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Camera Phones Create Privacy Issues in Hospitals

Monday January 28, 2008
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A patient sitting in the waiting room of a behavioral health facility takes out a cell phone and uses the built-in camera to snap a few photos of another patient. An associate on duty witnesses this and immediately informs the RN on duty.

The RN approaches the patient with the camera phone and explains that taking pictures of other patients is a violation of the facility's confidentiality policy. She asks the patient to stop taking photos and to delete those she had taken in the waiting room. The patient complies, and privacy is restored.

Cell phones with cameras threaten privacy more than traditional cameras because they are smaller and more easily concealed. A picture can be taken while a user appears to be making a phone call or sending a text message. By the time it is noticed that photos have been taken, the images might have been sent to others or even posted on the Internet.

A legal obligation

Today, some institutions are addressing the threats this technology poses. Camera phones are now banned in certain public places where there is an expectation of privacy, such as locker rooms of fitness clubs. In health care, the concern spans beyond courtesy to a legal obligation to maintain confidentiality.

Albert Einstein Healthcare Network in Philadelphia has grappled with the issue of camera phone usage for more than a year, says Information Security Officer Anahi Santiago. "Patient information, including pictures, should never reside on a personal portable device, including cameras," Santiago says. "This is difficult to control."

Einstein assembled a task force to discuss issues surrounding cell phone usage in health care settings. Some of the questions the group is dealing with are whether to obtain authorization from patients to have their pictures taken, how to control visitor usage of cell and camera phones, whether to allow family members to disrobe and photograph patients for use in future litigation, and rules involving employee use of cell phones.

Mental health strict on confidentiality

In psychiatric health care settings, camera phones pose a unique set of challenges, says Mardi Ehlers, director of quality management and regulatory affairs at Einstein's Belmont Center for Comprehensive Treatment in Philadelphia.

"Psychiatric patients are generally ambulatory. They have access to areas of the hospital that patients confined to their beds would not have," Ehlers says. "This leaves very few areas in the hospital that cellular phones can be safely used."

Due to the highly protected nature of patient information, psychiatric settings have abided by confidentiality laws that predate HIPAA. These laws prohibit the use of audio and visual recording in psychiatric settings.

In June 2007, the College of Health Information Management Executives (CHIME) released a study showing that 23% of health care organizations had lifted all restrictions on cellular phone usage, and 69% reported that cell phone restrictions apply only in certain areas, such as emergency departments and intensive care units. Only 6% of hospitals reported that all use of cell phones is prohibited.

Cell phone restrictions were lifted after several studies found interference with medical equipment to be negligible, according to CHIME's website (www.cio-chime.org). Allowing cell phone use is also a way to improve patient satisfaction, CHIME reports.

Although the CHIME study did not exclusively focus on camera phones, it was noted that some organizations have specific bans on camera phones in patient care areas.

Nurses can help with enforcement

Because policies differ from institution to institution, and sometimes between specific areas of the same hospital, nurses need to be aware of the protocols regarding use of cell phones.

It is also necessary to understand the potential risks to patients that camera phones pose in the health care arena, including breach of confidentiality and privacy, noise pollution, embarrassment and exploitation. Through diligence and swift action, nurses are in the unique position to prevent or minimize risk to patients posed by improper use of camera phones.

"Our motto is: Maintaining confidentiality is everyone's responsibility," Ehlers says.

Staci Silver Curran, RN,C, MSN, is a nurse educator and staff nurse at Belmont Center for Comprehensive Treatment in Philadelphia. She is also an adjunct faculty member at Holy Family University in Philadelphia. Mary Ann Zeserman, RN,C, BSN, is a staff nurse at Albert Einstein Healthcare Network, Philadelphia. To comment, e-mail editorPA@nursingspectrum.com