Beware - when NOT to use your smartphone
In a society where everybody dotes on the latest technology, it's no wonder that healthcare is jumping on the bandwagon.
The use of smartphones within medicine and dentistry has increased exponentially. This is understandable, considering these environments strongly rely on the importance and need for communication between team members at all times.
The development of smartphones with photo-messaging has revolutionised the way we as a society communicate. Photos can be sent at the tap of a finger and can often express more words than a text message or telephone call.
Yet, as technology advances, there is greater risk of this technology being used in the wrong way. It is therefore essential as healthcare professionals to remember our duty of care to patients and also reflect and understand the legal considerations regarding:
- Data Protection
- Patient Privacy and Dignity
- Patient Confidentiality and Consent
As a Maxillo Facial SHO, there are often times when you run into patients that do not fit the typical presentation one would expect. Our role within the team is to manage issues within our comfort zone, but also to escalate clinical scenarios to senior members of staff in the appropriate way. Sometimes it is extremely difficult to explain over the phone the appearance of a patient's lesion and at times a photo can seem the most appropriate way to explain what words can't manage. However, incidents of this nature have occurred and have serious repercussions.
A case which occurred in an UK NHS teaching hospital, started with the most innocent of intentions. A junior member of the Maxillo Facial team thought it might be easier to display the clinical appearance of a lesion to a senior member of staff in the form of a photo message. The person in question thought this was a quick and easy alternative to a) telephoning and discussing over the phone and b) asking the senior to come and see it themselves. It is important to note here, that as a junior member, it does not matter how simple the diagnosis/management, you must always feel confident to ask a senior to look as it is their responsibility to ensure good patient management.
Despite consent being obtained from the patient to take the image, the use of the image was deemed as inappropriate. Being sent across in text format, meant that this item was not secure. There was a risk that this image could potentially fall into unwanted hands for a few reasons which include, the possibility that the image could have been passed on to those not involved in the patient's care, through error. But also if the smartphone had been mislaid or stolen. Photo images in this case, were automatically uploaded onto the Cloud storage space (an external storage space supplied by the Apple software).
Unfortunately, this ended up being an entire debacle resulting in an investigation, confiscation and near disciplinary action which invoked a new topic to discuss with new and current employees.
The image had been deleted from the smartphone; however the investigators were able to retrieve the photo that was stored in the phone's data system. The phone in question was taken and the image was wiped from the source and its storage site. There was an investigation to see if the image had been intercepted by others and the storage site was shut down. It also meant the SHO was phone-less for this extended period!
Another scenario arises when using messaging applications such as WhatsApp and Viber. These use an internet connection to facilitate the sending of messages and photographs. Many teams find this application useful for keeping in touch as a group and updating the team about daily duties. The difficulty comes when trying to discuss issues without dispensing patient details through text. You must be extremely careful to anonymise patient information when using any messaging service and be respectful of patient privacy. If this information is passed on and it is found out again this could go down the route of confiscation of all those phones in receipt of the message, and investigation.
It is extremely important that we remember and consider the ethical principles, that we as registered dental professionals have a duty to uphold, before taking and using photographs within healthcare. This includes:
Confidentiality and Consent:
Within healthcare many records are collated about patients, and each should remain confidential to that patient. Images are an integral part of the patient's records and the normal principles of confidentiality still apply.
Images must never be used in the absence of consent. Patients must be informed of the reason why photographs are taken, what they may be used for and they must accept and allow you to take the photographs.
The data protection act 1998 was put in place to protect the privacy and accessibility of all patients and their records including handwritten notes and imagery. It includes eight principles that set the standard for handling of information; the most important of these to the current issue is the security of the data that is collected.
To summarise, although technology is fast taking over many forms of communication, this technology may not comply with our duty of care as dental and medical professionals. It is essential therefore to understand the ethical and legal principles surrounding patient documentation and act in accordance of this guidance. Before photographs are taken of a patient, consent must always be obtained and documented. The use of mobile phones may prove to be a contentious issue with regard to sending of patient data. It must be stressed that sending of photo a message on smartphones is insecure, carrying a high risk of falling into the wrong hands thus not upholding our ethical duties towards patients.
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