by Mieke Heyns and Anna Steve MD
University of Calgary, Canada
Modern development of smartphone technology and its integration into medical care has enhanced physician practice in the clinical setting. Consider the following example: A junior surgical resident evaluates an adult male construction worker for moderate hand trauma after a workplace incident, and decides to consult the plastic surgeon on-call. Pertinent history and physical exam findings are relayed over the phone, and a photo of the hand trauma is sent via a personal mobile device to help the surgeon better understand the extent of the injury. The photo allows him to assess underlying damage and rapidly determine a short-term management plan. The institution where this incident occurred has no policies in place for transmission of patient photography with personal mobile phones thus the rigor in which security measures are applied to the management of patient data is inconsistent and usually insufficient.
Today, despitethe evident clinical benefit, many institutions prohibit such a practice in the absence of a secure photo sharing network. Yet, a recent study led by a Calgary-based Plastic Surgeon, Dr. Frankie Fraulin, confirmed that over 89% of Canadian plastic surgeons are using their smartphones to photograph patients in similar scenarios. Compared to utilizing widely accepted services like medical photographers, smartphone photo sharing is much more efficient. Beyond consultation, clinician photography can aid in: planning for pre-operative positioning and wound debridement, proficiency of dressing changes, smarter referrals to burn centers, as well as facilitating research and teaching.
Mobile phone technology has been used in clinical practice at least since the early 2000s when plastic surgeons began employing mobile phone technology to triage emergency room patients from remote locations. Despite significant improvement in smartphone technology during the past decade, few guidelines have addressed issues of consent, storage, privacy and sharing of clinical images. Chan et al. 2016, found that less than 40% of respondents were aware of their hospital policy regarding clinical photography with mobile phones.
This discrepancy between guidelines and practice makes physicians vulnerable to litigation. Currently, many organizations and physicians are simply waiting for a convenient solution to be delivered, instead of being proactive about protecting their patients and themselves.
A remarkably simple solution was recently launched by Think Tank Innovations as a free download for iOS and Android devices. The application, developed by plastic surgeons, is called ShareSmart (@ShareSmartApp) and ensures clinician compliance with a wide range of industry regulations including the Health Information Act (HIA), the College of Physicians & Surgeons of Alberta (CPSA), the Personal Information Protection and Electronic Documents Act (PIPEDA), amongst others. Patient consent is automatically synced with photos, and users can track individual photo sharing history, including its archive status. The application allows for secure image storage, direct sharing, and group chats. Photos can be tagged or linked to a clinical presentation or a patient name for quick access and teaching purposes.
Smartphones alone do not meet the security requirements needed to safely handle patient information. In this context, ShareSmart, an application designed to facilitate secure transmission and storage of patient information may become a critical tool in the future.
Chan, N., Charette, J., Dumestre, D. O., & Fraulin, F. O. (2016). Should’smart phones’ be used for patient photography?. Plastic Surgery, 24(1).
den Hollander, D., & Mars, M. (2016). Smart phones make smart referrals: The use of mobile phone technology in burn care–A retrospective case series. Burns.
Hsieh, C. H., Tsai, H. H., Yin, J. W., Chen, C. Y., Yang, J. C. S., & Jeng, S. F. (2004). Teleconsultation with the mobile camera-phone in digital soft-tissue injury: a feasibility study. Plastic and Reconstructive Surgery, 114(7), 1776-1782.