Smartphones and Social Media Ethics in Healthcare

Introduction

The field of healthcare is eagerly embracing all technology capable of improving patient outcomes, lowering expenses, and streamlining operations. However, healthcare professionals need to pause and consider the negative effects of technology on patient care and privacy. Technology refers not only to devices, but also to social media applications — such as Twitter, Facebook, LinkedIn, Instagram, and MySpace — used on smartphones. Healthcare workers are increasingly employing smartphones for communication, care coordination, and efficiency. Before doing so, they must carefully consider various legal, ethical, and professional issues from both personal and institutional perspectives.

Case Scenario

As an emergency room nurse at a hospital, one of my Friday evening shifts — filled, as is typical, with crying babies, intoxicated and belligerent teenagers, COPD (chronic obstructive pulmonary disease) exacerbations, fractures, falls, and the predictable regular patients suffering from CHF (congestive heart failure) — caused me to miss a concert I had desperately wanted to attend. My best friend, who was at the concert, was constantly texting me, and I responded to her in between caring for patients. I was envious of her good fortune while I was stuck at work.

At around 2 a.m., I was radioed by medics and notified of the imminent arrival of an emergency accident victim, expected within approximately five minutes. I used the restroom and proceeded to set up the patient's room, forgoing a much-needed cup of coffee. The medics arrived and briefed me on the situation: the victim was a 28-year-old male who had been commuting on a bus that crashed, rolled over an embankment, and overturned. They reported that a number of passengers had lost their lives, while this patient remained unconscious. As they began relaying his vital signs, my attention was drawn to the patient's face. I was shocked to recognize him as Jerod — the lead singer of one of my favorite bands, "Blue Lizards" — whose concert I had grudgingly missed that very evening. It was apparent that the concert had just ended and the band was being transported to their accommodations when the accident occurred.

I quickly texted my best friend. She was skeptical at first and asked me to prove it. Without thinking, I snapped a photo of him with my smartphone when no one else was around and sent it to her. I reasoned that celebrities were "public property" and that having their pictures taken was simply part of their lives. I did not stop at one photo, however. I took multiple pictures of him while he was unconscious, in different stages of undress, and then photographed demographic data, his home address, and his telephone number from his EHR (electronic health record). I set my cellphone down on his bedside table before continuing my assessment of his condition.

The very next morning, a colleague texted me to report that a major investigation was underway at the hospital due to a HIPAA (Health Insurance Portability and Accountability Act) violation involving a celebrity patient who had been admitted. Apparently, a tabloid publication had obtained some of his photographs, and a lawsuit had been filed against the hospital. Convinced that I had sent only one photo to my trusted best friend, I reached for my phone — only to discover it was missing.

Advantages and Disadvantages of Smartphones and Social Media in Healthcare

Smartphone and social media use in healthcare is not without its advantages. Patients rely on social media to directly report data — such as blood glucose and blood pressure readings — to their doctors from home-based monitoring devices, or to document and report on medication use. Additionally, patients send data from their PHRs (personal health records) to their physicians (Social Media, Healthcare & Health Centers — RCHN CHF, n.d.). A California HealthCare Foundation study conducted in 2010, which surveyed over 1,800 adults, found that only seven percent of participants used a PHR, with use concentrated primarily in West California. However, an increasing number of patients are turning to PHRs: of the survey participants without a PHR, forty percent expressed a desire to use one. Notably, 58% of those interested in PHR use preferred one offered by a provider or hospital, while half indicated they would use an insurer-sponsored PHR. Although PHRs are not yet widely adopted, their growing acceptance points toward uses that incorporate social media that were previously not feasible or even considered.

Healthcare providers, including physicians, also make significant use of technology and social media. Providers rely on social media to connect with patients, share condition-specific information related to care plans, and obtain patient-reported data. Professionals also connect with peers for referrals, consultations, and smoother care transitions. PricewaterhouseCoopers cites a Manhattan Research finding indicating that 60% of American physicians already use, or are interested in using, Sermo and other Internet-based physician communities for collaboration and information sharing. A number of healthcare institutions and providers are informally using general platforms like Twitter and YouTube to facilitate communication among and between providers.

One of the Permanente Foundation's Medical Directors, Dr. Ted Eytan, has noted that utilization of the many forms of social media in healthcare will enhance the quality and quantity of both provider-to-provider and patient-to-provider communication, which in turn can help improve care quality and the pace of innovation (Social Media, Healthcare & Health Centers, n.d.). However, technology carries disadvantages as well. Concerns raised regarding mobile devices include: patient data protection and privacy; the reliability of mobile devices in clinical decision-making; the effect of device use on the patient-clinician relationship; and the challenge of effective integration into healthcare organizations. Healthcare providers have also voiced concerns about the lack of content accuracy and standards oversight, particularly regarding patient management applications (Ventola, 2014).

Providers who are uncomfortable with new technology, or who feel intimidated by it, may be disadvantaged if mobile device use becomes mandatory in healthcare settings. Social media adoption in healthcare may also be restricted by barriers including: lack of technological knowledge; time constraints; fear; cost; the rapid pace of technological change; unwillingness among students or faculty to use social networking tools; external distractions and competing demands; risk of ostracism or reprimand for social media misuse; and restrictive organizational policies (Schmitt et al., 2003).

Conclusion and Recommendations

Increased technology use by healthcare providers — both at the workplace and in their personal lives — has raised critical ethical and medico-legal implications. Consequently, it is necessary to establish clear policies and standards within healthcare organizations to ensure transparent, ethical conduct (Ventola, 2014). A thorough examination of the impacts of medical apps and mobile devices on clinical training and education has also been called for. Adopting these recommendations will prove greatly beneficial in guiding healthcare educators, clinicians, researchers, and administrators in determining how best to integrate increasingly advanced technological tools into clinical practice. Furthermore, best-practice standards need to be established for medical application developers. Such standards will serve to raise entry barriers into the medical app marketplace, while simultaneously enhancing app quality and reducing the overwhelming number of currently available — and often unvetted — medical applications.

Evaluating smartphone medical apps that claim therapeutic or diagnostic efficacy in terms of actual clinical utility and outcomes is equally important. Although numerous medical smartphone apps have been publicly available for several years, a lack of evidence supporting or identifying the best ways to use them persists (Ventola, 2014). As more data become available, a more reliable selection of validated smartphone medical applications will emerge for healthcare providers. Medical apps and devices have already proven to be invaluable tools for healthcare professionals, and as their uses and features expand, they will be incorporated far more widely into nearly all aspects of clinical practice.

Nevertheless, some providers remain hesitant to utilize them in their clinical work. Despite the undoubted advantages of medical apps and devices, many healthcare providers currently use them without a proper understanding of their associated benefits and risks. Rigorous best-practice standards, validation, and evaluation of medical smartphone applications are essential for ensuring a basic level of safety and quality when employing these tools in patient care.

References

RCHN CHF. (n.d.). Social media, healthcare & health centers. Retrieved March 15, 2016, from http://www.rchnfoundation.org/?p=1777

Schmitt, T., Sims-Giddens, S., & Booth, R. (2003). Social media use in nursing education. The Online Journal of Issues in Nursing, 17(3). Retrieved March 15, 2016, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No3-Sept-2012/Social-Media-in-Nursing-Education.html

Ventola, C. L. (2014). Mobile devices and apps for health care professionals: Uses and benefits. Pharmacy and Therapeutics, 39(5), 356–364. Retrieved March 15, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029126/