Mobile Point-of-Care Medical Photography: Legal Considerations for Health Care Providers.

Medical photographs have been used for decades to document clinical findings. The ease with which medical photographs can be captured and integrated into the electronic health record (EHR) has increased as digital cameras obviated the need for the film development process. Today, cameras integrated into smartphones allow for high-resolution images to be instantly uploaded and integrated into the EHR. With major EHR vendors offering mobile smartphone applications for the conduct of point-of-care medical photography, health care providers and institutions need to be aware of legal questions that arise in the conduct of medical photography. Namely, (1) what are the requirements for consent when taking medical photographs, and how may photographs be used after consent is obtained, (2) are medical photographs admissible as evidence in court, and (3) how should a provider respond to a request by a patient or parent requesting that a photograph be deleted from the medical record? Herein, we review relevant laws and legal cases in the context of accepted standards of medical practice pertaining to point-of-care medical photography. This review is intended to aid health care providers and institutions seeking to develop or revise policies regarding using a mobile application at their clinical practice.

Marketing of healthcare services in Denmark: the concept of misleading advertising.

As severe ill and incurable patients can be easy victims of misleading advertising activities for dangerous and non-effective healthcare treatments, the marketing of healthcare services are in many jurisdictions legislations tightly regulated. This article reviews the Danish regulation on marketing of healthcare services to identify which types of advertising activities that are legal. As the legislation only allows healthcare authorities to control the marketing and not the content and quality of the marketed healthcare services, their ability to intervene in serious cases of misleading advertising is limited. Misleading advertising are statements with the purpose to exaggerate or underestimate the effects and risks of healthcare services or to prevent patients from seeking conventional medical treatments. From a public health perspective, there is a need for a common EU legislation for regulation of the marketing of healthcare services as the increasing use of information technologies makes it possible for the providers to access consumers and patients directly across countries and legal systems.

[Ethical aspects of taking and using photographs in pediatric medical practice]. / Aspectos éticos de la toma y el uso de la fotografía en la práctica pediátrica.

From the beginning of medicine, the reproduction of patients' images, initially as drawings, either for didactic purposes or to share experiences, were common in medical practice. Photography greatly facilitated and generalized this practice within health teams. The images of the affected patients need the same consents and guarantees of confidentiality as any other parts of the medical record, so the importance of obtaining informed consent is highlighted. Beyond ethical aspects, professionals have to take into account the legal responsibility involved in carrying out this act.

Desde los inicios de la medicina, la reproducción de imágenes de pacientes, ya sea con fines didácticos o de compartir experiencias, fue considerada una práctica habitual en el quehacer médico. La aparición de la fotografía facilitó y generalizó enormemente esta práctica dentro de los equipos de salud. Las imágenes de los pacientes requieren el mismo consentimiento y garantías de confidencialidad que otras partes del registro médico. Se remarca la importancia del consentimiento informado. Se considera la responsabilidad legal de estos actos.

Use of Photography in Dermatology: Ethical and Legal Implications. / Implicaciones bioéticas y médico-legales del uso de la fotografía en dermatología.

Photographs are necessary in the clinical practice of dermatology, but there are ethical implications to consider. Moreover, dermatologists must be aware of and comply with certain legal requirements affecting the use of photographs. The main ethical principles are respect for patient autonomy and the physician's obligation to do no harm. The law differentiates between 2 bases for protection: one concerns the photographed person's rights over the image and the other protects personal data. Recent legislation places restrictions on taking photographs and exhibiting them. Photographs taken to be stored with a medical history have not been called into question, but the physician is recommended to inform the patient that they exist. When a photograph is exhibited for the purpose of teaching or illustrating concepts, it is necessary to determine whether or not the patient can be identified. If the answer is yes, the patient must give explicit permission. Caution should be exercised when publishing medical photographs on social media.

Digital sextortion: Internet predators and pediatric interventions.

PURPOSE OF REVIEW: Sextortion is defined as the act of coercing people into sending explicit images of themselves and subsequently blackmailing victims with the public release of said images. Prosecutions of sextortion cases involving minors have increased almost two-fold in the past 5 years. The purpose of this review is to explore the literature regarding the behavior of both victims and perpetrators, the effects on victims, and the support resources available for clinicians, victims, and parents. RECENT FINDINGS: Sextortion begins as an unassuming request for personal pictures and quickly escalates. Minors targeted by predators fear both punishment by guardians and the social consequences that follow the release of their explicit pictures. This cycle of victimization endangers minors and may lead to mental health problems, such as anxiety and depression. Recently, sextortion cases have risen to the forefront of national attention through the mainstream media with celebrities revealed as both perpetrators and victims. This higher visibility of sextortion highlights the importance of reviewing recent research regarding minors and their online behavior and the tactics of perpetrators. SUMMARY: Sextortion, an extreme form of cyber abuse, endangers minors and may lead to anxiety and depression. Pediatricians should be familiar with the concept of sextortion and discuss its dangers and available resources with parents and minors.

The Ethics and Legality of Using Personal Smartphones to take Medical Photographs.

Photography in the medical profession is an asset that may help during patients' follow-up, monitoring the progression of diseases, getting a second opinion and in medical educational activities. Advances in technology, specifically smartphones, have enabled medical professionals to obtain high-quality photographs with minimal effort and photography experience. This article discusses the ethics and legality of using personal smartphones in a medical professional setting for medical photography. Written informed consent should always be obtained from the patient and should include details about how the photographs will be used.

Clinical photography of skin lesions: Professional and legal considerations in primary care.

BACKGROUND: Clinical photography is a fundamental component of visually oriented medical fields. The ubiquity of digital technology has brought the capacity to capture clinical photographs to the palm of a practitioner's hand. It is important for general practitioners (GPs) who take clinical photographs of skin lesions to be aware of the associated legal and ethical obligations. OBJECTIVE: The aim of this article is to explore and explain current professional and legal considerations related to the use of clinical photography in general practice. DISCUSSION: Ensuring compliance with professional and legal standards when using clinical photography in general practice requires a firm grasp of the obligations associated with image capture, use, sharing, storage and security. GPs should ensure that before employing clinical photography, they have adequate consent-obtaining practices, regular habits of uploading images to the patient record, and sufficient device security. This will help to ensure that patient images are protected from being compromised.

Instructional design of a clinical photography course for undergraduate dental students.

Clinical and dental photography is an acquired skill. It is learned, developed and practised at post-graduate level by medical photographers across the U.K. But where does the medical photography profession stand in terms of transmitting slowly acquired skills to a wider clinical audience? If some or all skills need to be passed on, how and to whom should they be taught? This paper considers how dental practitioners may benefit from training in specific aspects of clinical photography and suggests a tried and tested model of instructional design for a clinical photography course utilised and implemented for undergraduate dental students studying at the University of Leeds. The authors found a course of this nature demanded skills and theoretical understanding of cognitive architecture beyond the purview of most clinical field experts. A collaborative approach to instructional design between a field expert and clinical educator was implemented, which allowed the design of a dental photography course that worked effectively by linking new to prior knowledge.

Medical photography with a mobile phone: useful techniques, and what neurosurgeons need to know about HIPAA compliance.

Medical photographs are commonly employed to enhance education, research, and patient care throughout the neurosurgical discipline. Current mobile phone camera technology enables surgeons to quickly capture, document, and share a patient scenario with colleagues. Research demonstrates that patients generally view clinical photography favorably, and the practice has become an integral part of healthcare. Neurosurgeons in satellite locations often rely on residents to send photographs of diagnostic imaging studies, neurological examination findings, and postoperative wounds. Images are also frequently obtained for research purposes, teaching and learning operative techniques, lectures and presentations, comparing preoperative and postoperative outcomes, and patient education. However, image quality and technique are highly variable. Capturing and sharing photographs must be accompanied by an awareness of the legal ramifications of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA compliance is straightforward when one is empowered with the knowledge of what constitutes a patient identifier in a photograph. Little has been published to describe means of improving the accuracy and educational value of medical photographs in neurosurgery. Therefore, in this paper, the authors present a brief discussion regarding four easily implemented photography skills every surgeon who uses his or her mobile phone for patient care should know: 1) provide context, 2) use appropriate lighting, 3) use appropriate dimensionality, and 4) manage distracting elements. Details of the HIPAA-related components of mobile phone photographs and patient-protected health information are also included.

Health Insurance Portability and Accountability Act Noncompliance in Patient Photograph Management in Plastic Surgery.

BACKGROUND: Today, plastic surgeons have largely transitioned to digital photography. This shift has introduced new risks to daily workflows, notably data theft and Health Insurance Portability and Accountability Act (HIPAA) violations. METHODS: We performed a national survey of digital photograph management patterns among members of the American Society of Plastic Surgery and trainees in Accreditation Council for Graduate Medical Education-accredited plastic surgery programs. RESULTS: Our findings showed that attendings preferred the use of stand-alone digital cameras (91.4%), whereas trainees preferred the use of smartphones (96.1%) for capturing patient photographs. The rate of noncompliance was nearly identical; 82.8% of attendings were HIPAA noncompliant when using stand-alone digital cameras compared with 90.2% of trainees using smartphones. Both groups also breached HIPAA rules when using other photographic management modalities. CONCLUSIONS: This is the first study to quantify the prevalence of noncompliance with regard to an entire digital photograph management workflow. These findings were consistent with previous studies that reported that younger physicians tend to embrace newer technologies, whereas older attendings are more reluctant. The findings also suggest that HIPAA noncompliance in digital photograph security and management is a significant problem within the plastic surgery community.

The Risks of Theft and Copyright Breach from Camera Use During Scientific Presentations: It's Time for a Debate.

Photographs are frequently taken during urological presentations and distributed on social media; they may represent a breach of copyright and, in instances of clinical photographs, a breach of data protection and human rights laws. Presenters and delegates attending conferences should be advised of the conference's copyright policies. Acceptable use of camera phones during scientific presentations should be debated by the scientific community.

Smartphone use in dermatology for clinical photography and consultation: Current practice and the law.

BACKGROUND: Smartphones are rapidly changing the way doctors capture and communicate clinical information, particularly in highly visual specialties such as dermatology. An understanding of how and why smartphones are currently used in clinical practice is critical in order to evaluate professional and legal risks, and to formulate policies that enable safe use of mobile technologies for the maximal benefit of practitioners and patients. METHODS: Australian dermatologists and dermatology trainees were surveyed on their current practices relating to clinical smartphone use. RESULTS: Of the 105 respondents, 101 provided useable results. The data show clinical smartphone use is common and frequent, with more than 50% of respondents sending and receiving images on their smartphones at least weekly. Clinical photographs were usually sent via multimedia message or email and were commonly stored on smartphones (46%). Security measures adopted to protect data were limited. There was inadequate documentation of consent for transmission of photographs and advice provided. Only 22% of respondents were aware of clear policies in their workplace regarding smartphone use, and a majority desired further education on digital image management. CONCLUSIONS: Given the frequency of use and the degree of importance placed on the ability to send and receive clinical images, clinical smartphone use will persist and will likely increase over time. Current practices are insufficient to comply with professional and legal obligations, and increase practitioners' vulnerability to civil and disciplinary proceedings. Further education, realistic policies and adequate software resources are critical to ensure protection of patients, practitioners and the reputation of the dermatological profession.

Management of electronic social networks by students of medicine: The case of publication of photographs with patients and professional medical conduct.

INTRODUCTION: The socio-demographic characterization of medical students at the Pontificia Universidad Javeriana in Cali, Colombia, was made using a survey and focus group discussion to collect information on access to the Internet, management of electronic social networks and the dissemination of photographs with patients taken during medical teaching rounds, a practice that constitutes a breach of professional medical conduct.  OBJECTIVE: To identify the management of social electronic networks by students of medicine with respect to the publication of photographs with patients.  MATERIALS AND METHODS: A descriptive cross-sectional study was undertaken to characterize students of medicine at the Pontificia Universidad Javeriana in Cali. Of the 423 students enrolled in January 2013, 299 participated in a survey designed with the software Cardiff TELEform®, version 10.0. Twenty students were also selected at random for a focus group discussion on the publication of photographs with patients on electronic social networks.  RESULTS: Of the students surveyed, 97.6% claimed to be active users of at least one of the main electronic social networks (96.2% Facebook, 70.5% Instagram and 44.1% Twitter). Of these, 52 (17.6%) admitted having published a photograph showing patient care on at least one occasion.  CONCLUSION: Most of the students had smartphones and user profiles on the main social electronic networks, on which they disseminated photographs of patients taken during teaching rounds, as well as images of various activities which could have ethical and legal implications and contravene standards of professional medical conduct.

Teledermatology and clinical photography: safeguarding patient privacy and mitigating medico-legal risk.

Capturing clinical images is becoming more prevalent in everyday clinical practice, and dermatology lends itself to the use of clinical photographs and teledermatology. "Store-and-forward", whereby clinical images are forwarded to a specialist who later responds with an opinion on diagnosis and management is a popular form of teledermatology. Store-and-forward teledermatology has proven accurate and reliable, accelerating the process of diagnosis and treatment and improving patient outcomes. Practitioners' personal smartphones and other devices are often used to capture and communicate clinical images. Patient privacy can be placed at risk with the use of this technology. Practitioners should obtain consent for taking images, explain how they will be used, apply appropriate security in their digital communications, and delete images and other data on patients from personal devices after saving these to patient health records. Failing to use appropriate security precautions poses an emerging medico-legal risk for practitioners.

Review of digital image security in Dermatology.

The inherently visual nature of dermatology naturally lends itself to photography. As technology has evolved, smartphone cameras have become ubiquitous and have the potential to improve education and patient care in dermatology. Although patients and physicians may agree that photography can improve patient care, there are certain risks involved with smartphone photography in the medical field. Perhaps most concerning is the number of dermatologists using smartphones to take unsecured images in their daily practice. A recent study revealed that 22% of surveyed dermatologists used smartphone cameras multiple times per day in their practice. Dermatologists may also overestimate patient comfort with smartphone use in clinical photography. We present a review of the use of smartphones in dermatology and address the potential lack of security and accompanying ethical dilemmas.

Digital Photograph Security: What Plastic Surgeons Need to Know.

BACKGROUND: Sharing and storing digital patient photographs occur daily in plastic surgery. Two major risks associated with the practice, data theft and Health Insurance Portability and Accountability Act (HIPAA) violations, have been dramatically amplified by high-speed data connections and digital camera ubiquity. The authors review what plastic surgeons need to know to mitigate those risks and provide recommendations for implementing an ideal, HIPAA-compliant solution for plastic surgeons' digital photography needs: smartphones and cloud storage. METHODS: Through informal discussions with plastic surgeons, the authors identified the most common photograph sharing and storage methods. For each method, a literature search was performed to identify the risks of data theft and HIPAA violations. HIPAA violation risks were confirmed by the second author (P.B.R.), a compliance liaison and privacy officer. A comprehensive review of HIPAA-compliant cloud storage services was performed. When possible, informal interviews with cloud storage services representatives were conducted. RESULTS: The most common sharing and storage methods are not HIPAA compliant, and several are prone to data theft. The authors' review of cloud storage services identified six HIPAA-compliant vendors that have strong to excellent security protocols and policies. These options are reasonably priced. CONCLUSIONS: Digital photography and technological advances offer major benefits to plastic surgeons but are not without risks. A proper understanding of data security and HIPAA regulations needs to be applied to these technologies to safely capture their benefits. Cloud storage services offer efficient photograph sharing and storage with layers of security to ensure HIPAA compliance and mitigate data theft risk.