BetterPhoto Q&A
Category: New Questions

Photography Question 
James Kerrigan
 

Camera to photograph medical records


I am in need of a digital camera to take pictures of medical records. The images will need to be of such detail that I will be able to determine the treatment that was performed by viewing the images. The images will be taken in the medical facility, therefore, the best light will not always be available. These records will also need to stand up in court so a third party will have to easily be able to determine what was written/typed. My budget is $250 for the camera. Could someone provide a suggestion for a camera and also suggestions on taking the pictures?


To love this question, log in above
9/26/2007 5:47:45 PM

 
W.   
Hi James,

if you're not really familiar with photography you need a fully automatic system. Any quality compact point & shoot with macro mode and selftimer for under $250. Rig a simple reproduction stand. Place the reproduction stand over the document. Select macro mode and selftimer on the cam. Stick it in the repro stand face down. Press shutter halfway to focus. Compose using the LCD. Press shutter button all the way down and release the cam carefully. Without shaking it. Stand back and wait till the sequence is finished.
Repeat with the next document.

Long shutter times aren't a problem with a reproduction stand of some kind, and a selftimer. Carefully taken reproduction photos like that ought to be very useful in legal proceedings.

If you will be racking up thousands of photos like that, however, you may want to pay specific attention to the way you manage them. You will want to be able to instantly retrieve any given document, won't you?
That's the software.
How about the hardware? Have you got a PC or Mac that can handle processing large volumes of high-resolution photos? Got a big enough harddisk?

Oh, and the legal aspect:
you will be building a database with confidential personal records.

Are you allowed to do that?


To love this comment, log in above
9/26/2007 6:50:52 PM

 
Carlton Ward
BetterPhoto Member Since: 12/13/2005
Contact Carlton
Carlton's Gallery
carltonwardphoto.com
  James, will a scanner do the trick ? Way better quality plus cheaper & easier than trying to get good lighting on a document to take photos. If you can take a laptop and scanner to the medical facility, this is the way I would go.
My .02,
Carlton


To love this comment, log in above
9/26/2007 8:27:31 PM

 
James Kerrigan   Thanks for your answers. A couple of questions from the answers. First, we will not have the ability to set up a reproduction stand as often times we are placed in cramped spaces with not great light in which we do our audits. Additionally, storage is not an issue as we have plenty of server and storage space and have laptops that are synced to our servers from the field.

The scanner was considered but we fly around the country and to take a scanner and laptop is quite a bit, unless you have any specific scanners in mind that are small but practical. Most that I have seen that can scan several pages per minute are the size of small printers and not really feasable for travel. I was hoping you had some scanner suggestions that I may not have been able to see. As FYI, we will be scanning approximately 200 pages per day.


To love this comment, log in above
9/27/2007 6:16:47 AM

 
W.   
Sorry, James, but if a small setup like a reproduction stand can't even be used – for TWO HUNDRED documents a day! – and you need to do that work in "cramped spaces with not great light", all that sounds as if it's not regular medical document reproduction. As if it's got be done very quickly, on the sly! Without anybody noticing.

Sounds like you're trying to do something very ILLEGAL!


To love this comment, log in above
9/27/2007 6:28:25 AM

 
Raymond H. Kemp
BetterPhoto Member Since: 4/2/2004
  Check out Ambir's Travel Scanners. They have a couple of models that are less than 250 bucks. Not sure how fast they are.

W.S., what is so illegal about what they are doing? Here in the States, medical providers must adhere to HIPAA and that includes any sub contractors which also are required to adhere to HIPAA via a BAA (Business Associate Agreement)with the covered entity.

Ray


To love this comment, log in above
9/27/2007 6:45:38 AM

 
James Kerrigan   W Smith, while your answers are appreciated, your comments that keep alluding to something illegal are very inappropriate. Auditing medical facilities to ensure compliance with participating rules is routine. The reason there are cramped spaces and low light is because medical facilities do not really want us there and often times do not want to provide us with quality space (sometimes, they are very hospitable). The reason I provided this information upfront is so that others could respond with suggestions knowing the difficulties that we run into. Therefore, I suggest you discontinue your assumptions and stick to the topic. Now, could someone explain what a simple reproduction stand is?

Ray, thanks for your input, I will also check out those scanners.


To love this comment, log in above
9/27/2007 7:53:14 AM

 
W.   
James,

"Auditing medical facilities to ensure compliance with participating rules is routine" sounds nice and official, but that doesn't jive with a budget of $250, and it doesn't jive with having to do it in "cramped spaces and low light"... Whichever way you cut it, it sounds very unprofessional.

For 200 docs a day, every day, you need a scanner. Not a camera.


To love this comment, log in above
9/27/2007 8:44:59 AM

 
Gregory LaGrange
BetterPhoto Member Since: 11/11/2003
gregorylagrange.org
  Think he's trying to tell you that the hospitals don't like people checking on them to make sure they're doing things the way they're supposed to. Like cops don't like internal affairs looking in on things.
So they try to make things difficult out of spite.
But a reproduction stand is really just an easel, that also has something to affix your camera to, to hold something flat and/or upright so you can take a picture of it and get the least amount of distortion, and keep things clear from edge to edge. Easier than taping documents to a wall, or standing on a chair looking down.
A scanner does sound easier at first, but you need to bring at least a laptop to hook it up too.
Although there is a document scanner I think from sharper image that has a small tube shaped one. You drag it over the paper, secret agent like, and it saves the image on a jump drive. It's relatively new so I doubt it's less than $250.


To love this comment, log in above
9/27/2007 11:06:01 AM

 
W.   
"So they try to make things difficult out of spite."

Like I said: very unprofessional.


To love this comment, log in above
9/27/2007 12:36:32 PM

 
John G. Clifford Jr
BetterPhoto Member Since: 8/18/2005
  There are also scanners out there that move the paper over a scanning slit. They're about the size of a paper towel roll core, so they're very portable. Yes, you will need to have a laptop, but you can get a ultra-mobile PC (UMPC) for around $1k that is the size of a VHS cassette, or you can use one of your existing laptops.

This would be the best solution for document imaging, and the scanner is going to be cheaper than a digicam.


To love this comment, log in above
9/27/2007 2:53:38 PM

 
Gregory LaGrange
BetterPhoto Member Since: 11/11/2003
gregorylagrange.org
  "Like I said: very unprofessional."

Hey, the health care system. If you're not rich, don't ever get sick.
So the saying goes.


To love this comment, log in above
9/27/2007 5:42:33 PM

 
Mark Feldstein
BetterPhoto Member Since: 3/17/2005
  Personally, I don't care what James does or doesn't do with his copy camera or scanner. But, I just can't stand it any more and I really feel compelled to say something in response to an underlying issue here.

It appears to me that James is working for an insurance company auditing selected doctors for either fraudulent practices or supporting reasons for treatment based upon standard "medical necessity guidelines". You know, things like "was removal of that brain tumor really medically necessary to the patient's well being".

This is just another in an escalating and seemingly never ending battle of distrust between doctors, patients and the insurance companies. For example, there's now an entire conglomerate called the Medical Information Bureau in Massachussetts that acts as a clearinghouse, exactly like a credit bureau, for confidential medical information based on diagnostic codes providers use to bill insurance companies for their patients. The purpose of this huge and growing database, is for ins. companies to see which patients have what conditions prior to either issuing a policy or to determine preexisting conditions before denying payment in many situations for ongoing conditions when someone changes carriers. When someone is denied coverage, they're listed in this database. Their monthly magazine touts how to catch people cheating on their insurance coverage, including doctors and patients. In many instances, these denials turn into battles of attrition.

BTW, the MIB was brought about courtesy of the HIPAA laws that allowed insurance companies to transmit patient information electronically. In part, it was represented as a bill to protect patient privacy, and in some ways it does but it also makes it more difficult for doctors to share info re. patients between themselves and other doctors for the benefit of their patients. Another area of distrust.

More and more physicians, psychologists, labs, etc., are making less and less notes in patient charts to avoid breaches of confidentiality rules that insurance companies want to violate to avoid payment of legitimate claims. In terms of admissibility in court, there are rules, such as the best evidence rules and chain of custody rules, prohibiting admission of copies when the original is available together with a custodian of those original records to testify that they have not been altered prior to being presented in court. So, my guess is that James' company does nothing more than use the copies to determine medical necessity prior to denying payment for procedure. This is a process that can be circumvented by the doctor providing his own records to the medical necessity review committee at the particular ins. co.

If he works for an attorney service, that's a different story. They go around gathering records for litigation or workers comp cases under less surreptitious circumstances, usually with some sort of judicial request for records that the doctors offices are too busy to deal with on their own. Under the federal rules of evidence, those records usually (I say usually because there are exceptions)can't be admitted into court records without testimony of a designated records keeper or the person who wrote them or made and / or interpreted the diagnostic test results like x-rays, CT scans, MRI's etc.

Every night when I go to sleep I pray for socialized medicine and that insurance companies promptly and summarily get put out of business in a single payor system. This is especially true in a country that prefers to fund an illegitimate war rather than fund health care for impoverished children. I don't get it. It just adds to the devisiveness in this country and personally, I really hate it.

That's my story and I'm sticking to it.

Take it light. But lobby for a single pay insurance system. This whole train wreck has GOT to stop ;>)
Mark


To love this comment, log in above
9/28/2007 9:28:29 AM

 
Carlton Ward
BetterPhoto Member Since: 12/13/2005
Contact Carlton
Carlton's Gallery
carltonwardphoto.com
  Yeah Mark,
You hit quite a few nails on the head there. I replied thinking more along the technical aspects but after W.S. & Gregory's responses, I started to think along deeper lines. If I didn't have overpriced insurance through my company, I couldn't afford it and it just looks bad that the mighty USA is behind many other countries in caring for their citizens. Insurance companies, Lawyers, General Dynamics, Pharmaceuticals, Faux Newz & Brittney Spears are controlling our lives and the "Fat, Dumb & Happy w/remote" hold down a solid 30% of our populace. Keep em dumb so they are easier to control and make them afraid so they will do what they're told and call the protesters UnAmerican so they will be chastised. I have been sick of this since the Chimp stole both elections and the machine (FCC) behind the media (6 corporations own 90% of what we hear or see on radio/TV) AOL/Time Warner, Bergleman, News Corp, Viacom & Disney are all under the control of Clear Channel Communications. These are tactics used by dictators and communist regimes. We have enormous freedom that was fought for and given to us by our forefathers (Madison, Jefferson, Franklin) and we have to fight to retain those rights from the criminals that are running the country.
Rant over....


To love this comment, log in above
9/28/2007 11:15:07 AM

 
Mark Feldstein
BetterPhoto Member Since: 3/17/2005
  Boy Carlton, you hit quite a few yourself there. For what it's worth, I agree with you. Thanks !!!

The present health insurance system here has really become essentially a war of deceptions on all sides of the fences currently dividing the population. It's really a shame.

I think it's rare these days (and really unfortunate) that anyone other than old(er) hippies like us still "questions authority". For those of us still doing that, don't stop !!! Don't stop !!!
Mark


To love this comment, log in above
9/28/2007 3:28:27 PM

 
Raymond H. Kemp
BetterPhoto Member Since: 4/2/2004
  Well, if you two old hippies are going to question authority, as it is our American right to do so, then you may want to have all of your facts correct.

Mark, MIB (Medical Information Bureau) has been around for decades and was in no way “brought about courtesy of the HIPAA laws.” It was formed way back in 1908 as a means for member U.S. and Canadian insurance companies to protect themselves from “attempts to conceal or omit information material to the sound and equitable underwriting of life, health, disability income, critical illness and long-term care insurance.”

The enactment of the current HIPAA laws was not for the purpose to allow insurance companies to transmit patient information electronically. Many companies before HIPAA were already doing that. But HIPAA did mandate the use of electronic claims processing. HIPAA was designed as a means to reduce administrative medical costs by standardizing the process of electronic claims submission and the security of patient records, which prior to HIPAA was a patchwork, governed by States.

HIPAA was born during the Clinton administration (originally known as the Kennedy – Kaussebaum Health Insurance Reform Bill) and for a brief period the rule establishment date was enacted by Clinton as one of his several “eleventh hour” executive orders just before his presidency ended. Bush canceled or delayed “scores” of Clinton’s eleventh hour orders, which included the delay of HIPAA. Bush reversed his delay order and the rule effective date was set for April 2001.

I feel bad for James for all he wanted was some info about using a digital camera to record some documents. For his query he was practically accused by W.Smith for doing something illegal, which coming from W.Smith doesn’t surprise me one bit.

Then Mark and Carlton decide this is a good place to setup their soapbox and proceed to go into a completely over the top political rant. Mark, you spent time to write seven paragraphs that has nothing to do with photography! Carlton you wrote one big one. And myself, I just realized I wrote six and they too have nothing to do with photography. See, now you got me doing it! Good night.

Ray


To love this comment, log in above
9/28/2007 5:49:39 PM

 
Mark Feldstein
BetterPhoto Member Since: 3/17/2005
  Well Raymon, I'm glad to see you attempting to ride to the rescue of James, although I think it's really unnecessary. OTOH, IMHO if you don't like what you're reading, you've still got the right to change the channel and go read something else. Insofar as I know, that right, along with our corresponding right to freedom of speech. As far as I know, the republicans haven't totally torched that one yet although I understand they're working on it.

While the MIB may have been formed in 1908, they hardly had the prominance or ostensible authority to actually do what their charter allowed them to do until HIPAA. Read the congressional intent, the federal register and proposed. Also read the interviews of members of congress and the senate who were lobied by the insurance companies for passage of the electronic portions of that bill. It's rather enlightening.

Now what were you saying something about scathing attacks toward someone who disagrees with you?
Take it light and lighten up a bit ray. Have a good weekend.
M.


To love this comment, log in above
9/28/2007 7:01:13 PM

 
Gregory LaGrange
BetterPhoto Member Since: 11/11/2003
gregorylagrange.org
  Now I'm confused about who I should throw my tomatoes at.


To love this comment, log in above
9/28/2007 10:06:46 PM

 
W.   
Me, of course!


To love this comment, log in above
9/29/2007 4:41:09 AM

 
Mark Feldstein
BetterPhoto Member Since: 3/17/2005
  Greg, if they're rotten (particularly rotten and malodorous) let's see....(processing, please wait....) OH !!! I know who and it's NOT W. In all likelihood, someone among us who supports MIB in their efforts. Perhaps a donor to them of some sort.

If those tomatoes are fresh, let's make salads.
M.


To love this comment, log in above
9/29/2007 9:15:34 AM

 
Mark Feldstein
BetterPhoto Member Since: 3/17/2005
  Speaking of tomatoes...I gotta go. I smell fertilizer in the form of bovenis excrementis. 0/:>0).
M


To love this comment, log in above
9/29/2007 9:17:09 AM

 
Log in to respond or ask your own question.