A picture is worth a thousand words: Ethical dilemmas presented by storing digital photographs in electronic health records

摘要

A dermatology practice that is part of a larger hospital system has recently transitioned from a paper record to an electronic health record (EHR). A 35-year-old woman with many dysplastic nevi, a longtime patient of this practice with an extensive past photographic paper record, comes for routine skin cancer screening. A suspicious nevus is identified on the right breast and photographed for serial monitoring. The image captures a portion of the breast demonstrating the lesion and the areola for reference to distance and location. It is uploaded into the EHR. A week later, the patient visits her internist in the hospital. She notices the image of her right breast as her internist reviews her electronic chart. She is appalled that all of her physicians have access to this image, contacts the dermatology practice and requests the image be removed from the chart.