Patient Confidentiality and the Social Network

1. PATIENT CONFIDENTIALITY & THE SOCIAL NETWORK Iris Thiele Isip Tan MD, MSc Professor, UP College of Medicine Chief, UP Medical Informatics Unit @endocrine_witch

2. CONFIDENTIALITY IN THE AGE OF SOCIAL MEDIA DOCTORS PROTECT CONFIDENTIALITY WHEN PATIENTS GIVE UP PRIVACY

3. PRIVACY CONFIDENTIALITY About people About identifiable data Extension of privacy Right to be left alone Limit access to public Prevent unauthorized access

4. PRIVACY PARADOX Bushel et al. Protecting human health & security in digital Europe: How to deal with the “Privacy Paradox”? Sci Eng Ethics 2014 Fear threats to personal autonomy and freedoms from globalized data processing by government Voluntarily disclose personal data on social networking sites (names, photos, dates of birth, marital status, medical data)

5. Although patients and providers benefit from SoMe, the boundaries between physicians and their patients can become blurred, putting both parties at risk. Roupret et al. European Association of Urology (@uroweb)recommendations on the appropriate use of social media. European Urology 2014;66:628-32

6. EXTENDING PATIENT-MD RELATIONSHIP ONLINE? Purpose Content Response time Farnan et al. Online medical professionalism: patient and public relationships: Policy statement from the American College of Physicians and the Federation of State Medical Boards Ann Intern Med 2013;158:620-7

7. Bosslet et al. The patient-doctor relationship and online social networks: results of a national survey. J Gen Intern Med 2011;26(10):1168-74 National survey of US medical students, resident & practicing physicians n=455 NOT ethically acceptable to interact with patients for either social (68.3%) or patient care (68%) on online social networks 79% expressed concerns about maintaining patient conﬁdentiality

9. CONFIDENTIALITY IS THE PILLAR OF OUR PROFESSION. The patient-physician relationship is built on trust that enables patients to share intimate details. Grotty B & Mostaghimi A. Confidentiality in the Digital Age. BMJ 2014;348:g2943

10. AVOID USING SOCIAL MEDIA FOR DIRECT PATIENT CARE & CONTACT Unencrypted Inadvertently accessible to others Controlled by a third party Grotty B & Mostaghimi A. Confidentiality in the Digital Age. BMJ 2014;348:g2943

11. SOCIAL MEDIA IS LIKE A CROWDED ELEVATOR. Others can easily overhear conversations without the benefit of context. Grotty B & Mostaghimi A. Confidentiality in the Digital Age. BMJ 2014;348:g2943

12. SOCIAL MEDIA TO FACILITATE CONVERSATION AROUND MATTERS OF PUBLIC HEALTH OR AVAILABILITY OF SERVICES rather than matters related to a speciﬁc patient Grotty B & Mostaghimi A. Confidentiality in the Digital Age. BMJ 2014;348:g2943

13. www.facebook.com/EndocrineWitch GIVE NOTICE TO PATIENTS THAT SOCIAL MEDIA IS NOT MEANT FOR CLINICAL COMMUNICATION Monitor. Take conversation offline if sensitive information is posted. Grotty B & Mostaghimi A. Confidentiality in the Digital Age. BMJ 2014;348:g2943

14. — Karen Michelle Devon, MD I WAS SURPRISED TO FIND AN IMAGE OF MYSELF, WEARING SCRUBS, AND HOLDING A THYROID GLAND. ” “ Devon KM. JAMA 2013;309(18):1901-1902

15. Palacios-Gonzalez C. The ethics of clinical photography & social media. Med Health Care & Philos DOI 10.1007/s11019-014-9580-y USE OF CLINICAL PHOTOGRAPHY PRIMARY For patient care SECONDARY For research and medical education

16. Clinical photography + social media DOES NOT equal telemedicine. Palacios-Gonzalez C. The ethics of clinical photography & social media. Med Health Care & Philos DOI 10.1007/s11019-014-9580-y Patients do not have adequate information to give informed consent. PRIMARY

17. Even if patients recant consent, nearly impossible to retrieve or delete clinical images. Palacios-Gonzalez C. The ethics of clinical photography & social media. Med Health Care & Philos DOI 10.1007/s11019-014-9580-y Moderate comments to avoid derogatory remarks about clinical images or patients depicted. SECONDARY

18. www.healthxph.net/manifesto I will value the patient’s dignity & privacy by not taking selﬁes, grouﬁes or videos during encounters with patients that include patients’ body parts, surgical specimens or that show patients in the background without their consent. #HEALTHXPH

19. www.healthxph.net/manifesto I will refrain from posting information online that will compromise patient confidentiality and privacy. #HEALTHXPH

20. PATIENT IDENTIFIERS Names Geographic information Dates (eg. birth date, admission date, discharge date, date of death) Telephone numbers Fax numbers Email addresses Social security numbers Medical record numbers Health plan beneficiary numbers Account numbers Certificate/license numbers Vehicle identifiers & serial numbers, including license plate numbers Device identifiers and serial numbers URLs IP address numbers Biometric identifiers (eg. finger and voice prints) Full-face photographic images & any comparable images Other unique identifying numbers, characteristics or codes Protected health information any medical information about a specific patient in combination with any information that could be used to identify that patient

22. PUBLIC HAS FEWER WORRIES ABOUT SHARING HEALTH INFORMATION THAN OTHER PERSONAL DATA Andrew Cole. BMJ 2013;347:f4753 The Wellcome Trust. Summary report of qualitative research into public attitudes to personal data and linking personal data. Jul 2013. www.wellcome.ac.uk/stellent/groups/ corporatesite/@msh_grants/documents/web_document/wtp053205.pdf.

23. HEALTH INFORMATION SHOULD NOT BE SHARED TO EMPLOYERS, INSURANCE PROVIDERS & DRUG MANUFACTURERS. Andrew Cole. BMJ 2013;347:f4753 The Wellcome Trust. Summary report of qualitative research into public attitudes to personal data and linking personal data. Jul 2013. www.wellcome.ac.uk/stellent/groups/ corporatesite/@msh_grants/documents/web_document/wtp053205.pdf.

24. Andrew Cole. BMJ 2013;347:f4753 The Wellcome Trust. Summary report of qualitative research into public attitudes to personal data and linking personal data. Jul 2013. www.wellcome.ac.uk/stellent/groups/ corporatesite/@msh_grants/documents/web_document/wtp053205.pdf. DATA LINKAGE, WHERE INFORMATION FROM ONE SOURCE IS USED TO INFORM WORK IN ANOTHER AREA Ex. Supermarket loyalty card to gauge public health program

25. J Am Acad Dermatol 2013;68:1030-3 Sarah liked Dr. W’s Facebook page. She commented on a discount coupon for tattoo removal. Sarah’s mother fears that “everyone will know” about Sarah’s tattoo. The mother demands that the clinic inactivate the Facebook page immediately.

26. DR. W SHOULD … A. Make no changes to the Facebook site. B. Institute a system for monitoring the site on a regular basis to purge inappropriate posts. C. Disable the site’s comment section to eliminate the possibility of patient’s disclosing personal information. D. Discontinue the requirement that patients “Like” the Facebook page to receive discount coupons. E. Discontinue the Facebook site. Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

27. DR. W SHOULD … A. Make no changes to the Facebook site. Sarah has the right to post protected health information (PHI). Exercise vigilance when establishing a web forum with foreseeable risk of unintentional disclosure of PHI. Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

28. DR. W SHOULD … B. Institute a system for monitoring the site on a regular basis to purge inappropriate posts. Approach is labor-intensive and imperfect Instantaneous dissemination of information on social networks Impossible to remove information from cached Web pages Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

29. DR. W SHOULD … C. Disable the site’s comment section to eliminate the possibility of patient’s disclosing personal information. Limits potential for patient education Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

30. DR. W SHOULD … D. Discontinue the requirement that patients “Like” the Facebook page to receive discount coupons. Prevent the MD’s direct complicity in exposing the patient’s treatment for a potentially stigmatizing condition Upholds social justice Orenstein et al. E-professionalism at the dermatology office: New challenges to confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

31. DR. W SHOULD … A. Make no changes to the Facebook site. B. Institute a system for monitoring the site on a regular basis to purge inappropriate posts. C. Disable the site’s comment section to eliminate the possibility of patient’s disclosing personal information. D. Discontinue the requirement that patients “Like” the Facebook page to receive discount coupons. E. Discontinue the Facebook site. J Am Acad Dermatol 2013;68:1030-3

32. Social media is a window through which we ask people to look. How big we make the window is up to us, as is what we do in front of the window. Journal of the American Pharmacists Association Nov/Dec 2013doi: 10.1331/JAPhA.2013.13536

Patient Confidentiality and the Social Network

Iris Thiele Isip-Tan

Patient Confidentiality and the Social Network