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The device in your pocket - the advantages and pitfalls of digital photography

30 July 2018

Is it acceptable to use your mobile phone to share dental images with colleagues online? Dentolegal adviser Dr Philip Johnstone touches on the advantages of digital photography and the potential dentolegal pitfalls in using your own mobile phone

This article will help you understand: 
  • Photographs taken in the surgery form part of the clinical record which is subject to Data Protection Regulation
  • Obtaining consent to share images online within a closed group
  • The alternatives to using the camera on your mobile or hand phone
Advantages of clinical photography
  1. Creating a “baseline” record of the patient’s presenting condition
  2. Recording progress and development of the above
  3. Improved usefulness of referral correspondence
  4. Improved clinical record keeping
  5. Assistance with the consent process
  6. Patient education and communication
  7. Improved laboratory communication
  8. Self-education
  9. Gallery of photographs to demonstrate treatment options
  10. Oral pathology
  11. Treatment planning

Most people have a mobile phone; sometimes more than one. With the increasing use of social media and competition amongst manufacturers, mobile phones are now equipped with high resolution digital cameras. How often would it be useful to take a photograph of a patient’s teeth using our own mobile?

Before you start taking photos here are some considerations to bear in mind:

When taking a photograph you must respect patient’s privacy and dignity and their right to make or participate in decisions that affect them.

The photograph should only be taken with appropriate consent, ensuring the patient was under no pressure to give their consent. The patient must be aware what the purpose of the image is and how it will be used. This consent process should be fully recorded in the patient’s records. The photograph must not be used for purposes beyond the scope of the original consent, without further consent having first been obtained.

Confidentiality is central to trust between clinicians and patients. Without assurances about confidentiality, patients may be reluctant to seek treatment or to share all the information needed by the clinician in order to provide the most appropriate care. But information sharing by medical and dental teams is essential to the efficient provision of safe, effective care, both for the individual patient and for the wider community of patients.

Photographs taken in the course of the patient’s care, form part of the clinical record and should be treated in the same way as written material in terms of security and decisions about disclosures.

Personal Data Protection Act (2012)
The Act requires that all public and private organisations are legally obliged to protect any personal information they hold. In relation to this, any individual who takes a photograph of another individual using the camera on their mobile phone, subject to exceptions such as for limited household purposes, will be processing personal data and must comply with the Act in relation to the circumstances in which the photograph is taken and the use of that photograph. The use of camera phones and other photographic devices can result in the creation of sensitive personal data such as the racial or ethnic origin of the individual or information about an individual’s mental or physical health. 

You must obtain the patient’s consent, which should usually be in writing, to make a recording that will be used in a widely accessible public arena such as the internet, regardless of whether or not you consider the patient will be identifiable from the recording.

Any image, whether it is anonymised or otherwise, forms part of the dental record, so this data must be stored and processed in accordance with the Act. It is therefore not acceptable to be carrying images of patients on your mobile phone or electronically sharing them with other devices in your possession (for example, synchronised via “the cloud”); there is clearly a risk of the data being lost or stolen. 

As the individual dentist is a data user who has an obligation to collect, store and use patient data correctly and if the images were lost, the dentist would have a duty to notify their employer/principal and the patient, which could lead to difficult questions being asked.

If there is a clinical need or a desire to take images for diagnosis or education purposes it is not appropriate to use personal cameras and mobile phones. Agreement by a patient to take a photograph does not obviate your obligations to an employer, or your duties of confidentiality. 

There are ultimately no circumstances, save for emergencies, when taking patient images on a personal mobile phone, whether or not you have their consent, is justified, so it should not be done. A dedicated digital camera, linked to the practice computer system storing patient details, offers a more secure method of storing photographic data. The practice record keeping system will already be compliant with the requirements of the Act and will allow the sharing of images between colleagues if the patient has given their consent. But the unintended risks that might arise if a mobile phone is lost or cloudsharing software is engaged, will have been eliminated. It also looks more professional!