Document Type

Original Report


Dermatology | Health Communication | Higher Education | Photography | Quality Improvement | Skin and Connective Tissue Diseases




Inpatient dermatology consultations can bring a mixed bag of pathologies. Due to the highly specialized nature of dermatology and the lack of dermatologic training in medical school, the dermatologic team is consulted for matters that range from non-urgent to pressing. Pictures are a critical component of dermatology and greatly aid in the diagnosis of cutaneous diseases. In the inpatient setting, pictures can help streamline diagnosis and prevent unnecessary tests or procedures. The purpose of this study was to evaluate for the presence of pictures in patients’ chart after a dermatology consult had been placed through EPIC at the University of Nebraska Medical Center (UNMC).


Baseline data was gathered for two months in regards to the presence or absence of pictures in patients’ charts upon consultation of the UNMC academic dermatology service. At the two month mark, a prompt was added to the EPIC order for dermatology consultation stating, “Are there pictures in the chart?” This prompt required the consulting team to check ‘yes’ or ‘no’ before proceeding with signing the electronic order. Data was then gathered after two months following initiation of the prompt.


In the baseline two months, 15/33 (45.4%) consults contained photographs. In the two months following the prompt, “Are there pictures in the chart?”, 57/71 (80.3%) of consult orders placed contained a photograph. A Chi-squared analysis was preformed and revealed a significant difference (Chi-squared statistic 12.823, p-value < 0.001) between the number of pictures placed in the chart with consult order before and after prompt.


By adding a prompt in the EPIC order questioning picture availability, a significant increase was seen in pictures taken by consulting teams. This can help improve patient care by decreasing time to diagnosis, preventing unnecessary testing or procedures, and practicing cost-efficient medicine.




Health Communication, Inpatient Dermatology, Photography, Medical Efficiency

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Table 1 QI.docx (12 kB)
Table 1

QI Figure 1.docx (46 kB)
Figure 1

Figure 2 QI.docx (89 kB)
Figure 2



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