A consultant wants to use a case as teaching material. The de-identified version goes to medical students; the original stays in the record. The redaction needs to be thorough enough that even a colleague who knows the patient can't recognise them.
PHI redaction for teaching is the toughest standard. Get it right and the case can be shared widely.
Beyond the obvious identifiers
Names, dates of birth, addresses, NHS numbers — these are the easy ones. The harder elements are free-text references: the patient's occupation if rare, their location if specific, references to specific events or family members. Walk through every page asking: could this combine with other information to identify the patient?
Proper redaction technique
Use redact PDF so text underneath is removed, not just covered. For teaching material, also consider changing identifying details rather than just removing — "a 45-year-old patient" might become "a patient in their forties" if exact age is identifying. Re-typing rather than redacting is sometimes the cleaner solution for teaching cases.
Photographic material
Full-face photographs and any image that could identify the patient must be removed or obscured. Cropping out the face isn't always enough — tattoos, scars, distinctive features can identify. For teaching, generic illustrative images often substitute better than redacted patient photos.
Verification step
Once redacted, ask a colleague who doesn't know the case to read it and tell you what they can infer about the patient. If they can guess age, location, occupation, or relationships, you have more redacting to do. This is the test that catches indirect identifiers other methods miss.
Consent as belt and braces
Even with thorough redaction, obtaining the patient's consent to use the case for teaching adds an extra layer. For unusual or sensitive cases, consent is best practice. Document the consent and retain it with the redacted teaching version.
FAQ
Is Safe Harbor redaction enough for teaching?
It's the baseline. For teaching material that will circulate widely, also remove indirect identifiers and consider patient consent.
Can I share a redacted case at a conference?
Yes if properly redacted, but check your professional body's guidance on case presentation. Patient consent for case presentation is best practice.
What about case publication in journals?
Most journals require explicit patient consent for case reports, even after redaction. Follow the journal's specific policy.
How do I redact a long free-text history?
Often easier to retype a de-identified version rather than redacting in place. Mark the retyped version clearly as a teaching adaptation.
Teaching cases need the highest redaction standard. Use Flint's redact tool, test by asking a colleague, and the case becomes shareable.