Secure enterprise imaging: Protecting child abuse victims

By Greg Strowig, Vice President, TeraMedica Division of FUJIFILM Medical Systems USA, Inc.

December 11, 2019 -- The statistics are staggering. An estimated 1,688 children died from abuse and neglect in the United States in 2017 alone. According to the National Children's Alliance, nearly 700,000 children across the country are abused every year.

Healthcare providers play a critical role in identifying abuse incidents and in capturing the evidence needed for community agencies and law enforcement to take appropriate action.

However, keeping sensitive clinical cases private in the age of enterprise imaging can be a challenge. Ensuring that certain images are restricted and only available to a limited number of people for viewing often opposes enterprise imaging's foundational goal of unrestricted imaging access.

An optimal enterprise imaging solution should be flexible enough to support these unique workflows that protect sensitive and restricted content. With the right technology in place, hospitals are in a better position to protect the privacy of victims while supporting the officials who can come to their aid.

Documenting Evidence, Flagging Records

Greg Strowig
Greg Strowig.

Children who have been sexually abused, neglected, or physically harmed are among the most vulnerable patients. When they arrive in the emergency department, it is vital that the enterprise imaging solution has security measures in place to protect their personal health information.

One of the most important aspects in treating young 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.

For example, Stanford recommends that clinicians thoroughly record all laboratory and radiological tests performed on potential victims. Specifically, SCAN cases should include an ophthalmology exam in children under the age of three, a skeletal survey in children under two, and a CT scan for babies less than 6 months old.

But to ensure privacy of those exams, the institution's enterprise imaging solution must include tools that support secure imaging workflows. So what should providers look for in a secure vendor-neutral archive (VNA) solution?

For starters, an optimal VNA solution means hospitals can flag individual records as sensitive or restricted. Restricted content has the highest security and will only be seen by those who are explicitly authorized to do so. However, sensitive content is viewable by a broader audience, again, as authorized, but with a warning before it is displayed so the user is aware that precautions surrounding their workspace should be taken.

Because child abuse victims may be seen by multiple specialties, the system should allow users to flag all content for that particular patient. Conversely, users should also have the option to choose to flag individual studies, groups of studies, and folders of images that include DICOM and specialty (non-DICOM) imaging.

The Stanford Medicine website also notes that in SCAN cases, pictures can be very helpful.

Stanford recommends that clinicians take one whole-body photo with clothes on, one picture of the face, photos of torn and/or bloodied clothing, a photo of the geographical area as well as a close-up of the injury, and photos of any past, permanent injuries.

While Stanford suggests using an instant camera, the right VNA solution will feature a secure mobile app accessible via smartphone or tablet that allows clinicians to capture images, videos, audio, and text notes at the point of care.

This means the clinical team can easily take photos of any bodily harm. In addition, an audio or video feature of a VNA app can be used to record the abused child and any witnesses or family members -- providing a valuable trail of evidence for law enforcement.

Specifically, Stanford Medicine recommends recording what the abused child said in their own words and whether the disclosure was spontaneous or in response to a specific question. The medical team should also interview the parents separately and record their explanation, including any discrepancies in the history. Finally, the team should record precisely what occurred -- when, where, how, and if there were any witnesses.

With a robust VNA solution, the entire process is streamlined and highly secure. Clinicians can flag the content as sensitive or restricted while they are capturing it using a mobile app feature as part of a routine encounter and not specifically as it relates to the abuse. That way, if a patient is being seen for another reason, it should be easy to create an extra folder to document the abuse to ensure vital information is saved.

The images should then be stored directly to the VNA through the mobile app -- without the need to log into multiple applications or navigate patients outside of the electronic health record. Without needing to separately identify the patient, the risk of patient misidentifications and medical errors is reduced, which helps to improve patient safety and save clinicians time.

VNA solutions can also include forms or checklists to make it simple for those reporting the abuse to document everything necessary to support the legal health record.

For example, SCAN departments can create a series of questions -- required or optional -- that users are asked to fill in while documenting the case. The system's tool can even feature a drop-down list with frequently used answers to make it easy and efficient to complete. The objective is to capture all of the necessary information without adding unnecessary burden to the clinical and administrative teams.

Many facilities only want two or three staff members to have access to restricted child abuse photos. An organization's VNA should support configurations where multiple people can capture the photos and mark them as restricted. However, as soon as the photos are uploaded to the VNA, those people lose access unless they have explicit "view restricted" permission.

The VNA should also have the ability to be configured so that any content stored in a specific department or regarding an individual patient is restricted. In this way, X-rays or other specialty imaging related to the abuse can also be automatically flagged as restricted. Yet, the technology has to be flexible enough so that these images can be easily exported at the appropriate time, and by the appropriate person, for use by law enforcement.

Hospitals must take many factors into consideration when choosing an enterprise imaging solution. Simply put, supporting unique workflows that protect sensitive and restricted content should be a top priority.

Data security has always been at the core of Fujifilm's Synapse VNA. The technology's structure was designed to provide data segregation and controlled access. Synapse VNA also features a robust audit trail that ensures chain of custody is clearly documented.

Synapse VNA offers best-in-class storage protection and advanced lifecycle-management tools that allow the chosen clinical and administrative team to save time and reference pediatric abuse cases quickly and securely.

Protecting the Most Vulnerable Patients

Protecting the smallest of patients is a huge responsibility. Because they cannot advocate for themselves, children are our society's most vulnerable population. Moreover, hospitals have a legal duty to call child protective services if it suspects a child may have been abused or the victim of neglect of a caregiver.

However, a recent report from NBC reveals a legal and medical system that sometimes struggles to differentiate accidental injuries from abuse, particularly in cases involving children too young to describe what happened to them.

"Physicians intent on protecting the most vulnerable in some instances have overstated the reliability of their findings, using terms such as '100 percent' and 'certain' to describe conclusions that usually cannot be proven with absolute confidence. Child welfare workers, overworked and untrained in complex medical issues, are not always sure how to proceed when the primary evidence against a caregiver comes in the form of a doctor's note," reports NBC.

Technology can help. With the right technology, law enforcement and child protective agency officials ultimately see the most credible evidence possible. A VNA solution that securely captures and documents diagnostic imaging -- as well as any telling photos and audio clips at the point of care -- and then securely stores those records, is a positive step toward protecting both the privacy and the well-being of the world's youth.

 

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