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A Picture’s Worth a Thousand…Dollars?

By Sanaz Cordes, MD

We’ve all heard the expression “a picture’s worth a thousand words.” Some might say we now live in a world where pictures are used more often than words for communication.  It’s a bit ironic that the only species on earth with the ability to speak prefers to communicate via mobile pics (enhanced with filters and apps that instantly make us skinnier, tanner, and younger).  We have evolved through anthropologic periods including the stone, iron, and jet ages, so are we now entering the “selfie age?” The evidence suggests so.  Instagram started out with 90 million users in 2013 and now has over 800 million.  With esteemed celebrity role models leading the charge (Kim Kardashian reportedly took 1,500 daily selfies during a 4-day vacation), we are uploading over 10,000 photos per second on Instagram, Facebook, and Snapchat.  Sharing images of ourselves doing extraordinarily fascinating things like eating dinner or shopping is now a widely accepted form of interpersonal communication.

Beyond Social Media:  Is Image Sharing Transforming Patient Care?

So, we’ve established that there is a cosmic surge in picture-sharing (driven by either a cry for help or vanity).  But there is one group of people sharing an increasing number of images for reasons completely unrelated to narcissistic displays of self-importance:  the increase in image capture and collaboration by healthcare providers. This use of image-sharing is improving health and even saving lives.  Unless you suffer from a severe case of iatrophobia (one of my favorite medical terms which means an intense fear of doctors), you may have noticed that many providers now document, track, and treat patients using clinical photographs.  

The ability to snap a mobile photo of a patient for collaboration with specialists has revolutionized access to care and speed to diagnosis.  For example, if a primary care provider sends a photograph with a written summary to a dermatologist, there is up to a 93% chance that an accurate diagnosis and treatment plan can be made.  And, over 69% of dermatologists are using text or email to communicate with colleagues regarding patient care.

Click and Send with Caution

Increasing efficiency, diagnostic accuracy, and improved access to care are some of the groundbreaking benefits of clinical image-sharing.  But, with all innovation comes risk.  In this case, the risks include compromised patient privacy, data breaches, and HIPAA fines.  The mere mention of these word can make healthcare providers queasy.  But protecting patient health information (PHI) is serious business.  Not only is HIPAA compliance the right thing to do, not adhering to its standards is costly and even criminally-punishable.   One sobering example is a Philadelphia-based nursing home that received a $650,000 fine for a PHI breach in 2016.  An employee’s iPhone containing patient images was stolen, and the investigation exposed lax mobile device policies that led to the expensive penalty.

So, forget the “thousand words” – is a picture worth up to $50,000 in fines?  A PHI data breach can cost between $100 to $1.5 million per instance depending on an institution’s HIPAA protocols and their level of compliance or willful neglect of them.  In 2017, HIPAA fines exceeded $19 million – as compared to $100,000 in 2008.  Additionally, the Office of Civil Rights (OCR) can impose criminal charges for certain HIPAA violations.

Avoiding the Wall of Shame

Once your organization has had a HIPAA breach, its name is permanently listed on the OCR Breach Portal, a.k.a. “The Wall of Shame.” Today, over 96% of physicians use smartphones as their primary device for clinical communication.  Yet despite the huge risks, healthcare providers admit to not being compliant with HIPAA requirements such as encryption, not storing photographs on the phone, not entering PHI into the phone, and proper authentication.  This is particularly astounding considering that providers are typically a highly intelligent and diligent group of people.  

If millions of selfie-admiring narcissists have discovered mobile apps that feed their ceaseless craving for attention, why aren’t smart professionals dedicated to caring for patients not following suit?  Perhaps they aren’t aware that apps now exist that support their image-capture workflow without compromising PHI security.  Some of these apps are extremely simple to use, and they can significantly reduce manual data entry and error.  Providers can improve patient care without incurring costly penalties, compromising patient privacy, or facing a lifetime of disgrace on the dreaded Wall of Shame.