Consent Cam Consolidation

The world of medicine is getting smaller, the conversation getting broader and the rate of development is exponential.

With the advent and increasing acceptance of #FOAMed resources, we are now able to converse globally on issues that would otherwise have laid dormant in the darkest recesses of our minds save for the uncomfortable douloureux of restless wakening…but now we may rest our weary lids secure in the knowledge that we are not alone…

The advent of the global stream of consciousness allows us to dip into the psyche of a veritable Smörgåsbord of medical experience to define, debate and deliver on some of the important issues that plague us in our daily practice

My most recent discussion concerned been the ability to take a clinical photograph, gain consent from the patient, record the consent and upload/edit the image for use on medical education platforms such as the Global Medical Education Project

[blackbirdpie url="https://twitter.com/EMtraveller/status/299000015551070208"]

This statement led to a 140 character debate on some of the issues facing clinicians on numerous continents and resulted in the deployment of

I thought I would share this story because it emphasises the potential for

  • Dissemination: the power of global conversation through #FOAMed
  • Discussion: it marks the starting point for a conversation which can continue on twitter and through blogs, then onto #SMAC2013 so that a global perspective can be obtained
  • Development: the seedling inclination to pursue a random thought can be magnified with altruistic assistance
  • Deployment: this may well result in a collaboration which leads to the production of an essential element for medical education provision

[blackbirdpie url="https://twitter.com/TessaRDavis/status/299529302830104577"]

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Comments

  1. Jeff says

    I’m really interested in how you guys set this up, since I’ve been thinking about how to do it at our institution which has a strong policy against mobile phone pictures of patients.

    I see the requirements as:
    1) App able to take clear images
    2) Able to attach name and clinic number to image
    3) Able to take video
    4) Able to send that info encrypted to a server
    5) Automatically erase the photo from a phone once it’s sent
    6) Able to upload on a PACS type system for hospital-wide viewing
    7) Password protected app
    8) Able to do a consent on the phone or just take a picture of a consent form
    9) Simple to use and something people would want to use (like something apple would design)
    10) Inability to save image on personal phone with personal photos or photostream
    11) Ability to work in a number of ways--for example, attach to the panoptic (like the iExaminer app coming out), attach to a video otoscope, or a slit lamp.

  2. Chris Edwards says

    Awesome work gang -- as I mentioned in twitter, I just get them to sign a consent form, I take a pic of it using iPad, with a self generated patient code (not the hospital UR) once I get the documents home from the iPad I edit the pics to remove patient identifiers.

    This is a bit labour intensive at times, would prefer it to be automated.

    Some suggestions on a prog:
    1. Generates a ‘folder’ for saving the consent form, pics taken, saved under a generated patient ID -- if you give this ID to the patient along with the consent form they signed (you have a digital copy) they just need to quote this when emailing you to withdraw consent -- avoiding the need for hospital URs etc
    2. When generating folder, generates a small txt file for you to put in (and update if necessary) relevant, but not identifying, patient notes (i.e. 43yo M presented w/ SOB, hx of TB)
    3. Likely all data needs to be encrypted and transferred encrypted to home device
    4. Option to upload to GMEP personal library (Mike -- if your data in GMEP is encrypted, could this end up being a way to store the data?)

    Just a note on the consent aspect as well -- you’ll note in the example consent I provided, it has a section which states -- ‘I understand that once published in this medium (internet), complete removal of material may be impossible’. I think this is an important part to add, as once published on the internet, nothing truly gets deleted :)

    I actually think, if a user friendly app can be developed, and individuals get support from their own hospitals, this could lead to an explosion in case based #FOAMEd as well as contributions to GMEP.

    I would be more than happy to lend a hand, although programming wise I won’t be alot of help as I’m out of date with programming languages these days -- but tech savvy otherwise. Would love to catch up with some of you at SMACC to discuss and maybe figure out a way to divvy up some tasks?

    Can’t wait for SMACC :)

    Chris

    • Andrew Perry says

      Funny how ideas all seem to snowball at once. Was reading the last few editions of the MJA recently where this very worthy topic has been discussed in multiple articles and started corresponding with one of the authors.
      After reading the articles I felt that not only was there a need for a digital app with features as discussed above but also some plain-english practical guidelines for doctors involved in this practice which acknowledge the significant potential benefits against the potential pitfalls, and try to accommodate the various state and territory based legislation that covers these matters. Ideally they would be endorsed by some sort of professional association(s) or body including an organisation with legal expertise.
      Another aspect to this issue to discuss at SMACC?
      Andrew
      ED Registrar

  3. says

    Some great suggestions and ideas here! I am going to try and collate all the comments (both here and via twitter) and come up a working framework for how we can take this forward.

  4. Andrew Perry says

    Have just downloaded my hospital’s policy, consent forms and associated paperwork regarding clinical photographs. They aren’t totally unreasonable although there are a couple of issues like not being able to take photos if they are purely for teaching/publication purposes without written consent which rules out a huge number of cases and the fact you can’t print out the online version of the consent form because it is locked necessitating a hard copy to be found.
    Is it worth starting to assemble these documents in the one spot such as another Google Doc?

  5. Scott Carrington says

    I think this as an idea is brilliant, for both education and patient care. Picsafe starts off well but the images can only be used in a closed network and the app comes at a cost. Not really FOAM.

    I’m happy to be involved with this. Must find my current hospitals policy to upload.

    • ellebellucci says

      Hi,

      Something to consider…while developing this app why not get crowd-sourced input from PATIENTS? There are alot of health care consumers on twitter, sure you’d get a bunch of input, specifically in terms of getting consent, withdrawing consent. What process would make them most comfortable and agreeable? Patients could add some unique perspective to the brainstorming phase.

      ellebellucci

  6. says

    Just an update. I have been working with a developer to see what is and isn’t possible.

    On an iphone it is not possible for pictures to be deleted by the system (i.e an app can’t be programmed to delete the picture once it has been sent to GMEP.org or an e-mail address etc)

    How big an issue is this? and does anyone know if this applies to androids as well?

    All the best

    Damian

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