Patient photos are the clearest case for local-only compression: they are identifiable, they are sensitive, and the entire benefit of compressing them (a file small enough to attach or upload to a records system) can be had without the file ever leaving the machine. Skwish does the work in the browser with the canvas API. No upload, no account, no server-side copy to reason about. The workflow that fits a clinic is batch-oriented. A photo session produces ten to fifty images that all belong together and all need roughly the same treatment. Dropping the whole folder in, compressing to one consistent setting, and exporting a single ZIP turns a tedious one-by-one attachment job into one file. Keep the quality high enough that the images still serve their clinical purpose — that is usually 85-90 on the slider, not the aggressive settings you would use on a social post.