Twitter, HIPAA, Privacy and Freedom of Speech
Twitter will get you fired, fined or sued. Well, it will if you’re a health care professional who doesn’t follow the rules set down by the federal government and patient bills of rights. Here are some thoughts on how to Twitter safely in the clinical care setting.
WHAT HAPPENS ON TWITTER STAYS ON TWITTER…AND SUMMIZE AND…
Permission-based processes, whether you know it or not, have been a central dogma of medicine and nursing for many years. Acquiring informed consents or refusals has always been a right of patients, whether or not it was properly acknowledged by practitioners.
Twitter is a remarkable tool for broadcasting the latest advances in medicine or nursing. It’s also a way to establish an ambient intimacy within a community. Unfortunately, it has opened up a publicly viewable portal into the effluence of private patient information. What happens on Twitter, stays on Twitter…and Summize and FriendFeed and Disqus and ping.fm and Google’s cashes forever and ever and ever. Oh, and right on that PowerPoint slide which the plaintiff’s attorney ginormously projects onto a court room wide screen.
HIPPA IS DEFECTIVE LEGISLATION. BUT I FOLLOW ITS RULES.
Patients have a right to privacy when receiving care. That’s just common sense. Unfortunately, there have been legislative attempts to regulate how providers ensure patient privacy and information security. Those steps are honorable. Their execution, however, is matter for another blog post. Suffice it to say, HIPAA is not the optimal solution to the problem of patient information security.
HIPAA (Health Insurance Portability Accountability and Accountability Act of 1996) is one of those legislative examples of fighting the right war with the wrong means. Again, I won’t get into the merits of fighting HIPAA, but I’ll emphasize that until the act is properly amended, health care professionals are well advised to comply.
Why? Here are just two civil and crimianl penalties for non-compliance (Source):
- fines up to $25,000 for multiple violations of the same standard in a calendar year (ouch!)
- fines up to $250,000 and/or imprisonment up to 10 years for knowingly misusing individually identifiable health information (yikes!)
I’d hate to see any doctor or nurse lose their job, get fired or sued by a patient for violations that are easily avoided.
If you’re a health care provider and you plan on using Twitter or a similar tool to open up the world to what happens in the clinical setting (and I applaud you), here are two questions to ask yourself:
- Would I want my care to be broadcasted to who-knows-whom?
- Even if my name wasn’t mentioned, would I want my care to be on TwitterVision? If I do, did I sign a fully informed consent?
FREEDOM OF SPEECH
So, how could health care providers use Twitter to express their freedom of speech while protecting the information safety of patients? Here are some off-the-cuff suggestions:
- Be fictive with cases if your Twitter feed is on a public time-line
- Get permission, in writing, from patient’s or patient representatives
- Understand the ways in which protected health information privacy rights can be violated
- Remember that patient privacy is a part of patient safety
- Think about the purpose of a Tweet
- If you don’t have a real purpose to Tweet, don’t update
- Look at your license, recall that oath (I know corny, but it’s better than staring at a jail cell wall for 10 years)
I understand the excitement over using Twitter in a clinical setting (hey, I’m one of the advocates of Improvement through Health 2.0). But I don’t want that excitement to lose its luster in the wake of avoidable violations.
I’m not a big fan of HIPAA but I follow its rules. And so should you if you want to keep your license and practice the artful science of being a Jedi. Twitter’s awesome. But I’m not going to endanger my patient’s dignity and safety over it. All that, it ain’t.
Perhaps our first Tweets about the state of health care aught to be made about a wider discussion about how to simultaneously protect patient privacy and health professional sanity. HIPPA may be a stupidly constructed work of legislative ignorance, but it has the enforceable power to fine and jail you. Tweet Smart.
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A Model for Real-Time Medical Mircroblogging
Peviously, I expounded shortly on the utility of using a Twitter-like service for medical and other healthcare professionals. Right now, Twitter’s reliability, feature-limitations, spam susceptibility and other problems make the Twitter platform shaky for more professional use in healthcare.
But the basic concept is one that aught to inspire an easy-to-use system for the healthcare industry.
Enter Enterprise Social Messaging Experiement (ESME), tweeted by @dahowlett. ESME is a SAP-backed project supported by Siemens IT Solutions and Services (a division of Siemens) that was developed to help clients to communicate with other members of a professional team. ESME includes a service architecture that can allow business users to dynamically communicate, collaborate and solve collective problems. Furthermore it can allow for knowledge mining and microblogging.
The clip below illustrates how ESME can provide the tools to integrate real-time solutions to disparate problems:
IMPLICATIONS FOR HEALTHCARE
What if there were a similar service for the healthcare industry? How more effecitve could problem-sovling get with such a tool?
There are some features in ESME which would be desirable in a medical environment. Additionally, medical social messaging should include:
- Security
- HIPAA-compliance
- Reliability
- Scalability
- Real-time networking
- Dynamic integration
- Searchable content
- Role and group filtering
- Tagging (including priority statuses)
A properly engineered medical social messaging system would naturally be a hefty investment; but the ROI could be worthy of the effort. Of course in its place we have IM, Twitter, Plurk, FriendFeed and countless other services which localized groups of physicians, nurses, and other healthcare providers could exploit rather effectively.
But the the openness of these current services pose problems which a customized enterprise solution could overcome. The public timeline feature is a blessing and a curse. A blessing because it opens users up to potentially millions of of helathcare professionals. A curse because that number could be overwhelming without the proper filters and logins, which if breeched, could harm a patient’s dignity and privacy.
ESME is being developed for use in manufacturing in the example provided in the video. But a similar thought experiement should be conducted for the medical industry.
Image via WikipediaA scalable system could be developed for use within a closed-off network or a within a global network.
Imagine the implications for clinical research, treatment advancement, learning, and the spreading of critically important memes. The list of applications is virtually limitless. An ESME like app could dig deeply into knowledge mines.
The tag cloud and group filtering features are ingenious user-friendly solutions to the problem of data over-abundance. They would go a long way toward intelligent and effective collaborative problem-solving.
There’s a lot of inspiration offered here with ESME. I plan on future posts to discuss the possibilities.
Learn a bit more (and find out what esme also means) here.
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Elements of Hospital Blogging…Some of the
Image via Wikipedia
My post on Blog ROI generated some excellent questions about how to face the specific challenges of hospital blogging. There’s a lot of unchartered territory, and I doubt that any one person or group has all the answers. But I’ll pound out some on-the-fly thoughts.
A Little Internal Trackbacking
Before offering thoughts on how to address the specific problems of hospital blogging, it should be noted that whether or not a blog itself is ultimately worth burning the candle, there can be merit to the process of blogging.
There’s something about the discipline of blogging that confers benefits worth considering.
Just as the process of writing and reading can help you become a better communicator, thinker, problem-solver or just a more awakened animal, blogging can polish the lens through which you see things. The pliancy of the blogging process offers the ability to zoom-in on details you might otherwise miss or zoom-out to view the larger forest. It also connects you with other people and those people in turn connect you with new ideas or novel mutations of older ideas. And although it can be a solitary discipline, it opens you up to the world around you (if you’re paying attention). (Uh oh, I just caught myself meta-blogging. Shoot!)
Web 2.0 Shmeb 2.0…But: It’s Still Useful
For all the ridicule of Web 2.0’s hype, its tools permit a connection to the rest of the world that is unprecedented. That’s not a small thing. In fact it’s so big that it’s probably going to overwhelm us.
Still, the tools have utility in the right hands. For example, RSS feeds help you to stay on top of what an oncology nurse is thinking. And in conjunction with Twitter and Yahoo Pipes, RSS can help medical students Follow (spy on?) doctors. And I’m sure that there are ways to use FriendFeed similarly, if not even more powerfully.
(Incidentally, if you’re experiencing comment-fragmentation due to FriendFeed, here’s a WordPress plugin that’ll make your day.)
It’s usually blogging around that gets you hooked into these tools. So far, most of the social tools are being used to fuel untreated addictions. But that’s OK: boredom will eventually set in and the tools will evolve refinements that get us back to being more productive with them. For now, it’s a good time to adopt, play around, and figure out what works for you. Just don’t take all it too seriously.
That’s my argument for why hospitals might want to consider blogging. Not necessarily to throw a blog up (especially without seriously thrashing the project about up-front). But the benefits that the blogging process confers might justify its work-up. In the process, your employees might learn things they never knew were possible.
FACING THE CHALLENGES…SOME PROPOSALS
Basics…Start with Them
My primary suggestion for hospital blogging is to keep the focus pretty limited at first. I don’t think being comprehensive all at once is a safe approach. Rather a narrow focus on a topic that has a low risk of causing controversy and legal entanglements is a smart start.
Fear is not a strategy. It’s a paralytic.
Mindfulness is the Antidote.
For example, a CEO’s or CNO’s posts about her plans for her facility could be low risk with a better return than posts about controversial matters. Starting small also gives more wiggle room for the mistakes inevitably needed for learning.
Involving the right people is another important step. Scout for hospital employees who (responsibly) blog on their own time. There are some pretty web-savvy doctors and nurses out there who might just love the opportunity to contribute. Give them permission to be champions!
Ah, Them Lawyers and PR Wizards
Yeah, they blog…some of them do. And they’re smart and helpful…many of them are. Consulting with these resources is another important component of taking the first steps toward a hospital blog. Public relations may have a bad reputation (some of it earned, some of it not) but it’s an important tool in ensuring that the right kinds of messages are sent out.
“The right means in the wrong hands lead to the wrong results.”
That’s what good PR agents help you to avoid: costly and unnecessary wars. So consult with them and solicit their feedback.
In fact, PR and Legal might be able to spot bad operational decisions before they’re implemented since they may have a fresh perspective on a project that even the most capable operational managers can miss. So get them involved in the pre-launch thrashing. Don’t dismiss them. The up-front expenses of remarkable PR are probably lesser than their back-end replacements.
[[Link Update: Seth Godin indirectly invokes to the spirit of what I'm talking about with respect to PR and lawyers.]]
Involve IT, but Don’t Let ‘Em Bone You Out with “Can’t Do”
Strange as it is, the (important) IT component of blogging isn’t the biggest challenge. Blogs can be fairly straightforward, technologically. It depends on what you want. Find out how you might want to grow the blog. Consider the sorts of things should you build in at the beginning in case you want to expand your blog.
Establish strict security protocols. And make sure that the users of the blog can just blog and not have to worry too much about technical tweaks in a shaky system.
Custom-built bogs are one way to go. For smaller entities WordPress.org or Blogger might work. But WordPress, for all of it’s remarkable features, can be quirky and troubling. A simple and stable solution might be TypePad. Sure it’s not as sexy, but sex isn’t what you’re going for here I suspect.
Your Patients (aka Citizens)
Safety First. Always.
Don’t look for home runs or gushing bursts in your revenue streams. Instead, simply enable your community to interface with your facility’s human beings. Give time to sew the seeds and grow as it were. There’s no rush to assault Mount Remarkable. Don’t set high or unrealistic goals. Keep things simple.
Set strict privacy policies for your blogging. There shouldn’t be any reason for a hospital to mention the names of patients in a blog. And in fact, cases probably should not be discussed…at least until your blogging routine becomes well established. Start with fictive cases if that’s an interest.
Develop a Terms of Service policy. On one hand, you want to make it easy for participants to enter your blog; on the other, you need to establish their informed consent. And blog monitoring should ensure that participants do not reveal the names of other patients.
Complaints (legitimate) on a blog are perhaps the single most valuable commodity on a hospital blog. Why? Becuase they’re information. They’re (free) consulting data. Use what’s being given to you. Follow up immediately, whether or not it’s appropriate to do so on your blog. Give your citizens simple and easy choices on how to complain. Invite your complainers to a personal meeting. Ask them for more. And: thank them.
(You know what the Return in ROI really is? It’s “thank you”. Just a thought for all you John von Neumanns of financial ratio fetishes out there.)
ADDING IT UP
This is just a small outline of a larger plan for implementing a blogging strategy for a healthcare facility. These are just open-ended intuition pumps, to be taken more for early project-thrashing than as Gnostic Gospels with precise schematics to blindly follow.
It’s easy to get lost or burned blogging about your hospital activities. But it’s even easier to get burned providing the very services you provide daily. Examples of the risks/costs hospitals face/incur almost every day:
- Medication Errors
- Surgical blunders
- Patient Identification FAIL
- Protocol Breaches
These are the risks already inherently built into the fundamental operations of a hospital.
Blogging, for all its pitfalls and potentials for blunder, probably won’t harm people as much as the items above. Put things into perspective. If anything, the practice of blogging might:
- Enable a more efficient dialogue about the risks listed above
- Provide your facility with the opportunity to explain the challenges of running a hospital that you strive successfully to meet (people love the honesty of competent minds)
- Offer an information-based incentive for your staff to provide the remarkable services for which you hired (and pay) them
Creatively capitalize on your investments. (And don’t stare at sunk costs. You’ll fall into a black (red?) hole.)
With a successful blog, you just might shine your sincere concern and commitment to safety and efficacy of care. That’s an assurance that’s good for patients. And your tush-line.
So, here are some of my off-the-cuff, very informal and un-researched suggestions for hospital blogging:
- Start small…but don’t be afraid to think big
- Keep the focus narrow, to one topic perhaps (e.g. fundraising events)
- Recruit passionate bloggers internally (or externally)
- Establish good blogging hygiene
- Monitor comments and vanguard privacy
- Promote locally first
- Don’t promote too heavily (at least in the beginning)
- Involve Legal and PR ahead of time (thrashing)
- Don’t get discouraged by setbacks
- Invite guest bloggers for consultation and/or posting
- Reach out to the community of “Social Media” folks…(but use your common sense and skepticism!)
Don’t blog until you really understand the hard work needed for easy use. The intangible costs of blogging are heavier than the tangible ones (yes, a paradox of physical laws, but that’s blogging). When in doubt bail out and get back in when you’re vision is clearer.
Again, my disclosure: I’m no paid expert. I simply have a passion about this matter and I am simply passing along the little pearls that I have gathered along my own personal blogging trek. Blogging is an open affair, whose floorboards are set down on the fluid air. But so is life, which is what healthcare is all about serving.
The purpose of a blog (at least this one) is to spread ideas, have them filtered through other brains and watch them grow. My hope is that I encourage free (not hate) speech with critical commenting.
The process is the principle.
TWO MEDICAL BLOGS OF INTEREST I RECOMMEND:
The Efficient MD
These aren’t “hospital blogs” but they do illustrate what some smart folks are doing with these tools.
Please…comment: it’s free and useful.
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The Cyber Drug of Choice
According to the San Fransisco CBS affiliate Twitter is the “cyber drug of choice”. Here’s a clip about Twitter that includes a talk with Robert Scoble about the service:
Kind of funny to watch. It ran in 2007 and it’s interesting to see how viral Twitter has become in the last year. I love how Scoble Twitters the story itself while its being produced.
Twitter me your comments.
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Is Twitter Necessary?
The answer is long, so I won’t really give it here.
Twitter’s the latest craze. It’s a strange thing too because so much is being blogged about it and so many people are stumped as to what Twitter is for. Google “Twitter” and you’ll see what I’m talking about.
As I said, I won’t give my answer yet. Instead I’ll let Andy Rooney mention something:
Computers make it easier to do a lot of things, but most of the things they make it easier to do don’t need to be done.
If Twitter can save lives, then it might be necessary. I have an idea I’m nursing. If you follow me, maybe I’ll Tweet it.
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