Home' News Bulletin : ADA News Bulletin October 2015 Contents 11
DENTAL INSTRUMENTS MATERIALS AND EQUIPMENT
Clinical images and the use of
PERSONAL MOBILE DEVICES
Recently, a guide to the proper use of personal mobile devices
when taking clinical images was produced by the Australian Medical
Association (AMA) and the Medical Indemnity Industry Association
of Australia (MIAA). While this guide was aimed at medical students
and hospital doctors the guidelines equally apply to dentistry.
This article outlines several ethical and legal issues providers of
patient care should be aware of before using a personal mobile
device to transmit clinical images for the purpose of facilitating
GUIDE TO USE OF PERSONAL MOBILE DEVICES
Prime points the guide makes are:
• Prior to taking a clinical photograph, consider the purpose for
which you require the image, and obtain patient consent.
• Ensure the patient understands the reasons for the image, how
it will be used, and to whom it will be shown.
• Always document the consent process in the patient's record.
• Never transmit a clinical image to anyone unless the patient has
consented to do so, or if the patient would reasonably expect you
to send the image for the purpose of their clinical management, or
if you are otherwise permitted to do so by law.
• If the transmission is inadvertently sent to the wrong
recipient then the patient's privacy has been breached. In such
circumstances, advice should be sought from your ADA branch
and/or professional indemnity provider.
• Make sure clinical images are not uploaded to any social media
• Have controls on your mobile device to prevent unauthorised
• Delete any clinical image from the device after saving it to the
EXAMPLES OF BREACH OF CONFIDENTIALITY
Along with these points the AMA provides examples of cases
where patient confidentially has been breached.
In one case report, a patient was having cardiac surgery and
underwent cardiac arrest. A medical student filmed the event on
an iPhone and posted the video on Facebook under "Guess what
happened at work today?"
The AMA defines a clinical image as a photo, video recording or
The clinical image in dentistry may not only be the patient, their
teeth and soft tissues but also an image of a pathology report or
According to the guide, patients have the right to refuse the
taking of a clinical image. However, the refusal of consent should
not compromise their care where there is a suitable alternative.
Patients have the right to withdraw their consent for an image to be
used but should be informed at the time of gaining consent that,
once an image has been captured and becomes part of the dental
record, it cannot be deleted from the record. A patient's refusal or
withdrawal of consent should also be documented in their record.
The documentation process should include that the image has
been sent on to a senior colleague for comment and the patient
should be informed of the image transmission.
In the case of de-identification of images it should be remembered
some devices contain metadata that could be used to identify an
individual. For example, time/date, details of the device and GPS
location. In de-identifying images care must be taken to remove
Patient images must be treated in exactly the same manner as
other information in their dental record. They can be accessed
for use in legal proceedings and patient complaints. It is also
recommended details be recorded as to who took the image and
the date of capture.
As a recipient of clinical images you are bound by the same legal
and ethical requirements as if you had taken the image. The
practitioner capturing the image has the responsibility for ensuring
the image forms part of the patient's record.
On behalf of the DIME Committee and SPC on e-Health
Reference: Clinical Images and the use of personal medical devices
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