WHY PHOTOGRAPH PATIENTS? Photo documentation can make an important contribution to the medical record by documenting patient outcomes; for example, trends in wound healing, forensic documentation of injuries, or documentation of injuries following motor vehicle crashes or workplace accidents. But to protect patient privacy and keep you and your facility out of legal trouble, you need policies and procedures that provide guidelines for photographing patients and using the photos as documentation.
Photographs of patients fall under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Unless state and federal laws specify otherwise (as in some forensic cases), the patient must provide informed consent to be photographed. Competent, capable minors also should be asked for consent. If photographing patients is a routine part of the care at your facility, the consent can be written into the HIPAA-mandated information given to patients and included in the facility's admission consent documents.
Policies and procedures should outline:
* when and how patient photography is allowed at your facility
* patient-consent processes
* who owns the photographic images (facilities almost always retain copyright ownership)
* how images are stored and retrieved. All photographs need to be securely stored in a way that will allow easy access to appropriate caregivers, preserve the photograph's quality, and protect the patient's privacy.
* how long images are kept
* when, why, and to whom patients may authorize release and use of images outside of the facility's jurisdiction.
Photos as part of the medical record
Just as with all medical record information, photographs may be admitted into evidence during court proceedings. So take steps to avoid images that could later raise questions in court. If you're taking photos to document a wound, for example, place a measurement scale, such as a small ruler, in the photograph. To do this, take one photo with the measurement tool included, followed immediately by a second photo without the measurement tool. That way, no one can accuse you of concealing important details beneath the measurement tool.
To clearly connect the photo to the patient, you can print the patient's name and hospital number or birth date, the date and time of the photo, and the photographer's name on a sheet of paper. Take a picture of that paper at the beginning and the end of the roll of film or series of digital pictures.
If photographs and video recordings are kept somewhere different from the rest of the medical record, document where these items are located in the medical record. All photographs should be kept for the same reason and the same time period as any other part of the medical record.
Photos for other uses
If the patient's photograph is to be used for a published manuscript, staff education, facility publicity, or conference presentation, the patient (or his legal representative) will need to authorize its use. This authorization should be in writing with a full signature, which needs to be witnessed by a competent adult when applicable. The witness's name should then be printed legibly directly below the signature. This form will then be entered as a permanent part of the medical record. Any new series of photographs will need additional signed and witnessed forms. As with all health care procedures, the patient or legal representative has the right to withdraw consent at any time.
If photos are taken as part of a research study, the approved research protocol should include clear mechanisms for patient's informed consent (and withdrawal of consent, if applicable) before, during, and after photography.
Be sure to document the patient's name, the date and time of the photograph, the photographer's name, and any other reference information on the reverse side of the printed photograph. Use great caution not to damage the printed photograph in any way with this documentation.
Document in the patient's medical record that you've taken these photos. Also document all patient teaching about the photographic process, as well as the patient's responses to that teaching.
Hjort B, et al. Patient photography, videotaping, and other imaging. AHIMA Practice Brief. Journal of AHIMA. 72(6):64M-64Q, 2001.
Langemo D, et al. Digital wound photography: Points to practice. Advances in Skin & Wound Care. 19(7):386-387, September 2006.
Smith JW. Photographing patients: Guidance for staff. Ashford and St. Peter's Hospitals. March 2007. http://www.ashfordstpeters.nhs.uk/intranet/Ashford-/Publicatio/Policies-a/Photog. Accessed June 6, 2007.