ClickCare Café

Cameras -- What Really Works for Long Term Care & Care Coordination?

Posted by Lawrence Kerr on Tue, May 17, 2016 @ 07:30 AM



The early days of telemedicine and telehealth brought extensive discussion about images. When we started working with nurse practioners in school-based health setting, most people hadn't used a digital camera, much less thought about diagnosing something through a digital image.

To be fair, the quality of those early images was so dramatically far from the images we have now that some discussion was certainly justified. But most discussion was simply based on fear and knee-jerk reactions.

Even today, though, there are concerns about the quality of photos. As this study puts it, "Smartphone cameras are rapidly being introduced in medical practice, among other devices for image-based teleconsultation. Little is known, however, about the actual quality of the images taken."

The results of that study were clear, though.Three different platforms (Apple, Blackberry, Android) were compared to a Canon professional its a 35 mm lens. Assessment was by lay people and common pictures, thus reducing clinical bias. The iPhone exceeded the function of the professional camera. And when comparing digital cameras to in-person appearance, two conclusions were drawn:

  • The camera did just as well as viewing with the naked eye; or,
  • The camera was superior.

It's not hard to think about why this might be when you remember trying to see something in a squirming child or fidgety elder, for example. It is easier to have the subject “hold still” with a 1/100th of a second exposure and quiet unhurried study than struggling to pinpoint a small rash on a moving target.

Many studies documented the equivalency or superiority of digital images in the five years before and after the turn of the century. The obvious specialties were radiology (now exclusively digital), wound care, dermatology, plastic surgery and pathology.

Chase Jarvis said: “The best camera is the one with you." And we always say: The best camera is the one in your pocket. With the advent and advances of smartphones since 2010, we have made several design decisions. One of the major ones was the use of the iPhone and later, the iPad, as an input device -- for exactly this reason -- it is always with you and you already know how to use it.

Our one caveat is that you should never use the camera roll in your smartphone for medical photos. With iClickCare, the camera roll is within the application, password protected, and separate from the routine pictures of vacation and kids. And that, or something similar, is the only HIPAA secure way to take medical photos on a smartphone.

If you're using photos for medical collaboration or care coordination, you can get our ebook on medical iPhone photography here:

Buy Medical iPhone Photography


Tags: telemedicine, medical collaboration, iPhone photography, HIPAA, Telemedicine and HIPAA, HIPAA secure images, long term care, care coordination

Are High-End Cameras and Hardware Key to Telemedicine Success?

Posted by Lawrence Kerr on Thu, Jul 23, 2015 @ 07:00 AM


For a long time, telemedicine was considered to be something sophisticated and difficult. It has often been seen as the province of expensive equipment, complex cameras, and burdensome scheduling.

Of course, when video teleconferencing was the only option for remote collaboration and consultation, that was the reality to some extent. We saw so many hospitals invest in expensive hardware, only to find scheduling tricky, workflow difficult, and the technology very quickly becoming obsolete.

The reason we have been such vocal advocates for Hybrid Store and Forward telemedicine is that you can use any computer or smartphone to do the telemedicine consult, and at your convenience, since you don't have to be available for a videoconference at the same time of other providers.

The cameras that iClickCare users use to capture images of patients for these consults are, amazingly enough, their smartphones. We've found that when used through iClickCare (which doesn't use your phone's camera roll), these images are both HIPAA secure and of more than adequate quality.

But can the camera in your phone -- the one that's always in your pocket -- be good enough?

Apparently institutional thinkers and government regulators and reimbursement specialists can't believe it. Reams of policy and procedures have been written and payment for simple secure store and forward telemedicine has been slow to be accepted by CMS.

In our experience, and from stories of iClickCare users across the country -- smartphone cameras are actually superior to regular cameras, since everyone already knows how to use them. We did extensive testing in order to write our book iPhone Medical Photography and documented the validity of replacing the complex with simple. That is why we were so interested to notice a blinded study that finding that several smartphones outperformed a respected digital camera. Of these, the iPhone was top of the list. The authors successfully removed variables in the design of the study by blinding the study, using more objective lay evaluators, common objectives, and random camera order. As we teach, the principles of good medical photography are even more important than camera type.

And above all, the most important thing is not what you're using, but that you just do it -- that you work to collaborate with the tools available to you, whatever those may be.

Click below for our free primer on Hybrid Store-and-Forward telemedicine -- so you don't need expensive hardware.


ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine, iPhone photography, Medical iPhone Photography, hybrid store and forward medical collaboration

Are You Making HIPAA Mistakes in Sending Medical Photos Online?

Posted by Lawrence Kerr on Thu, Feb 13, 2014 @ 08:54 AM

babyemail resized 600

(Reviewed and updated May 18, 2016)

Recently, we've shared our suggestions on how to share patient files securely and the best ways to take medical photos. From those posts, an additional question came up from our readers who are using technology but still trying to stay HIPAA secure...

How do I send medical photos securely over the internet?

Good question! Many of the tactics for staying HIPAA-safe while sending medical photos over the internet came up in our recent posts, but there are a couple of specific things to keep in mind.

When sending medical photos on the internet, don't make these HIPAA mistakes:

  • Texting from your phone. As with texting patient information, you can't text photos unless you use a secure service. Merely texting from your smartphone definitely won't do the trick when it comes to HIPAA, even if it's just a patient photo (without their record.) 
  • Saving photos on your camera roll. Few people realize that the camera roll on your smartphone is not HIPAA-secure. ClickCare uses a HIPAA-secure camera roll for that very reason.
  • Sending photos via email. Email isn't HIPAA-secure, even "secure" email. If you're looking for the kind of sharing that email and photos can give you, consider doing medical collaboration with a hybrid store-and-forward telemedicine platform, which can let you share photos while not running afoul of HIPAA. 
  • Leaving them on your data card. A final thing to be careful of is the data card in your digital camera. If you store your data card in a place where people can get to it, or you're sharing your camera with other people, that data card is not HIPAA secure. The system we recommend is to erase the data card as soon as you've uploaded your photo to the secure sharing platform you're using. 
  • Saving them on your hard drive. As safe as it may seem, in most contexts it is not HIPAA-compliant to leave patient photos on your computer's hard drive. So use the same protocol as with a data card -- erase the photos as soon as they're uploaded to your telemedicine platform. Did you know your copier also has a hard drive - the old way may not be so safe either!


For an in-depth look at HIPAA mistakes you might not know about, get our guide:

New Call to action

Image courtesy of ben_grey on, used under Creative Commons rights.


Tags: iPhone photography, Medical iPhone Photography, medical collaboration software, HIPAA, HITECH, Telemedicine and HIPAA, HIPAA secure images, mhealth, iPhone medical apps, medical photography

What is the Best Camera for Medical Photography?

Posted by Lawrence Kerr on Tue, Feb 11, 2014 @ 08:58 AM

cameracloseup resized 600


I'll admit it: I love cameras.

I'm the guy that buys (and actually reads) the geeky magazines about new camera gadgets. I go to camera stores just for fun. And I've been known to bring a 15-pound video camera to my children's school plays.

Plus, as a surgeon, I've found medical photography to be a crucial part of my practice. Since the '70s, I've used photos to show patients their progress, teach medical students, and support my own learning and progress. And once we started experimenting with telemedicine and medical collaboration -- eventually founding ClickCare -- photos became not just helpful, but a fundamental part of what it means to practice medicine. I've found incredible satisfaction and powerful patient outcomes from using telemedicine to send simple photos and collaborate with other providers.

Because of my passion for using photos in medicine, I'm sometimes tempted to search out the best or most high-tech cameras for medical and clinical photography. The truth, however, is that you don't need a fancy camera to take great and effective medical photos.

When someone asks about the best camera for medical photography, I recommend 3 things:

  1. Use your iPhone. Most of us have a pretty high-tech camera in our pockets at all times-- our smartphone. Because of the convenience factor alone, I recommend that medical providers start taking pictures with their iPhone. In addition to the convenience, ease of use, and ever-improving quality, the connectivity of these devices makes it incredibly easy to make the small jump to medical collaboration with telemedicine. However, the is one very big caveat here. Saving pictures on your camera's camera roll is not HIPAA-secure. So you need to use a platform like ClickCare that allows you to save photos on a separate, HIPAA-secure, protected camera roll.
  2. Use whatever you already have. If you don't have a smartphone with a camera that you use regularly, my next suggestion would be to use whatever camera you do already have. Maybe it's your daughters snap-and-shoot or the camera of a provider down the hall, but I suggest using what you have, getting in the habit of taking pictures, and then using that experience to decide if you want to upgrade. Remember that one place a patient's health information can be exposed is on the card inside your camera, so that should be treated with the same care as you would a patient's record.
  3. Use whatever is easiest. Finally, I encourage everyone to keep it simple! Instead of getting a 1% increase in photo quality by spending $3,000 on a camera and taking 3 full weeks to learn how to use it, choose a camera that feels easy and accessible. The important thing is using medical photography in your practice -- not necessarily taking gallery-ready photos.


Finally, get our guide on taking effective medical photos in less than 5 minutes:


Medical iPhone Photography


Image courtesy of auggie_tolosa on, used under Creative Commons rights.

Tags: medical collaboration, iPhone photography, Medical iPhone Photography, medical collaboration software, best medical apps, clinical photography, medical photography

A Telemedicine Solution is also a Gift Solution

Posted by Lawrence Kerr on Tue, Dec 11, 2012 @ 10:47 PM

We are all busy taking care of patients. How can we find time to buy the perfect gift? Consider this book; it's not a complete telemedicine solution like iClickCare, but it is a building block for any medical image sharing.

- Improve your skills.
- Be sure you have time off.
- Give a Gift.


Medical iPhone photographyImprove your Skills: Medical Photography with the iPhone

We are celebrating Medical iPhone Photography. This book is designed to be put in your pocket. Indeed, it is the exact size of the iPhone itself. Brief and concise, it shares over 30 years experience in medical photography from practicing physicians.

It falls into the long tradition of Harriet Lane's handbooks, American Heart Association's color-coded cards or even, your dog-eared crib notes.

Learn as you earn. In no time, you will have a new skill that will benefit your patients and make your iClickCare collaborations even more valuable. 


Full color, printed version is available on Amazon. >>

Buy the Kindle version here >>

Buy the Nook version here >>

Buy the Apple iBook here >>

Medical collaboration on callIt is the Holiday Season. Do You Know How to be Off Call?

You can be off call and still check on your patients when you get back. You can choose someone to cover (with their permission, of course). When you get back, you can see their responses go into the Everything Else part of your List. 

Check out the Online Web Help >>

Give gift of medical collaborationGive a Gift:

To Your Patients: Start collaborating today. At least take a picture that is HIPAA secure.

To Colleagues: Invite them to join you. They will have peace of mind by sharing responsibility. 

To Yourself: Work can be fun. Enjoy clinical photography with the camera that is in your pocket.

Happy Holidays and Best Wishes in the New Year!


medical photography introductory chapter

Tags: medical collaboration, iPhone photography, telemedicine solutions, clinical photography

iPhone Security, iClickCare and HIPAA

Posted by Lawrence Kerr on Sun, Mar 04, 2012 @ 01:35 PM

The New York Times reported this week that some iPhone apps were collecting users' address books and later, photos from users' camera rolls. Later, the same security risk was described in Android phones.

This risk does not apply to iClickCare. While the camera roll looks the same and works the same, it is placed within iClickCare itself, and thus is not accessible.

First layer of HIPAA security on iPhone

                                                               HIPAA security with login

When using iClickCare we recommend that you use the general device password. Of course, to use iClickCare a second layer of protection is provided since admission to the app is only by user name and password. iClickCare’s browser interface also needs the same login information. Parenthetically, users and usage are monitored by the secure server.


While any device can be hacked, it would take evil intent, and considerable skill, to breach iClickCare. We encourage use of the iPhone rather than a routine digital camera (which works with your desktop) in this very secure two-password schema, in that their is not a digital storage card which can be removed. Loss of the iPhone can also corrected by tracing and wiping the iPhone remotely. Of course, because iClickCare is software as a service, in the cloud, and instantly synced, your pictures and comments are not lost to you. They are unaccessible, however, to the iPhone thief if your lost phone was actually stolen.

More detail is available here:  The iPhone Camera Roll is described in greater detail in our book Medical iPhone Photography.

                                       Click me

Tags: iPhone photography, HIPAA, iPhone medical apps

Telehealth and the Big Blue Marble, Earth

Posted by Lawrence Kerr on Mon, Feb 06, 2012 @ 11:08 PM

Startling images were released this week by NASA.  They are a continuation of the theme Blue Marble, the first in a series being released from Apollo 17. The current set was taken from 28,000 miles away by the Suomi NPP satellite on October 2011.

collaborate with colleagues where ever you are

Attribution: NASA

Red, Blue, Green and more, combine to make a greater whole.

Pictures, Words and a collabortive attitude, combine to give: 

Access, Collaboration, Education

The images are awesome and inspiring. Not only a model of graphic explanation of data, but also the collaboration of color (red, green, blue) and of thermal infra-red imagery, two types of ocean data, radiotelemetry and observations of Antarctica -- they all combine (collaborate) to make a whole greater than its parts.

Telemedicine and telehealth are two names that elicit thoughts of technology. Medical collaboration is far more than technology.  Medical collaboration is an attitude, an attitude that values results and substance over regulation, stimulus and reimbursement. This attitude can be successful without technology. But, in this complicated world, technology can make it easier.  

access, collaboration, education

This diagram clarifies a complex process, and the process shows us a new view of our world. We feel that pictures and words supported by a strong technology can do the same for our patients. Carry on the conversation with us. 

medical photography introductory chapter  You can't produce these incredible pictures with your iPhone, but download this first and other chapters for free, or buy our book Medical iPhone Photography online at Amazon, Barnes and Noble, or iBooks.

We thank Goddard scientist Norman Kuring  for compiling these images.


Tags: telemedicine, medical collaboration, telehealth, iPhone photography, Medical iPhone Photography

Medical iPhone Photography, Call and Accountable Care

Posted by Lawrence Kerr on Wed, Dec 21, 2011 @ 02:12 PM

  • Improve your skills.
  • Be sure you have time off.
  • Consider Accountable Care.

Improve your Skills:  Medical Photography with the iPhone

medical iPhone photographyIt is now complete! We are announcing Medical iPhone Photography. This book is designed to be put in your pocket. Indeed, it is the exact size of the iPhone itself. Brief and concise, it shares over 30 years experience in medical photography from practicing physicians.

It falls into the long tradition of Harriet Lane's handbooks, American Heart Associations color-coded cards or even, your dog-eared crib notes.

Learn as your “earn.” In no time you will have a new skill that will benefit your patients and make your iClickCare collaborations even more valuable.

Buy the Kindle version

Buy the Nook version



It is the Holiday Season. Do You Know How to be Off Call?


You can be off call and still check on your patients when you get back. You can chooseclickcare collaboration on call someone to cover (with their permission, of course). When you get back, you can see their responses go into the Everything Else part of your List.



Upcoming in the New Year...

Last year’s strange word is next year’s buzzword. What do you know about ACOs, accountable care, and care coordination? How are payments made? Who participates? Why is this occurring?

We will be discussing this in the next few months and try our best to simplify the confusion and government speak.

Please help us plan by answering these three short questions. 



  Click me



Tags: iPhone photography, accountable care, ACO, medical photography

Chapter 9: Bringing It All Together for Care Coordination

Posted by Lawrence Kerr on Wed, Dec 14, 2011 @ 01:30 AM

This is the ninth week of our chapter-by-chapter release of Medical iPhone Photography.

Many of you have loyally downloaded each chapter as it has become available.

You have learned:

  • Tips and Tricks and the technical reasons behind them.
  • Good principles of clinical photography also known as medical photography.
  • Some subtle aspects of the iPhone as it is used to take care of patients.

Coordinated Care with PicturesThe book is now about to be published in iBooks in the Apple iTunes store, in Amazon, and in Barnes and Noble’s eBook section. Of course, this is complex, and while we delayed this post until everything was tied up with a bow for the holidays, we aren’t quite there yet.

One pleasure of ClickCare is working with wonderful people. For example, the world expert on electronic publishing, Liz Castro, has graciously and expertly helped us finalize our electronic version of the complete book. So stay tuned for our release announcement of the complete Medical iPhone Photography book. We will tweet it as well.

The print version also has been proofed and is ready. It is just the right size (iPhone size) to fit in your pocket and be a holiday gift.

So what is coming in Chapter 9?  We will talk about iClickCare itself, and how it incorporates the excellent medical photographs you have learned to take, and how it allows them to be quickly and conveniently used for discussion and collaboration. HIPAA and HITECH security are both baked in, and managing the network is familiar and easy. If you have an organizational administrator setting things up, fine, and if not, you can do it yourself.

Look for the printed version as well as the electronic forms. We are aiming to make your holiday shopping easier just now, and the rest of the year stress free as well.

In the meantime download Chapter 9 now, and see the finished picture.

  Click me


Tags: telehealth, iPhone photography, iPhone medical apps, clinical photography, medical photography

In Chapter 8, a Unique Way to Collaborate with Photographs

Posted by Cheryl Kerr on Thu, Dec 08, 2011 @ 10:29 PM

  • More than clinical photography? Can you photograph the xray viewer?
  • Can you send ECG's or gastroscopy findings?
  • What are some traps that need judgement?

We continue to be excited sharing decades of experience in use of photographs for better collaboration. In this chapter, you wil feel even more comfortable in documentation both descriptively and visually. Medical students, therapists, aides, all can send each other those unique pictures which will enhance care coordination and make healthcare immensely better.

ECG can be photographed and sent for care coordination

For the past couple of months, our readers have seen how to enhance quality from that small camera "in your pocket." Together we are amazed at the results of imagination coupled with these simple techniques. We also marvel how simple and "good enough" combine with good judgement and good intent to greatly benefit the patient, but also give satisfaction and peacefulness to the provider.

Click me


This is the next to last chapter in Medical iPhone Photography until the book is both an iBook for the iPad or iPhone or a PDF for everything else. Then the book will become available in printed form for holiday giving to your favorite healthcare provider.

Tags: iPhone photography, mhealth, care coordination, medical students

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