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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Four Steps to a Healthy Layoff

If you had to layoff your employees, how would you do it? We can blame big companies for being ruthless and uncaring. But for the people doing the actual layoffs, it can be a terrible experience. A layoff doesn’t have to be an evil, does it? Layoffs happen every day and people survive, don’t they? In fact, don’t layoffs give people the opportunity to find  better ways to invest their time? Is there such a thing as a healthy layoff?

Layoffs are often botched by thoughtlessness or by fear of saying the wrong things. Some businesses do better in this department than others. For whatever reason, though, many businesses don’t really understand how to layoff. Layoffs aren’t supposed to happen. But they do. Almost everyday we hear about them. So why not outline a Layoff Action Plan that could help, not hurt, people?

Where the danger grows, so does the saving grace.

Friedrich Holderlin

A layoff can be an opportunity for a company to redeem itself from the tactical and strategic blunders it made that may have led to the layoff. For the people who actually do the layoff, a creative Layoff Action Plan can be the difference between another drink and the happiness derived from helping others overcome adversity.


So, how would you do it? How could you make the most of it and turn bad news into a reason to hope?

Would you stealthily order your lawyers to structure the layoff so you don’t have to call it a layoff? After all, that would save the PR fees which qualm your fears of how the word layoff will make you look to the general public. Whatever would Wall Street do with your stock if they discover your secret? Heaven forbid!

Or would you consider these completely different approches?


Introduce your employees to your competition and say:

Here are one hundred remarkable employees. We know they’re remarkable because we hired them. We’re having a tough time right now and we don’t quite know what to do with them. Maybe you or your connections do. Please do what you can because we want our industry to thrive and these people are our industry’s future.


Introduce your employees to your vendors, your suppliers, your alumni, you neighbors, your minister, your rabbi, your monk, and your therapist {the risks of depression and suicide increase after layoffs}. Introduce them to your friends or relatives who own businesses thirsty for the remarkable talent that you’re pouring away.

If nothing else, your employees will feel appreciated. They could be energized to find a beautiful land beyond your crumbling empire.


Invite them to your LinkedIn profile and write them recommendations that will last in their profile for the rest of their careers? Would fewer calls for reference checks lighten your newly weighted workload?

Use the Answers and other features to promote your former employees in creative ways. You should do this selflessly, of course, but could you think of any beneficial side-effects from this approach?


Instead of playing legal word-games, call a spade a spade and proudly proclaim your layoff to the world. Let the whole world know that you’re liberating enormous talent for hire into the community. Issue a press release on your own terms that outlines that you’re doing #1, #2 and #3. Let the world know how much you sincerely care about the social consequences of your economic misfortune.

Now is the time to invoke the genius of your PR folk. Get them to market your employees to the community. This is a radical departure from the status quo; this isn’t your boiler plate PR. It would be unique and remarkable PR for PR. Imagine how your employees and the community would feel about you now.

What would happen to your company’s wealth if you simply explained what happened and how you intend for your company to thrive in a time of adversity?

Do you think that your customers and the public would LOVE that story? Do you think that Wall Street would entrust your long-term leadership with more of their investing dollars because NOW you look like you know what you’re doing? After all, it’s clear now that you’re not afraid of acclaiming your status as a remarkable leader in your industry. You’re in it for the long-run now, not the short-term speculative nonsense that’s puling our Republic into mindless consumerism.

This post is a Capitalist Manifesto.


So, what do you think? Do think these steps are worth a try? How much psychological and economic depression could our contry avoid if we did things in steps 1 through 4? Since it’s my goal to improve the health care of every child, woman and man in the world, this would advance my cause.

Perhaps some would say: This is too much work! To that I’d say: No wonder you have to layoff your employees! If a business can’t do the hard work needed to get through its Dips, then it should responsibly close up shop and leave it to competitors who know how to work hard and creatively.

Is it possible that so many companies botch layoffs because it’s culturally expected that layoffs are a bad thing, a terminal curse? What would happen to our world if we shook up the bowl, thought and did things in ways we never did before? Sometime we are more programmed for certain responses than we realize.

We are more than the product of our assumptions.

The world’s changing, whether you’re in denial about it or not. Why not make your next layoff remarkable?

If you have ideas to add to this list, feel free to add. Who knows, a brokenhearted CEO might stumble upon this blog. Maybe she’ll change the world and found a novel way to network talent for the 21st Century.


If you’re in a cog job, find out why. Go bookmark Seth Godin’s blog (he’s not just for Marketing types; in fact I think he’d appreciate it more if cog-jobbers read him as if he were our Poet Laureate). Also, download A Brief Guide to World Domination, print it out and read it.  It will expose that lie you were told years ago.

For those of you who have been laid off, or who might one day end up at the end of the layoff riffle, here’s a little secret I’d like you to keep:

You must change your life.

Rainer Maria Rilke

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