Picture of wound?

[Glycerine82, LPN]

Hypothetically speaking, if a nurse took a picture of a wound on an area such as a patients hand and there was no identifying information or anything else in the picture except for the actual wound, could that be a privacy (or some other) violation? I know it's not a HIPAA violation and honestly, I can't see what it would violate besides perhaps facility policy, but I"m curious what others think.

In this purely hypothetical situation the patient gave permission, no devices came near the patient and the photo was deleted right after she/he was done documenting.

The reason the nurse took the photo was to assist her in documenting the appearance of the wound as she hadn't seen anything like it before and wanted to be sure to accurately describe it.

Just curious. This nurse thought she was thinking on her feet and now she is second guessing herself.

[Kaisu]

I work home health. We routinely photograph patient wounds, however, they sign a consent when first admitted, and verbally consent each time.

[bugya90, ASN, BSN, LVN, RN]

If it was taken on a personal non-secure device then yes. I've actaully seen a Physican Assistant fired for this exact thing (taking pics of wounds and/or rashes on their smart phone).

If it is going into the medical record, your company should have some sort of secure device for this. We have an iPad that is linked to our EHR and will automatically upload the pic into that persons chart.

[Crush]

Only if done according to facility policy with written consent by said person/patient on a facility approved camera, not a personal smart phone. Be extra careful to follow facility policy.

[CharleeFoxtrot, BSN, RN]

FWIW I know of someone who got fired for that exact thing, management stated it violated facility policy.

[NuGuyNurse2b]

The only time I've taken a pic is using the patient's own camera because they were curious what it looked like, or they wanted to document their progress. It is in their belonging, they can do whatever they want with it. I would never use my own camera.

[KatieMI, BSN, MSN, RN]

If the picture ended up outside of EMR, with whatever goal, then yes, it is HIPAA violation even with consent signed and no identifying details.

I had it done many times when info had to be communicated between, say, LTACH and accepting SNF or home care, when relative living on the other end of the country wanted second opinion for patient, when potentially accepting facility, again right across the country, wanted to have those pictures so they could decide what kind of surgery could be done, etc., etc. Every time, it took days and plenty of paperwork to make it go through "official" channels. Families were so frustrated that sometimes they talked "accepting" side into working with pictures taken with their own cameras and sent through ordinary email services, with myself and everyone else quietly looking other way. As long as families used their own smartphones and did it themselves (read: an RN prepped spot, fixed measurement tapes, arranged light, showed how to hold camera to show tunneling/undermining, etc, - shortly, did everything but taking actual picture), everything looked just cool from legal point of view.

[mmc51264, BSN, MSN, RN]

We have an app at our facility (I personally don't need it) that can take pictures on encrypted phones that can be inserted into progress notes. The wound nurses take pics of things so we can see progression. The ortho docs will take pics of wounds to see before and after (I try to avoid those-I'll see the limb AFTER it is fixed please). Pts will ask me to take pics of stuff they can't see with their own phones.

[Buckeye.nurse]

Our computer charting system recently gained the capability to link pictures to our wound assessment charting. We have portable hand-held smart devices that we can take pictures with in addition to scanning meds and other functions. We're actually encouraged to take pictures (with the patient's permission) to enhance our charting, and all of the wound-ostomy nurses love it. Sometimes a picture really does say a thousand words.

Taking a picture on your own device is a *lot* different. I would check with your unit manager, unit educator, or a similar authority figure first. Taking pictures on your own device could land you in a lot of trouble if you don't have the backing of administration/hospital policy.

[Elfriede]

Hhhmm...

In Germany you need an "agree in writing" from the pt or the legal carer

1.) to make a photo and

2.) to hand it off to physicians, insurance or specialists.

In doubt, I would ask my management `bout a written instruction.

[Apple-Core, ASN, BSN, RN]

If the picture ended up outside of EMR, with whatever goal, then yes, it is HIPAA violation even with consent signed and no identifying details.

I had it done many times when info had to be communicated between, say, LTACH and accepting SNF or home care, when relative living on the other end of the country wanted second opinion for patient, when potentially accepting facility, again right across the country, wanted to have those pictures so they could decide what kind of surgery could be done, etc., etc. Every time, it took days and plenty of paperwork to make it go through "official" channels. Families were so frustrated that sometimes they talked "accepting" side into working with pictures taken with their own cameras and sent through ordinary email services, with myself and everyone else quietly looking other way. As long as families used their own smartphones and did it themselves (read: an RN prepped spot, fixed measurement tapes, arranged light, showed how to hold camera to show tunneling/undermining, etc, - shortly, did everything but taking actual picture), everything looked just cool from legal point of view.

How do websites/Apps such as Figure1 make it work then? Not confronting what you're saying - just interested in how it is ok to upload a pic of injury/x-ray/illness to such a site that has a world-wide audience and it be OK??

[Meriwhen, ASN, BSN, MSN, RN]

The nurse was right to photograph the wound, especially if the patient had the injury prior to admission--otherwise it could easily be assumed/claimed that the patient sustained the injury while in hospital. And given that Medicare and insurance companies are taking a hard line about covering costs for injuries sustained while in the hosptial's care...

So we routinely photograph wounds, bruises, decubiti, etc., and these photos become part of the patient's EMR. But we ask permission prior to photographing, use only facility equipment to take the pictures, and use only initials and the medical record number for identification.

Your friend should look up what the facility's P&P are regarding photographing injuries and follow them to a T.