Data Storage and Retrieval

All communications are part of a patient record and potentially legal documents.

Storage and retrieval has to satisfy several demands:

• Easy to do as part of the regular process. You may want to return to images and text as part of ongoing exchanges.
• It should be backed up beyond the normal level of your pc. This can be done using a cd or dvd writer. If you are part of a hospital network you may be able to transfer files onto a central server that is backed up regularly.
• A further back up option is to send and receive to a third party. This means that there is access to the files independent of yourself and this can be useful in your absence as well as backing up your data.
• All networks, pcs and back up media (eg cds) with patient data on should fulfil the requirements of the Data Protection Act. Eg, your pc will be password protected. Your trust will have a data protection officer to advise.
• Where patients have paper records, contributions to their care from teledermatology should be printed for inclusion in the notes.

Encryption

Encryption describes the process of making a message unreadable if intercepted or diverted from the intended recipient. Some services use the NHSnet alone as the required level of encryption. This would make data unreadable to those outside the NHS – probably. Others use additional encryption. When considering additional encryption factors to consider are:

• Cost
• Ease of use: it can take some time to go through the protocol of decrypting a message. An ideal system is invisible and means that once you have logged on to your computer you do not need to think about the process. However, encryption packages can do inconvenient things like shutting down after 20 minutes in case you have left your desk, require frequent changes of passwords or are time consuming when decrypting large files such as images
• Ease of installation: it is common to require installation at both the point of delivery (primary care) and receipt (Dermatology department). Someone has to do this and it can be a rate limiting factor, especially if it goes wrong and needs adjustment.

Anonymity

Where GPs/nurses are requiring feedback on a clinical problem, it may be possible to forward anonymised enquiries. The GP may use no personal identifier or an alias created for the exchange. The image may fail to convey identity. This material remains part of the medical record in primary care, but may not require encryption or use of the NHSnet.

Linkage to notes and clinical information

The most basic link is printing out the material and putting it in the paper notes.

Printing images takes time: it can be more convenient and give a better result to divert this to a medical illustration department who will have high quality equipment.

Electronic linkage to the notes is the next step and is commonly available in primary care. Typical GP patient data systems are able to store attached images and e-mail content.

There are some software packages designed to embrace the process of telemedicine/teledermatology. We do not know of one that stands out for recommendation.

Electronic linkage in secondary care should be considered in description of local solutions for the Electronic Patient Record. Some options might allow integration with departments of medical illustration.