Promoting a “clinical” approach to the taking and transmission of clinical images

The guide, Clinical Images and the Use of Personal Mobile Devices, was developed jointly by the AMA and the Medical Indemnity Insurance Association of Australia (MIIAA), with specialised input from the AMA Council of Doctors in Training (AMACDT) and the AMA Council of Salaried Doctors (AMACSD).

AMA President, A/Prof Brian Owler, said the guide outlines the key ethical and legal issues that doctors need to be aware of before using a personal mobile device to take or transmit clinical images for the purpose of providing clinical care in the Australian health care system.

“Medical professionals routinely take clinical images while caring for patients,” A/Prof Owler said.

“These images form part of a patient's medical record, so are subject to the same privacy and confidentiality principles as the rest of the record.

“With an ever-increasing range of portable devices available to the medical profession, it is important that doctors and medical students are aware of the benefits and risks associated with the use of this new technology in clinical settings.

“The guide outlines the professionally appropriate processes of informed consent, documentation, capture, secure storage, disclosure, transmission, and deletion of clinical images, including de-identification and privacy legislation.”

A/Prof Owler, said the guide is in keeping with the AMA’s commitment to uphold the principles of medical professionalism.

“Sharing clinical images is extremely valuable for teaching, research, and advice – but there are also associated legal, professional, and ethical responsibilities,” A/Prof Owler said.

“The guide will inform doctors of the obligations associated with the capture and use of clinical images, particularly when using a personal mobile device.

“Under Australian privacy laws, clinical images should only be taken where necessary, and with consent where practicable.

“The images must be stored securely, and only disclosed where needed in line with the consent given, or if there is a legal obligation to do so.”

A/Prof Owler said the AMA believes that better systems need to be developed for integrating clinical images with the medical records of patients.

“The AMA has written to State and Territory Health Departments to encourage them to provide a secure platform to enable doctors to use this technology safely, efficiently, and effectively,” A/Prof Owler said.

MIIAA Chairman, Dr Andrew Miller, said that the MIIAA was very pleased to have been able to work with the AMA on the development of the guide.

Dr Miller said that the guide fulfils the need for practical contemporary guidance for clinical trainees and practitioners on the use of personal mobile devices in day-to-day medical practice.

A/Prof Owler and Dr Miller both acknowledge the inspiration and leadership of AMACDT Chair, Dr James Churchill, who worked tirelessly to bring the guide to fruition.

Key instructions from the guide for doctors and medical students include:

Consent to collection, use, and disclosure of clinical images taken with a personal mobile device

• Before taking a clinical image, consider the purpose for which you require the image and obtain appropriate consent.
• Make sure the patient understands the reasons for taking the image, how it will be used and to whom it will be shown.
• Document the consent process in the health record. Check what your health service/hospital requirements are for written consent.
• Never send a clinical image to anyone else unless you have the patient’s consent to do so, or the patient would reasonably expect you to send the image for the purpose of their clinical management or you are otherwise permitted by law to do so.
• If the clinical image is sent to the wrong person, patient privacy has been breached. In these circumstances you should seek advice from hospital management or your medical defence organisation.

Storage and security of clinical images

• Find out what your health service/hospital policy is for storing clinical images, and what systems your hospital has in place to facilitate the storage of digital images.
• Make sure clinical images do not auto upload to any social media networks or back up sites.
• Delete any clinical image after saving it onto the health record.
• Have controls on your mobile device to prevent unauthorised access

Clinical images and the use of personal mobile devices: A guide for medical students and doctors is available here.

21 November 2014

CONTACT:        John Flannery                     02 6270 5477 / 0419 494 761

                            Odette Visser                      02 6270 5412 / 0407 726 905