Is it permissible to upload a case-based image?

Uploading Case-Based Images: Guidelines and Consent Requirements

Yes, you can upload a case-based image, but proper informed consent must be obtained from the patient before doing so, as patient images require the same consent and confidentiality safeguards that pertain to other parts of the medical record. 1

Consent Requirements for Medical Images

Who Should Provide Consent

• The person whose photograph is being taken should generally be the one to provide consent
• Parents or guardians may provide consent for photographs of minors or those who are developmentally disabled 1
• Explicit discussion of all intended uses of the image is necessary, especially for electronic publications that may reach wider audiences

Types of Consent Based on Image Content

• Full consent is recommended for all images, even those that do not identify the patient 1
• More stringent forms of permission are needed for identifiable photographs compared to those with higher levels of anonymization 2
• Written consent is strongly preferred for identifiable images, as demonstrated by healthcare professionals' awareness (88-89% of doctors and students recognize this need) 2

Best Practices for Image Sharing

Security Considerations

• Use secure platforms with appropriate security measures (encryption, access controls) when uploading sensitive medical information 3
• Be cautious about any patient information that might be visible in the background of medical test results 3
• Consider using secure EHR-integrated apps for point-of-care medical photography using mobile devices, which has shown favorable patient attitudes 4

Privacy Protection

• Ensure the platform used has appropriate security measures in place to safeguard medical information 3
• Consider whether consent might be needed from healthcare providers visible in the images 3
• Be aware that once published electronically, images enter the public domain and cannot be easily removed 1

Common Pitfalls to Avoid

• Failure to obtain proper consent: Many patients have poor awareness regarding the importance of written informed consent for image sharing 2
• Insecure transmission methods: Avoid using relatively insecure methods like SMS text messages or email that don't preserve images as part of electronic medical records 4
• Assuming de-identified images don't need consent: The focus has shifted toward obtaining full consent for all images, even those that do not identify the patient 1
• Not specifying all potential uses: Patients should be informed about all intended uses of their images, with acceptance rates declining as the audience size increases 4

Recommended Consent Process

1. Use a standardized consent form that clearly outlines all potential uses of the image
2. Discuss explicitly all intended uses of the image with the patient
3. Show the patient the image that will be used beforehand
4. Provide a copy of the consent form to the patient with contact information
5. Ensure the patient understands that their medical care will not be affected by refusal to consent 1

Remember that while many patients may be comfortable with their images being used for one-on-one education (90%), acceptability declines significantly for wider distribution, with only 42% approving use on social media for medical education 4.