Video Recording Patients for Direct Care Purposes: Systematic Review and Narrative Synthesis of International Empirical Studies and UK Professional Guidance

Introduction

Background

Video-based documentation is a growing practice in health care, but both clinicians and patients have concerns about associated ethico-legal issues [1,2]. Video recordings capturing specific aspects of a patient’s condition may offer advantages that could support patient assessment and monitoring, support clinical decision-making, and lead to better clinical outcomes. However, little is known about the application, acceptability, and impact of video recordings for direct care purposes.

Video Recording Applications in Health Care

Video recording has demonstrated value across research, education, and performance assessment, as well as in clinical audit and quality improvement [1,2]. Researchers value the richness of video data that include sound, environmental context, and body language, which facilitate the objective and accurate documentation of behavior [3,4]. Video-based feedback assists clinicians in recognizing visual and auditory clues during clinical consultations that cannot be derived from text-based learning, and video-based curricula have led to an accelerated learning curve for surgical trainees [2]. Furthermore, video-based surgical case reviews have informed quality improvement initiatives through the provision of increased detail and nuance beyond what exists in operative notes alone [2,5-7].

Ineffective Communication

Certain aspects of a patient’s condition (such as functional ability, cognition, and behavioral symptoms) can be challenging to convey to others involved in a person’s care, and recognizing changes in a patient’s condition over time can be difficult, particularly when a patient receives care from multiple different clinical staff [8]. Moreover, information captured about a patient away from the clinical setting can be useful to inform diagnosis, care, and treatment (eg, symptoms occurring in the home). As ineffective communication of pertinent patient information is known to negatively affect care continuity and is linked to medical errors and adverse events [9,10], new consideration should be given to how best to capture and communicate these data [11].

Video Recording Advantages

One of the proposed solutions is video recording. Video recordings offer a detailed and objective record that can be reviewed repeatedly as a longitudinal record by multiple clinical staff members [8]. Video recordings provide a record that has not been condensed into words and thus preserves the original situation without the added lens of a patient, family member, or intermediary health professional [7]. However, privacy concerns and issues with storage in the electronic patient record have limited the use of video recording for direct care purposes [12,13]. Early studies suggested that patients can feel censored or self-conscious in front of a camera, and video recording can alter the dynamic between the patient and clinician in negative ways [13,14]. However, over the last decade, the proliferation of smartphones has resulted in photographs and videos being captured in everyday life and being used for agile communication. Technological advances are supporting lawful collection, handling, and cloud-based storage of visual data to address storage limitations and protect people’s privacy in line with data protection legislation [15-18].

At a time when video technology is ubiquitous in everyday life, little is known about how video recordings can support the safety and quality of individual patient health care. The aim of this review was to synthesize the international empirical literature on video recording patients for direct care purposes to evaluate acceptability, effectiveness, and ethico-legal considerations and to summarize the relevant guidance of professional and regulatory bodies in the United Kingdom.

Methods

Protocol and Registration

The review protocol was specified in advance and registered in the PROSPERO database (CRD42022331825).

Search Strategy and Eligibility Criteria

Two separate search strategies were used: (1) empirical studies (international) and (2) professional and regulatory guidance (United Kingdom only).

Empirical Studies

Empirical studies were identified by searching electronic databases (MEDLINE, Embase, APA PsycINFO, CENTRAL, and HMIC) and by scanning the reference lists of relevant articles. The literature search was based on two broad concepts: (1) video recording and (2) patients (Multimedia Appendix 1). Studies were eligible for inclusion if they evaluated an intervention involving video recording adult patients, service users, or care home residents (aged ≥18 years) for the purposes of providing direct care in a health or care setting (Table 1). All study designs and countries of publication were considered. Direct care was defined as activities that directly contribute to the diagnosis, care, and treatment of an individual [19]. Articles were excluded if the video recordings were taken solely for research data collection or for medical education or training purposes.

Professional and Regulatory Guidance

To identify relevant recommendations of professional and regulatory bodies, we searched the following websites and archives: National Institute for Health and Care Excellence, Social Care Institute for Excellence, National Health Service Knowledge Library Hub, General Medical Council, Nursing & Midwifery Council, Health & Care Professions Council, Care Quality Commission, Parliamentary & Health Service Ombudsman, and Government publications. Similar to the search strategy for empirical studies, the search was underpinned by two concepts: (1) video recording and (2) patients. As we specified our review protocol in advance and anticipated that it would not be feasible to cover all countries, we opted to include professional and regulatory guidance documents issued in the United Kingdom where the authors are based.

For both search strategies, the last search was conducted on December 13, 2022, and we excluded papers that were older than 10 years or not published in English [20].

Study Selection and Data Extraction

Overview

Two reviewers (RL and SE, both with clinical, research, and academic backgrounds) independently screened all the records. The reviewers were blinded to each other’s screening decisions, and disagreements were resolved through discussion and consensus. Screening decisions were recorded using Covidence, a web-based systematic review management system.

Empirical Studies

Both reviewers independently extracted the following data from the included studies: authors and year of publication; study design and type of publication (eg, conference abstract or full journal publication); country of publication and clinical setting; focus of the paper; details regarding the video recording intervention (intervention goal, equipment used, procedure, etc); sample size and participant characteristics (age, sex, ethnicity, and medical problems or diagnoses); main findings relating to the outcomes of interest (acceptability, effectiveness, and ethico-legal considerations); and study limitations. Acceptability was defined as the extent to which people delivering or receiving health care interventions consider it appropriate based on anticipated or experienced cognitive and emotional responses to the intervention [21]. Effectiveness was defined as the ability of an intervention to have a meaningful effect on a patient in normal clinical conditions [22].

Professional and Regulatory Guidance

Key recommendations for video recording patients for direct care purposes were extracted independently by the reviewers.

Quality Appraisal of Empirical Studies

Owing to the inclusion of various types of evidence encompassing a variety of study designs and qualitative, quantitative, and mixed methods approaches, quality appraisal was undertaken using the Quality Assessment with Diverse Studies (QuADS) appraisal tool [23]. The use of a single tool permits the evaluation of methodological quality, evidence quality, and quality of reporting across a body of diverse evidence, and the QuADS tool considers the extent to which there is transparency and congruency in the research and its reporting and the implications for evidence quality [23].

We used the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports [24]. For conference abstracts, we devised a bespoke appraisal tool based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist of items to be included when reporting observational studies in conference abstracts [25]. Study quality was assessed independently by 2 reviewers.

Synthesis

The study’s findings were synthesized using a narrative approach. To evaluate acceptability, recruitment and retention rates were extracted or calculated (reported data permitting), and the reported views and experiences of patients and clinical staff were analyzed thematically using a framework-based synthesis [20]. The Theoretical Framework of Acceptability (TFA) of health care interventions (Textbox 1) was applied as a preliminary coding framework, and an inductive approach was used to derive new themes from the data [21]. The framework approach was also applied to synthesize reported ethico-legal considerations. To evaluate effectiveness, we selected studies reporting any clinically relevant, objective measure of impact of the video recording intervention, considering the results of observational studies and randomized controlled trials (RCTs) separately, because although RCTs are usually considered to be the gold standard design for decisions about the effect of interventions, they are arguably less applicable to real-world clinical practice than observational studies, and this review was concerned with direct care delivery [22]. Key recommendations for professional and regulatory bodies are summarized and tabulated.

Reporting

We followed the reporting recommendations outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement [26] (Multimedia Appendix 2).

Results

Overview

The searches of the MEDLINE, Embase, APA PsycINFO, CENTRAL, and HMIC databases yielded 14,218 study citations. Following the removal of duplicates, the titles with the addition or removal of abstracts of 8715 citations were screened. Of these, 5420 citations that clearly did not meet the inclusion criteria were discarded during the title screen, and a further 3205 were excluded on reviewing the abstracts. The full reports of the remaining 90 studies were retrieved and examined in detail. In total, 24 studies meeting the inclusion criteria were retained for review; 3 additional studies were identified through a hand search of reference lists (Figure 1). A total of 13 guidance documents were identified via the websites of public and regulatory bodies and Google search, of which 7 met the inclusion criteria and were retained for the review.

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Study Characteristics

Overview

Of the 27 studies, there were 5 RCTs [27-31], 17 observational studies [32-48], and 5 case reports [49-53] (Multimedia Appendix 3 [27-53]). In total, 22 studies were full reports in academic journals [27,28,30-34,36-39,41-45,47,48,50-53] and 4 were conference abstracts [29,35,40,46], and there was 1 doctoral thesis [49]. All the studies were published in English between 2012 and 2022. A total of 17 studies were conducted in the United States [29,30,32,34-39,41,42,46,47,49-51,53] (including 1 binational study: United States and Mexico [34]), 3 in the United Kingdom [27,28,45], 2 in the Netherlands [33,48], 2 in India [40,44], 1 in Spain [43], 1 in Portugal [52], and 1 in France [31].

Participants

The studies involved 1551 patient participants. Patients were care home residents and older people with dementia [32,38,39,42]; adults with seizures [41,43,44,50]; hospital inpatients with stroke [28,29], cancer [35,36], or mental health disorders [27,31,33]; surgical outpatients [30,47,53]; and patients with Parkinson disease [40,48], musculoskeletal disorders [49], tuberculosis [34], and dysphagia [6,9,12-14,16-18,21,25,45]. Clinical staff member’s experiences and perceptions regarding the video recording intervention were reported in 16 studies [28,32,34,37-41,43-45,49-53].

Video Recording Interventions

In 11 studies, patient video recordings were used to support assessment and diagnosis, including the evaluation of seizures [41,43,44,50,52], gait or movement patterns [40,48,49,51,53], and dysphagia [45]. In 7 studies, video recordings were used for treatment purposes: patients with stroke or musculoskeletal disorders were video recorded during physiotherapy sessions, who then viewed the recordings to support their rehabilitation [28,29,49]; in 3 mental health studies, patients watched video recordings of themselves to enhance insight into obsessive compulsive or psychotic behaviors (“video self-confrontation”) [27,31,33]; and in a study of medication adherence, patients submitted home videos of themselves ingesting their tablets to their clinical team [34]. In total, 9 studies evaluated the application of video recordings for patient care [32,35-39,42,46,47]: in 2 studies, care home staff members reviewed video monitoring footage to support postfall care [32,42] and, in 1 study, in-home video monitoring enabled clinical staff members to support informal caregivers of people with dementia [39]. In other studies, video recordings were used to communicate patients’ care preferences [35-38], enhance patients’ recall of clinical information [30], and support patient-provider communication [46,47]. Most video recording interventions use mobile devices (ie, mobile phones or tablets) for video capture; some used specialized applications or software [30,32,34,39,42,48,49].

Quality Assessment

In total, 17 empirical studies were reported as full-text articles and were therefore suitable for methodological assessment using the QuADS appraisal tool [27,28,30-34,37-39,41-45,47,48]. Methodological and reporting quality was generally poor: only 4 studies achieved a maximum score of 3 in ≥10 of the 13 QuADS criteria [28,31,33,34] (Table S1 in Multimedia Appendix 4 [28-53]). Overall, QuADS scores tended to be higher in RCTs (mean total score 32.8, range 27-39; 4 RCTs) than in observational studies (mean total score 27.8, range 17-36; 13 observational studies). The quality of the 5 conference abstracts was mixed (Table S2 in Multimedia Appendix 4). The Joanna Briggs Institute Critical Appraisal Checklist indicated satisfactory quality of the 5 case reports (Table S3 in Multimedia Appendix 4).

Synthesis

Acceptability

Recruitment and Retention Rates

The mean recruitment rate was 68.2% (range 34.2%-100%; figures based on 12 studies that reported recruitment data; Multimedia Appendix 5 [27-29,32-35,40-48]). The mean retention rate was 73.3% (range 16.7%-100%; figures based on 17 studies that reported retention data). Reasons for nonparticipation or withdrawal related to both the video recording intervention itself (eg, privacy concerns and feeling self-conscious about being recorded) and to other factors mostly related to the patient’s condition (eg, low frequency or short duration of seizures precluded video capture; Multimedia Appendix 5).

Framework Synthesis

The TFA was systematically applied to 16 studies that reported the perspectives and experiences of the patients and clinical staff. Framework synthesis generated 23 themes linked to the 7 TFA constructs; two additional themes not covered by the TFA also emerged: (1) operational pressures and (2) environment (noise, etc; Figure 2). Additional verbatim quotes for each theme are provided in Multimedia Appendix 6 [21,28-30,32-39,41,45-48].

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Affective Attitude

Stakeholder reports coded to this construct were universally positive. Many patients and service users were positively engaged in being video recorded and were eager to share their video recordings with people involved in their care [28,30,45]. Patients’ families and clinical staff members described the video recordings as “helpful” [35-37,47] and “reassuring” [28,46], and most said they would recommend video recording to other patients [35-37,47].

Burden

Stakeholder reports were mixed for this construct. Some patients and clinical staff reported that video recording processes were “easy,” particularly when mobile devices (smartphones or tablets) were used [32,34,38,39,45]:

The mobile device app provided to review videos proved to be accessible and easy to use to facility staff.
[Results extract [32]]

Others described an additional burden: for example, some clinical staff members were concerned about losing the mobile video recording devices in the clinical setting; others described technical problems in operationalizing the video recording intervention [28,37,39,47]. Some patients “wished their appearance in the video was better” [31,37,38] while others said they needed time to prepare for being recorded [37,38].

Ethicality

Patients’ reports coded to this construct were from 1 study, which explored perspectives on home-based video recording for movement analysis in Parkinson disease [1,2,48]. For most patients, it was important to have a “sense of control over the camera” (participant-patient 16 [48]; eg, the opportunity to delete recordings). Some patients pointed out that it would be important to obtain consent from other persons appearing in the videos (eg, family members) [48]:

Other people should be kept out of the video as much as possible... but this is probably not possible, so my partner needs to consent as well.
[Participant-patient 7]

Intervention Coherence

It was clear from some patients’ reports that they clearly understood how the video recording intervention worked [28,33,45]; for example, patients with obsessive compulsive disorder believed that by observing their own compulsions, they gained more insight into their illness and became more motivated to change [33]. However, video recording technology is unfamiliar to some service users with learning disabilities [45]:

Some service-users showed curiosity about the iPad and appeared not to recognise or understand it. One person asked if it was a mirror and looked to brush her hair, another asked if it could continue to see him in another room.
[Results extract]

In 1 study [28], therapists suggested that a video-guided exercise intervention for patients with stroke could be optimized by “using older videos [of patients] to demonstrate progress and goal attainment.”

Opportunity Costs

In 1 study [48] in which the intervention involved home-based video recording for movement analysis, some participants were concerned about the impact on their personal privacy:

I don’t want a camera in every room at the same time, I need to have some privacy somewhere.
[Patient 8; patient with Parkinson disease]

However, in another study [47] where clinical medical encounters were video recorded, “no patient made a comment that the video was intrusive.” A further study [30] involving video recording clinical encounters reported that the incorporation of video recordings into the clinical workflow “did not add any significant time to the visit.”

Perceived Effectiveness

Video recordings were perceived to be valuable in supporting patient assessment, including assessing condition severity and monitoring changes [32,33,45]. Specifically, video recordings of patients were considered to have certain advantages, including the “true visual representation” (study participant—speech and language therapist) and “depth of information not usually achieved by written transcription of assessment alone” (Results extract) [45]. Patients and clinical staff considered video recordings to be valuable for remote assessments [34,39,45] and removed the need to coordinate the availability of specialist clinical staff with the timing of specific events (eg, mealtimes and dysphagia assessment [45]). Patients and clinical staff members perceived video recordings to be effective in supporting care or treatment in different ways; for example, to inform fall prevention measures [32], to guide patients undertaking physical therapy after stroke [28,29], and to improve patient insight into obsessive compulsive disorder [33]. When an intervention involved patients viewing their video recordings, the videos were considered valuable in promoting patient engagement in their own health care [28,33,34,45]. Video recordings were perceived to improve communication; for example, some patients and their families felt that video recordings better conveyed problems, symptoms, care preferences, or clinical information [37-39,47,48]:

When you visit a neurologist you really need to describe the problem the right way and you never know exactly how often symptoms appear.
[Patient 10 [48]]

Clinical staff members reported that patient videos supported multidisciplinary communication as well as referrals for advice or a second opinion [45]. Video recordings were also perceived to improve the recall of information about a patient’s previous condition or clinical encounters [28,45,47]. In 2 studies, some patients believed that the video recordings had no benefit [38,47].

Self-Efficacy

Four studies reported factors affecting patients’ ability to engage with or participate in video recording interventions; these were as follows: cognitive impairment—“Cognitively impaired patients were less likely to engage with the tablet” (results extract) [28]; computer literacy—“respondents...indicated it was difficult for them to figure out how to get to the video” (results extract) [47]; and illness or psychological state [29,30].

Other

In 1 study [32], operational pressures meant that the video recording intervention (video monitoring and review of falls) was not used in the first few weeks of implementation, “because of numerous other challenges faced with operating a memory care facility and the little obvious value granted to the video so far” (results extract). In 2 studies [27,33], patients commented that there was too much noise or insufficient space in clinical areas and that these environmental challenges affected how well they could participate in the video recording intervention.

Effectiveness

Effectiveness was quantitatively measured in 10 studies. Of these, 5 were observational and examined the use of home videos as adjunct tools in epilepsy diagnosis [41,43,44] or the impact of continuous video monitoring on falls incidence and postfall care provision [32,42]. All 5 observational studies reported results favoring the impact of the video recording intervention on specific process measures (Table 2). However, among the 5 RCTs (which examined the impact of the intervention on patient outcomes), no study demonstrated that the video recording intervention was superior to controls (Table 3). Video self-confrontation did not improve patients’ insight into their psychotic behaviors [27,31], and providing rhinology patients with access to video recordings of their clinical visits did not improve their satisfaction with care or recall of procedural risks [30]. Showing stroke patients video recordings of the gait during inpatient rehabilitation may have a positive effect on functional outcomes, but the sample size for this study was small (N=23) [29]. A randomized feasibility trial reported that functional outcomes for video-guided exercise appeared to be similar to treatment-as-usual; however, the results of this pilot study were only indicative of possible effects [28].

Ethico-Legal Considerations

Ethico-legal considerations relating to video recording of patients for direct care purposes were described in all but 3 included studies; these considerations were broadly categorized into 8 themes (Figure 3).

Some authors cited adherence to relevant local, regional, or national legislation and guidelines, including local institutional review boards and clinical information governance protocols, state legislation (US studies), national health service policy, and federal law; for example, the Health Insurance Portability and Accountability Act (1996; US National Standard for Protecting Patient Health Information) [32,38,39,42,45,47]. Key priorities were obtaining informed consent, storage of video recordings, and data protection. Patients consented as principal subjects of the recordings; however, the importance of consenting others who may appear in the video was also raised [48]:

Other people should be kept out of the video as much as possible... but this is probably not possible, so my partner needs to consent as well.
[Patient 7]

Arrangements for secure transmission and storage of, and access to, video recordings were described, including the use of encryption, secure servers and local network storage devices, password protection and limiting access to certain personnel, file backup, and long-term storage [30,32,34,39,41-43,45,47,51]. Functionality enabling automatic or remote deletion of patient videos from portable recording devices (smartphones and electronic tablets) has also been reported [30,34,45,47]. Although secure storage was considered vital for patient confidentiality, easy access to patients’ video recordings was perceived as equally important for clinical decision-making [54]:

To compare a patient’s examination over time, one ideally would like to have the ability to access a video file quickly and easily in clinic. The desire for accessibility, however, must be balanced by the need for patient privacy and confidentiality.
[Results extract]

Measures undertaken to protect the privacy of patients and health or care staff included careful consideration given to the video recording location—for example, avoiding placing cameras in bathrooms [42], capturing recordings in a private room [38], and selecting a location where other people are unlikely to unintentionally video record [48]. Further suggestions included the possibility for patients or staff members to stop video recording at any time and use functionality to blur faces [32]. In 2 studies [32,42], the authors described signage (posters or stickers) to raise awareness that video recording was taking place to support care. Escalation procedures for staff members witnessing events causing concern in video recordings were also reported [32]. The authors highlighted the potential for patients to be distressed by seeing themselves on video and highlighted the need to mitigate this possibility when video recordings are viewed by patients as part of their treatment [32,36,38].

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Guidance of Professional Bodies in the United Kingdom

Several professional bodies in the United Kingdom have provided guidance on or relating to video recording patients for direct care purposes based on national legislation, such as the Data Protection Act 2018 [21], UK General Data Protection Regulation [23], and the Caldicott principles [55] (Textbox 2). Table 4 summarizes the key recommendations of professional bodies, which address many of the ethico-legal considerations raised in the included studies and are consistent with their recommendations, including obtaining informed consent, privacy and confidentiality, data storage, and data protection. Additional recommendations relate to the disclosure of recordings made as part of a patient’s care for secondary use such as research or education and guidance on what to do if a patient wishes to record a clinical consultation.

Discussion

Principal Findings

Video recording patients for direct care purposes appears to be acceptable, and this is evident in the recruitment and retention rates in studies evaluating a video recording intervention and the predominantly positive views and experiences of patients and clinical staff members. Concerns about privacy and physical appearance were voiced by some patients, whereas clinical staff members were concerned about device security, technical issues, and operational and environmental considerations associated with implementing video recording in a clinical setting. Video recordings were perceived to be valuable in supporting patient assessment, care, or treatment; in promoting patient engagement; and in enhancing communication and recall of information. The results of observational studies suggested that video-based patient records are effective in supporting direct care delivery; however, RCTs demonstrated that the video recording intervention was not superior to the controls. Of note, methodological and reporting quality was generally poor considering the studies collectively and worse in observational studies compared with RCTs. This review summarizes and discusses relevant professional guidance and national legislation for UK practice, including recommendations for obtaining consent, protecting privacy and confidentiality, and securing data transmission and storage.

Comparison With the Wider Literature

Although our review explored video recording in the context of direct care delivery, 2 previous literature reviews examined the evidence on video recording patients’ research and training purposes. A review of audio-visual recordings during general practitioner consultations for research purposes, published 15 years ago in 2008, found that patients who had not been videoed before were more likely to dislike the idea than patients who had previous experience with video recording during health care interactions [63]. In contrast, our findings are consistent with a later 2016 systematic review on the acceptability and design of video-based research, which reported that most patients and clinical staff regard video recording as acceptable and worthwhile for research and training [1]. It follows that the proliferation of smartphones over the last decade, their video recording functionality, and widespread adoption of videoconferencing during the COVID-19 pandemic have led to video recording becoming more acceptable in clinical practice for patients and clinical staff members [11].

Our review found that the factors influencing acceptability among clinical staff were technical issues and mobile device security. Similarly, previous research has reported issues with the installation or usability of video recording equipment, images not being transmitted to patient records, and mobile devices being stolen [12,64,65]. The inherent lack of anonymity in video-based records was reflected in patients’ concerns about their physical appearance or privacy; however, these concerns were voiced by only a small number of patients [31,34,42,48]. However, it is widely recognized that patients are apprehensive about how their personal data are handled and shared in the health care context [66,67]. A lack of transparency in how personal data are used undermines patients’ ability to trust that measures are in place to protect their privacy and thus reduces their willingness to engage with health information technologies [68]. As such, adherence to relevant legislation and professional guidance is not only essential from a medico-legal perspective, but it will also be important for the successful implementation of video-based records within health care settings.

Although video-based records were perceived to enhance several aspects of direct care delivery, the methodological and reporting quality of the body of evidence was generally poor, which limits the conclusions that can be drawn regarding effectiveness. Among the 5 RCTs, video recording interventions were not associated with improvements in clinically relevant outcome measures, although most trials were underpowered. Of note, our study was concerned with direct care delivery, and the applicability of RCTs to real-world clinical practice has been debated [22]. Although the research settings and target populations of the included RCTs were generally well described (Tables S1 and S3 in Multimedia Appendix 4), small sample sizes and lack of discussion around contextual factors that may have influenced the results make it difficult to judge how applicable these trials are to other settings. The results of the included observational studies (arguably more applicable to real-world settings if well designed) favored video recording, but the study designs lacked adjustment for confounders and were not suitable for estimating causal effects. A recent systematic review evaluating home videos for seizures demonstrated consistent improvements in diagnostic accuracy and clinical decision-making [69]. However, some studies in that review did not evaluate video recordings in a real-world direct care delivery context, and similar to our review, the findings were based on studies with diverse patient populations, interventions, and outcome measures that were not designed to test effectiveness, thus limiting internal and external validity.

Pertinent to video recording patients in health care, data protection legislation sets out how personal data must be collected, handled, and stored to protect people’s fundamental right to privacy. Although some countries, such as Canada, have complex data protection legislation at the federal and provincial levels, there is consistency in legislation across the globe pertaining to key issues, such as consent and data security, as laid out in the Personal Information Protection and Electronic Documents Act (2000; Canada) [70], the Data Protection Act (2018; the United Kingdom) [15], General Data Protection Regulations (the United Kingdom and European countries) [16,17], the Health Insurance Portability and Accountability Act (1996; the United States) [18], and the Privacy Act (1988; Australian Privacy Principles) [71]. As professional and regulatory guidelines are underpinned by data protection legislation, it follows that there is consistency in the recommendations for audio-visual recording patients. The professional and regulatory guidance collated for UK practice as part of this review lacks detailed information about how to operationalize the recommendations in clinical practice. Furthermore, there is tension between ensuring patient confidentiality and the accessibility of video recordings to inform clinical decision-making [51]. The Caldicott principles (Textbox 2) underline the need to strike a balance between protecting patient privacy and sharing information responsibly for individual care [56]. Technological advances permitting storage of electronic health records on secure cloud servers, integration of mobile device apps with electronic health records, and secure information exchange between providers will likely support health care organizations in achieving this balance. Although current professional and regulatory guidelines in the United Kingdom make recommendations for securely storing video recordings, they do not consider the importance of recordings being easily accessible to clinicians for direct care purposes.

Practice Recommendations and Future Research

Ensuring public trust and confidence in how personal data are used by the health service is a central concern for health care organizations and policy makers [72-74]. High levels of patient trust are paramount for the implementation of video-based patient records, particularly given the inherent lack of anonymity in video recordings. Clinical staff involved in delivering video recording interventions must be equipped to provide patients with information on how privacy and confidentiality will be protected [75]. As data controllers, health care organizations should have robust policies and procedures for operationalizing data protection legislation when implementing video-based patient records. This will include arrangements for secure storage and transmission of video recordings and facilities for remote content deletion where portable devices are used.

The methodological and reporting quality of the studies included in this review was generally poor, and further research is needed, particularly for the effectiveness of video-based patient records in direct care delivery. Although RCTs are considered the “gold standard” of causal impact evaluation, they should adopt a pragmatic attitude to evaluating video-based records for direct care purposes and be reported according in line with the CONSORT (Consolidated Standards of Reporting Trials) statement extension for pragmatic trials [76]. Theory-based mixed methods approaches are recommended to identify and explore the active ingredients of video recording practices, including the contextual and behavioral factors driving possible effects [77].

Strengths and Limitations

A strength of this review lies in the comprehensive synthesis of qualitative and quantitative data and professional guidance to address a range of important considerations for the implementation of video-based patient records. A robust systematic review process was followed, with 2 reviewers independently undertaking screening, data extraction, quality appraisal, and coding of qualitative findings. We ensured rigor and transparency in the qualitative synthesis by applying the framework method to derive insights from the included studies [20]. However, the number of studies on video recording for direct care purposes is small and scattered across traditional disease boundaries. Therefore, despite our efforts to carefully perform the search and selection processes, we may have missed some relevant studies. As it was anticipated that the body of literature would be small, we included studies with different designs and did not exclude low-quality studies. Heterogeneity relating to the study populations, video recording interventions, and outcome measures as well as the collectively poor methodological and reporting quality of the studies mean that firm conclusions cannot be drawn, particularly in relation to whether video-based patient records are effective in supporting direct care delivery. This review sought to collate professional and regulatory guidance for video recording patients in the British National Health Service. Although these recommendations may not directly translate to health care settings outside the United Kingdom, there is broad consistency in data protection legislation around the globe regarding several key issues, such as seeking consent and implementing data security measures.

Conclusions

Video technologies have been piloted in various health and care contexts to support diagnosis, care, and treatment. Video recording practices appear to be acceptable to patients and clinical staff despite concerns about privacy, technical considerations, and integration into clinical workflows. The methodological and reporting limitations of the studies included in this review prevented firm conclusions from being drawn. Pragmatic, mixed methods trials, particularly in the field of movement disorders, older adult care, and in patients’ homes, should evaluate how video recording impacts diagnosis and treatment monitoring, patient and care provider communication, and patient safety. Professional and regulatory documents should provide practical guidance for the secure, ethical implementation of video recording in routine practice.