By Laurence Yudkovitch, Product Manager – Synapse VNA, TeraMedica Division of Fujifilm
This post is going to contradict most of what we generally preach for enterprise imaging. Typically, the goal of enterprise imaging is to increase the availability of any medical image for any clinician, and that is appropriate in 80 to 95 percent of cases. However, some images are more sensitive and shouldn’t be shared with every clinician. Instead, these images must be restricted and made available only to a very limited number of care providers based on their role in the patient’s care. An optimal enterprise imaging solution supports workflows that protect this sensitive, restricted content.
Some of this sensitive content includes graphic images that may frighten or shock people who aren’t expecting them. Examples can be photos of large wounds, nudity, or abuse victims. One of the most frequent requests for managing access to restricted content relates to abuse victims. Images of children who have been sexually abused, neglected, or physically harmed are especially sensitive. Rape victims and subjects of domestic violence are other examples of patients whose data should be closely guarded, especially when friends or family members may be hospital employees and otherwise have access to those records. The third class of patients who often warrant additional privacy when being treated is VIPs. Wealthy customers, celebrities, and politicians often seek treatment for issues such as depression, substance abuse, or cosmetic surgery that they don’t want publicized.
For these reasons, it’s vital that an enterprise imaging solution has tools in place to protect these records. When a suspected child abuse or neglect patient shows up in the emergency department, it’s crucial that hospital staff is able to identify the concern and capture all the evidence needed for use by community agencies and law enforcement to ensure patient safety and privacy. Data security has always been core to Synapse® VNA; its hierarchical org structure was designed to provide data segregation and controlled access, and its robust audit trail ensures chain of custody is clearly documented.
Modern workflows are enhanced with additional tools to support more granular controls. With recent improvements, Synapse VNA lets you flag individual records as sensitive or restricted. If the Plastics department considers everything they capture as sensitive, since nudity is often involved, Synapse VNA can flag the entire department. Abuse victims may be seen by multiple specialties, so the VNA supports flagging all content for the patient. You can also flag individual studies, groups of studies, and folders of images that include DICOM and specialty (non-DICOM) imaging.
One of the most important aspects in caring for victims is documenting evidence of the abuse. Stanford Medicine provides extensive guidance on what should be documented in suspected child abuse and neglect (SCAN) cases. Connext Mobile, TeraMedica’s mobile app, lets you capture images, videos, audio, and text notes at the point of care. This is perfectly suited for workflows that require taking pictures of the victim’s face and body to capture any evidence of bodily harm. The audio and video features can be used to record the patient (e.g., the abused child) and any witnesses or family members describing the abuse in their own words so there is no risk of misinterpretation later on. This is recommended by Stanford for child abuse, domestic abuse, and elder abuse.
Clinicians can flag content as sensitive or restricted while they are capturing it in Connext Mobile as part of a routine encounter, and not specifically as it relates to the abuse. If a patient is in for another reason, it’s easy to create an extra folder to document the abuse to ensure vital information is immediately captured. Synapse VNA can also include forms or checklists to make it easy for those reporting the abuse to document everything necessary to support the legal health record. SCAN departments can create a series of questions users must fill in while documenting the case. Questions can be optional or required, and users can be offered a drop-down list with frequently used answers (including optional default responses and/or help text) to make easy and efficient to fill out. The goal is to capture all the necessary information without adding unnecessary burden to the caregiver.
Many facilities want only two or three staff members to have access to restricted abuse photos. Synapse VNA supports configurations in which multiple staff members can capture the photos and mark them as restricted. Once uploaded to the VNA, only staff with an explicit “view restricted” permission may then access those images. The system can also be configured so that all content stored in a specific department or regarding an individual patient is restricted. In this manner, X-rays and other specialty imaging related to the abuse can also be automatically flagged as restricted. These images can easily be exported for use by law enforcement.
For more-typical VIP patient workflows, the sensitive and restricted flags on patients and departments are compatible with the Connext encounters-based worklists. In fact, unless the user has “view restricted” permission, they won’t be able see worklist entries for a restricted patient. This helps to ensure privacy for even the most sensitive guests. And if download and export capabilities are disabled, there’s no risk of facility staff sharing a compromising post-plastic surgery video with the paparazzi; unfortunately for celebrity clients, we are unable to prevent loving moms from sharing such compromising evidence with Jimmy Fallon.