Photographs are necessary in the clinical practice of anatomic pathology, but there are ethical implications to consider. Furthermore, laboratory professionals and pathologists must be aware of and comply with certain legal requirements affecting the use of photographs. The main ethical principles are respect for patient privacy and the anatomic pathology specialist’s obligation to do no harm.
In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was implemented to enhance the portability and continuity of health insurance coverage in the United States. HIPAA also contains a mandate for protecting the privacy of medical records. A section of HIPAA called “Subtitle F-Administrative Simplification” offers the definitions of “protected health information” (PHI) and “individually identifiable health information.” The Secretary of Health and Human Services (HHS) was tasked with the promulgation of the final regulations to accomplish the goals outlined in HIPAA. In the years that followed, the HIPAA “Privacy Rule” and the “Security Rule” were formulated by the HHS to establish the standards by which healthcare providers are held accountable. The Final Privacy Rule set forth the concept of “de-identification” of health information (including medical photographs) for exemption from HIPAA requirements. The distinction between “de-identified” patient information and identifiable PHI is important because each is handled differently. For identifiable PHI, healthcare providers must follow the requirements of HIPAA and its supporting legislation. In contrast, de-identifiable patient data is no longer considered identifiable PHI, such that the mandates and requirements of HIPAA are not applicable.4
