A colleague and I were recently discussing how we “close” our cosmetic consultations, using a variety of patient education and sales techniques. One of the most successful tools is to illustrate a procedure's key technical components, as a picture can be worth not only a thousand words, but also several thousand dollars of procedural revenue. I explained that I like to do this through my electronic medical record (EMR) system on an iPad. My colleague commented that he also draws for his patients—usually on the white paper roll that covers the exam chair. Both of us seek to enhance the patient's understanding of the proposed surgery and to build a rapport founded on trust and good communication. We discussed some of the advantages of using software tools for drawing in the consultative examination room.

1. Plastic surgery and cosmetics are visually oriented specialties—our results are visible to patients, their families, their friends, and other professionals. The patient's first exposure to our artistic senses can be positively influenced by providing a clean, professional-looking drawing during that first meeting.

2. Properly designed drawing tools can be integrated right into a natural workflow using an EMR system or other patient education software suite. There are several of these on the market, including EMR systems from Modernizing Medicine, TouchMD, Canfield's image tool suite, and others. A physician, aesthetician, or other user can potentially record recommendations, findings, and treatment parameters directly on a patient's photo taken in the iPad, or on an illustration. Modernizing Medicine's Electronic Medical Assistant® (EMA™) platform has a built in drawing tool that allows the user to draw on iPad-taken photos, specific excerpts from the multi-layer EMA Interactive Anatomical Atlas™, or any user-specified cropping from the atlas. The array of image types that can be created is substantial. Annotation with text, arrows, and other overlaid drawing content can cleanly add to a patient's comprehension of a proposed procedure, or can easily lay out today's treatment parameters to make it easy on the provider in the next treatment session.

3. Illustrations and marked-up photos can potentially be shared with the patient through electronic portals or printed from JPEG and PDF files, giving them tangible examples of the surgeon's visualization of the procedure. The patient can share this information with family members and other stakeholders in their surgical plan in order to help with planning for surgery.

4. Many drawing tools allow the provider to have the patient sign the document, if desired, in order to datestamp and verify that the patient attested to understanding the information contained in the diagram.

5. Despite multiple verbal attempts to help a patient understand the location and extent of expected incisions in a surgical procedure, a simple drawing on the patient's photo or on an atlas illustration can go a long way to helping assess a patient's interest in proceeding with surgery.

6. Consultative drawing tools can furnish information that supplements the written data in a medical record. Most systems give the provider some control as to whether illustrations generated within the tool can/will be saved to the medical record formally.

7. Modern tablets and Wi-Fi systems easily facilitate broadcasting a tablet's screen content to a larger wall-mounted display, which opens up the consultation room and creates a more immersive experience for the patient. A savvy provider or sales consultant can swipe between drawing tools in a medical record or consultation software program to a photo gallery tool, medical animations or the practice's website for the patient to look at in a less clinical, more interactive environment. The ergonomics of tablet-based tools are also generally preferable to laptop or desktop computers in terms of keeping the doctor-patient relationship intimate. Eye contact is better facilitated with a tablet in the doctor's lap, with a similar form factor to a paper chart, as opposed to the doctor typing into a computer screen with attention distracted from the patient.

8. The use of computer-based drawing tools positions the provider as a state-of-the-art practitioner who is up to date on the latest tools and technology. Your patients are accustomed to viewing content on screens—we look at screens upward of 100 times a day in many cases—so furnishing medical information to them this way fits with their social and professional experiences.

Who would you rather outline a procedure for you: a surgeon drawing on an iPad reflected to a huge LED screen in a state-of-the-art exam room, or a doctor writing on your exam table roll of paper?

Tim A. Sayed, MD, FACS is Medical Director, EMA Plastic Surgery™ and EMA Cosmetic™ at Modernizing Medicine. He is also an Executive Committee Member of HIMSS EHR Association.