Keywords
plastic surgery - information technology - Health Insurance Portability and Accountability
Act - photography
Whether to monitor the progression of lower extremity wounds, share “before-and-after”
aesthetic photos, or depict intraoperative techniques for a complex surgical case,
clinical photography is essential in the practice and progression of plastic surgery.
Today, plastic surgeons are equipped with exceptional means for potable capturing,
sharing, and storing standardized, high-resolution clinical photographs that improve
patient care.[1]
Logically, most plastic surgeons use their smartphones to capture (50–90%) and store
(46–57%) clinical photography.[1] In a pilot survey of 30 resident and attending plastic surgeons at a single academic
institution, we observed that 100% of respondents reported routinely photographing
patients (8.2 ± 11.06/d), with their iPhones (80%) and sharing photos via Apple iMessage
(67%). These behaviors do not correlate with the intentions of surgeons to protect
the sensitive content in photography of patients undergoing breast reconstruction
and gender-affirming surgery. Modern facial recognition technology (FRT) adds to the
risks of collecting and storing biometric data such as facial features, tattoos, and
unique tissue deformities or wounds. These theoretical consequences have surfaced
as breaches of plastic surgery photos, and associated biometrics have led to blackmail,
ransoms, irreversible identity theft, and permitted access to bank accounts and personal
information.[1]
[2] This is concerning in the context of the Federal Court case, Hazlitt v. Apple Inc.,
2021, in which Apple is facing a class action for violating the Illinois Biometric
Information Privacy Act. The plaintiffs alleged that the Apple Photos app uses FRT
software to collect and store digital faceprint databases that users cannot limit
control or remove from their phone.[3]
Plastic surgeons face conflicting responsibilities to provide the best possible care
for their patients and protect their confidentiality. Merging these duties requires
implementing a secure digital tool for point-of-care clinical photography. However,
our survey reveals a gap in the institutional and user acceptance of HIPAA-compliant
software. Only 57% of plastic surgeons reported having access to an HIPAA-approved
method for clinical photo sharing, and 53% cited using the said platform. Marwaha
et al present a framework that helps health care organizations (HCOs) navigate institutional
and individual barriers to deploying technology, stressing the importance of conducting
site-specific needs assessments and interdisciplinary collaboration.[4]
Mayo Clinic realized that an outright banning of smartphones was impractical and led
to inconsistent behaviors. In response, Mayo Clinic conducted an interdisciplinary
review of its local regulations, site-specific policies, institutional framework,
and technological bandwidth.[5] This intimate understanding of local workflows and available resources for quality
improvement informed their decision to internally develop an iOS-based application,
PhotoExam which maintained the convenience of smartphone-based photography while ensuring
cybersecurity and privacy for patients.[6] The success at Mayo Clinic suggests that secure point-of-care clinical photography
is feasible if HCOs use a strategic approach that respects key considerations consistent
with those raised by Marwaha et al.[4]
[5]
[6]
Ultimately this communication presents the potential consequences of the ongoing widespread
disorganization of clinical mobile-photo sharing and offers a solution for individual
HCOs to adapt to their unique institutions. The field of plastic surgery and patient
confidentiality depends on prioritizing these matters.
