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Health Insurance Portability and Accountability Act Noncompliance in Patient Photograph Management in Plastic Surgery

Lam, Jonathan S., MD; Simpson, Benjamin K., BS; Lau, Frank H., MD

doi: 10.1097/SAP.0000000000001760
Circumspectus Medicinae: Texts and Contexts

Background Today, plastic surgeons have largely transitioned to digital photography. This shift has introduced new risks to daily workflows, notably data theft and Health Insurance Portability and Accountability Act (HIPAA) violations.

Methods We performed a national survey of digital photograph management patterns among members of the American Society of Plastic Surgery and trainees in Accreditation Council for Graduate Medical Education–accredited plastic surgery programs.

Results Our findings showed that attendings preferred the use of stand-alone digital cameras (91.4%), whereas trainees preferred the use of smartphones (96.1%) for capturing patient photographs. The rate of noncompliance was nearly identical; 82.8% of attendings were HIPAA noncompliant when using stand-alone digital cameras compared with 90.2% of trainees using smartphones. Both groups also breached HIPAA rules when using other photographic management modalities.

Conclusions This is the first study to quantify the prevalence of noncompliance with regard to an entire digital photograph management workflow. These findings were consistent with previous studies that reported that younger physicians tend to embrace newer technologies, whereas older attendings are more reluctant. The findings also suggest that HIPAA noncompliance in digital photograph security and management is a significant problem within the plastic surgery community.

From the Department of Surgery, School of Medicine, Louisiana State University Health Sciences Center—New Orleans, New Orleans, LA.

Received July 9, 2018, and accepted for publication, after revision October 17, 2018.

Conflicts of interest and sources of funding: The authors have no conflicts of interest, of any nature, to disclose.

Reprints: Frank H. Lau, MD, Louisiana State University Health Sciences Center—New Orleans, 1542 Tulane Ave, Room 734, New Orleans, LA 70112. E-mail:

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