N437 Module 5 Privacy, Security and the Law Example

One Photo, Two Phones, No Encryption: Privacy, Security and the Law After a Wound Picture Sent by Text

Student Name

Pre-licensure BSN Program, Aspen University

N437: Healthcare Informatics

Instructor Name

Month Day, Year

One Photo, Two Phones, No Encryption: Privacy, Security and the Law After a Wound Picture Sent by Text

At 3 a.m. on a composite medical-surgical unit, Ms. J., a night-shift nurse, found a new sacral wound on an 81-year-old patient. The wound nurse would not arrive until 8 a.m. Wanting advice, Ms. J. photographed the wound with her personal phone and texted it to the wound nurse's personal number. The picture showed part of the patient's wristband. Ms. J. meant well, and the wound nurse replied with useful advice. This paper examines the privacy, security and legal issues her choice raised and how the same goal could be reached safely.

Two Rules, Two Duties

HIPAA, the federal health privacy law, contains two rules that matter here. Its Privacy Rule sets out who may use or share a patient's protected health information and why, while the Security Rule requires administrative, physical and technical safeguards for electronic protected health information. A wound photograph with a wristband is protected health information. Sharing it with another nurse for treatment is a permitted use under the Privacy Rule, so the purpose was acceptable. The problem lay in security: the photo now lived, unencrypted, on two personal devices outside the hospital's control.

Why the 2013 Rule Changes Matter

The 2013 modifications to the HIPAA rules, which carried out the HITECH Act of 2009, strengthened breach notification and extended obligations to business associates (U.S. Department of Health and Human Services, 2013). Under the breach standard, an improper disclosure counts as a breach unless the organization documents, after assessing the risk, that compromise of the information is unlikely. If either phone were lost or stolen, or the photo synced to a personal cloud account or appeared on a family computer, the hospital could face a reportable breach, notification of the patient and possible penalties.

Minimum Necessary and the Wristband

The Privacy Rule's minimum necessary standard expects organizations to share no more than a purpose requires, although disclosures to a provider for treatment are an exception. Even so, the principle offers practical guidance for clinical photographs. The wound nurse needed to see the wound, its size and the surrounding skin, not the patient's name, face or wristband. Framing the photo tightly, placing a measuring guide beside the wound and linking the image to the correct chart through the record, rather than through identifiers in the picture, protects the patient if the image is ever seen by someone else. In Ms. J.'s photo, the visible wristband meant that anyone who saw the image could identify the patient, which raised the stakes of every copy that existed.

How Common Is This?

Ms. J.'s choice is far from unusual. In a survey of 99 medical students, 86% used their personal phones for patient-related communication during clinical rotations, 26% had no security feature on their phone, and 22% still texted or emailed identifiable patient data to colleagues even though 68% believed personal phones posed a privacy risk (Tran et al., 2014). The pattern, knowing the risk and doing it anyway because it helps patients, is exactly why systems must make the secure path easy. Nurses on night shift, with fewer colleagues nearby and specialists at home, may feel this pull most strongly.

Social Media and the Nurse's License

The same photo could become a far larger problem if shared further. Board guidance warns that posting or sharing patient images or information, even without a name, can breach confidentiality and lead to discipline by the state board, termination and civil liability (National Council of State Boards of Nursing [NCSBN], 2018). The guidance is clear that deleting a post or message does not undo the disclosure. Nurses are accountable to their board as well as their employer, and boards have disciplined nurses for images shared in private group chats.

What Ms. J. Should Have Done

The hospital offered a secure clinical messaging application on unit phones and a wound photography feature within the electronic record that stores images in the chart. Ms. J. could have photographed the wound with the unit device, uploaded it to the record without a wristband in the frame, and sent a secure message to the wound nurse referencing the chart. If no secure option existed at 3 a.m., she could have described the wound in detail using a standard staging and measurement approach and requested an early consult. The goal, timely expert advice, would have been met without two unprotected copies of a patient's body on personal phones.

The Organization's Responsibilities

The Security Rule places obligations on the organization, not only the nurse. Hospitals must assess risks, set policies for mobile devices, train staff and provide workable tools. If the secure messaging application was slow or unfamiliar to night staff, the hospital shared responsibility for Ms. J.'s choice. After this event, the unit could add the wound photography workflow to night-shift orientation, ensure unit phones are charged and available, and remind staff through huddles that personal phones are not for patient images. Finally, the organization's privacy officer should be told about the event, since a risk assessment may be required, and the photos on both phones should be deleted under guidance, with the deletion documented.

Ethical Dimensions

Beyond law, the photo raises questions of dignity and consent. The patient, who was asleep, did not know her body had been photographed or shared. Nursing ethics asks nurses to protect privacy as part of respect for persons, and patients who later learn their images traveled on personal phones may lose trust. Wherever possible, nurses should explain why a photo is needed and follow the facility's consent policy for clinical images.

Conclusion

Ms. J. used a permitted purpose, treatment, through an insecure means. The Privacy Rule allowed the sharing; the Security Rule and the breach standard made the method risky; board guidance made it a licensure concern; and ethics asked whether the patient's dignity was respected. The solution is a secure, easy workflow and staff who know it, so that the next nurse at 3 a.m. can get advice without putting a patient's image on a personal phone.

References

National Council of State Boards of Nursing. (2018). A nurse's guide to the use of social media. National Council of State Boards of Nursing.

Tran, K., Morra, D., Lo, V., Quan, S. D., Abrams, H., & Wu, R. C. (2014). Medical students and personal smartphones in the clinical environment: The impact on confidentiality of personal health information and professionalism. Journal of Medical Internet Research, 16(5), Article e132. https://doi.org/10.2196/jmir.3138

U.S. Department of Health and Human Services. (2013). Modifications to the HIPAA privacy, security, enforcement, and breach notification rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; other modifications to the HIPAA rules. Federal Register, 78(17), 5566-5702.