Best Practices for Medical Photography in Blood and Marrow Transplant (BMT) Long-Term Follow-up (LTFU) Telemedicine

Abstract

Topic Significance & Study Purpose/Background/Rationale BMT survivors have complex follow-up needs including treatment of chronic Graft vs Host Disease (cGVHD). After the first 100 days, most care is provided in community settings. Our LTFU program supports greater than 6,000 survivors and their community providers via telemedicine, an on-site clinic and ongoing research. The use of photography in telemedicine allows LTFU to remotely assist patients who would otherwise need to travel a distance to the BMT center and prioritizes the most urgent cases for in-person evaluation. Photography is a useful tool for cGVHD affecting skin, oral, and joint/fascia, both for initial diagnosis and assessment of response to treatment. Education is essential to ensure patients and providers capture key diagnostic features in quality photos. Methods, Intervention, & Analysis LTFU clinic nurses take medical photos prior to BMT service discharge to establish a baseline, as well as with every LTFU visit. When patients or community providers contact LTFU to request consultation, they are asked to securely email photos to LTFU. Photos are saved in a private database filed by patient name and date. Photos are reviewed by the LTFU telemedicine team in rounds and compared to prior dates. Recently developed educational pamphlets and an instructional video are located on the LTFU website, providing detailed instructions for medical photography of skin, range of motion, and oral cavity. Photos of classic cGVHD signs are used in education materials for patients and providers. Findings & Interpretation A comprehensive photography program for LTFU patients should be based on best practices and be responsive to technology changes and process improvements. Standardized processes, consistent verbal and written communication, and concern for security of patient photos ensure the foundation for a successful photography program. Initial evaluations of process improvements to the photography program have been favorable. Discussion & Implications Continued access to LTFU experts is critical for community BMT survivors. The BMT center's photography program allows for improved diagnosis of cGVHD, reveals physical changes over time, and informs the triage process for scheduling patient visits on-site. Newer technologies may become available for digital file transfer to increase efficiency. Currently only still photographs are used, but looking ahead, LTFU is exploring videography or livestreamed physical assessments.