• Chirag Patel

The world has come very far with respect to technology. In reality, technology, social media, and smart phones have breached the mainstay in our everyday lives in a short period of time. Gone are the days of cassette and VHS tapes. Gone are the days of typewriters and cursive handwriting. Those outdated technologies have been replaced with tablets, smartphones, and social media websites like Facebook. The same types of technologies have found its way into healthcare. Lambert, K., Barry, P., & Stokes, G. (2012) state that, “Social media has infiltrated all of our lives both personally and professionally.” For better or for worse these technologies have blended into our everyday lives with no end in sight therefore, knowing they aren’t going away and how we use them will say as much about ourselves and as society as a whole.

Today’s technologies allow us to be more connected to one another. Both patients and healthcare providers have information available at their fingertips including a patient’s personal health information (PHI). On concern could be stated as such, “How safe are today’s technologies and will patient’s personal health information be compromised?” The U.S. Department of Health and Human services created HIPPA (Health Insurance Portability and Accountability Act). HIPPA is a federal law that protects medical information of patient’s and is enforced by the Office of Civil Rights.

According to Lambert, K., Barry, P., & Stokes, G. (2012), “The use of social media may expose professionals and healthcare entities to liability under the Health Insurance Portability and Accountability Act (HIPAA) as well as individual state privacy laws. HIPAA, as modified by the Health Information Technology for Economic and Clinical Health Act (HITECH), governs the permitted use and disclosure of PHI by covered entities, including hospitals, physicians and other healthcare providers. The HITECH Act provides breach notification requirements and expands various requirements to business associates.”

So why take the risks? Like anything in this world sometimes you have to take the good with the bad. A few advantages of today’s technologies and social media sites include accessibility. Patients can now play an active engagement in their health care. Social media and various apps allow an individual to do their own research on their conditions. It can give a patient a feeling of empowerment when otherwise they would feel helpless. Social media and varying apps allow for individuals to connect with support groups and message boards that can lend much needed empathy from people who are going through similar situations. We’ve heard the stories of bullying on Facebook but on the flip side there are stories of triumph and support when used in a way that garners sympathy and empathy. Facebook can be both an advantage and disadvantage depending on how it is used.

Doctors, nurses, and other healthcare providers have advantages as well. They too can have the latest research and decision making support tools available to them at palm of their hands. Access to real time information such as the latest prescription recall or access to the most recent white paper of medical breakthroughs benefits both the healthcare provider and ultimately the patient. This collective online and mobile brain trust allow for healthcare providers to create robust medical strategies that can help in the decision making. Online and smart phone resources include mobile apps like Epocrates ®, Medscape, and even AHRQ ePSS an app designed by the United States Department of Health & Human Services (HHS). Online communities’ such as American Medical Association provide resources from varying topics including: managing your practice; medical ethics; legal issues; and career development.

In general, most individuals prefer to keep their health status confidentiality hence, the patient-doctor confidentiality relationship. But with smartphones and use of social media the totality of a person’s health information could be vulnerable if safeguards are not in place. Solomon, P., et al. (2012) suggests that healthcare providers who have access to patient information made aware of strategies and facility policies in order to safeguard patient privacy. They should also be mindful and place themselves in a situation where access can be vulnerable i.e. leaving a computer on and unsecure. Solomon, P., et al. (2012) state emphatically that “Confidentiality is a legal right for clients as well as a professional ethical responsibility of providers.” A break in trust serves to weaken the relationship between the healthcare provider and the patient.

Let’s go back to our original scenario. The nurse worked a night shift while her friend attended a concert. The lead singer of the concert the nurse missed is now her patient. At the end of her shift, what does she do? Our group chose the following conclusion:

You go on Facebook, on your day off, and talk about the night you had at work and how you didn’t really feel as bad having to miss the concert, because you actually got to meet Jerod in person and even “Got his number!” You then post a picture of Jerod on Facebook and Instagram, figuring that most of your contacts would never recognize him anyway. It’s your day off and your personal time, so no harm, no foul, right?

The scenario above is a plausible outcome in the world with which we live in. However, there are a lot of things wrong with the nurse’s line of thinking. It is not unreasonable for the nurse to think that her personal Facebook page is her private business. However, in the New York trial of Romano v. Steelcase (2010) the Supreme Court stated that, “It is reasonable to infer from the limited postings on plaintiffs public Facebook® and MySpace® profile pages that her private pages may contain material and information that are relevant to her claims or that may lead to the disclosure of admissible evidence. To deny defendant an opportunity to access these sites not only would go against the liberal discovery policies of New York favoring pretrial disclosure, but would condone plaintiffs attempt to hide relevant information behind self-regulated privacy settings.” In other words, what the nurse posts on her Facebook could be used against her for several reasons 1). The photo was taken while she was working, 2). The photo violates a patient’s right to privacy and confidentiality and 3). By violating the patient’s right to privacy and confidentiality she could be setting herself for termination of employment and/or criminal or civil violations. Those are possible consequences that may prove costly in the long run. The nurse should stop and ask herself if the notoriety would be worth losing her reputation and career over.

In summary, there are many advantages and disadvantages to smartphones and use of social media. Advantages include active engagement for patients in their health status; readily available resources in real-time; and ease of use and accessibility for all users both front-end and back-end. Some disadvantages include lack of privacy; accountability for posts on personal social media sites; and data integrity and vulnerability. Do the Pro’s outweigh the Con’s? One can only say that training, awareness, and professional and ethical responsibilities should dictate an individual’s actions. As the old saying goes, “Just because you can doesn’t mean you should.” A good warning that should be heeded by all.

References

Kosieradzki, J. (2011). Social media and privacy: when personal posts intersect with the business of litigation. Journal of Legal Studies in Business. (17), 51-64

Lambert, K., Barry, P., & Stokes, G. (2012). Risk management and legal issues with the use of social media in the healthcare setting. American Society for Healthcare Risk Management. 31(4), 41–47. doi: 10.1002/jhrm.20103

Romano v. Steelcase, 907 N.Y.S.2d 650, 658 (N.Y. Sup. 2010)

Solomon, P., Molinaro, M., Mannion, E., & Cantwell, K. (2012). Confidentiality Policies and Practices in Regard to Family Involvement: Does Training Make a Difference?. American Journal Of Psychiatric Rehabilitation, 15(1), 97-115. doi:10.1080/15487768.2012.655648