A Picture is Worth a Thousand Words, but is it Worth a Clinical Diagnosis? 

As virtual consultations become increasingly popular, healthcare providers are adopting new tools to facilitate remote care and support clinical decision-making. One such tool is the use of image sharing apps, which allow clinicians to share and review images with patients in real-time.  

In the UK, the National Health Service uses a range of image handling apps to support the treatment of various conditions.  They are used in wound management to monitor wound healing progress over time, which helps clinicians identify issues early on and adjust treatment plans accordingly. In dermatology, images can be shared between patients and clinicians to assist with diagnosing skin conditions. In remote areas, image sharing can be used to diagnose and treat stroke patients, where clinicians remotely review CT scans to determine the best course of action. Image sharing can also be used to diagnose and treat eye conditions remotely using apps that allow patients to perform self-guided eye exams and share the results with an ophthalmologist. In sexual health, image sharing can be used to remotely diagnose and treat sexually transmitted infections using apps which allow patients to share images and results from home testing kits with healthcare providers for diagnosis and treatment. This is but a small list of examples where image sharing is being used in healthcare. 

While image sharing has been successful in certain areas at providing more efficient care, it does have its limitations and there have been instances where it hasn’t worked well.  There are cases where the image has been misinterpreted by the clinician resulting in an incorrect diagnosis and leading to inappropriate treatment, with one study which found the use of image handling apps for the diagnosis of melanoma resulted in a high rate of false positives. Poor image quality due to factors such as low resolution, inadequate lighting, or image distortion  can make it difficult for clinicians to interpret the image and make an accurate diagnosis. For example, a study published in the British Journal of General Practice reported that poor-quality images from smartphones and digital cameras were a major limitation in the use of telemedicine for wound management. Legal issues can arise when medical images are shared without proper consent or when they are used for unauthorized purposes, which can lead to lawsuits and other legal repercussions. There may be ethical concerns around the use of medical images, particularly when it comes to issues of consent, privacy, and autonomy. In some cases, the use of medical images may pose a risk to patient safety, particularly in emergency situations where it may not be possible to obtain or transmit medical images quickly enough to inform treatment decisions. As it stands, there is currently no of standardisation in image sharing protocols and clinical systems, and this could lead to difficulties in integrating different types of images from different sources and result in errors and confusion for healthcare professionals. 

Despite these challenges, image sharing can provide numerous benefits. Image sharing apps can facilitate seamless collaboration between healthcare professionals resulting in improved patient care outcomes. For example, a domiciliary clinician can remotely share an image with a wound specialist while visiting a patient’s home, for diagnosis and advice. Image sharing apps can help engage patients in their own care by allowing them to view and share their medical images, thereby improving patient engagement. Image sharing apps can help reduce costs associated with travel and consultations for both the patient and clinician, by reducing the need for in-person consultations. They can also improve data management by helping healthcare providers to manage and store medical images more efficiently. Ultimately, it helps to improve Improved patient outcomes by providing healthcare professionals with quick and easy access to medical images to enable decision making. 

Aside from the consultation room, image sharing can enhance training and education for healthcare providers, allowing them to learn from real-life case studies and improve their skills and knowledge. It can also make a contribution to future research by providing researchers with access to large, diverse datasets of medical images, allowing them to identify patterns and develop new insights. 

However, the question remains: is it safe to make a clinical decision based solely on an image? While images can provide valuable information, they do not provide the full context of a patient’s condition. As such, it is important to consider the limitations associated with image sharing apps before making a clinical decision based on an image alone.  As with any tool, it is important to weigh the benefits and risks and use clinical judgement when incorporating image sharing into virtual care. While there is potential for these tools to revolutionise healthcare, it is essential to approach them with caution and ensure that they are used safely and effectively.