While facilitating interdisciplinary colloaboration is a central objective with enterprise imaging platforms, this author says implementation of these platforms must ensure optimal patient privacy in sensitive cases involving abuse, assault and domestic violence.
In the United States, nearly 700,000 children are abused every year. In 2020, about 298,628 women across the nation were raped or sexually assaulted. According to the Centers for Disease Control and Prevention, approximately one in three women and one in four men have experienced severe physical violence by an intimate partner in their lifetime.1 In fact, an estimated 10 million people experience domestic violence every year.
Unfortunately, it is common for health-care providers to see patients who are the victims of abuse, assault and violence. In these cases, not every physician should have access to the images and information for these patients. In fact, there is often a need to restrict access to just a handful of members of the care team.
However, in today’s digital world, X-ray images and photographs of clinical conditions are obtained easily and shared via smartphones. In a 2014 survey of the Canadian Society of Plastic Surgeons, 89 percent of the respondents transmitted clinical photographs using smartphones with the figure rising to 100 percent for residents. In the same study, 57 percent of the surgeons had stored patient photographs on their smartphones, and 10 percent did not use password protection on the device.2
Fast forward to 2022 and the prevalence of smartphone usage in clinical settings has clearly risen. However, the use of digital technology in this manner may run counter to patient privacy concerns, especially when cases are highly sensitive. The continued rise of enterprise imaging also amplifies the challenge of keeping sensitive clinical cases private. While ensuring patient privacy is an important piece of a comprehensive enterprise imaging strategy, many healthcare facilities might not prioritize this goal when implementing enterprise imaging as they are typically more focused on the exact opposite: streamlining easy access to images and patient records across all the specialty departments.
Accordingly, let us take a closer look at pertinent considerations in choosing an enterprise imaging solution that provides optimal interdisciplinary collaboration while ensuring privacy in the handling of sensitive patient information.
Emphasizing Data Security as a Key Feature for Any Enterprise Imaging Solution
Typically, the objective of enterprise imaging is to increase the availability of any medical image for any clinician, and that is appropriate in the majority of cases. However, the best enterprise imaging solutions will be flexible enough to protect as well as share images.
Specifically, an optimal enterprise imaging solution should support workflows that protect sensitive as well as restricted content. Sensitive content can include raw and graphic images like large wounds, nudity, or signs of physical abuse. Images of children who have been physically or sexually harmed are especially sensitive. In addition, celebrities, politicians and dignitaries who undergo any kind of treatment or cosmetic surgery do not want their images shared or publicized. It is incumbent upon providers to closely guard all of these types of medical images.
It is vital that an enterprise imaging solution has tools in place to protect sensitive information in these cases. When a suspected abuse victim presents in the emergency department, it is crucial that hospital staff identify the problem and capture all the evidence needed for use by child welfare workers and law enforcement while simultaneously ensuring patient safety and privacy. That means choosing and relying on an enterprise imaging solution engineered with data security as a top priority. Fujifilm’s Synapse VNA was designed to provide data segregation and controlled access, and its robust audit trail ensures chain of custody is clearly documented.
Key Tools That Facilitate Evidence Documentation and Patient Privacy
Providers seeking to protect sensitive information should also look for additional tools that support more granular controls, like a vendor neutral archive (VNA) that allows you to flag individual records as sensitive or restricted. Even whole departments, such as Plastics where nudity is common, can be designated as sensitive.
Moreover, in the case of Synapse VNA, when authorized personnel access studies, the Synapse Mobility enterprise viewer presents a warning to the end user that they are about to view a sensitive study. This allows the user to take precautions around his or her workspace if needed.
In cases that involve abuse victims being seen by multiple specialties, Synapse VNA supports the designation of all content for the patient as sensitive. You can also flag individual studies, groups of studies, and folders of images that include DICOM and specialty (non-DICOM) imaging.
Documenting evidence of abuse is of utmost importance and a provider’s enterprise imaging solution can play a key role. Stanford Medicine provides extensive guidance on what should be documented in suspected child abuse and neglect (SCAN) cases.3 With a robust VNA solution, the entire process is streamlined and secure.
A VNA with a clinical connector tool allows providers to document evidence efficiently and securely. Fujifilm’s Connext Mobile VNA mobile app can capture images, videos, audio, and text notes at the point of care. Photos of the victim’s face and body capture any evidence of bodily harm. Audio and video features can be used to record the patient and any witnesses describing the abuse in their own words so there is no risk of misinterpretation later.
Synapse VNA can also include forms or checklists to make it easy for those reporting the abuse to document everything necessary to support the legal health record. For example, in Stanford Medicine’s SCAN workflow, departments can create a series of questions health-care providers must fill in while documenting the case.
Another scenario is when a facility may only want two or three staff members to have access to restricted images involving abuse. Providers should choose a VNA that supports configurations in which multiple staff members can capture the photos and mark them as restricted. Once these images are uploaded to the VNA, only staff with “view restricted” permission may subsequently access those images.
In the case of VIPs, unless the provider has “view restricted” permission, he or she won’t be able to see worklist entries for a restricted patient. This helps to ensure privacy for dignitaries and celebrities and remove the risk of compromising photos or post-plastic surgery videos, for example, falling into the wrong hands.
Every patient deserves privacy to protect his or her dignity. In addition, certain cases such as abuse, rape and domestic violence victims warrant an even higher degree of protection. Maintaining confidentiality of images and records is of paramount importance. After all, public perceptions of medical record privacy are directly connected to the trust the public has in any given health-care system and the entire health-care establishment.
Health-care organizations that seek to uphold the highest standards when it comes to protecting sensitive information should implement a comprehensive enterprise imaging strategy along with robust technology that is designed with that goal as a key priority.
1. Centers for Disease Control and Prevention. Fast facts: preventing intimate partner violence. https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html . Updated October 11, 2022. Accessed October 18, 2022.
2. Chan N, Charette J, Dumestre DO, Fraulin FO. Should ‘smart phones’ be used for patient photography? Plast Surg (Oakv). 2016;24(1):32-4.
3. Stanford Medicine. Child abuse. https://childabuse.stanford.edu/reporting/documenting.html . Accessed October 18, 2022.