The Emergence of Social Media!
Social Media and Health Care
More than 60 million Americans are consumers of “Health 2.0” resources (Kane, Fishman, Gallaugher, & Glaser, 2009). Varying types of health care programs comprise a large sector of this quickly developing space. This space includes self-help cyberspace or individual/consumer space. This domain is where individual electronic patients (e-patients) access and use on-line health resources of their picking (Ferguson, 2007). Within this domain, individuals can seek and find friends, family, patient peers and online electronic health (e-health) or virtual communities. Medical and pharmaceutical web-sites exist for individual patient empowerment, engagement and knowledge. Unstructured e-mail with physicians and other health care providers falls in the self-help cyberspace (Ferguson, 2007). In this self-help cyberspace, the patient is in charge rather than the professionals. Many e-patients and some health care providers incorporate Facebook, web-based health forums, Twitter and You Tube to promote health information, peer-to-peer support and doctor-patient support. Social Media and Health Care
Some organizations incorporate short message service (SMS) platforms. Health insurers like Humana’s Lifesync Division, Independence Blue Cross and Accenture Health are employing social media to engage consumers in health care related wellness to aid in the development of electronic health records (EHR) and to bolster brand. The Mayo-Clinic is launching a social media site on health care issues, as is the Veteran’s Administration. New mobile health start-ups, healthcare organizations, the government and medical centers are taking advantage of social networking platforms to reach more people, provide information, gather feedback and promote support and services. Due to the rapid growth and development of social media as tools designed to reach large volumes of people, health care is trying to lawfully and ethically implement the use of these platforms.
Background
To illustrate the growth of social media, Facebook has more than 750,000,000 active users and about 70% of the users are from outside the United States. There are over 70 translations available on site and more than 200,000,000 active users access Facebook via their mobile phones. More than 2.5 million websites have integrated with Facebook, including over 80 of comScore's U.S. Top 100 websites and over half of comScore's Global Top 100 websites (Facebook Pressroom, 2011). Hospitals and academic medical centers have over 300 You Tube channels and 500 Twitter accounts (Sharp, 2011). The number of electronic health care consumers reached 146,000,000 adults in America in 2008 (Manhattan Research).
Data from the Pew Internet and American Life project found that 66 percent of Internet users (49 percent of all adults) seek medical information online and that patients with chronic health conditions use on line health information more often than healthier individuals. Chronic disease patients who seek information about medication and over the counter medication via the internet surpass healthier individuals (51 percent to 35 percent). Chronic health patients seek alternative therapies on line at a higher rate than their healthier counterparts (42 percent to 25 percent) (Fox & Jones, 2009).
As these newly developing e-patient trends and programs ebb, tide and evolve, so do problems and challenges in application, law and ethics. Because electronic health consumers and providers are increasingly engaging in social platforms, the Health Insurance Portability and Accountability Act (HIPAA) must be taken into account. Potential intended and unintended consequences with personal health information (PHI) must be concerns of health care organizations utilizing social media. The legal analysis is principally concerned with confidentiality and privacy constructs, described as the “Law of Boundaries” (Terry, 2010). The Law of Boundaries can be applied to physician social information online, patient health-related information online, physicians and patients as “friends,” and physicians “tweeting” or posting about their work (Terry, 2010).
In a time when world citizens are putting personal information, willingly and publicly on- line, health care still remains very conservatively driven with emphasis being placed on a closed information system. “Closed information systems rely on supply-side quality control measures” (Ferguson, 2007, pg. 30). In closed information systems only those authorized can add or edit information and the accuracy of the data is closely examined, monitored and regarded as being universally correct (Ferguson, 2007).
Social media are regarded as open information systems regulated by “demand-side quality control measures” (Ferguson, 2007, pg. 30). In social media any person can publish material, accurate or inaccurate, without monitoring. This causes some physician and patient trepidation regarding e-health tools. Social media and health care are converging but are fundamentally different in informational exchange structures. Health care based organizations will run into challenges trying to positively integrate social media and health care law and ethics with current constraints and expectations.
Healthcare Law and Ethics
Much tension and inconsistency lie in the definitions of Health 2.0, Medicine 2.0 or 3.0. Terms and language are not clearly defined and objectives are not clearly delineated. Legislation, regulation and guidelines are not yet clearly in place for health care law and social media convergence. Health care providers are guided by ethics focusing on scope of practice, causing no harm, autonomy, beneficence, nonmalificence and justice. Rights of the individual versus the rights of society must also be considered on an ongoing basis, as there is a Patient’s Bill of Rights and a Resident’s Bill of Rights (Mitchell & Haroun, 2007). HIPAA states that the purpose of the act is to improve the efficiency and effectiveness of health care delivery and that the act is to protect and enhance the rights of patients by controlling the inappropriate use or disclosure of personal health information. This includes standards for health information transactions, confidentiality and security of patient data. The enforcement of HIPAA began in April of 2003 (Newby, 2009). HIPAA must be adhered to by all health care providers, organizations, health plans, clearinghouses and business associates. Any provider or organization of health care, ground based, web-based or mobile-based, must comply with HIPAA standards even though social media standards and health care applications have not yet been clearly developed.
Facebook, Twitter and HIPAA
By the sheer nature of a Facebook page, Facebook discussion or Twitter post, names will be displayed and personal information transmitted. Because of the ease and access of posting information by anyone, PHI can be intentionally or unintentionally disseminated to large numbers of individuals globally. HIPAA regulations and requirements that are violated, such as improper dissemination of patient information, are subject to civil and or criminal punishment. HIPAA is enforced by The Office of Civil Rights and civil penalties can range from $100.00 to $25,000.00 a year. A criminal penalty can consist of a $50,000 dollar fine and or one year in prison for wrongful disclosure or up to a $250,000.00 and ten years in prison for the intent to sell information (Newby, 2009).
Anything relating to patients health care, on any platform, is considered private and confidential, unless society is at risk. The health care worker and or provider are ethically and legally responsible to maintain patient privacy and confidentiality. These facts pose challenges for the convergence of social media and health care systems. According to Hadler and Brown (2010), an unauthorized Facebook, Tweet or other online posting by a health care provider, health care professional or organization about a given patient would more than likely constitute publication for purposes of determining liability for invasion of privacy as demonstrated in Peterson v Moldofsky, No. 07-2603, 2005 WL 3126229 (D. Kan. Sept. 29, 2009).
Patient privacy and confidentiality is a primary concern in any health care organization, as is health misinformation and fraud (Terry, 2010). If a health care provider or organization wants to develop a Facebook page for peer social support, physician support, patient engagement, encouragement and compliance, the provider must consider the nuances and potential mishaps of social media. This could include conversations between patients, with patients, of patients, by patients and for patients. Considering Facebook and Twitter in relation to HIPAA, individual names could be replaced with screen names or avatars, but the screen names or avatars are still personally identifiable to a given individual via the ISP or another third party.
Allowing personally identifiable information visibility or unintended information dissemination is regarded as HIPAA non-compliance. The use of social media platforms by health care organizations do not have to be completely avoided due to HIPAA. Shortcomings in social media application can be diverted if HIPAA is always abided by and patients give informed consent allowing doctors and peers within the social networking community to speak with them via Facebook or other platform formats (Hawn, 2009). By considering HIPAA and informed consent, the patient is made aware of the possible risks involved with public, on-line communication and disclosure, thus removing specific liability from the physicians, health organizations, educational organizations, drug companies and affiliated e-communities.
Concluding Comments
The emergence of social media is forcing a change in conventional health care structure and thinking. The challenge with social networking and health care occurs when health care engages in peer driven and patient centered communities that enlist the support of physicians, organizations or peers. Because of rigid HIPAA regulations and health care ethics the convergence of social media becomes complex and multi-faceted.
Social media embrace public knowledge, patient centered health care, group support and the notion of free flowing information. Health care priorities revolve around safety, liability, confidentiality, privacy and patient-doctor relationships. Open informational systems are innately contrary to closed informational systems, hence structural frameworks and or new models of health care need to be re-examined to fit into social media. Health care organizations will continue to seek new ways to employ social media models, but it seems likely social media will serve as adjunct mechanisms as opposed to primary frameworks for the patient-doctor relationship.
Primary ethical and legal concerns lie with on-line privacy, confidentiality of PHI, misinformation and unethical individuals trolling for information. Disseminating false or inaccurate information to best serve a personal or group agenda must also be taken into account when considering health care and social media nuances. Misleading, inaccurate or misinterpreted information has the potential to cause harm, sickness or even death.
A restructuring of basic health care conceptions is needed to transform the current accepted conception of physician centered health care to a more patient centered platform. This would allow for easier implementation of health care in social media realms. The current goal of health care is to develop frameworks, structures and guidelines that can better integrate health care and social media. Until this happens, social media will be used primarily to seek out health care information and education.
Peer interaction and doctor patient communication will continue to be limited unless the patients voluntarily choose to give informed consent and waive liability. The peer to peer related component for media and health care is an issue that needs to be further investigated. Further research is needed because peer based systems serve as great healing, motivating and coping platforms for patients. Patients, of their own free will, can establish health related or chronic disease support groups, but once again, patients must be aware of who is on line, what is being said, how the information is being used and to be aware of unethical and misleading organizations or individuals.
References:
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Fox, S. & Jones, S. Generations online in 2009. Washington, DC: Pew Internet & American Life Project; 2009. Retrieved September 12, 2011, from http://www.pewinternet.org/Reports/2009/Generations-Online-in-2009.aspx.
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Peterson vs. Moldofsky (2009). Retrieved March 3, 2011, from https://ecf.ksd.uscourts.gov/cgi-bin/show_public_doc?2007cv2603-54.
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Terry, N.P. (2010). Physicians and patients who “friend” or “tweet”: Constructing a legal framework for social networking in a highly regulated domain. Indiana Law Review 43 (2).
