Personal Wireless Handheld Device Guidance
PDF Version of DQA 09-029
(PDF, 64 KB)
Personal Wireless Handheld Device Guidance
The Division of Quality Assurance (DQA) recognizes the value and
efficiencies gained by the appropriate use of wireless handheld devices in
healthcare settings and does not intend to prevent the legitimate use of new
technologies. Rather, the purpose of this memo is to recommend uniform
guidelines for the appropriate use of personal wireless handheld devices
including, but not limited to, cell phones, cameras, and personal digital
assistants (PDA's), as well as raise awareness of the potential for misuse
of such devices.
Therefore, DQA recommends that healthcare facilities and nurse aide
training programs (further referred to as entities) proactively respond to
the potential privacy violations and caregiver misconduct issues that may
arise from the use of such devices. This memo contains important information
and guidance on the following topics:
- Wireless Handheld Device Usage Background,
- Resident Rights,
- HIPAA Protections,
- Caregiver Misconduct Issues,
- Entity Responsibility, and
Wireless Handheld Device Usage Background
As the popularity of wireless handheld devices increases, so does the
potential for misuse or abuse by electronic means. Cameras on cell phones,
PDA's and laptops are particularly troublesome because they can be used
without anyone knowing that a photograph is being taken. Further, the user
can instantaneously transmit the photograph to the Internet, at which point
the subject's confidential information may no longer be protected or
Information may be transmitted by electronic media or transmitted or
maintained in another form or medium. With the ever-increasing popularity of
online social networking websites including, but not limited to, Facebook,
MySpace, and YouTube, the potential for the inappropriate use of handheld
devices in healthcare settings is also growing.
Resident and Patient Rights
Wisconsin state statutes and administrative rules for all regulated
healthcare providers consistently address each resident's and patient's
right to privacy in care, treatment and accommodations. In addition, Wis.
Stats 51.61 rights apply to patients served by AODA, mental health and
psychiatric hospital programs. The inappropriate use of handheld wireless
devices to capture or transmit images of residents receiving care and
treatment or engaging in activities of daily living is not consistent with
the provider's obligation to protect and promote each resident's right to
privacy. Furthermore, invasion of privacy may form the basis for criminal or
civil liability. See Wis. Stat 942.08, 942.09 and 995.50.
All entities have an obligation to protect the rights of their clients,
patients or residents. For more information regarding resident rights, fair
treatment, privacy and confidentiality, please access the Department's
website at http://www.dhs.wisconsin.gov/rl_DSL/index.htm, select the appropriate
provider type and go to Rules and Regulations.
All entities have a duty under the Health Insurance Portability and
Accountability Act (HIPAA) of 1996 to protect Individually Identifiable
Health Information (IIHI). Photographic and comparable images that record
the physical or mental health or the condition of an individual fall within the
definition of "protected health information" in 45 CFR 164.
Entities generally have recognized that photographs, which identify or
allow for the identification of clients, constitute protected health
information and have prohibited staff from taking photographs of a client
without the client's consent. For more information regarding HIPAA
requirements, please see the US Department of Health and Human Services
website at http://www.hhs.gov/ocr/privacy/index.html.
Caregiver Misconduct Issues
Along with resident rights violations and possible HIPAA violations, the
misuse of handheld devices may also constitute caregiver misconduct. Over
the last three years, the Department has seen an increase in the number of
reported incidents involving the misuse of camera phones and the
inappropriate and unauthorized dissemination of client information.
The following are actual case examples of incidents reported by Wisconsin
- Cell phone photo of a client with food all over her face posted on
caregiver's MySpace webpage with statement "good eater."
- Cell phone video of a caregiver jumping on a client's bed and client
repeatedly asking "why would you do this to me?" and to
- Cell phone photo of caregivers giving a combative client a shower.
- Cell phone photo of a client on the toilet with Attends on her head,
which was then sent to another caregiver's phone.
- Caregiver was outside the facility showing a cell phone photo of a
deceased client to friends.
- Caregiver wrote comments on her MySpace webpage using client's name.
- Caregiver showed a client sexually inappropriate cell phone photos.
To protect the safety of clients, staff, volunteers and visitors, it is
recommended that entities adopt a written policy that defines the accepted
appropriate use and the unaccepted inappropriate use of personal handheld
devices in that entity's healthcare setting. This policy may be included as
part of the entity's human resource policy and procedure manual and may
incorporate the following:
- That personal devices are never to be used to record images of
clients. If such images are needed for purposes of care or training,
they should be obtained by authorized persons only and use only the
equipment specified in the policy.
- Indicate that any authorized photographs or images are the sole
property of the entity and that the distribution of these photographs or
other images to any person outside the entity's setting without written
authorization for a permissible use is prohibited.
- Define the areas of the entity and the circumstances in which personal
cell phone and other wireless handheld devices may be used, i.e. on
breaks or lunch in the breakroom or outside, etc. Specify the
consequences for failure to abide by the entity's policy.
- Inform clients (or designated responsible agent) and family/visitors
about privacy considerations and the use of personal cameras, cell
phones and wireless handheld devices.
- Ensure that all staff, contract/pool agency staff, students and
volunteers are aware of and trained on the entity's written policy on
the use of personal cell phone and other wireless handheld devices.
Entities are strongly encouraged to regularly review and update policies and
handbooks to assure that they are reflective of current (and future)
technologies in order to assure client protection and privacy. Policies
currently in place may not be reflective of the current usage/availability
of cell phones/cameras.
Consideration should also include that the use of personal devices can
cause disruption and distraction to the caregiving process, aside from the
privacy considerations. The following examples are actual entity and
training program policies shared with DQA:
Entity Policy Examples
Use or possession of personal electronic devices capable of audio and/or
video recording and or transmission is prohibited in any area open to, or
adjacent to, areas of resident access. This includes devices capable of
texting and still photographs. Use of any personal electronic device that
impairs or distracts an employee's ability to respond to alarms, resident or
staff injury, overhead pages, verbal warnings or calls for assistance is
Facility X prohibits the use of personal cell phones or PDA's during
working hours for incoming and outgoing calls, text messaging and taking of
photographs. The use of camera phones, PDA's or other audio or video
recording capable devices within this facility may constitute an invasion of
resident, patient and employee personal privacy. Therefore, the use of
camera or other video-capable recording devices is prohibited without the
express prior permission of the administrative team and of the person(s)
present for the photography.
Personal calls during work hours, regardless of the phone's use, can
interfere with employee productivity and be distracting to others. Cell
phones are not to be carried on the job without specific permission from
management. Employees found using their cell phone or PDA during working
hours will have their device taken by the supervisor until the end of the
shift. Employees found using personal equipment to take photographs of
residents or patients will have the equipment confiscated and receive
corrective action up to and including termination.
Nurse Aide Training Program Policy Example
Personal cell phones and other electronic devices must be turned off
while in the classroom and lab. Electronic communication devices are not
allowed on your person when in the clinical portion. Students participating
in a clinical rotation of a nurse aide training program must abide by the
policies and procedures of the facility to which they are assigned.
Please see the following articles related to wireless handheld device
usage in healthcare settings:
Phone Camera Use in Healthcare Facilities: Shutter It, Patricia A.
Markus, Esquire and Erin S. Zuiker, Esquire, Smith Moore Leatherwood LLP
Nationwide Combat Employee Camera-Phone Abuse, Randy Dotinga
Phones Create Privacy Issues in Hospitals, Staci Curran, RN,C. MSN
and Mary Ann Zeserman, RN, C, SN
If you have questions regarding HIPAA or resident rights requirements,
please contact the appropriate DQA Bureau. See http://www.dhs.wisconsin.gov/rl_dsl/bqa.htm
for contact information. If you have questions regarding caregiver
misconduct issues, please contact the Office of Caregiver Quality at DHSCaregiverIntake@wisconsin.gov
or (608) 261-8319.
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