Table 3.

Challenges in photographing SJS/TEN patients.

Category	Challenge	Explanation	Solution
Room conditions	Lighting inconsistency: Variation in light tone and/or intensity, time of day, or weather.	Lighting inconsistencies increase the chance of shadowing, glare, and distorted skin tone in images.	Document the light sources in the room during the photo session. Consistently utilize the same device between sessions. Capture both flash and non-flash photos. Use portable light devices.
	Rushed environment: A high-stress intensive care environment caused by time constraints, simultaneous performance of procedures, photographer inexperience, or patient discomfort.	A rushed environment negatively impacts attention to detail and photography session quality.	Establish a relationship with the care team. Communicate with the care team. Get familiar with the hospital and the unit. Regularly conduct timed practice sessions with a volunteer.
	Distractions/obstructions: Objects, unrelated to the photography, which distract from or obstruct the patient’s skin.	Objects may obstruct part of the skin, visually distract the viewer, and impact the consistency of daily images.	Move items out of frame. Move items off patients’ skin, if able. Drape distracting items.
Communication	Scheduling: A missed opportunity to capture uncovered patient’s skin (e.g., dressing change, bath) due to miscommunication between the patient’s care team and photographer or unavailability of the photographer.	Missed dressing changes or baths prevent a complete photograph of the entire skin surface across all body sites from being collected daily.	Communicate daily with the patient’s care team. Ideally, multiple trained photographers should be available. Photographers should have flexible schedules to allow time for sessions when needed.
Patients	Patient wellbeing: The physical or emotional comfort and discomfort of the patient.	Patient wellbeing determines if they are willing to fully participate in repeated photography sessions.	Communicate with the patient and their caretaker. Ask permission to photograph at each session. Explain that the photography session can be stopped at any time. Limit the number of people in the room.
PHI	Protecting PHI & privacy: Photographs may contain sensitive and/or identifying information.	Protecting privacy and PHI helps to establish trust between the patient and photographer.	Cover hospital bands with gauze or tape. Flag photos considered sensitive. Flag photos containing PHI. De-identify photos.
Data management	Data management: The organization of photos by establishing standard operating procedures for naming and storing files.	Standardized data management protocol ensures optimal organization, prevents data loss, and makes locating files easier.	Develop a protocol for naming and storing photos. Ensure that filenames are consistent with the naming convention. Keep at least two copies of each photo (have a back-up).
Technical difficulties	Technical difficulties: Technological malfunctions due to a loss of power, Wi-Fi, or issues capturing images.	Technical difficulties can prevent data from being collected properly and affect its overall quality.	Use newer-model devices. Fully charge the device before each session. Bring a backup photography device. Confirm all photos are submitted before exiting the photo capture app.