Lots of social media tools are available for health care specialists (HCPs), consisting of social media platforms, blogs, microblogs, wikis, media-sharing sites, and virtual reality and gaming environments. These tools can be made use of to enhance or enhance professional networking and education, organizational promo, patient care, patient education, and public health programs. Nevertheless, they also present possible risks to clients and HCPs regarding the distribution of poor-quality information, damage to professional image, breaches of patient privacy, infraction of personal– professional boundaries, and licensing or legal concerns. Lots of health care organizations and professional companies have actually provided standards to prevent these dangers.
WHAT IS SOCIAL MEDIA?
The definition of “social media” is broad and constantly developing. The term typically refers to Internet-based tools that allow individuals and communities to gather and communicate; to share information, ideas, individual messages, images, and other material; and, in some cases, to work together with other users in real time. Social media are also described as “Web 2.0” or “social networking.”.
Social media websites provide a variety of features that serve various functions for the individual user.19 They may include blogs, social networks, video- and photo-sharing websites, wikis, or a myriad of other media, which can be organized by purpose, serving functions such as:.
- Social media (Facebook, MySpace, Google Plus, Twitter)
- Professional networking (LinkedIn)
- Media sharing (YouTube, Flickr)
- Material production (blog sites [Tumblr, Blogger] and microblogs [Twitter]
- Knowledge/information aggregation (Wikipedia)Virtual reality and video gaming environments (Second Life)
Participation in social media by the general public has actually increased dramatically over the past 9 years.5,11 In the united state, the proportion of grownups using social media has actually enhanced from 8 % to 72 % considering that 2005. Making use of social media prevails throughout any ages and professions and is pervasive all over the world. In 2012, Facebook users exceeded one billion individuals worldwide, a number that represents one-seventh of the world’s population. In addition, each day 100 million active Twitter users send more than 65 million tweets, and two billion videos are viewed on YouTube. Social media have been linked to highly significant political events, such as the Arab Spring transformation, in addition to to prevalent social trends, including the shortening of individuals’ attention periods and the decrease of print news media.5.
INVOLVEMENT IN SOCIAL MEDIA BY HEALTHCARE PROFESSIONALS
Social media provide HCPs with tools to share information, to debate healthcare policy and practice concerns, to promote health behaviors, to engage with the general public, and to enlighten and communicate with clients, caretakers, students, and coworkers. HCPs can use social media to potentially enhance health outcomes, develop a professional network, boost personal awareness of news and discoveries, motivate clients, and supply health information to the community.
Physicians usually sign up with online neighborhoods where they can check out news articles, pay attention to specialists, research study medical advancements, seek advice from associates concerning patient concerns, and network.9 There they can share cases and concepts, go over practice management obstacles, make referrals, share their research study, market their practices, or take part in health advocacy. A growing minority of doctors also uses social media to communicate straight with clients to augment medical care.
A study of more than 4,000 doctors carried out by the social medias site QuantiaMD found that more than 90 % of physicians use some type of social media for personal activities, whereas only 65 % use these websites for professional factors. Almost a third of physicians have actually reported taking part in social media. However, both personal and professional use of social media by physicians is enhancing.
Unlike doctors, pharmacists have actually been fairly sluggish to adopt social media.1 Much of the growth in the professional use of social media among this group appears to involve pharmacist-specific social media. Studies have actually shown that many pharmacists use Facebook.1 Although this use is most often for personal interactions, more than 90 pages on Facebook are related to the drug store occupation, such as the Pharmacists Interest Page, the American Pharmacists Association, and the Cynical Pharmacist.1 Only 10 % of pharmacists use Twitter, and a look for “pharmacist” on LinkedIn identified 274,981 profiles.
SOCIAL MEDIA SITES FOR HEALTHCARE PROFESSIONALS
Social Media Sites
As social media has progressed, medically focused professional communities have been established.14 These networks are frequently private and safeguarded from nonmembers, such as the lay public as well as members of other health careers.1 Funding sources for these sites differ, with financial support frequently being offered by professional associations, marketing or data sales, research study funding, and pharmaceutical companies.
Sermo is a “physician-only” social media community that confirms the qualifications of new members during registration.15 Physicians representing 68 specializeds in all 50 states gather on this site to network, to discuss treatment alternatives, and to query peers for skilled suggestions.15 As of April 2014, Sermo boasted a U.S. subscription of 260,000 doctors, most of whom use pseudonyms for anonymity. Sermo consists mostly of a huge message board on which physicians create topics for conversation. It also provides a rating system by which medical professionals rank posts on the site on the basis of viewed credibility.
Doximity is a more recent “physician-only” social media community that provides text and images that are compliant with the Health Insurance Portability and Accountability Act (HIPAA), which allows point-of-care information crowdsourcing.15 As of 2013, more than 100,000 doctors and students were members. Doximity uses a nationwide database to create “placeholder” accounts with market and contact information for all U.S. doctors. For that reason, although only 12 % of U.S. physicians are active members of Doximity, almost 100 % can be messaged through the network.
The Medical Directors Forum (www.medicaldirectorsforum.skipta.com) is a social media site for medical directors that supplies a verified, safe, closed-loop environment for peer-to-peer interaction. The resources on this site consist of a comprehensive library, discussion groups, calendar posts, and alerts. The site also provides dedicated group pages for medical directors working in a wide range of sectors, including: medical facility, veterans affairs, Medicare, group practice, employer, behavioral health, handled care, reformatory, and long-term care.
Other doctor networking websites include QuantiaMD (www.quantiamd.com), Doctors’ Hangout (www.doctorshangout.com), and Doc2Doc (doc2doc.bmj.com). Many of these sites require medical professionals to submit their credentials to a site gatekeeper, recreating the intimacy of a “physicians’ lounge” in an online environment.
The not-for-profit Student Doctor Network is a popular social community site for undergraduate and exercising doctors, dental practitioners, and vets in the united state and Canada. It claims more than 40,000 active members and 1.5 million unique regular monthly visitors. The forums on Student Doctor Network concentrate on scientific career topics, do not support in-depth user profiles or “friending,” and motivate privacy.
Social media websites are also available for pharmacists. These websites include ASHP Connect (www.connect.ashp.org), which is sponsored by the American Society of Health-System Pharmacists; PharmQD (www.pharmqd.com); and The Pharmacist Society (www.pharmacistsociety.com). Professional networking online forums for nurses consist of the American Nurses Association’s ANANurseSpace (www.ananursespace.org), NursingLink (www.nursinglink.com), and SocialRN (www.twitter.com/socialRN).
In addition, HCPs can easily connect with each other by means of “general purpose” online social media, such as Facebook, Twitter, and LinkedIn.8 Facebook is the most popular social media site in the united state, while LinkedIn is the most popular professional networking site.
The “blog,” a term formed by truncating “Web log,” is the earliest and most recognized form of social media, which has been made use of in medication given that as early as 2004. Blog sites can reach wide audiences, especially if one writes material that is of substantial interest. Posts that amass enough interest can be shared and seen again and again by readers (referred to as “going viral”).14 Content that goes viral can establish a track record or an online presence.
Blogs can also offer the opportunity to release big amounts of information in a variety of media (text, video, and audio) in an open online forum. The majority of blogging platforms allow readers to respond to released content by posting their own comments. This enables a continuous dialogue in between the blogger and his or her audience. Examples of widely made use of complimentary “long-form” blogging platforms consist of Tumblr (www.tumblr.com), WordPress (www.wordpress.org), and Blogger (www.blogger.com).
Some doctors use blogs to interact with other HCPs or the public. For instance, the Clinical Cases blog site (www.clinicalcases.org) features case studies in a vast array of medical specializeds.17 This blog site also consists of a special area on admission note design templates, procedure guides, and relevant material. Blog sites are becoming more popular amongst pharmacists, however roughly two-thirds of these blog sites are written anonymously.
Microblogs offer the most dynamic and succinct type of information exchange by means of social media. This format allows users to publish a a great deal of quick messages or updates over a brief period. Various microblogging platforms exist; nevertheless, Twitter is the most prominent. On Twitter, users publish messages (called “tweets”) that include an optimum of 140 characters. Tweets can be supplemented with hyperlinks to other online media, such as videos or sites. Tweets can also include “hashtags,” a form of information indexing that allows people to look for tweets that are related to a particular conversation or subject. Hashtags followed by HCPs consist of #HCSM (for Health Care Social Media), #MDChat, and #Health 20.
There are more than 140 reported usages for Twitter in health care. The Penn State College of Medicine has actually utilized Twitter to help with conversations between students and trainers, to carry out course examinations, to get class responses, and to monitor students’ progress. A Twitter Journal Club also provides advance posts about documents and concerns to be gone over, together with a hashtag, so that students, physicians, and any individual interested in the subject can interact. Twitter has also been used at medical conferences to go over and improve speaker presentations by posting real-time comments from the audience. Some physicians have utilized Twitter to develop a huge following, allowing them to reach a broad audience and possibly even influence health policy decisions.
Wikis are public online forum websites featuring text and multimedia content that can be edited by users. “Wiki” is a Hawaiian word meaning “quick,” which describes the speed with which information on a wiki can be accessed, added, modified, or deleted.
Remarkably, Wikipedia is the most typically used wiki in the medical community. It is commonly utilized as a reference by clinicians, despite its known imperfections, such as errors and slim breadth of information. One study discovered that 35 % of 1,056 pharmacists used Wikipedia, although only 19 % trusted it. In another survey of more than 1,000 pharmacists, one in 5 participants said they relied on Wikipedia, however only one in 4 knew that anyone could edit the site.1 One reason for the appeal of Wikipedia is its prominence in Google searches. A research study found that 70 % of 35 junior doctors utilized Wikipedia to find medical information during a week-long duration, with 93 % mentioning ease of use as their primary motivation.
As the precision and completeness of Wikipedia are often disputed, the drug information on that site was compared with a validated and trusted information source, the Medscape Drug Reference. This analysis found that Wikipedia included roughly 76 % of the material discovered in Medscape and had very few factual mistakes (most were mistakes of omission). In contrast, other researches have actually discovered that Wikipedia includes factual mistakes and has a lack of depth compared with traditionally edited, peer-reviewed, evidence-based information sources.
Other wiki jobs replicate Wikipedia in that they crowd-source medical material. Nevertheless, to keep editorial credibility, they also confirm the qualifications of contributors. RxWiki (www.rxwiki.com) allows just pharmacists to include or modify drug information. This was also the design for Medpedia (an initiative from Harvard University, Stanford University, the University of Michigan, and the University of California at Berkeley), which verified authors’ qualifications prior to enabling them to generate material. However, when most articles posted on “author confirmed” wikis were compared with open initiatives, such as Wikipedia, they were found to be shorter, to be of equal or lower quality, and to include less references. Wikipedia was also discovered to promote quality and precision more actively over a duration of 90 days because of crowdsourcing, compared to Medpedia, which had a relatively restrictive editorial process.
Media-sharing sites, such as YouTube, provide a large option of social media tools that are enhanced for viewing, sharing, and embedding digital media content on the internet. They also provide functions that are normally discovered on other types of social media websites, such as profiles, connections, remarks, and private messaging. The majority of media-sharing websites are easy to use, supply totally free fundamental accounts, and are accessible from both desktop and mobile phones.
In medicine, media-sharing sites can be vital resources for education, community building, marketing, and branding. Amongst the most noteworthy media-sharing sites for HCPs is The Doctors’ Channel (www.thedoctorschannel.com), which hosts videos featuring medical news, continuing medical education, and health care-related entertainment.
Virtual Reality and Gaming Environments
Multi-User Virtual Environments (MUVEs) are three-dimensional environments that permit users to connect with each other through a virtual representation of themselves (referred to as an avatar). The application of MUVEs in healthcare is growing rapidly. They are significantly being utilized for patient education, for the simulation of epidemiology and mass prophylaxis, for psychotherapy, for surgical treatment, and for research. Nevertheless, that MUVEs are typically viewed as video game instead of as severe medical tools may impede their adoption by health care institutions.
MUVEs can be classified as general-purpose or health care– particular. The most widely known general-purpose MUVE is Second Life. This general-purpose environment, however, is commonly used for health care education.17 One study discovered 68 health-related virtual locations on Second Life. These consisted of the Centers for Disease Control and Prevention (CDC) education center, which intends to influence the real-life decision-making capabilities of visitors. Healthcare– particular MUVEs are generally utilized for one purpose, such as medical education (e.g., CliniSpace [www.clinispace.com], surgical simulation (e.g., OpenSim [www.opensimulator.org], or psychiatric treatment (e.g., InWorld Solutions [www.inworldsolutions.net].
USES OF SOCIAL MEDIA IN HEALTHCARE
The most popular social media sites for doctors are those where they can take part in online communities, listen to professionals, and network and interact with associates relating to patient issues. Making use of social media by pharmacists also regularly focuses on communication with coworkers. The social-networking platforms utilized for professional networking are often exclusively easily accessible and specifically deal with individuals within these careers. Besides scientific topics, discussions on these sites deal with diverse topics, such as principles, politics, biostatistics, practice management, career techniques, and even dating in a medical environment. They can also supply an encouraging environment for HCPs who subspecialize.
Another example of professional networking amongst HCPs is crowdsourcing, which involves harnessing the understanding and skills of a community to address problems or to gather information and opinions. Social media can also be made use of to connect HCPs in third-world countries with experts in more medically innovative places. For example, surgeries can be streamed by means of the Internet and concerns can be asked by means of Twitter in real time. Hence, social media offer a new communication channel for HCPs to network skillfully to share and exchange medical information in ways and at a pace that was never before possible.
The communication abilities offered by social media are also being used to improve scientific education.5 The high usage rate of social media by 18- to 29-year-olds has motivated the adjustment of scientific curricula to reflect the altering practices and culture of incoming students.1,5 Many research studies have actually explained the use of social media tools to enhance scientific students’ understanding of communication, professionalism, and ethics.2 Universities are also using social media to hire students, to increase access to academic libraries, and to develop virtual class and office hours, along with other unique knowing experiences.
Social media are also being widely executed in undergraduate drug store curricula.1 One-third of drug store programs have actually reported using Twitter in some capacity.1 A 2011 survey also discovered that 38 % of pharmacy professor use Facebook for teaching, with half reporting that they plan to use social media in the future.1 In one example, an instructor in a geriatric pharmacotherapy course at the University of Rhode Island used Facebook to encourage class conversations and to link students with seniors who had actually volunteered to participate in the course.1 This experience improved student perceptions of older adults as well as presented the senior citizens to Facebook.1 At Auburn University, trainers developed Twitter handles so that drug store students could participate in class discussions anonymously.1 By semester’s end, 81 % of students felt Twitter had let them reveal viewpoints they wouldn’t have actually shared otherwise, although 71 % believed that Twitter had actually been sidetracking.
Online social media platforms have also influenced the educational experience for nurses, with one study reporting that 53 % of nursing schools are now using these tools. For instance, Twitter has actually been used to enhance the scientific decision-making skills of nursing students in critical care situations.2 The students viewed videos of clinical situations and tweeted their observations on the patient’s condition for trainer feedback. Other usages of Twitter in nursing education consist of publishing a live stream of student insights during class, or developing a class hashtag so that resources such as videos, sites, articles, and pictures could be shared. Media sharing websites such as YouTube can also be used in the classroom to promote conversation, to illustrate a point, or to reinforce a principle. Students can see a video then respond to questions that promote clinical reasoning.
The incorporation of social media into scientific education has actually consulted with mixed evaluations, nevertheless. Courses that integrate such tools have actually typically been positively received, however in some cases, students have actually reported feeling that the use of Facebook for teaching functions is an intrusion into their social lives. Stabilizing the boosted communication chances offered by social media with the drawback of enhanced diversion in an instructional environment is also a challenge. Unfortunately, standards guiding the suitable use of social media tools in education are in their infancy.
Healthcare organizations, consisting of healthcare facilities, health systems, professional societies, pharmaceutical companies, patient advocacy groups, and drug store advantage companies, are using social media for numerous functions. Makes use of consist of communicating with the community and patients; boosting organizational visibility; marketing services and products; developing a location for getting news about activities, promotions, and fund-raising; offering a channel for patient resources and education; and supplying customer service and support. It has actually been approximated that 70 % of U.S. health care organizations use social media, with Facebook, Twitter, and YouTube being the most popular. Blog sites are also used by lots of medical centers and health centers.
Research studies have shown that this use of social media can considerably enhance the image and visibility of a medical center or medical facility. In one research, 57 % of consumers said that a hospital’s social media presence would strongly influence their choice relating to where to choose services. A strong social media presence was also interpreted by 81 % of consumers as being a sign that a hospital provides innovative technologies. In another research study, 12.5 % of checked health care companies reported having successfully attracted new patients through using social media.
The rate of social media adoption by nonprofit healthcare organizations is also enhancing.9 The Mayo Clinic ended up being an international leader in such efforts when it developed the Social Media Health Network (http://socialmedia.mayoclinic.org) in 2010. In its objective statement for the network, the clinic stated it looked for to offer an “genuine voice for patients and health care experts, constructing relationships through the revolutionary power of social media.” To that end, this effort has created a presence on Facebook, YouTube, and Twitter. It also provides a large library of post, podcasts, conferences, and webinars to engage different community stakeholders. The Mayo Clinic and other academic health care organizations have actually also made use of blogs to cultivate peer-to-peer knowing and to carry out new protocols. Many universities also have a branded YouTube channel, where videos can be shared through the university’s social media site.
Social media also enable drug stores to interact with huge groups of customers simultaneously, to carry out studies, and to make it possible for clients to feel that they belong to a drug store community. Lots of drug stores use social media to reach out to fans about products, services, discounts, relevant events, and health information. Several huge pharmacies and insurance companies have actually piloted programs that provide prescription refill and consultation reminders by means of social-media text messaging.
Although there has actually been an unwillingness amongst HCPs to use social media for direct patient care, this practice is gradually being allowed by clinicians and healthcare centers. For instance, Georgia Health Sciences University has actually provided patients with access to a platform called WebView, which allows the patients to reach their medical professionals to ask questions or to demand prescription refills.
Current researches have discovered that doctors have actually started to develop an interest in communicating with clients online.9 Some doctors are using social media, consisting of Twitter and Facebook, to boost communication with clients. Roughly 60 % of physicians were found to favor interacting with patients through social media for the purpose of supplying patient education and health monitoring, and for encouraging behavioral changes and drug adherence, with the hope that these efforts will certainly result in “better education, increased compliance, and much better outcomes.” Nevertheless, other research studies have actually revealed that considerable resistance still exists to using social media to communicate with patients. In a survey of approximately 480 exercising and student physicians, 68 % felt it was ethically troublesome to communicate with clients on social media for either individual or professional factors.
Evidence indicates that electronic communication with clients can improve their care and health outcomes. Studies have revealed that additional electronic communication emphasizes physicians’ suggestions and improves adherence for clients with chronic conditions. It might also enhance patient satisfaction by increasing the time invested communicating with and having concerns responded to by their doctors. A survey of clients at an outpatient family medicine clinic discovered that 56 % wanted their HCPs to use social media for tips, for scheduling appointments, for diagnostic test outcomes, for prescribed notifications, and for addressing general questions. Patients who did not use social media said they would start if they understood they could connect with their health care service provider.
Social media can also enhance clients’ access to health care information and other academic resources. In the united state, eight in 10 Internet users search for health information online, and 74 % of these individuals use social media. Through social media, patients can sign up with virtual communities, take part in research, get financial or support, set objectives, and track individual progress.
Physicians are also using social media to promote patient health care education. They tweet, make post, record videos, and take part in disease-specific conversation forums focused on patient education. Such online forums offer an important chance for doctors to distribute evidence-based information to counter inaccurate material on the Internet. In some social media forums, the general public is offered with an opportunity to participate in these conversations.
Unlike other health recommendations that a patient may encounter online, doctors might use social media to develop messaging that may be more likely to resonate with and be acted on by clients.8 Some doctors think that social media would be particularly advantageous for patients with chronic, rare, or deadly diseases; with concerns about maternal or infant care; or with individual health-related goals, such as weight management. The distribution of credible information has actually been shown to inspire observable behavioral changes within social media. Research has started to show that interventions based on social media can favorably impact weight-loss, tobacco cessation, risky sexual habits, and exercise.
Clients are also using social media to get in touch with others influenced by similar conditions. For instance, the social mediasite PatientsLikeMe (www.patientslikeme.com) supplies a location for patients to access information, suggestions, and support from other people who have the very same disease or condition. Facebook groups also regularly focus on certain medical conditions. These groups actively take part in peer-to-peer support as well as fund-raising efforts for affiliated companies and individuals.
Public Health Programs
Social media have actually developed huge global networks that can quickly spread out information and mobilize great deals of people to assist in greater development towards public health goals. Social media can therefore be a powerful tool for public education and advocacy concerning public health concerns. Some states’ public health departments are using Twitter and other social media for these functions.
Other public health organizations use keyword content from Twitter and other social nmedia, in combination with location-tracking technologies, to respond rapidly to disasters and to keep an eye on the health and well-being of populations. The CDC keeps an active presence on Twitter and Facebook to track “tweets” that may indicate a flu outbreak and to share updates about such occurrences. The CDC has also utilized social media to find and keep an eye on sources and thought cases of Legionnaire’s disease.
Organizations such as the Red Cross track Twitter posts throughout natural catastrophes, such as hurricanes and earthquakes, to gather information about where the greatest requirements are. Citizen-report blog sites have also been kept track of by health centers for information about potential mass casualty occasions. When made use of in this way, real-time social media websites supply higher agility and enhanced preparedness for responses to catastrophes and public health emergencies. Social media websites also offer disaster and emergency situation response workers with a way to quickly share and access essential information offered by agencies such as the CDC and the united state Preventive Services Task Force.
The extensive use of social media can also influence public health habits and objectives through social support.8 Because human beings are a highly social species, they are frequently influenced by their buddies, in addition to by friends of friends.8 One example of the powerful effect of social media was seen after Facebook decided to permit users to publish their organ-donor status in their profile. According to Donate Life America, the week after this feature was presented, online state organ-donor computer system registries experienced a 23-fold surge in donor pledges that was most likely due to this social-networking impact.
Violation of the Patient–HCP Boundary
HCPs who interact with their patients on social media may be violating the patient–HCP boundary even if patients initiate the online communication. A recent study found that patients often extend online “friend” requests to their physicians on Facebook. However, very few physicians reciprocate or respond, since it is generally thought to be ill-advised for an HCP to interact with a patient through a general social media forum such as Facebook. In addition, organizational policy statements often discourage personal online communication between HCPs and patients.
HCPs should therefore become familiar with the privacy settings and terms of agreements for the social media platforms to which they subscribe so that they can maintain strict privacy settings on their personal accounts. Rather than “friending” or communicating with a patient on social media, HCPs can suggest that the patient set up a website that is specifically designed for posts regarding medical events, so that the HCP can follow the updates in a more professional manner. For example, CaringBridge (www.caringbridge.org) is a nonprofit website that is designed to create a social media presence for patients on a protected, user-friendly venue.2 Patients can use their CaringBridge profile for the purpose of interactively communicating with concerned followers during a health event.
Physicians may also violate a patient’s personal boundary through the inappropriate use of information found online or on social media. Since social media can provide a wealth of information about a patient, it can be used in a positive way to aid clinical care. This practice, known as “patient-targeted Googling,” has been described in many medical settings. Anecdotal reports have highlighted some benefits to this practice (for example, using information found on social media to identify an amnesic emergency patient or intervening when a patient is blogging about suicide). However, the potential for the blurring of professional and personal boundaries exists, since this practice can also be spurred by inappropriate curiosity, voyeurism, and habit.
An HCP may observe posts or photos on social media sites that depict patients participating in risk-taking or health-averse behaviors. Digitally investigating the personal behaviors of patients, such as whether they have quit smoking or are maintaining a healthy diet, could threaten the trust needed for a strong patient–physician relationship. Therefore, in such instances, an HCP should consider the source of this information and use clinical judgment to determine whether and how to reveal this discovery during patient management.
The use of social media can also adversely affect an HCP’s credentials and licensure. State medical boards have the authority to discipline physicians, including imposing restrictions or suspending or revoking licenses. These penalties can be meted out for unprofessional behavior, such as the inappropriate use of social media, sexual misconduct, breaches of patient privacy, the abuse of prescribing privileges, and the misrepresentation of credentials.
U.S. licensing authorities have reported numerous professional violations by HCPs on social media that resulted in disciplinary action. For example, an emergency medicine physician was reprimanded by the Rhode Island State Board for “unprofessional conduct” and was fined after making comments on Facebook about a patient. The physician did not mention the patient’s name in the post; however, sufficient information was included that allowed others within the community to identify the patient. Misrepresentation of credentials is one of the most common online violations reported to state medical boards.15 Physicians should be familiar with the requirements of state medical boards regarding online communications to ensure they do not commit any violations that might jeopardize their license.
Nursing boards have also disciplined nurses for violations involving online disclosure of patients’ personal health information and have imposed sanctions ranging from letters of concern to license suspensions. The posting of unprofessional content on social media by HCP students is also fairly common. One survey found that 60% of medical school deans reported incidents in which students had posted inappropriate content online, including patient information, inappropriate language, depictions of intoxication, and sexually explicit material.
The widespread use of social media has introduced new legal complexities. A number of constitutional rights can be applied to the use of social media, such as freedom of speech, freedom from search and seizure, and the right to privacy; however, these rights can be successfully challenged.
In 2009, a U.S. District Court upheld the expulsion of a nursing student for violating the school’s honor code by making obscene remarks about the race, sex, and religion of patients under her care. The court concluded that the school’s honor code and confidentiality agreement signed by each nursing student governed the standards of acceptable behavior, dismissing the student’s claim that her right to freedom of speech had been violated. A similar ruling was made in a case in which a student posted pictures of herself as a drunken pirate on MySpace.
Legal cases should never be discussed on social media because most current case law dictates that such information is “discoverable,” although this may depend on the purpose for which the information is sought. Even if it is posted anonymously, various investigative methods may potentially be used to directly link legal information to a specific person or incident. The Facebook policy for the use of data informs users that “we may access, preserve, and share your information in response to a legal request” both within and outside of U.S. jurisdiction. The policy also states that information may be shared for a number of reasons, including to aid investigations, to prevent fraud or illegal activity, and to protect Facebook, the user, or anyone else. Information posted on social media can also be used to portray—rightly or wrongly—an image of an individual’s character in lawsuits.
HCPs can also expose themselves to lawsuits if they respond to a question sent via social media by providing medical advice. It has been suggested that a legally sound approach in response to requests for such advice would be to send a standard response form that:
1) informs the inquirer that the HCP does not answer online questions;
2) supplies offline contact information so that an appointment can be made, if desired; and
3) identifies a source for emergency services if the inquirer cannot wait for an appointment.
In circumstances where a patient–HCP relationship already exists, informed consent should be obtained prior to online discussions between the HCP and the patient regarding medical care.15 A careful explanation regarding the risks of online communication, expected response times, and the handling of emergencies should be included.15 The informed consent and any online interactions should be documented in the patient’s chart.
THE RISKS OF SOCIAL MEDIA
Poor Quality of Information
The main constraint of health information discovered on social media and other online sources is a lack of quality and dependability. Authors of medical information found on social media websites are typically unidentified or are recognized by limited information. In addition, the medical information might be unreferenced, incomplete, or casual. While evidence-based medication de-emphasizes anecdotal reports, social media have the tendency to emphasize them, relying on individual patient stories for collective medical understanding. Comparable problems exist with traditional online media; however, the interactive nature of social media amplifies these problems, since any user can submit content to a site. Social media users might also be vulnerable to both covert and visible conflicts of interest that they may be incapable of translating.
Measures are available that might be useful in resolving this problem. HCPs can assist patients to credible peer-reviewed websites where the information undergoes quality control.10 The World Health Organization is leading a demand to the Internet Corporation for Assigned Names and Numbers to establish a new domain suffix that would be made use of solely for verified health information. The issuance of this domain suffix would be strictly managed, and the material of websites with these addresses would be monitored to assure compliance with stringent quality criteria.19 These domain addresses would be focused on by online search engine when offering results in response to health-related inquiries.
Damage to Professional Image
A significant threat associated with the use of social media is the posting of unprofessional material that can reflect unfavorably on HCPs, students, and affiliated institutions. Social media convey information about an individual’s personality, values, and priorities, and the first impression created by this content can be lasting. Understandings might be based upon any of the information featured in a social media profile, such as images, nicknames, posts, and remarks suched as or shared, along with the pals, triggers, organizations, video games, and media that an individual follows.
Behavior that could be interpreted as less than professional includes infractions of patient privacy; making use of profanity or discriminatory language; images of sexual suggestiveness or intoxication; and unfavorable comments about clients, a company, or a school. Such public missteps by HCPs have actually been documented, consisting of doctors taking digital photographs during surgical treatment, posing with weapons or alcohol, and posting “tweets” that are damaging to an individual or the career.10 The airing of frustrations, or “venting,” concerning clients also happens in online forums and is not recommended.
Information collected from social media can also be utilized making decisions concerning admission to medical or professional programs, selection for residencies, or work. Companies and residency programs now search Facebook and other social media sites before hiring candidates. A Microsoft survey discovered that 79 % of employers see online information regarding potential workers, and only 7 % of job candidates were aware of this possibility. By making public posts, a person has actually willingly made information offered for anyone to see for any purpose.2 For some, it logically follows that candidates who do not use discretion in deciding what material to publish online may also be incapable of exercising sound professional judgment.
It is not unusual for social media users to be linked to overlapping networks of buddies, family, and coworkers.11 Some users attempt to keep their personal and professional images different by producing different accounts. This might be difficult to implement in practice due to the fact that personal and professional contacts typically overlap. However, most social media websites now supply privacy settings that permit people to tailor both their profile material and who can see it. Preferably, account and privacy settings should be embedded in a way that allows one’s network to expand while restricting the exposure of information to individuals beyond the network. Any settings offered by the social media site that enable users to identify various relationships so that just suitable information is shared with particular groups or people need to also be used. HCPs need to conduct routine searches for their own names or other recognizing information to make sure that their social media presence forecasts a professional image.
Breaches of Patient Privacy
Issues relating to using social media by HCPs frequently center on the potential for unfavorable consequences resulting from the breach of patient privacy.5 Such offenses may expose HCPs and health care entities to liability under federal HIPAA and state privacy laws.
HIPAA, as customized by the Health Information Technology for Economic and Clinical Health (HITECH) act, regulates the permitted use and disclosure of patient information by covered entities, including HCPs and healthcare facilities. The HITECH act details privacy-breach notification requirements and broadens various requireds to consist of business associates. Area 13410(d) addresses civil and criminal fines for offenses that are based on the nature of the violation, in addition to resultant damage. Although making use of social media isn’t really particularly referenced, these tools can certainly provide dangers under HIPAA and HITECH. An HCP might breach federal HIPAA/HITECH or state privacy laws in a number of ways when publishing information, remarks, images, or videos worrying a patient to a social media site. Whether interacting with or about patients on social media, breaches of patient privacy can result in legal action against an HCP and potentially his/her company. However, it is very important to keep in mind that HIPAA does not restrict the distribution of medical information that has actually been “de-identified.”
In 2003, the Department of Health and Human Services (HHS) provided the HIPAA Privacy Rule, which offers the very first federal privacy requirements for the protection of patient information to be followed by “covered entities,” such as HCPs, health centers, and health insurance. The HIPAA Privacy Rule levies heavy fines and possible criminal charges on the unauthorized disclosure of individually identifiable health information by covered entities in oral, paper, or electronic form. The HIPAA Privacy Rule also consists of a “safeguards basic” that needs covered entities to reasonably protect clients’ health information from unauthorized disclosure by using physical, management, and technical safeguards. The safeguard requirements are rather flexible for entities of various sizes and resources.15 For circumstances, communication in between a patient and an HCP using unencrypted email might be allowable, as long as other sensible safeguards are followed.
To abide by the HIPAA Privacy Rule, scientific vignettes published on social media concerning clients should have all personal determining information and any exposing references removed. This “de-identification” can be accomplished by changing or leaving out key patient information (e.g., names, insurance coverage or Social Security numbers, date of birth, and images), by avoiding the description of unusual medical issues, and by not including specific time frames or locations without the patient’s authorization. Nevertheless, regardless of these preventative measures, there have still been numerous well-publicized unintended breaches of the HIPAA Privacy Rule involving social media. Securing an individual’s identity when writing about patients is commonly harder than might be expected. A research of medical blog sites written by HCPs discovered that individual clients were described in 42 % of the 271 samples studied.15 Of these samples, 17 % were discovered to consist of enough information for patients to determine themselves or their suppliers, and three consisted of identifiable pictures of the patients.
The patient’s permission is a vital problem to think about when using social media. An HCP or healthcare organization may determine whether patient consent is needed by considering the place of publication. Making use of particular HIPAA-compliant messaging systems, such as that supplied within Doximity, may be in theory safe even for patient-identifying information, assuming that the recipient has medical justification for getting such information.14 However, it is ultimately up to the individual HCP, the practice, or the organization to decide when they will seek patient authorization prior to posting de-identified case details online.
PROFESSIONAL GUIDELINES FOR THE USE OF SOCIAL MEDIA
Social Media Guidelines Issued by Healthcare Institutions
Social media posture lots of risks for healthcare companies that might possibly influence the security and security of patient information, patient authorization, work practices, doctor credentialing and licensure, the infraction of HCP– patient borders, and other ethical issues. For that reason, it would be advantageous for health care organizations to establish employee guidelines relating to the proper use of social media. Repercussions regarding policy infractions ought to also be specified.
Concepts for Health Care Organizations’ Social Media Policies
Healthcare institutions need to resolve the risks presented by the use of social media in their employee policies. Policies must include discrimination, harassment, wrongful termination, leaking of confidential or proprietary information, damage to the organization’s reputation, and performance along with other concerns. A health care organization might also consider establishing policies that involve disciplinary actions in response to workers’ use of the Internet, cellphones, or tablets during working hours. The establishment of such policies might reduce a number of concerns regarding the online publishing of photos or other patient information that could break federal or state privacy laws or might sidetrack from patient care.
Numerous institutional policies also prohibit using work email addresses on social media, showing an issue for security and the significance of separating individual and professional activities. The use of institutional graphics or logo designs on staff members’ personal social media pages may also be forbidden. Prospective problems of interest are also a concern. A lot of policies forbid arrangements that involve the exchange of money for online posts or other activities, and require full disclosure with disclaimers if such a relationship exists.
A number of health care organizations have policies that need a signed HIPAA authorization before any patient-specific information may be published on social media. Other organizations, particularly medical schools, have actually broadened this idea to include authorization from research topics and volunteers. It is good practice for professors at universities to inform students about prospective consequences for breaking this and other social media standards, given that such offenses may not only expose the student to academic or professional corrective actions but can also breach state and federal laws, leading to civil and criminal charges.
Additional information regarding social media guidelines can be discovered in the online database at http://socialmediagovernance.com/policies. This resource consists of 247 social media policies, lots of for health care organizations or professional societies, such as the Mayo Clinic, Kaiser Permanente, and the American Nurses Association.
Social Media Guidelines for HCPs Issued by Professional Organizations
Many health care professional societies have provided guidelines for making use of social media. In 2012, the ASHP released a statement concerning making use of social media by pharmacists. The ASHP recommended pharmacists to provide scientific recommendations only in adherence with professional standards (i.e., when a total history is understood); to acknowledge when a patient’s requirements would be better fulfilled by other means of communication; to supply timely and accurate information when suitable; to rebut any deceptive information; to protect patient privacy; and to keep the pharmacist’s reputation throughout anonymous or personal use of social media. The ASHP also suggested that medical facilities or health systems that allow the use of social media develop best practices through policies and treatments that balance the benefits of social media with the prospective threats and liabilities of such media.6.
In 2010, the American Medical Association (AMA) released official standards for the ethical use of social media by physicians.19 These guidelines emphasize the need to preserve patient confidentiality; to be cognizant of privacy settings; to preserve proper patient– doctor boundaries; to supply precise and truthful information; to act with collegiality; to avoid privacy; to state problems of interest; and to keep separate individual and professional profiles. The AMA’s policy also advises that members know that privacy settings might not supply complete protection which anything posted on the Internet might be permanently offered online.
The Federation of State Medical Boards (FASB) released a guidance document on the suitable use of social media in medical practice in 2011. This file highlights protection of patient privacy and confidentiality; professionalism and openness; the avoidance of giving medical recommendations online; and the caveat that when information is put online, it can be distributed interminably.
The National Council of State Boards of Nursing (NCSBN) also provided its White Paper: A Nurse’s Guide to using Social Media in 2011. This document consists of practical guidelines for governing the proper use of social media in the healthcare environment by nurses.
When made use of wisely and prudently, social media websites and platforms provide the prospective to promote individual and public health, as well as professional development and development.11 However, when made use of thoughtlessly, the dangers these technologies posture to HCPs are powerful.8 Guidelines provided by health care organizations and professional societies provide sound and beneficial concepts that HCPs need to follow to avoid mistakes.