P072 Improving governance and consent in dermatology clinical photography: a retrospective audit informing development of a secure digital workflow

Abstract

Clinical photography is integral to dermatology practice; however, image capture frequently relies on clinician-taken photographs using personal devices and nonstandardized workflows. Limited access to dedicated clinical photography services increases reliance on ad hoc processes, raising concerns regarding consent documentation, data protection and image traceability under General Data Protection Regulation. Secure, standardized clinical photography pathways integrated with electronic medical records remain limited. Our aim was to assess baseline compliance with consent documentation and governance standards for dermatology clinical photography and to inform development of a secure digital workflow. A retrospective audit was conducted in a tertiary dermatology centre in Ireland reviewing clinical photography taken between 1 and 31 October 2024. Photography sets were identified from the departmental clinical photography drive and matched to dermatology clinic notes or procedure consent forms using image timestamp metadata. Image sets that could not be matched to a patient encounter due to missing identifiers were excluded. Consent documentation was assessed through review of consent forms, including photography consent or explicit documentation of verbal consent within clinical notes. Where neither was present, consent was recorded as not documented. In total 211 photography sets were identified. Eleven sets (5.2%) were excluded, leaving 200 sets for analysis. Documented consent was present in 75 of 200 cases (37.5%), while 125 of 200 cases (62.5%) had no documented consent. Among cases with documented consent, 55 of 75 (73%) were recorded on consent forms and 20 of 75 (27%) within clinical notes. Excluded image sets highlighted image traceability risks. This audit identified significant governance gaps in dermatology clinical photography. The findings informed development of CliniSnap, a secure digital workflow incorporating patient identifier verification, in-app consent confirmation, prevention of camera-roll storage, direct upload to the electronic medical record, and an auditable image trail. Pilot implementation and reaudit are planned.