Telemedicine Resource Center

A State-of-the-Art
Teledermatology Application

derM-ED is a high-end, store-and-forward Teledermatology System developed by the Telemedicine Resource Center. This system consists of 2 digital imaging kits and several custom-programmed modules that integrates multiple services (paging system, secure mail and cold fusion servers) (A) with derM-ED application's image and document processing modules (B).

derM-ED system uses 2 digital imaging systems: a) 1 compact, pocket size digital camera that physicians can carry around, and b) 1 professional digital SLR camera with 10 megapixel DX format CCD and advanced wireless macro lighting kit. Macro shots creates the most difficult lighting situations in dermatological photography. They require a lot of light on the subject. The depth of field becomes so shallow when shooting close up and small apertures (f/22, f/36) creates the extra need for light. At the same time, since the camera is to close to subject, users can block the light from whatever they are using to illuminate the scene. Furthermore, standard electronic flash units cannot illuminate at macro distances. derM-ED system uses a wireless macro imaging kit that sets lighting rations between several units.

The software component of derM-ED application has a brand new clinician-centric interface. There is one input module which collects data for all automated tasks. Physicians 1) can check "ColdFusion database (physician on call)", 2) choose attending physicians pager numbers, and 3) e-mail addresses automatically from the pull-down menu, and 4) enter additional physician's pager numbers, 5) uniqnames, 6) add an alphanumeric page, and 7) text caption onto pictures through this one interface.

derM-ED application transfers all images, resizes, processes, optimizes, merges and creates one compressed PDF file from multiple images. This file is optimized for CareWeb integration.

After this step, the application connects to secure server and sends all pictures and referral automatically. At the end, it sends an alphanumeric page through the pager server and notifies all recipients simultaneously.

derM-ED application does not use any third party server or phone lines. At the end of each process, it deletes all data from the workstation and camera. derM-ED uses secure communication technologies and complies with all HIPAA rules.

A Step-by-Step Visual Guide for
derM-ED Application

Printable Instructions

(PDF Format, 292 KB)
To Download, right click on the link
and choose "Save Target As..."

Brief Summary:

I) Fill out the derM-ED Electronic Form.
II) Fill out the Dermatology Referral Form.
III) Once fully automated process begins, no user intervention is required; wait for the "Final Confirmation" message box.

Step-by-Step Instructions:

Step 1: Take the picture.

Step 2: Place the camera onto the docking station.

Step 3: Click onto the "derM-ED Application" icon and launch the program.

Step 4: a) Click onto the "TUTORIAL" button to read tutorial. b) Select your camera (Nikon Coolpix or Nikon SLR) and click onto the "SEND REFERRAL" button (click only once slowly onto the button; DO NOT double-click)

Clicking onto the TUTORIAL button will launch online derM-ED instructions.
To send a referral, choose Red Button for compact digital camera and choose Blue Button for SLR digital camera.

Online Tutorial:
http://www.med.umich.edu/telemedicine/dermed/

Step 5: Fill out derM-ED Electronic Form.

Information Panel - Panel 1

Click onto the "CLICK HERE" button to see today's on call physician list.

When you click onto this button, the application will connect to the following ColdFusion database interface.

Information Panel - Panel 2

Click onto the "UM Online Directory" button to learn additional pager numbers or uniqnames (optional).

When you click onto this button, you will see the following X.500 directory screen.

Information Panel - Panel 2

Click onto the "Search Pager Number" button to learn additional pager numbers (optional).

When you click onto this button, you will see the following Paging screen. Use this screen to search unknown pager numbers and enter this information into Panel 4.

Referral Panel - Panel 3

Click onto the "PHYSICIAN ON CALL" pull-down menu and choose today's on call physician. When you make a selection, derM-ED will automatically load physician's pager number and e-mail address into memory. Do not type same physician's information into Panel 4 (if you type, on call physician will receive duplicate messages).

This section is not mandatory and you don't have to choose any name from this menu.

When you click on pull-down menu, the following menu will appear.

Referral Panel - Panel 4

Enter additional 4-digit "UMHS PAGER NUMBER" and/or "UNIQNAME" into this panel. Please type uniqnames carefully. If you mistype the uniqname, the recipient will not receive it. Please do not type full e-mail address (i.e., DO NOT type "jsullivan@umich.edu"; type "jsullivan" only).

You can type up to 3 pager numbers and uniqnames. You can also type only 1 pager number and/or 1 uniqname depending on your needs (i.e., you might prefer to send e-mail(s) without a page or vice versa).

This section is not mandatory and you can leave this field blank.

P.S.
Novell Groupwise fills names automatically when you start typing last names in the e-mail window. This feature is Novell's protected proprietary and derM-ED does not have this autofill function.

Referral Panel - Panel 5

Enter your "ALPHANUMERIC PAGE" into this panel. All recipients (on call physician that you chose from pull-down menu and/or the pager numbers that you entered into Panel 4) will receive this message.

Please do not exceed 240 characters. Please note that if the recipient's pager is turned off or if Paging System is down, the recipient(s) might not receive the page. Please follow-up urgent referrals with a phone call if your page has not been returned in a reasonable amount of time (like all other page messages).

When you fill out the panel above, the application will connect to the Paging Directory and send your message to all recipient's automatically.

Referral Panel - Panel 6

Enter your "TEXT CAPTION" into this panel. This text will appear on all images. You can type a short definition of lesion, your diagnosis, date, name and CPI number up to 40 characters (including spaces).

The text you entered will appear on all images.

Referral Panel - Completing derM-ED Form

Click onto the "DONE" button when you finish filling out the form. Nothing is mandatory in the referral panel and you can leave all items blank.

If you leave all items blank, the application will only print a hard copy and not send any page message or e-mail.

Step 6: Dermatology Referral Form.

The application will download the most up-to-date REFERRAL FORM from the server and launch it automatically. At this point, derM-ED will wait for your input.

Please fill-out the form, and choose SAVE and EXIT (choose File>Save and File>Exit) when you are done. There is no time limit to fill-out the form. It is not mandatory to fill out this form, you can leave all sections blank and Exit.

You can also click onto the CLOSE button in the upper-right corner and choose YES when you see the following message: "Do you want to save the changes to derm_ed.doc?".

Please note that the application will not continue if you don't exit Word completely.

Final Step

Sit down, relax and have your coffee...

After collecting all necessary information, the application will perform various digital image processing algorithms, compress and optimize pictures, add text caption, create a PDF file, send all documents to recipients, print hard copies and finally send your page. This process takes several minutes and you don't have to do anything during this step.

Please DO NOT touch keyboard and mouse until "FINAL CONFIRMATION" message appears.

This Final Confirmation message box will disappear automatically in 30 seconds.
You can also Close this message box manually.

Tracking Referrals

Open TM-dermed proxy, go to Sent Items and track the delivery and read receipt of your referral from "Properties" window.

When you click on Groupwise > Sent Items > Properties menu, this interface will appear.

Future Enhancements

While we develop our systems, we always plan our future enhancements ahead. The next version will come with Pocket PC support, so physicians and nurses will be able to carry around their compact camera and history & referral forms.