Issue 13 / 13 April 2015

ANYONE working in an Australian hospital, health service or clinic will tell you that clinical images are routinely captured and used by doctors and medical students every day, often using personal mobile devices.

But how do you ensure that you are meeting your professional, ethical and legal responsibilities when taking and using these images?

The capture of images of clinical signs, injuries and lesions has been common practice for years for a wide variety of medical practitioners, ranging from GPs to geriatricians and everyone in between.

Clinical images can improve professional referrals, particularly in regional, rural and remote settings where specialist services may be limited, and have long been used for non-clinical purposes such as teaching, training and research.

However, there is concern that many doctors have an inadequate understanding of their significant legal, professional and ethical obligations regarding the use of clinical images.

Pitfalls for doctors are common at almost every step of the process, including obtaining adequate consent and documentation, quality and de-identification, secure storage, transmission and ownership. Few systems exist for integration of clinical images into medical records.

Additional complexities arising from the capture of images on personal mobile devices can also prove difficult for doctors to navigate, including ensuring adequate quality for decision making, appropriately managing device features such as automatic cloud backups and the inadvertent recording of metadata such as image location.

Protection of patient confidentiality is central to doctors’ longstanding professional and ethical codes of practice. Legally, under the new Australian Privacy Principles that came into effect in March 2014, significant financial penalties apply for breaches in confidentiality of medical records, as well as to various state and territory legislation that applies to public hospital records.

The AMA Council of Doctors-in-Training has collaborated with the Medical Indemnity Industry Association of Australia to develop Clinical images and the use of personal mobile devices: a guide for medical students and doctors.

The document is the first Australian professional guide for doctors to meet their responsibilities regarding clinical images and the use of personal mobile devices in providing clinical care.

It outlines professionally appropriate processes of informed consent, documentation, capture, secure storage, disclosure, transmission and deletion of clinical images, including considerations of quality, de-identification and privacy legislation.

A simple and pragmatic flow chart, summary and checklist for busy doctors is included, as are case reports and discussion of complex situations.

Despite the existence of clinical imaging departments in many hospitals, pragmatic doctors who capture images using personal mobile devices often find it difficult, if not impossible, to integrate these images into the medical record. There is a clear need for health services to urgently improve these systems.

Since the release of the guide late last year, a number of health services have been trialling mobile apps that can integrate captured images automatically into patient records with minimal interruption to a doctor’s busy workflow. It’s important that these trials have input from doctors-in-training, who are most likely to be the heaviest users of such apps.

Clinical Images and the use of personal mobile devices is a must-read for doctors and medical students who capture and use clinical images.

Dr James Churchill is the immediate past chair of the AMA Council of Doctors-in-Training.

3 thoughts on “James Churchill: Mobile images

  1. Department of Health Victoria Clinicians Health Channel says:

    Do medical imaging departments still exist? And should doctors be using these instead where practical?

  2. SA Health Library Network says:

    The main imaging I have used is taking a mobile phone picture of an xray (on a light box) I’ve taken in a rural hospital to send to a tertiary hospital orthopaedic registrar to discuss whether the angulation of the fracture requires reduction etc. No patient name is transmitted with the image. This has now been superceeded by the digital xray equipment that’s just been installed so the images go off to town digitally as well as being on a screen for me to look at. (It’s very strange not to have to go into the dark room for hand developing.) 

    Patients often bring in pictures of the evolution of their rash or of their haemarrhoids etc on their mobile phones. These I find useful. At present the pictures don’t go into the clinical record, however I think all this photography is a rapidly changing field.

  3. Philip Dawson says:

    most of the images you describe are taken with a  mobile phone and in most instances are a waste of time. To capture a good image and send it via email to a dermatologist at a distance use a proper camera with a ring flash (as taking the patient outside in the bright sunlight is often not practical). A good enough SLR can be had for the price of a high end mobile phone, a ring flash for a few more $100s, and will last a long time ( unlike aforementioned mobile device, most of which get thrown out every 2 years, despite many doctors being interested in being “green” (with envy at someone’s better phone?)). We have done some telehealth and with a webcam or mobile phone picture the dermatologist is not satisfied with the image quality, and neither should any doctor be. Record shots of injuries for medico-legal purposes should only be taken by the police photographer due to evidence requirements. Interesting cases to show students may be taken with the patient’s permission, but again a good quality camera is best. I remember poor quality images of rashes shown to me as a student and you needed a fair bit of imagination to diagnose them. I can’t think of any other good reasons to take pictues of patients, I  think its a passing fad which will not last. I think a lot of people includng doctors are quite taken with the power of a smartphone to take a photo and send it instantly. if you are outside in good light you can take a passable scenery shot, but clinical photography requires better. Plus you have to remember to turn off the autoupload feature on your phone so the patient’s photo doesn’t end up on socal media sites (mine auto uploads to dropbox and google+  I don’t take photos of patients with it.

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