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.


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 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.


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):

  1. fines up to $25,000 for multiple violations of the same standard in a calendar year (ouch!)
  2. 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?


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:

  1. Be fictive with cases if your Twitter feed is on a public time-line
  2. Get permission, in writing, from patient’s or patient representatives
  3. Understand the ways in which protected health information privacy rights can be violated
  4. Remember that patient privacy is a part of patient safety
  5. Think about the purpose of a Tweet
  6. If you don’t have a real purpose to Tweet, don’t update
  7. 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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  1. That’s a brilliant idea. I really struggle to learn social media, so I’m going to spend a bit of time watching what others do. Thanks Twitter.

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