In this article we discuss the ethical and legal implications of using personal mobile devices for clinical image sharing and outline the key issues health professionals should consider.
Clinical images should be considered part of the patient’s medical record and handled with the same regard as other clinical documentation.
Ensure patient consent is obtained prior to taking a clinical image. Consent may be written or verbal, and should be documented in the clinical record.
Obtain consent when sharing clinical images for teaching, education and research purposes.
Delete images on personal mobile devices once they have been transferred to the patient clinical record.
Ensure clinical images don’t automatically upload to third party cloud storage sites or social media sites.
Secure personal mobile devices to prevent unauthorised access.
Adhere to the clinical image policy of your hospital/ and or health service if one exists.
Benefits of clinical image sharing
Personal mobile devices such as mobile phones and tablets have transformed the way health professionals communicate, collaborate and share critical health information.
As device technology has evolved, clinical image sharing from mobile devices has become an increasingly popular means for health professionals to facilitate quick sharing of clinical images among professional teams, enhancing clinical decision making and enabling faster diagnoses.
One of the main advantages in using mobile phones for the sharing of clinical photos is the convenience and accessibility it offers. With the widespread use of smartphones among health professionals, images can be easily captured, shared, and accessed from any location. This allows for real-time consultation and faster decision-making, especially in emergency situations. Rural and remote clinicians are no longer bound by geography and are able to leverage specialist advice during emergencies in situations where access and support would otherwise be challenging.
What constitutes a clinical image?
Clinical images may be shared for the purposes of clinical care, and sometimes for administrative purposes (e.g. Medicare billing), or education, training and research.
Examples of clinical images include:
Photos of skin lesions, wounds/ ulcers and rashes
Images of reports (e.g. pathology, radiology, surgical)
Radiology images (e.g X-rays of features)
Clinical documents (e.g. part of the patient record)
Many Australian hospitals have implemented clinical image policies. Clinicians need to ensure they understand and follow their organisation’s policies with respect to use of personal mobile devices and clinical image sharing. Some organisations prohibit the use of personal mobile devices altogether to capture and share clinical images.
Privacy considerations for clinical image sharing
Healthcare workers have a professional, ethical and legal duty to respect a patient’s right to privacy and confidentiality with regards to their personal health information and how it should be used.
Clinical images are considered ‘health information”, and therefore must be treated with the same privacy and confidentiality as any other health record or information. Therefore when using and sharing clinical images from mobile devices in a public hospital setting, users are bound by the relevant state and territory privacy legislation.
A breach of privacy obligations risks substantial fines, and also risks one being subject to an AHPRA complaint, an internal hospital investigation, or a professional standards review.
Practitioners operating in Australian private hospitals, general practice, pharmacies, and outpatient allied services operate under the National Privacy Act 1988. In this environment users are also subject to the reporting requirements of the Mandatory Data Breach Scheme which we have discussed in depth in a previous article.
In all instances, images should be taken with appropriate consent, handled and stored in a compliant manner and only disclosed in accordance with the consent given. Sharing of images for use other than for which consent has been obtained, is inappropriate, unethical and has the potential to result in censure or patient complaint.
The need for informed consent
Clinicians should ensure patient consent is obtained prior to capturing and sharing clinical images. Competent patients have the right to refuse capture, use and sharing of clinical images. If a patient is incapable of providing consent, consent can be obtained from their substitute decision maker.
Consent may be written or verbal. In the case of the latter, consent should be documented in the clinical record.
Clinical photos shared for the purpose of training, education and research are subject to the same consent requirements. Image de-identification is recommended, where possible.
Capture of images - best practice
It is important to consider the quality of the images being provided and the impact on quality care. At times, a poor quality image (e.g. low resolution, poor light etc) may be a hindrance rather than an aid to best patient care. . Will image sharing facilitate patient care? Is the image quality sufficient?
Clinical images should be stored in the clinical record. Your organisation may have a formal process for recording images in the clinical record.
De-identification of images (including metadata) is advised when using clinical images for teaching, training and research.
Messaging apps: consumer and healthcare specific
Consumer messaging apps have become ubiquitous in our personal and professional lives, offering a quick and convenient way to communicate with others. The ability to effectively message to groups sets them apart from simple SMS based messaging.
However, the use of consumer apps for clinical care generally conflicts with best practice. Encryption alone does not mitigate against data breach (e.g sharing to the wrong recipient) and in many instances these apps store data both on the device and in third party cloud services in off-shore data centres (violating data sovereignty requirements).
Information shared on messaging apps should be treated as a part of the patient record and stored accordingly.
A number of compliant healthcare-specific messaging apps are now available. These have several advantages over consumer messaging apps, including dedicated clinical workflows, integrations into clinical systems, with controls to avoid inadvertent data sharing to the device or third-party cloud providers.
Securing your mobile device
A number of steps can be taken to secure your mobile device when used for clinical photography and clinical image sharing:
Ensure your device has strong password protection
Remove images from the device after uploading to the patient record, if a specific healthcare messaging application has not been utilised
Avoid inadvertent image upload to social media sites or back-up cloud services.
To learn more about Foxo and how our platform is used for clinical applications including messaging, and compliant clinical imaging sharing features you can contact us at foxo.com/contact or get started now for free.
The Australian Medical Association in conjunction with the Medical Indemnity Industry Association of Australia have provided a guide for health professionals, primarily targeting organisations and individuals working in Australian public hospitals that identifies the key ethical and legal issues to be aware of before using a personal mobile device for clinical care.
AVANT, a large Australian Medical Indemnity has provided an update around professional and ethical considerations for use of social media for health professionals.