The modern smartphone has revolutionized how healthcare providers and patients capture and share images, enabling faster diagnoses and collaborative care. This is becoming increasingly important with the expanded use of telemedicine. However, this convenience introduces ethical, legal, and practical questions regarding patient privacy, consent, and compliance around sharing and storing medical images. For example, previous studies have found that over half of physicians store patient images on their phones, but as many as 10% of them do not keep their smartphones password protected¹.
Consistent compliance with best practices is critical to maintaining patient confidence. Here we summarize current guidelines and offer recommendations for the responsible use of patient photographs in clinical care.
LEGAL AND ETHICAL CONSIDERATIONS
Patient Privacy and Deidentification¹
Clinical images are considered protected health information (PHI) under HIPAA and similar laws. To exempt images from these regulations, healthcare providers must ensure they are properly deidentified. Patient characteristics that are considered potentially unique identifiers and should be removed include patient tattoos, birthmarks, body piercings, and clothing. Geolocation data embedded in photos (known as exchangeable image file format [EXIF] data) must also be removed. The Department of Health & Human Services sets forth two deidentification processes: the Expert Determination Privacy Rule and Safe Harbor Privacy Rule. Both approaches require removing the features identified above as well as full-face images to ensure compliance.
Consent for Use and Sharing
Written consent is generally required for the use of identifiable photographs in treatment, payment, or healthcare operations. The distinction between consent and authorization is critical. Consent refers to written permission that is often general in nature and used for routine purposes. Authorization is specific and detailed, including the purpose of disclosed information and the duration of validity. Authorization is needed for non-treatment uses such as medical education, marketing, or publication. General consent is not sufficient for medical images at risk of subsequent secondary use, such as in a lecture at an educational conference². When obtaining authorization for such purposes, providers must disclose the possibility that identifiable material may appear on the internet or social media². Verbal agreements may be appropriate in time-sensitive scenarios but should be supplemented with written documentation where possible¹.
PRACTICAL GUIDELINES FOR HANDLING IMAGES
1. Secure Capture and Storage
- Use dedicated, encrypted platforms to store and transmit images instead of standard texting apps or personal devices. Non-secure SMS or MMS is not HIPAA-compliant due to lack of encryption¹.
- EMR systems are recommended for secure storage. Though it may be less convenient than traditional smartphone image capture and storage, it mitigates the risk of non-compliance with patient privacy protections. For example, using the standard camera application may store the image on the cloud indefinitely.
- Providers should be aware that conventionally stored images typically remain accessible for thirty days even following deletion.
- Enable remote-wipe features in the event of loss or theft of your device.
2. Patient-Submitted Images
- Patients must be informed that submitting images via text or email may not be secure, and consequently there is an inherent risk to patient privacy.
- Upon receipt, patient images should be stored in the EMR, and non-secure copies should be deleted.
- Whenever possible, communicate to patients a means of securely transmitting images before they are sent.
3. Deidentification Protocols
- To exempt images from patient privacy laws, they must be deidentified.
- Remove identifying elements, including visible features (e.g., facial tattoos, scars) and metadata like timestamps or geolocation, before sharing images for purposes beyond direct patient care¹.
- Turn off GPS tagging on devices to avoid embedding location data into clinical images. This can be done in your device’s privacy settings.
4. Establishing Policy Standards
- Healthcare organizations should implement clear policies on the acquisition and use of patient images. This includes training providers on secure platforms and obtaining appropriate consent forms tailored for image usage.
- Emphasizing the use of image capture and storage within the EMR can mitigate compliance risks.
- Establish encrypted channels for patients to remotely submit medical images. For example, a HIPAA-compliant healthcare portal.
EMERGING TRENDS AND RISKS
Telemedicine—The increasing reliance on telemedicine has amplified the use of patient-submitted images. With increasing volumes it becomes important to differentiate between images that will be used for routine patient care and those that will be used for secondary purposes in this setting. Standardized consent forms can expedite treatment-related sharing in this setting; however, separate written authorization is required for educational or publication purposes¹,².
Smartphone Technology and Compliance—Studies show that a significant number of physicians use smartphones to capture and share patient images, often without adequate safeguards such as password protection or encryption1. Adopting HIPAA-compliant apps can mitigate risks while maintaining the benefits of rapid communication.
Machine Learning and AI—Clinical images are frequently used in machine learning datasets, underscoring the need for transparency about how patient photographs may be used beyond direct care. As with use for any research or publication purposes, explicit authorization is required for AI application².
RECOMMENDATIONS FOR PHYSICIANS
Patient Education and Consent
Engage patients in discussions about the risks and benefits of sharing their photographs. Provide clear explanations of consent forms, particularly when images may be used for secondary purposes¹,².
Using Secure Platforms
Transition to proprietary, HIPAA-compliant tools for image storage and transmission. Avoid relying on non-encrypted methods like standard texting or consumer apps¹,³. Review historical platforms for unsecured medical images and other PHI.
Institutional Support and Policies
Advocate for standardized institutional policies that integrate technology responsibly, ensure staff training, and regularly audit compliance with privacy regulations¹.
Smartphone technology and telemedicine are transforming the use of patient images in healthcare, offering unprecedented convenience but posing significant privacy and compliance challenges. By following best practices for consent, secure transmission, and deidentification, healthcare providers can responsibly leverage these tools to improve patient care while upholding ethical and legal standards. As technology and guidelines continue to evolve, it is essential for providers to evolve their practice as well.
The information provided herein does not, and is not intended to, constitute legal, medical, or other professional advice; instead, this information is for general informational purposes only. The specifics of each state’s laws and the specifics of each circumstance may impact its accuracy and applicability, therefore, the information should not be relied upon for medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation.
Article originally published in 1Q25 Copiscope.
