JMIR Publications

ABSTRACT

Background:

Point-of-care clinical photography using mobile devices is coming of age as a new standard of care for clinical documentation. High-quality cameras on modern smartphones facilitate faithful reproduction of clinical findings in photographs; however, clinical photographs captured on mobile devices are often taken using the native camera application on the device and transmitted using relatively insecure methods (e.g., text message, email) that do not preserve images as part of the electronic medical record. Lack of robust security features and direct integration with the electronic health record (EHR) may limit patient acceptability and usefulness to clinicians. In March 2015, Mayo Clinic overcame these barriers by launching an internal mobile application that allows healthcare providers to securely capture clinical photographs and upload them to the EHR in a manner that is compliant with patient privacy and confidentiality regulations.

Objective:

To understand perceptions, attitudes and experiences of patients who were photographed using a mobile point-of-care clinical image capture application. In particular, we were interested in understanding the nature of concerns about privacy and confidentiality as well as perceived clinical benefit.

Methods:

Mail-out survey sent to 292 patients who were photographed using a mobile point-of-care clinical image capture application in Rochester, Minnesota within a preceding two-week period.

Results:

Surveys were completed by 71 patients who recalled being photographed. Most (69%, n=49) patients reported that photographs were taken to simply document the appearance of a clinical finding for future reference. Only 14% (n=10) said the photographs were used to obtain advice from a specialist. Seventy-four percent (n=51) would recommend medical photography to others and 67% (n=46) thought the photos favorably affected their care. Patients were largely indifferent about the device used for photography (mobile device vs. professional camera; 58%; n=40) or the identity of the photographer (provider vs. professional photographer; 75%; n=52). Ninety percent (n=64) of patients found re-use of photographs for one-on-one learner education acceptable. Acceptability for other uses declined as the size of the audience increased, with only 42% (n=30) deeming re-use on social media for medical education appropriate. Only 3% of patients expressed privacy/confidentiality concerns. Fifty two percent (n=33) preferred to provide consent verbally and 21% (n=13) did not think a specific consent process was necessary.

Conclusions:

Patient attitudes regarding medical photography using a secure, EHR-integrated application were favorable. In general, patients perceived that photography improved their care despite the most common reason for photography being to simply document the appearance of a clinical finding for future reference. Privacy/confidentiality concerns were rare, and verbal consent was acceptable to most patients. The unique security features of the application were identified as potential facilitators of patient acceptability. Whenever possible, healthcare providers should utilize secure, EHR-integrated applications for point-of-care medical photography using mobile devices.