMR number
- Clinical special case
- Diseases: each disease in a different folder
- The requirement to define the parameter used in seraching skin lesion image and reports

- USG image is stored in PACS and used to create reports
- Currently some code systems do not provide code for specific skin lesion diagnosis, hope that there is a more specific code system for describing it