Presentation at smaccGOLD 2014 detailing results of a descriptive survey looking at how critical care doctors use mobile phones and camera photography.

1. Mobile phones in
Clinical Communication
JAKE BARLOW, MBBS
@CJDBARLOW
JAKEBARLOW.ME/PHONES

2. Background
▪ Clinician photography has demonstrated clinical benefit 1-3
▪ 97% of patients have positive opinions around camera phone
photography 4
▪ Observational studies suggest use is growing
▪ No large studies of use conducted

3. Background
▪ Concerns exist around:
▪ Adequacy of consent taken 5
▪ Security of image storage on personal devices 6
▪ Methods clinicians use to share data and images
▪ Lack of policy from governing or regulatory bodies
▪ Survey designed to gauge baseline use of smartphones

4. Methodology
▪ Multi-centre multi-site survey of 3 major Victorian healthcare
networks
▪ Ethics approved by MHREC and each institution
▪ Incentivised online survey over one month
▪ Advertised through posters and email
▪ 46 questions covering different clinical roles and disciplines

5. Methodology
▪ 212 responses from all disciplines
▪ Subcohort study examining 47 critical care responses
▪ Majority of critical care responses from consultants and HMOs

6. Key Findings

7. Key Findings

8. Key Findings

9. Limitations
▪ Small cohort limits utility of sub-group analysis
▪ Variation of practice within critical care clinicians
▪ Recall bias
▪ Selection bias to clinicians with smartphones
▪ Dropout

10. Discussion – Key Issues
▪ Legitimate concerns exist around adequacy of consent taken
▪ Current practice does not appear to be compliant with Australian
Health Privacy Principles

11. Discussion – Key Issues - Consent
▪ Consent is taken inadequately in at least 47% of cases
▪ Discussion in literature focuses predominantly on clinician
education to improve quality of consent
▪ Clinical photography guidelines require documented consent

12. Discussion – Key Issues – Health Privacy Principles
▪ National Privacy Principles enacted on 12 March 2014
▪ Transported Data Flow
▪ Health data cannot be stored or routed outside of Australia
▪ e.g. iCloud, iMessage, WhatsApp, Dropbox, Google Drive, Skydrive
▪ Data Governance
▪ Security of devices
▪ 5% of clinicians surveyed lost phones/USB sticks containing identifiable
patient information
▪ Requirements differ depending on intended use

13. Conclusion
▪ Clinicians are using camera photography as part of their practice
▪ Use does not appear to comply with current legislative standards

14. Contact
stewart@stewartmorrison.com
hughstephens@hughstephens.com
cjdbarlow@gmail.com
david.pilcher@alfred.org.au

15. References
1. Padmasekara G, Nazarian N, Wall C. The reliability of mobile multimedia messaging (MMS) for decision making in distal radius fractures: an
effective alternative. J Mobile Technolog Med 2012; 1: 8-12
2. Lamirel C, Bruce BB, Wright DW, et al. Nonmydriatic digital ocular fundus photography on the iPhone 3G: the FOTO-ED study. Arch Ophthalmol
2012; 130: 939-940.
3. Demaerschalk BM, Vargas JE, Channer DD, et al. Smartphone teleradiology application is successfully incorporated into a telestroke network
environment. Stroke 2012; 43: 3098-3101.
4. Tomlinson JK, Myers AJ, Meads BM. “Click first, care second” photography. Med J Aust 20104; 198 (1): 21-22.
5. Burns K, Belton S. “Click first, care second” photography. Med J Aust 2012; 197: 265.
6. Maher PD, Foley PA, Sheed-Finck A, Baker CS. Legal considerations of consent and privacy in the context of clinical photography in Australian medical
practice. Med J Aust 2013; 198 (1): 48-49.