Sending MD pictures of wounds on cell phone?

merlee · Nov 17, 2012

This is an interesting situation. Unless the photo is identified as belonging to a particular person then it shouldn't be a HIPAA violation.

Wounds have been photographed for many years, and I have always liked the idea of weekly photos. Wished I could have photographed some of the amazing results with the vac-assisted devices. Sometimes I wanted to show the patient what their wounds/incision really looked like.

But I certainly understand your hesitance.

katielea · Nov 18, 2012

I was seriously asked by one of the attendings to text pictures of wounds during rounds to his cell phone. Needless to say I said "No, but you're more than welcome to come on fridays when we do rounds with the specialist if you'd like to see for yourself how they're healing." My facility does not photograph wounds during weekly measurements/assessments with the wound specialist and there isn't a chance in you know where that I'm going to take a picture of a wound with my personal cell phone to send to the MD or anyone else. I told my DON/Admin about this and they will be taking care of the situation. When I confronted the MD about the request with the statement "why did you ask me to do something you knew illegal?" He stated a lot of the MD's at the "big hospital" do it. I'd be ****** if someone took a picture of a wound on my rear and sent it around to anyone/everyone. Has anyone else heard of doing this? Texting pictures.

I know some nurses that do this. I suppose you could call them street nurses, though that's not their official title - they do outreach to shelters and drop-in centres, often at hours during which MDs aren't willing to attend. They wind up doing what is essentially home health for homeless people. Fantastic ladies, all of them.

So they take photos of wounds that they're "following" whenever they get the chance and text them to the MD for a quick response because you never know when you're going to see that patient again. I don't think they use their personal cell phones, though, I think their phones are provided by the health authority they work for. I think it's a fantastic idea!

followyourbliss · Nov 18, 2012

Hi Everyone,

Wow- I think that we have really gotten away from Confidentiality!

Where I work, at a Wound Clinic, the patient has to sign a consent form; this is regardless of it being " just the wound".

If " we" as Nurses and Clinicians can identify the Wounds so can others. We have a special camera and the images are only allowed to be kept within our system. We accept pictures and communication with images, this is very strictly monitored and tight parameters.

Great topic!

Follow Your Bliss

pedspnp · Nov 19, 2012

Our office had a habit of sending me text messages regarding patients with name, reason for calling. I asked them to please not text me if they needed to contact me when I was out of the office as it was a violation of our policy . They justified it by saying this would be proof that they had contacted me, sorry that did not fly with me what if I had lost my cell phone or someone else saw the message. I told them I would no longer be accepting text messages from the office.

jeannepaul, BSN · Nov 19, 2012

I have done it, with the pt/family permission, sent it and then deleted the pic. sometimes, you just cannot describe what you are seeing to the doc. I have not taken any pics of sensitive areas, no booty's. Our docs will only accept texts first. we get our responses back much quicker that way, and they like it because we get to the point. I don't use names, just dx. and what I need.

dirtyhippiegirl, BSN, RN · Nov 19, 2012

Definitely bring up the idea of photographing wounds with your team/DON/whatever! We have a digital camera on our burn unit that is specifically for photographing wounds. Not going to get into using your cellphone to document wounds -- but having a dedicated camera, with a memory card, is *so* helpful in evaluating wound progression because you're able to compare previous pictures.

tewdles, RN · Nov 19, 2012

You may be able to photograph the wound, but the photo should not be texted to a provider with patient identifiers as that would violate HIPAA.

Texts are typically not secure forms of communication.

nurse2033, MSN, RN · Nov 23, 2012

You need a forensic or photographic policy. Photographs qualify as forensic evidence. Since a work photograph is owned by your employer, and a part of the medical record, it must be taken on agency-owned equipment. It must be securely stored and protected as any part of the health record is. There are ways for MDs to access the medical record from their smart phones, but I don't know what it is.

VA Hospice Nurse · Mar 2, 2013

I am in home health and we do it all the time. It is the only way to communicate to the MD. It is always with the express permission of the patient. It is not a violation of HIPAA if the patient permits it.

MrChicagoRN, RN · Mar 2, 2013

When I confronted the MD about the request with the statement "why did you ask me to do something you knew illegal?" He stated a lot of the MD's at the "big hospital" do it. I'd be ****** if someone took a picture of a wound on my rear and sent it around to anyone/everyone. Has anyone else heard of doing this? Texting pictures.

You were not asked to send it around to anyone/everyone, you were asked to send it to the attending. I don't know how secure a photo is when sent by phone is, but sending medical information electronically to a physician directly involved in the patients care is not automatically "illegal."

However, declining to do it until there is a clear policy in place is perfectly appropriate.

tktjRN · Mar 3, 2013

I'm a Director of nursing at a SNF and the wound care director. This is an absolute breech of confidentially. Even texting an MD for orders is a HIPPA violation. If I found out that anyone of my staff nurses did this, they would be terminated on the spot. Imagine if that was your family member!! Come on people... Be an advocate for your patients