Social media: Patient friend or foe?
What goes online stays online
By now, HIPAA is well known to the healthcare community. Hospital staff and physicians have long been practicing a strict standard of patient privacy.
HIPAA was put in place for a number of reasons-to protect patients from extortion, abuse, embarrassment, discrimination, and pain and suffering. But it was enacted just as the Internet was beginning to become the force we now know it to be. Now, more and more hospitals are finding that they need to explicitly tell staff and physicians that HIPAA applies to the World Wide Web as well.
Anne Huben-Kearney, RN, BSN, MPA, CPHQ, CPHRM, likens social media sites like Twitter and Facebook to a virtual hospital elevator, implying that you never know who might step on and be listening. Huben-Kearney is vice president of risk management at ProMutual Group, which focuses on risk identification, management, and litigation in many types of healthcare settings.
Social media provides the opportunity to share information at any time, and it creates a permanent record that cannot be erased. "It has to be clear to staff that they never stop being a nurse, physician, or hospital staff when it comes to patient privacy and confidentiality, even in off-hours," says Huben-Kearney.
Dangers of social media
The permanent record created by social media can lead to repercussions for those who use it. For example, in April 2010, four staff members were fired and three were disciplined at St. Mary Medical Center in Long Beach, CA, after using social media to post pictures of a man on the brink of death who had been stabbed several times. In addition to the obvious HIPAA violation, it can be argued that the staff neglected patient care because they were busy taking pictures and posting them rather than treating the patient. (See the sidebar below for examples of social media snafus.)
The St. Mary Medical Center incident is an extreme example, says Huben-Kearney, but it proves a point.
"How can you be taking care of the patients while you're taking pictures? That example still blows my mind," she says. "But it could be anything. It could be not acknowledging an alarm because you're using Facebook or Tweeting." She notes that social media use should, at minimum, be limited to defined breaks.
Huben-Kearney notes that nurses who are requesting more staff in their department might want to ensure that they aren't using social media during work hours, as this could hurt their case.
She also warns that social media is not the place to communicate critical information about a patient. Such information needs to be subjected to rules such as appropriate abbreviation, and it needs to be documented-that means even closed communications such as texts aren't a good idea. "It will impact patient care and safety," says Huben-Kearney. "Just don't do it."
Policies and training
Social media policies should be clear, simple, and give examples.
"I think hospitals that are doing this well have a very short and succinct policy," says Huben-Kearney. "Everyone who works at the hospital should sign the policy. If the policy is zero tolerance, it has to be clear and it has to apply to everyone."
Training should be given at orientation and should include real-life examples to help explain the importance of the policy, says Huben-Kearney.
Of course, the Internet can help as much, if not more, than it can hinder. (See the sidebar below for some examples.) Physicians can log into physician-only social media sites and discuss cases. Patients are given diagnoses and advice online all the time. Providers have begun to use programs like Skype™, a videoconferencing platform, to help diagnose stroke and other illnesses for which visual cues are often instrumental.
Because social media and new technology has the ability to both help and hurt, many hospitals and associations are giving guidance on how to use it appropriately. The AMA has released physician guidelines for social media, which can be found at www.ama-assn.org. The guidelines suggest that physicians should maintain professional relationships with patients online, should not rely on privacy options on social media sites to protect them, and should call out colleagues who may be using social media inappropriately.
"I wouldn't be surprised if, in time, The Joint Commission comes out with a Sentinel Event Alert on social media," says Huben-Kearney. "But many of these concerns are already addressed within the patient rights and leadership standards."
Whether social media is ever specifically addressed in Joint Commission standards, Huben-Kearney says the idea of being careful how and with whom you share information isn't new.
"The concept isn't new, it's just that the vehicles for providing information have evolved," she adds. "They've become more casual as well. It has an instantaneous and spontaneous nature."
Patient privacy breached through social media
Hospital staff and physicians must understand the dangers and consequences of using social media. The following are a few specific examples of clear HIPAA breaches through the use of social media over the past few years:
- In November 2008, nurses at a Fargo, ND-based healthcare system began using Facebook to provide unauthorized shift change updates to their coworkers. (Journal of AHIMA, January 6, 2010)
- In April 2010, four staff members were fired and three were disciplined at St. Mary Medical Center in Long Beach, CA, after they posted pictures of a man on the brink of death who had been savagely stabbed several times. (Los Angeles Times, August 8, 2010)
- In June 2010, five nurses were fired at Tri-City Medical Center in Oceanside, CA, after hospital managers discovered that the nurses had been discussing patients on Facebook. (Los Angeles Times, August 8, 2010)
- In April 2011, an emergency physician at Westerly Hospital in Charlestown, RI, was fired and had her medical privileges revoked after posting about a patient on Facebook. She did not include the patient's name, but her post gave enough information for others in the community to identify the patient. (Boston Globe, April 20, 2011)
Social media helps treat, educate
Social media certainly has its benefits when it comes to patient diagnosis, treatment, and education, although in the case of an online diagnosis, it can be difficult to determine whether information given was advice or treatment, leaving the online contributor's role in the patient's case ambiguous, presenting a legal problem if something goes wrong. Still, social media can help providers share information and educate newcomers to the field. Here are a few examples:
- A pediatric nurse spotted a white glare in a toddler's eye on a picture posted on Facebook, and warned the family that it could be a sign of eye cancer. The nurse's suspicion was correct. (Daily Mail, October 20, 2010)
- A 4-year-old boy's picture was posted by his mother after she had taken him to the pediatrician. Three friends, one a physician, posted a diagnosis of Kawasaki disease and suggested she take him to the ED. The diagnosis was correct. (Slate, July 13, 2011)
- In February 2009, surgeons at Henry Ford Hospital in Detroit Tweeted a surgery live with the patient's consent. Other physicians and medical students could follow the surgery. (CNN, February 19, 2009)