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A novel, web-based dermatology image management application (MDID) has been developed to facilitate the practices in the Department of Dermatology at the University of Missouri School of Medicine. Since its launch in early January, there are over 1700 images of over 500 patients have been uploaded to the MDID. What are the conventional practices? Are there any differences of preference and activities among professional groups? Are there any changes in image use after adoption of MDID? To answer these questions, we are conducting a mix-method research including surveys, field observations, interviews, and user activity log analysis. A pre-launch survey has been completed with a response rate of 82%. Field observation, user interviews and feedback surveys are currently in progress. Another assessment tool is to analyze user activity logs which are being populated every day. The log data provide us rich information about database use behaviors and preferences without interruption of user’s normal use of MDID. From the preliminary analysis, we discovered noticeable differences of site access and functionality usage among user groups. With a progressing adoption of the MDID into clinical activities, we are expecting to see a potential culture change in the context of medical image management in clinics, research and education.