Secure Clinical Photography

By Dr Vikram Balakrishnan

Smartphones have taken over the medical workforce as the go to method of communication. Consistent with this use has been an explosion in the use of the smartphone camera function at work. Doctors are now taking photos of patients using their personal smartphones more than ever before.

The reasons for this explosion are multiple. Smartphones now contain high quality cameras with automatic and instantaneous focus, improved flash and increased pixel density.

Access to a high quality mobile camera has allowed doctors to improve their workflow, instead of describing a wound to someone else in the care team, doctors can take a photo and instantaneously transmit the image to that person. Rather than mentally noting the appearance of a wound, a doctor can keep a log of the wound in their smartphone, as a timeline.

Doctors are not only taking photos of patients directly, doctors take photos of items such as patient labels, theatre lists, medical charts and other personal health information (PHI)

None of this use is malicious, but, it does raise a number of security and ethical questions.

The Australian Medical Association (AMA) have produced a guide for the proper use of personal mobile devices when taking clinical images. A survey of junior doctors working in public hospitals show that these guidelines are rarely followed.

Doctors want to work efficiently, and clinical photo-taking allows them to do so, improving patient care. To adequately deal with security and the legal issues surrounding clinical photo taking, doctors need a more customised application, which has integrated the AMA guidelines for the proper use of taking clinical images.

Guidelines

  • Before taking a clinical image, a doctor should obtain appropriate consent for the photo and document this consent in the health record.
  • Before taking a clinical image, consider the purpose for which you require the image, and obtain appropriate consent.
  • Make sure the patient understands the reasons for taking the image, how it will be used, and to whom it will be shown.
  • Document the consent process in the health record. Check what your health service/hospital requirements are for written consent.
  • Never send a clinical image to anyone else unless you have the patient’s consent to do so, or if the patient would reasonably expect you to send the image for the purpose of their clinical management, or if you are otherwise permitted by law to do so.
  • If the clinical image is sent to the wrong person, patient privacy has been breached. In these circumstances, you should seek advice from hospital management or your medical defence organisation.
  • Find out what your health service/hospital policy is for storing clinical images, and what systems your hospital has in place to facilitate the storage of digital images.
  • Make sure clinical images do not auto upload to any social media networks or back-up sites.
  • Delete any clinical image after saving it onto the health record.
  • Have controls on your mobile device to prevent unauthorised access.

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