Photographic images, digital imaging, dermatology, and the law

Abstract

Patient photographic images play an important role in medical record keeping and training. They are particularly important in ophthalmology, dermatology and plastic surgery. Digital photography has made such imaging more accessible. However, an assessment of the legal implications of image taking is necessary to use images properly. This article summarizes some of the legal issues. Specifically, it discusses the image as part of the medical record, images as medical evidence, and implications of the Health Information Portability Accountability Act (HIPAA) of imaging. Indeed, images are part of the medical record and must be treated with the same care as written medical records. Because multiple digital images are sometimes taken and digital images can be easily manipulated, they present novel issues in this regard. Images can be used as evidence in court. Issues regarding digital images include authentication, manipulation, audit trail verification, and data compression. HIPPA requires that health care providers control and track those who have access to identifiable digital medical information. This should facilitate the use of digital images as evidence because the provenance of digital images can be established. HIPPAA covers the use and disclosure of protected health information, such as “full-face photographic images and any comparable images.” To publish identifiable digital images (images of the face), it seems prudent for patients to waive in writing their rights to this protected health information. Images will continue to enhance medical care, and understanding and accounting for the legal underpinnings of their use is prudent.—Valerie Biousse