The scope and reach of physicians are expanding rapidly due to an increase in user-created content and online media in the digital age. Social media sites, such as Twitter and Facebook, internet-based applications, blogs, texting and emailing, media-sharing sites, and networking sites have all led to an increase in the communication between physicians and their patients, physicians and the public, and among physician colleagues. In fact, over 60% of physicians use some type of social media for professional purposes. Although the various platforms present a convenient means of communicating both patient information and general health information, there are significant challenges to consider, including maintaining confidentiality, privacy, and professionalism in the medical community as it pertains to information sharing. Concerns continue to arise as new technologies are introduced but policies and guidelines for appropriate use continue to lag behind. This article will review the most popular digital technologies, especially those related to social media platforms, and will help navigate models for appropriate use.
Facebook and Twitter are ubiquitous in our society. Most medical professionals use these sites for personal use but still find themselves confronted with how to deal with patient interaction on such a public platform. Over one-third of physicians have stated that a patient has attempted to “friend” them on Facebook. While the majority of these physicians (75%) decline or ignore the invitations, the remaining 25% accept the request. Of those that do, even a smaller percentage feel comfortable with the decision and are unsure how to respond to patient questions. Additionally, the personal information exchange on Facebook and Twitter represents a two-way street which allows patients to view the personal behavior and opinions of their practitioner and physicians to observe patients participating in health-adverse behaviors, which also introduces issues in patient care management. Also, the patient-physician relationship can begin to erode as the professional boundaries are blurred as the perceived “friendship” is accepted. A Rhode Island doctor was fired from the hospital and reprimanded by the Medical Board after she posted on her Facebook page about a long day at work. She never referred to the patient’s name but gave out enough details about the injuries to allow others to guess who it was. Most practice organizational policy statements advise against online communication between medical professionals and their patients and also set forth standards for clinic or hospital staff. Some physicians have developed professional Facebook and Twitter pages for their patients to have indirect access to the practice. These types of sites allow for the positive exchange of information in public forum while also allowing for strategic marketing of clinics and services.
Other popular platforms favored by many physicians are blogging and online forums. The Pew Internet and American Life Project estimated that eight in ten internet users utilize online services to garner health information, making it the third leading popular activity among internet users. Patients will often receive a diagnosis from a physician and proceed to do additional research online and compare this with their physician’s recommendations. For this reason, physicians should be discuss all treatment options with the patient and explain the chosen treatment so that patient trust can be maintained. Online decision aids, such as WebMD, are highly popular in areas where access to care might be limited or where patients need a trip to the physician to be warranted. Due to the surge of popularity in these online aids, it is suggested that physicians familiarize themselves with these types of sites in order to best serve their patients. Regarding blogs and online forums, it is very important for physicians to provide accurate information based upon cited clinical studies and peer-reviewed media that the patient can access as a guide. Additionally, since written posts can be perceived as contextually ambiguous, due to the lack of body language, “pausing before posting” is a good rule of thumb regarding posting in social media platforms. It is also important for physicians to avoid “venting” in online forums as these are accessible to the general public, including current and potential patients. Physicians can provide a wealth of information via posting in blogs or online forums, and this information can be very beneficial to internet users. However, it is important to maintain professionalism, remain without bias, and place accuracy before opinion when sharing.
Physician-physician interactions are becoming increasingly popular through the use of secure networking sites, email, video conferencing, and even text messaging. Professional networks are extremely beneficial and can provide education opportunities among medical colleagues, especially when presented with clinical anomalies through sharing of treatments and experiences. When referring to patient or clinical vignettes, it is important to maintain complete confidentiality by deleting all defining characteristics or revealing references to the patient. It is also highly recommended, before any patient story be shared online, even between physicians, that the patient’s consent is obtained. Sometimes it is necessary to share confidential patient information between physicians via email, text, or video conferencing. In these cases, it is very important to ensure privacy by using only secure platforms where the information being exchanged cannot be accessed by unintended parties. Many practices and hospital systems have employed device management systems for tablets and cell phones that allow for remote monitoring and additional security. In 2012, a Massachusetts ENT clinic settled a case for $1.5 million due to a HIPAA security breach stemming from a stolen laptop containing clinical information and confidential patient records. Overall, the benefits of interaction between medical professionals outweigh the risks, but special measures must be adhered to in order to maintain confidentiality of patient records and to abide by HIPAA rules.
A lesser-known platform that allows for patient education are online communities. These communities bring together those patients or their family members who may be suffering from a chronic illness, cancer, or rare disease. These types of communities offer wide spectrum of benefits, including emotional support, education, and prevention. The best sites are partnered with specialty physicians who can ensure the accuracy of the information being shared and foster a sense of trust within the online communities. Of the physicians who are aware of these resources, over 40% stated that they currently recommend the communities to their patients, and another 40% stated they were willing to consider recommending these resources. These communities have the potential to be very beneficial to the general medical community if they are managed properly.
Social media and digital technologies are an ever-present source of information and communication in our society. Although they bring multiple benefits for medical professionals, it is crucial to set forth policies and guidelines for use by being familiar with HIPAA and HITECH rules. If you would like to review these rules, they can be found at http://www.hhs.gov/ocr/privacy/. Additionally, most carriers now offer cyber liability limits that can either be added to an existing policy or purchased as a separate policy. Many physicians are unaware that they can purchase this type of protection until a claim has been filed, and then it is too late. If you have questions regarding IT security, have concerns about social media use, or would like to inquire about cyber coverage, please contact Diederich Healthcare, and one of our trained, professional agents will assist you in answering any questions you may have.
References:
Farnan, Jeanne M., M.D., Snyder Sulmasy, Lois, J.D., Worster, Brooke K., M.D., Chaudry, Humayan J., D.O., Rhyne, Janelle A., M.D. and Arora, Vineet M,, M.D. Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and the Federation of State Medical Board. Annals of Internal Medicine. 2013; 158:620-627.
Modahl, Mary, Thompsett, Lea, Moorhead, Tracey. Doctors, Patients, and Social Media. QuantiaMD and Care Continuum Alliance. September 2011.
Sachin, Jainh, M.D. Practicing Medicine in the Age of Facebook. New England Journal of Medicine. 2013; 361:649-651.