How-To Guide

Table of Contents

Changelog

3.0 - August 09, 2019

2.2 - August 06, 2019

2.1 - April 05, 2019

2.0 - November 28, 2018

1.1 - May 31, 2018

1.0 - May 17, 2018

Introduction

Welcome to SkinIO - a full-body imaging/mole-mapping system that you can set up and use in office and even encourage your patients to use at home. SkinIO is specifically designed to build an objective visual timeline of patients’ skin and identify/track new or changed lesions over time. Using SkinIO is a straightforward process - through the iOS app, you will be able to:

For dermatologists:

SkinIO should be used purely as a visual aid as you examine patients; it is not diagnostic and is not intended to be used in lieu of an in-person medical examination.

For non-dermatologists:

While SkinIO results are reviewed by SkinIO’s in-house team of dermatologists, results are NOT a substitute for medical advice or diagnosis. Patients should contact a qualified healthcare provider if they have any questions or concerns about particular skin conditions or general health at any time.

Office Setup Checklist

As you set up SkinIO in your office, you should have the following items. Please contact setup@skinio.com if you are missing any items or need any additional supply.

Authentication

Login

When logging into SkinIO, you will be presented with a list of recently logged in users on the left hand side. If you see your name listed, you can select it and sign in using your PIN or password. If your name is not listed, you can sign in using your username and password after selecting “Other User”.

Username + password login
Username + password login
PIN login
PIN login

PIN

Immediately after logging in for the first time, all medical staff will be prompted to set a security pin. This pin is tied to the account and is shared between all devices a given doctor, nurse, or staff member uses.

PIN creation (first login only)
PIN creation (first login only)
PIN screen
PIN screen

The PIN has two purposes:

  1. To provide security while navigating patient records
  2. To re-authenticate the local session to avoid logging out due to inactivity

After setting the PIN, the app can be navigated like normal. The pin wall will come up when:

  1. Exiting a patient record
  2. Canceling patient creation
  3. Re-opening the app after 5 minutes of inactivity

If at any time you forget your PIN or wish to change it you can do so by:

Log In → Settings → Account Settings → Change PIN

You do not need to know the previous PIN to set a new one. The only requirement is that you are logged in to your account.

Home Screen

Once you log in, you will be presented with your home screen. The home screen displays either a searchable list of your patients or a list of your daily appointments (if you an EMR integration), as well as metrics for your SkinIO account.

Patient List (No EMR)
Patient List (No EMR)
Appointment List (EMR)
Appointment List (EMR)

The [Cloud] icon leads to the photo upload manager. The SkinIO app is designed to automatically encrypt and upload photos immediately in the background, but if an upload happens to fail or stall, you may use the photo upload manager to restart any uploads.

The [Settings] icon will take you to the settings screen where you can manage your personal account details, billing details, and settings. You can also sign out from your session through this screen.

The [Photos] icon opens the patient image interface, where you can view and respond to photos from your patients.

Viewing Patients

Finding a Patient

Without EMR:

To view a patient, search for them by name in the search bar, and select them from the list of results.

With EMR:

To view a patient, select them from the list of daily appointments, or select the “Patients” tab to search for them by name. If there is a blue SkinIO circle by their name, they have a SkinIO account, and selecting them will open their profile.

Patient Profile

In the patient profile, you can view a list of photo sessions for that patient. Selecting a session from the list will show the photo grid, populated with the pictures that were taken for that session.

Viewing patient’s photo session
Viewing patient’s photo session

The [Settings] icon lets you update the patient’s information and send account activation emails.

Patient Creation

Triggering Creation

Without EMR:

You can create a new patient by tapping the [Add Patient] button in the bottom right corner of the screen. This will launch the patient creation form, where you can enter the patient’s information.

With EMR:

You can create a patient by first finding them either in the appointments list, or through patient search, and selecting them. This will launch the patient creation form with the patient’s information from the EMR autofilled. If for whatever reason you are unable to find them in the appointments or patients tab, you can tap the [Add Patient] button to open the patient form.

Filling in Patient Information

Once you trigger patient creation, you will see a list of fields that need to be filled in.

If you have an EMR integration, patient information from your EMR will be autofilled into the fields.

The email field is optional, but will need to be filled in if you wish for your patients to be able to access their account. Please be careful of typos in this field, as a mistype will prevent patient access.

Once all the required fields are completed, the arrow button in the bottom right corner will light up blue, and you can tap it to create the patient. The patient must be informed that by agreeing to create his/her account, he/she is agreeing to the Terms of Service and Privacy Policy of SkinIO (both links are accessible for their review through the patient creation form).

Empty patient creation
Empty patient creation
Completed patient creation
Completed patient creation

Photo Taking

Interface

To take photos of a patient, you will first need to navigate to the patient view. If you have just created the patient, you will automatically be directed there. Otherwise, you will need to select them from the patient list, or appointment list/patient search results if you have an EMR integration.

To start a new photo session, tap the [Camera] button. You will be presented with a grid view of the regions to be photographed. This list will include the default 13 regions, and can optionally include more depending on your practice’s needs.

At the top of the photo taking grid, there is a blue button labeled Start guided photo taking. This will launch a guide that will step you through taking each of the thirteen full body photos.

For each of the five sides of the patient you will be photographing (front, back, left, right, and top), you will first be greeted by a splash screen showing the pose and green dot locations. We have found that the best way to position the patient is to demonstrate the pose yourself to the patient, and have them match you (making sure the patient’s correct side is facing you). Then, you should put a green dot near each location shown. You can then proceed to pan down the patient’s body, to take the head, torso, and leg photos. After taking the three photos, you will be directed to do the same for the next side.

Photo session grid
Photo session grid
Guided photo taking
Guided photo taking

To photograph each region, the photo taking interface is launched. This includes an outline of the region that you should try to match the patient to, tilt detection to help you level the device, and region specific tips for the pose.

If you would like to just photograph an individual region without using the guide, tapping the region cell will go straight to to photo taking interface for that region.

Photo taking interface
Photo taking interface

If you would like to photograph a region that is not listed, you can add a region to the grid by tapping the “Regions” button in the top right corner. If “Show by Default” is checked, the region will show up in every patient’s photo grid alongside the default 13 regions. Regions with the “Has Overlay” label are extra regions defined by SkinIO that have overlays just like the default 13 regions.

Custom regions
Custom regions
Create a region
Create a region

When you have finished taking photos of the patient, you can tap the green checkmark button to submit the session to SkinIO. You will be presented with an encryption splash screen. Be sure to let encryption complete before navigating away from the SkinIO app. Once the encryption has completed, the photos will automatically start uploading to the SkinIO server. For timely results, please ensure that photos complete uploading before closing the app. In the event that uploading is interrupted, the uploads manager button on the home screen can be used to restart or resume uploading in the background. The app may be used to enroll additional patients and take photos while other photos are uploading.

Tips

Outline

Align the patient as close to the outline as possible, making sure to follow any on-screen pose tips. Taking the photo too far away (including skin outside of the region) negatively affects the results.

Green Dot

Make sure there is a single, prominently placed green dot in the photo. The green dot should be placed on a flat part of the patient’s skin, so that it appears circular in the photo.

Focus

By tapping the screen, you can trigger tap-to-focus on that location. Use tap-to-focus to give the photo proper focus and exposure. If part of the patient’s skin is very bright and washed out from a light source, tapping that area will correct the exposure levels to get a good photo.

Photo View

When viewing a photo session in a patient’s profile, tapping a region thumbnail will open the photo view. In this view you can view all photos taken for that region, as well as all relevant data for those photos.

Photo view
Photo view
Spot selection
Spot selection

Comparison

On tablets, comparison will be turned on by default. On phones, the default view is a single photo. Tap the [Compare] button to turn comparison on and off. This button will be disabled if only a single photo has been taken. To change the photos being compared, tap the date in the bottom left of each photo.

Spot Side Bar

Tapping the [Spot] button will toggle the Spot Side Bar, which shows cropped images of all lesions that are marked or have close-up images. This view allows you to quickly jump through lesions that are important, and makes taking follow-up dermoscopic images easy.

Spot Side Bar
Spot Side Bar

Locking

When comparing, tap the [Lock] button to turn locking on and off. Locking configures the views so that zooming and panning are consistent and auto-zooming is disabled.

Color Correction

When viewing a photo, you can tap the [Color Drop] icon in the picture bar to toggle color correction. This balances the colors in the photo, making skin and lesion colors more true to life, and more consistent between settings.

Showing/Hiding Spots

In the bottom picture bar on each photo are toggles to show/hide spots on the image.

Picture Bar
Picture Bar

Marked by Provider: Toggle spots that you have marked, taken a dermoscopic or close-up image of, or attached a note to. These are the markings that your patients will be able to see.

Suggested by Software: Toggle spots that SkinIO’s patent-pending algorithm has suggested as either new or changed. These markings are only for your use, and do not show up for patients.

At any time, regardless of the spot mode, detected spots can be selected by tapping on the picture and spot details will be shown.

Annotating Spots

With a spot selected, sizing details and annotation actions will appear in the bottom bar if available.

Spot Detail Bar
Spot Detail Bar

Mark: Marks the selected spot for special attention

Images: A close-up image attached to the spot

Notes: A text note shared between the provider and patient with details about the spot

Tags: An educational resource. Allows the provider to mark what a spot is, and SkinIO will automatically provide additional reading in-app for the patient.

Close-Up Images

At any time a provider may attach a close-up image to any spot. A close-up can be either a dermoscopic image taken with a dermoscopic attachment, or a close-up image taken a few inches away from the skin without any attachment . After selecting the spot, click the “Image” button. This will bring up a camera interface if no dermoscopic images have been taken before, or will show the previous images if some have been taken before. In the case that dermoscopic images exist for a given spot, click add in the top right to take another.

Spots with close-up images will receive additional markings, and the close-up images can be seen easily within SkinIO.

Spot with a close-up attachment
Spot with a close-up attachment
Spot close-up view
Spot close-up view

Dermoscopic Analysis

Dermoscopic images are automatically analyzed on iOS devices, providing you with an analysis of any lesion you photograph. This analysis includes: an outline of the lesion contour, major and minor axes, area, and perimeter. These measurements are automatically sized in millimeters, eliminating the need to use tick marks to estimate the size of lesions.

Dermoscopic Analysis
Dermoscopic Analysis

In-App Doctor Review

Dermatologists that are reviewing their own photos have a whole suite of tools for assistance in a skin exam built right into the SkinIO app. The most recent photo for each region can have its spots modified.

Marking Spots

After selecting a spot, the spot bar will pop up. Tapping Mark will mark the spot for special attention. This will be visible to both you and your patient.

Adding Spots

If a spot was not detected by SkinIO, it can manually be added. Click “Add Spot” in the bottom bar. The spot creation bar will be shown. Click anywhere on the picture to add the spot.

Add Spot
Add Spot

The circles are used to select the display size. If you clicked in the wrong location, just click again in a different location. Nothing is saved until ‘Save’ is pressed. You can cancel at any time prior to saving.

Once a spot is saved, it cannot be removed.

Annotating Spots

Full spot annotation is available during the review period, as well as after. See annotating spots for more information.

Close-Up Images

Close-Up images are available to be viewed and taken during review. See close-up images for more information.

Patient Images

Practices have the option to enable patient images, which allows patients to take photos at home and share them with the practice. Patients can take either a full body region photo (i.e. Back Torso) or a close-up image of a particular lesion. An email notification is sent to the doctor when this happens, and the patient image can be accepted and viewed within the app.

To view patient images, you can tap the [Photos] icon on the home screen. If there are images that have not yet been accepted, there will be a red banner on the icon with a count of new images.

From within the patient images interface, you can see a list of images that have been shared with you. Patients are required to leave a message alongside their image to let you know what their concern is. You can choose which images you would like to accept, and review them. This interface allows you to send a message to the patient, so that you can respond to their concern in-app.

Accepting a patient image
Accepting a patient image
Viewing a patient image
Viewing a patient image

Clinic Management

Every SkinIO clinic will be created with an admin account. From within this admin account, if you log in to the app and go to settings, you will see a list of Clinic Settings. These settings are for managing your practice, including your staff accounts for SkinIO, billing information, and account statements.

Staff Accounts

Everyone at your practice that uses SkinIO should have their own account. To create accounts, log in to the admin account, go to Settings, and select Clinic Management. You can tap the Staff cell to see which accounts already exist. Tapping the + brings up staff creation. After creating an account, you are shown the staff account profile. From here, you should set the privileges you want that account to have. Tapping Set Defaults sets the privileges that are required for normal app use (viewing/creating patients and taking photos). Make sure you hit Save to save the privileges.

If you have a staff member leave your practice, or otherwise would like to prevent an account from logging in, you can select Deactivate to prevent that account from being able to log in and access any practice data.

Clinic management
Clinic management
Clinic staff privileges
Clinic staff privileges

Clinic Billing

Within Clinic Billing in Settings, you can set the card you would like your clinic to be billed with and the email all billing communication should be sent to.

Web Portal

While SkinIO is optimized for use via the mobile app, SkinIO data can also be accessed via web browser at https://app.skinio.com/.

Login screen
Login screen
Patient profile
Patient profile

You can use the same login credentials as the iOS app to access data via the web. The navigation is the same in the web-app as the iOS app. Patients can be located from the patient list, sessions can be opened from the patient profile, and photos can be opened from the session grid.

Exporting a Session PDF

If you would like to export a PDF of a session, there is an Export as .pdf button in the top right corner of every session view.

Exporting Session Photos

If you would like to export all the photos of a session, there is a Download Images button in the top right corner of every session view. You can also download individual photos by using the Download button in the picture view.

Importing Patients

For clinics without EMR integration, importing patients in advance can be an easy way to speed up patient creation during a visit. The patient import tools do not create patient records. Instead, imported data is used to autofill the registration form and speed up the process, just like the experience when EMR integration is enabled.

Patient import tools
Patient import tools

To import patients:

  1. Prepare the records for import. Fill in the excel template or export a list of patients from EMA.
  2. Open the import tool. This tool can be found in clinic settings, under Patient Import, and is available here.
  3. Select the file. Click choose file, and provide the prepared *.xlxs file
  4. Click “Import”. The file will be processed and submitted to SkinIO for import and review. The results will be immediately available in a table below the file selection area.

After importing a group of patients, a new entry will be added as shown below.

Imported patient group
Imported patient group

In this example, 3 patients are ready to be created in the iOS application, 3 patients were marked as duplicates and filtered, and no patients have been enrolled.

Imported patients require first and last name, and DOB as the minimum number of fields. Any rows missing that information will not be imported.

At any time the Clear Data button can be clicked to remove all imported data from SkinIO. No patients created using that data will be removed, but the list of imported records will be fully removed.