Table of Contents
- Office Setup Checklist
- Home Screen
- Creating Patients
- Patient Profile
- Photo View
- In-App Doctor Review
- Web Portal
1.1 - May 31, 2018
- Added guide for photo taking overlay toggle added in iOS version 3.2.0
1.0 - May 17, 2018
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:
- Enroll a patient
- Capture a full-body set of 13 photos
- Review photos and mole-mapping results
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.
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 email@example.com if you are missing any items or need any additional supply.
- iPad or iPhone (with 12MP camera)
- 1 black SkinIO photography backdrop (optional)
- 6 black floor mats (optional)
- 1 roll of 3,000 reference marks (green felt circles 3/8” in diameter)
- Marketing materials
All access to your data and patient data is secured behind an SSL (secure sockets layer) encrypted login mechanism. To mitigate the risk of the app being left open post-login, potentially exposing data to unauthorized access, SkinIO will automatically sign you out of the system after 4 hours if you do not sign out on your own before then.
To log into SkinIO, open the SkinIO app and tap the “Login” button, which will launch the login screen:
Enter your username and password in their respective fields. The > button at the bottom right of the screen will turn blue and become tappable when you have successfully filled out both fields. You may tap the eye icon in the password field if you need to see the actual characters you typed in for your password.
If you forgot your username, you can tap the “Forgot username?” link under the Username field on the login screen. Enter your email, which will activate the > button at the bottom right of the screen. Tap the button to trigger the event. You will be sent an email with your username.
If you forgot your password, you can tap the “Forgot password?” link under the Password field on the login screen. Enter your username, which will activate the > button at the bottom right of the screen. Tap the button to trigger the event. You will be sent an email with a unique password reset link that will be valid for 3 days. If you do not access that link and reset your password within the 3 days, you will need to tap the “Forgot password?” link again to restart the process.
Your new password must meet the following rules:
- At least 8 characters
- Contains an upper case letter
- Contains a lower case letter
- Contains a number
- Contains a special character: @$!%*?
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.
The PIN has two purposes:
- To provide security while navigating patient records
- 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:
- Exiting a patient record
- Canceling patient creation
- Re-opening the app after 15 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.
To sign out of the SkinIO app and end your session, navigate back to the home screen and tap on the icon to access your settings screen. The “Sign out” link will be at the top right of the modal (tablet) or window (phone).
Once you log in, you will be presented with your home screen. The home screen varies slightly depending on if SkinIO has integrated with your practice’s EMR.
If your clinic’s EMR is not integrated with SkinIO, the home screen will show a searchable list of all patients in the SkinIO system.
If your clinic’s EMR has been integrate with SkinIO and the particular EMR allows access to the appointment list, the home screen will be a list of patients with appointments occurring today.
Next to each patient’s name will be the SkinIO logo. Blue indicates that the patient is in the EMR and SkinIO. Grey indicates that the patient is only in the EMR.
The cloud icon at the top left of the patient lists 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 upload manager also shows what photos are currently uploading. Force closing the app while uploads are occurring will pause the uploads. To resume uploading, the app must be re-opened and you must log in again.
The question mark icon at the top right of the patient list will direct you to SkinIO’s in-app customer support. You can chat directly with support staff through that interface.
The gear 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.
New patients can be created in a variety of ways, differing based on SkinIO’s level of integration with a clinic’s EMR. All patients require the same set of fields. The patient’s email is optional, but will be used to send account activation information.
EMR: From an Appointment
From the appointment list, a blue logo indicates a SkinIO account exists, while a grey logo indicates that a SkinIO account needs to be created.
Selecting the patient with the grey logo will open the registration form and auto-fill data from the EMR, while the blue logo will go directly to the patient profile.
EMR: From Patient Search
To search an EMR for a patient, click the button in the bottom right. This will bring up the patient search screen where patients can be searched by first, last or both first and last name.
The SkinIO logo again indicates if the given patient has a SkinIO account.
EMR: Not in the EMR
Should the EMR search not return the correct patient, or if the patient does not have a record in the EMR at all, a new patient can be created with only a SkinIO account.
After searching for a patient, click “New Patient” at the bottom of the search results. (See screenshot above)
Without an EMR
If SkinIO is not integrated with your practice’s EMR, or your practice does not use an EMR, then from the homescreen you will be able to click to open the registration form.
The > button at the bottom right will be enabled and turn blue when all requisite fields are filled out without error.
The patient’s basic profile information will be shown next to their session results. Each session card will be color-coded for quick visual delineation of status:
- Green - no changes detected
- Blue - currently uploading, processing or in review by a dermatologist
- Red - medical attention required; the patient will be explicitly notified via email (and SMS/push notifications, if enabled by the patient) to schedule an in-person visit with a dermatologist
EMR: from Appointment List
Any patient with a blue SkinIO logo can be selected from the appointment list to open their profile. See patient creation from an appointment if the logo is not blue.
EMR: from Patient Search
Any patient with a blue SkinIO logo can be selected from the search results to open their profile. See patient creation from search results if the logo is not blue.
No EMR: from Patient List
Any patient name can be selected from the home screen to open their profile.
Photo taking can be started at any time from the patient’s profile. Please see Patient Profile for more information on opening the patient’s profile.
From the profile, click the button to get started.
To receive the highest quality results, please follow the following rules:
- Background - make sure the patient is set up in front of, and framed within, the provided SkinIO backdrop
- Clothing - clothing should be removed to expose as much skin as the patient is comfortable revealing for screening; underwear is optional and can be filtered out by SkinIO’s algorithm, as needed
- Hair & Jewelry - patients should put up long hair and remove any jewelry
- Lighting - make sure that lighting is as uniform on the patient as possible to ensure best results; glare or shadows can affect SkinIO’s ability to detect spots on the skin
- Green dot - make sure the green adhesive reference mark is placed on the patient (not covering a spot) in every photo for automated sizing
After the quality tutorial, you will see a list of regions to take photos for. This list will include the default 13 regions, and can optionally include more depending on your practice’s needs.
To take a photo, simply click the region.
If you would like to add a new region, click “Regions” in the top right.
Additional regions at your practice can be added to the patient’s session by clicking the green + or can be removed with the red - (after adding). If a region is not in the list, it can be created by selecting “New Region”.
Please note, if “Show by Default” is selected this region will be listed in the original grid for every session created by every provider at your practice. “Show by Default” should only be selected if it is a common region that is relevant for most of a patient body.
Exiting a Session
A session can be exited by selecting “Delete” from the top left. If any photos have been taken and “Delete” is selected, these photos will not be uploaded, and will be deleted.
Taking a Photo
To take a photo, tap the region you would like to photograph. The display will automatically update to show the required orientation. Please rotate your physical device to match what is shown.
When photo taking is started, a series of tutorial screens will be shown to explain what to photograph, and what the red and green tilt indicators mean.
If the tilt indicators are not followed, and are not green when the ‘take photo’ button is pressed, the software will not take a photo.
In the photo taking interface an overlay will be shown to guide the photo taking process. The default overlay depends on if this is the 1st time a photo has been taken for a given region, as well as the hardware and software on the particular iOS device.
The three options are:
- None: An empty viewfinder
- Default: The neutral outline traditionally used with the first image
- Previous: A stylized outline of the previous photo for a given region
In app versions 3.2.0 and higher, tapping on the icon in the bottom corner will switch between available overlay modes. If no other modes are available, the text and icon will be greyed out.
Regardless of the overlay shown (previous, default, etc.), please make sure to align the patient being photographed as closely as possible.
Focus is extremely important. At any time while taking a photo, you can tap the screen to focus the camera before clicking the ‘take photo’ button.
For the original 13 regions, a box will be shown with a recommended placement for the green dot. This is not a hard requirement, but instead is a recommendation. Good adhesion and an area that will present a full circle (not angled green dot) to the camera is most important.
After taking a photo, you will be presented with a full view of that new image, and can click to toggle between the new photo and previous one (should it exist). Please check for consistency.
Click ‘Use’ when you are satisfied.
Photos can be retaken:
- When being taken originally. After taking a photo, you can click “Use” or “Retake.”
- From the grid of photos. Click any photo and select “Retake” from the top menu.
If photos have been taken in a session:
- Click “Edit”.
- Tap each region you would like to delete.
- Tap the red “Delete” button that appears at the bottom of the screen.
Once you are satisfied with the set of photos of the patient, you can tap the green “Submit for processing” button at the bottom of the screen to submit the photos to the SkinIO system.
The submitted photos will be automatically encrypted by the SkinIO system before sending to our HIPAA-compliant servers for processing.
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 in 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.
Tapping a session card from the patient profile will open a particular session.
The summary of all photos in the session will be presented on top, while the [!] icon on some photos indicates where the new, changed, and suspicious spots come from.
Tap a region’s thumbnail to open the the full view.
On tablets, comparison will be turned on by default. On phones, the default view is a single photo.
Tap the 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.
When comparing, tap the button to turn locking on and off. Locking configures the views so that zooming and panning are consistent and auto-zooming is disabled.
What is a skin mask? A skin mask is the section of a photo identified as skin, and displays the area that will be searched when identifying and matching lesions.
To toggle the overlay showing where this is, click the button.
There are 3 modes that can be used when viewing pictures. Tap the mode (bottom left) to change it.
- None - No spot data will be shown
- Marked spots: new, changed, suspicious
- Tagged spots: notes, education, dermoscopic images
- All - Every detected lesion will be shown
At any time, regardless of the spot mode, detected spots can be selected by tapping on the picture and spot details will be shown.
If you would like additional information on what an icon means, click the legend at the bottom of the screen to pull up the full legend.
With a spot selected, sizing details and annotation actions will appear in the bottom bar if available.
Image: A dermoscopic 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.
At any time a provider may attach a dermoscopic image (or regular close up image) to any spot. 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 dermoscopic images will receive additional markings, and the close up images can be seen easily within SkinIO.
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 standard SkinIO review period is 4 hours, and review is designed to be done in-person with the patient. After 4 hours, the photos will leave review and a summary of the session will be sent to the patient.
After selecting a spot, a list of types (new, changed, suspicious) will be shown. Click one to classify the spot. Classifying a spot will change the color of the spot and the bar. This coloring is consistent throughout SkinIO for easy and fast referencing of data.
If a spot was not detected by SkinIO, it can manually be added. Click “Add Spot” in the bottom right corner. The spot creation bar will be shown.
Click anywhere on the picture to add the spot.
The circles are used to select the display size, and the spot can be classified at this time (as well as after saving). If you clicked in the wrong spot, 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 but can be reclassified.
Full spot annotation is available during the review period, as well as after. See annotating spots for more information.
Taking Dermoscopic Images
Dermoscopic images are available to be viewed and taken during review. See taking dermoscopic images for more information.
While SkinIO is optimized for use via the mobile app, SkinIO data can also be accessed via web browser at https://app.skinio.com/.
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.