Social media, the internet, and the healthcare industry

Legal Ethics of E-Mail and Social Media and Its Applicability to the Healthcare Industry

Consequences of Social Media

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Perils of Building an Online Network

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Caution with Employee Email Accounts

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Issues when Endorsing other Companies

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Benefits of Social Media

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Legal Ethics of E-mail and Social Media and its Applicability to the Healthcare Industry

Social media has without a doubt changed the way we live, the way we view the world and the way we interact with one another. This paper acknowledges the undeniable good that social media has given us, while identifying the many ways that it has created issues and intricacies for the healthcare industry at large. This paper discusses the benefits of social media for healthcare professionals, while identifying some of the dire consequences, the perils of an online network, the issues connected to an employee email account and the caution one must take when it comes to endorsing products. Finally this paper concludes with a discussion of the benefits of social media to health care professionals.

The benefits of social media, e-mail and all forms of electronic communication are apparent in the world today. There's an ability to make friends from all over the world, to reconnect with old friends and to otherwise share one's life over the Internet. It allows for the creation of an online community and easier ways to stay in touch. However, in the world of professional healthcare, privacy and confidentiality aren't just an expected part of the overall professionalism; there are very real and very immediate legal obligations that are directly connected to protecting patient privacy. Thus, there needs to be a more aggravated responsibility towards protecting patient privacy when it comes to social media and the Internet. "Surveys show that 35% of American adults have a profile on a social networking site. Seventy-five percent of Facebook users admit to checking their Facebook at work, on company time and company-owned equipment. In 2004, more than 10% of employees spent more than half of the day on email (86% of which is personal), and more than one in five employers (21%) had employee email and instant messages subpoenaed in the course of a lawsuit or regulatory investigation" (osma.org). These numbers demonstrate just how widespread the use of social media and the Internet truly are when it comes to the healthcare industry and how this creates the potential for sticky legal issues and a compromising of legal data. However, the issue becomes even more complicated as more and more healthcare industries are relying on social media as a means of promoting themselves and reaching out to new clients and existing patients. However, with this increased usage comes even more heightened ethical concerns that warrant attention.

Pay Attention to Consequences

The only "right" involved when healthcare professionals post something on social media or on a social forum is the right they have to write or to exercise their freedom of speech. There are still formidable amounts of consequences which go along with this right and they must be faced by the healthcare professional. For example, if a doctor wants to share a meaningful discovery about a patient that she recently had and feels that the information could assist and enlighten other doctors, this is indeed worthwhile information to share. However, there's still a need to protect patient privacy. For example, the information posted needs to be so generic that there would be no way possible to identify a given patient. Even so, one still has the obligation to be mindful of the laws which govern patients and the healthcare arena.

For example, consider Title VII of the Civil Rights Act of 1964 this was something which truly altered the American landscape, because it not only disallowed racial discrimination in the job market, but racial and sex discrimination were outlawed as well (CAP, 2004). This means that when it comes to the professional arena, there's really no room for any remark or post on social media or any other form of electronic communication which indicates an element of discriminatory practice. "The Act indelibly changed life in America. 'Whites only' water fountains, pools and restaurants became illegal, and 'no blacks need apply' job announcements became a violation of federal law. Title VI provided a major tool in the desegregation of hospitals, nursing homes, and other health care facilities" (CAP, 2004). This act also helped an achieve a certain amount of victory for women as well, as jobs which were deemed "male only" thus became illegal, and women who had been fired because they were pregnant or had small children now had ammunition behind them to fight back (CAP, 2004). Another piece of legislation which is in some way connected to this act is the Equal Employment Opportunities Commission which grew out of this act, which gave both women and minorities a more workable tool with which to shatter the oppression that they often faced in the workplace: "Overall, the Act was groundbreaking, and has given new hope, relief, and opportunity to countless Americans" (CAP, 2004). This means that since this act legally created a more tolerant playing field for women and minorities, there continues to be a more aggravated need and necessity to engage in the most respectful and politically correct manner regarding women and minorities in all arenas of the professional field -- this means social media and email as well. Thus, their equality needs to be protected, and healthcare professionals need to ensure that this occurs and is never compromised through anything that they post.

Another relevant piece of legislation that this all applies to is the Americans with Disabilities Act, which seeks to accomplish the integration of individuals with disabilities among all pillars of society, along with health care (Rosenbaum, 2013). However, the intricate web of federal and state pieces of legislature mean that public and private health care financing can be embedded within other markets and within federalism -- which can make certain healthcare goals for minorities and others somewhat aspirational. Thus, finding a way to reconcile the ADA's goals with the specific legal provisions in the U.S. healthcare system means that it is all formidable task for all involved, particularly when the regulatory focus is on healthcare professionals (Rosenbaum, 2013). Even so, when it comes to electronic communication, along with This means that healthcare professionals have to be careful in that nothing they post or write indicates a lack of following the ADA or is discriminatory against people with disabilities. For instance, one doctor posted something on Facebook that seemed to be harmlessly complaining about the use of emotional support animals on airplanes by individuals. This doctor was not complaining about any one patient or revealing information about any one patient, he was just griping about what he felt was an unfair and abused situation in general. Unfortunately, as a result of this post, the doctor received a ton of backlash from all over the world. He was accused of not only being intolerant, but of being discriminatory to people with disabilities.

One of the major dangers in connection with what healthcare professionals post is in direct connection to the Healthcare Insurance Portability and Accountability Act (HIPAA). "HIPAA is the federal law that establishes standards for the privacy and security of health information, as well as standards for electronic data interchange (EDI) of health information. HIPAA has two main goals, as its name implies: making health insurance more portable when persons change employers, and making the health care system more accountable for costs -- trying especially to reduce waste and fraud" (Miami.edu). Thus, one of the main goals of HIPPA has been to improve accountability through administrative simplification via a promotion of efficiency and this is generally achieved through the better use of information technology. This was mostly because at the time this legislation was being enacted, healthcare was still very paper-based: however, the switch to more electronic records has been a double-edged sword, as a more increased use of computers means that there's a greater chance for the misuse of patient's health information which means that privacy and security standards have to be tougher.

Because these standards have to be tougher, clinicians and other health care professionals are thus held to higher standards of excellence and of conduct, and are expected to behave at more professional and intensive level of excellence. The four rules of HIPAA are intensive and they govern expectations for computer to computer information exchanges, along with identifiers for healthcare providers, along with information security standards, in conjunction with stringent privacy standards (Miami.edu). Thus, doctors need to be well aware of these standards and expectations which it comes to HIPAA and all connected concerns.

Building One's Online Network

Healthcare professionals need to be aware of the fact that they need to be extra discriminatory when it comes to who they accept as friends and who they allow to follow them on social networking sites. This is largely connected to the fact that accepting lots of friends can give the appearance of privacy or of a more insulated circle. This is just and appearance and at times can be a dangerous or destructive one to have. More and more professional healthcare facilities are urging doctors and other clinicians to not set-up relationships with patients on Facebook and other forms of social media; this is a result of the fact that there is a real danger that confidential data and an absence of professionalism could manifest in the interim (Vaas, 2012). Network World is a periodical which pointed to nearly this exact scenario in the case of a Stanford University School of Medicine student who accepted a spot at a major Boston hospital, and received a letter which specified what the hospital advised in regards to the new resident's specific Facebook settings (Vaas, 2012). Essentially, the hospital recommended that if Facebook was used, the new resident should take every precaution to try and optimize his privacy; in fact the hospital also asserted that if the new resident should review any pictures of himself already posted online so that he could be certain that his online identity was already one which had the appearance of professionalism. Some clinicians do express utter disappointment in having their interactions and presence online be so regulated, however, hospitals today largely view this as an absolutely necessity. Hospitals see the use and of social media as something that could unleash quite the legal quagmire when it comes to social interactions that could violate patient privacy. This is significant as a recent study did a survey to determine how many physicians actually use social media for professional purposes, finding that 65% of them do -- and not just Facebook and twitter, but online communities connected to the profession: though only trace amounts are in connection with patients (Vaas, 2012). Instead, the bulk of the communication which occurs has to do with education or consultation about new developments in the field or in consultation with peers about patient issues (Vaas, 2012).

One sign of the fact that his particular playing field has become somewhat heated is that the AMA (also known as the largest physician and medical student association in America has recently set for some very detailed guidelines which issue strict warning about the dangers of allowing the patient-doctor bond bleed into an online environment (Vaas, 2012). The concern is largely understandable. The AMA frets that doctors won't be able to maintain their reputations and their level of public trust if people are seeing Facebook pics of their doctor engaging in silly or cavalier antics. However, the greatest fear is that doctors are going to somehow ruin or compromise patient confidentiality in some manner. "The AMA's first suggestion goes right to the heart of this concern, which is completely understandable, given that disclosing confidential patient information can mean running afoul of the Health Insurance Portability and Accountability Act (HIPAA), a U.S. regulation that addresses the security and privacy of health data" (Vaas, 2012). This is important not just because it's the law and one of the new standards of professionalism: it's important because if hospitals need to avoid lawsuits they need to follow it. "The AMA recommendation: Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online" (Vaas, 2012). Thus, hospitals and the AMA are being smart in describing in no uncertain terms what the new expectations for doctors are. This is so important because it communicates precisely how doctors are supposed to act along with guidelines about what they are greatly discouraged from doing.

Employee Email Accounts

Another issue that needs to be addressed in the information age is the impact of employee email accounts and the ways in which they can be monitored. One example that occurred in the medical field is that the friend of a sent her an email chain and the email contained some comical, but largely inappropriate content. The nurse then forwarded this email to someone else, though this person did not work in their hospital and was not a healthcare professional. Even so, this nurse was fired because she was using her professional email account to move along insensitive materials. This is a prime example of privacy and work emails. All healthcare professionals need to remember that their professional email accounts are in fact monitored. This is largely because the AMA worries very heavily about doctors maintaining their reputations and public trust over email.

Thus, in the healthcare arena, employees should expect that their professional email accounts are being monitored and are not private. For the entities that are monitoring these email accounts, they really should be as explicit as possible when it comes to their policy on employee-email monitoring. "For employers, they must be as explicit and specific as possible in terms of providing notice in their policies to employees as to how they may monitor the employee's electronic communications and the level of privacy. Hardly any employees can expect full privacy in their communications. However according to the New Jersey Supreme Court, notwithstanding all of the clear notice in the world, some monitoring still may not be permissible" (findlaw, 2010). Thus, just as employers might be well within their rights to fire an employee who engages in dubious emailing using their work account, an employee could also take retaliatory legal action against an employer who screened or monitored his email account or snooped into certain information without his explicit consent or knowledge. The exact dynamic is really a slippery slope. This is largely because of the fact that without proper communication, employees can sue medical institutions and vice versa. Thus, there needs to be a plainly stated code of protocol and expected behavior so that all parties are on the same side.

"As far as employees, they should read and understand their employers' computer use policies. They should recognize that they indeed may have very little privacy in their electronic communications sent and received using employer computer equipment. When in doubt, they should send personal communications from their own personal equipment using their own private accounts. Of course, that is easier said than done. Employees spend long hours at work and on portable work equipment, and they may not always remember to separate their work and private lives - and some courts may, and some courts may not, find that to be reasonable on the facts of given cases" (findlaw, 2010). Thus, it's important that all members of staff realize that there's a very real price to be paid if they forget to separate these two spheres of their lives. Forgetting to engage in that extra amount of vigilance can have pretty hefty consequences for an employee if he or she isn't careful. Thus, there's an aggravated necessity for being extra careful to make effective efforts to separate one's personal life from one's professional life.

Endorsing Products and Other companies

In this new and heightened playing field of the online arena, doctors also need to be extra careful when it comes to the products that they endorse along with the companies that they publically support. Like all individuals, doctors have a the freedom to express their opinion and the exercise their first amendment rights. However, the need to be aware that they will often be under more scrutiny when they do this, as their opinion and expertise can matter so much. One example of the problem and the damage that this can cause which was recently on the news was the scandal which occurred with Dr. Oz and some of the claims which were made on his show. Dr. Oz was recently brought before the Senate consumer protection panel and was scolded by Chairman Claire McCaskill as a result of certain claims that were made on his television show. In a very direct and public manner, the doctor was told, "The scientific community is almost monolithic against you in terms of the efficacy of the three products you called 'miracles,' said McCaskill, a Missouri Democrat. She said she was discouraged by the 'false hope' his rhetoric gives viewers and questioned his role, 'intentional or not, in perpetuating these scams'" (pix11.com, 2014). The recent humiliation and questioning of Dr. Oz was also a huge message to the entire community of physicians to be wary and careful about the products they decide to endorse, as they all ultimately need to determine if the product or company does what they claim to do. Because the credibility and the reputation of the doctor is really what is at stake. As one senator explained, "I don't get why you need to say this stuff when you know it's not true. When you have this amazing megaphone, why would you cheapen your show?… With power comes a great deal of responsibility" (pix11.com, 2014). Thus, in the case of Dr. OZ, which really is an example to all doctors, there is the aggravated need to not be seduced by money or payment so that they're trusted named will be used by these companies to sell bogus products to misinformed consumers. Also, vilifying Dr. Oz is not completely the most accurate thing to do: in this case it demonstrates how after Dr. Oz generically supported one particular supplement (green coffee bean extract) and many companies placed his endorsement on their products without his permission. However, it appears that Dr. Oz did nothing to set the record straight until he was called forth by the senate committee.