What happens ONLINE - Wild Apricot · • Social media is a great way to educate many patients, but...
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Transcript of What happens ONLINE - Wild Apricot · • Social media is a great way to educate many patients, but...
What happens
online stays…
ONLINE
Disclaimer: The views and opinions expressed in this presentation are solely those of the author
PSIC does not set practice standards nor should this information be considered legal advice.
We offer this only to educate and inform
Disclaimer
What is Social Media?
Information, opinions or visual imagery created,
shared, exchanged or “liked” through virtual
communities, networks and sites.
The Numbers
• 2016, 2.3 Billion active SM users
• 2019, 4.3 Billion active SM users
• 70% of American adults use SM sites
• 500 Million tweets per day, 6000 tweets every second
• 2015, $8.3 Billion generated from social networking advertising
• 2018, $51 Billion generated from social networking advertising
Other Stats
• Most popular websites– Google
– YouTube
• Facebook is the top choice for reaching the broadest audience
• 76% of Facebook users visit the site daily; 55% visit multiple times per day
• 93% of Twitter users also use Facebook
• 95% of Instagram users also use Facebook
• 92% of Pinterest users also use Facebook
The Statistics
• Every 60 seconds 510k comments are posted, 317k
statuses are updated, and 147k photos are uploaded.
• 5 Billion comments are left on FB pages monthly
Twitter 2016
• 1.3B accounts.
• 500M tweets sent each day (6000/sec!)
The StatisticsInstagram 2019
• 500M active users. • 4.2B likes everyday. • 100M photos shared per day on average.
YouTube 2016
• 2B users• 500 hours of video content are uploaded every minute• Nearly 5 billion videos are watched every single day• 2018, 30M users daily• 62% of businesses use YouTube• More content is uploaded to YouTube in 30 days than all three major TV
networks combined have created in 30 years!
Why Does Social Media Matter?
• More than 40% of consumers say that information found
on social media affects the way they deal with their
health. (Source: Mediabistro)
• 90% of respondents from 18-24 years old said they would
trust medical information shared by others on their social
media networks. (Source: Search Engine Watch)
• 41% of people said that social media would affect their
choice of a specific doctor, hospital or medical facility. (Source: Demi & Cooper Advertising and DC Interactive Group)
• Of the 74% of adults who use the internet;
– 80% of internet users have looked online for
information about health related topics
– 34% of internet users, or 25% of adults, have
read someone else’s commentary or experience
about health or medical issues on an online
news group, website, or blog
– 24% of internet users, or 18% of adults, have
consulted online reviews of particular drugs or
other healthcare treatments
Why does Social Media Matter
Social Media and Doctors
• A social media policy urged doctors to
“pause before posting” and not to “friend”
patients online.
• The position paper, issued by the American
College of Physicians (ACP) and the
Federation of State Medical Boards, was
released at ACP Internal Medicine 2013 in
San Francisco, California, and was
simultaneously published online April 11 in
the Annals of Internal Medicine.
Social Media and Doctors• The position paper provided
recommendations for users of social media.1. Doctors should keep their professional and personal identities separate;
they should not friend or contact patients through social media.
2. Establishing a professional profile which appears first during a search can
provide some measure of control that the information is accurate.
3. Email and other electronic communications should only be used by doctors
within an established patient-doctor relationship and with patient consent.
4. When a doctor is approached through electronic means for clinical advice
in the absence of a patient-doctor relationship, the individual should be
encouraged to schedule an office visit or go to the nearest emergency
room
5. Text messaging should never be used for medical interactions, even with
an established patient, except with caution and consent from the patient.
6. Trainees can harm their future careers by not posting responsibly
What Doctors Are Doing?
• Doctors, like patients, utilize social media in various ways
too.• A desire to gain medical knowledge from peers
• Forums to discuss cases with peer community
• Promote better health among public
• Marketing & Branding opportunities• Staying in front of patients and potential patients by actively utilizing
social media – providing links, information, blogs, etc.
• Build an online identity sharing information (limited) about
themselves, their practice, etc.
Doctor Utilization
• Doctors, like patients, utilize social media in various ways
too.• A desire to gain medical knowledge from peers
• Forums to discuss cases with peer community
• Promote better health among public
• Marketing & Branding opportunities• Staying in front of patients and potential patients by actively utilizing
social media – providing links, information, blogs, etc.
• Build an online identity sharing information (limited) about
themselves, their practice, etc.
• Doctors generally receive little to no training on how to effectively utilize and deal with social media within their formal education.
• George Washington University and Johns Hopkins University Study
• Findings
– 60% reported violations
Doctor’s Training?
• Further Outcome from Study:
• 62% of medical schools have no
professionalism policy for student posting
online content
• 11% of Deans stated they were developing
policies
• 50% said they were going to update existing
policies
Healthcare Usage
• Hospital Usage is on the Rise!!
• As of 2013 (Ed Bennett Hospital Social Networking List)
– 716 You Tube channels (compared to 398 in August 2010)
– 1292 Facebook pages (compared to 631 in August 2010)
– 998 Twitter accounts (compared to 634 in October 2010)
– 209 Blogs (compared to 87 in August 2010)
– Patients now can stay informed, have more control over their own healthcare and
learn from experts at their own pace
Healthcare Usage
Copyright 2014 - NCMIC Group, Inc.Copyright 2017 - NCMIC Insurance Company
Social Media – Doctor’s Concerns
• Areas of Concern
– Doctor’s Privacy:
• Personal information - using privacy settings to
protect to the greatest extent possible.
• Professional Reputation – monitor to ensure
information posted is accurate and appropriate
– Personal & professional should be separated
– Boundaries for interaction with patients
• Should you even interact with patients through social
media?
• If so, should be consistent with professional ethical
guidelines
– Patient Privacy
Social Media – Doctor’s Concerns• The Good:
• Social media can be a great tool if understood and used ethically and
properly.
– Great marketing tool
• Generally low cost (not always!)
• Can reach a wide net of prospects and current patients/clients
• Keep you and your clinic in front of people on a frequent basis
– Can establish your online identity and mold it the way you wish
• Personalize your clinic by sharing info on you, your staff,
experience, etc.
– You can share information quickly and frequently
• Info on your office – hours, closings, special announcements,
etc. (Can compliment clinic website – “search engine
optimization”)
• The Good:
• One of the opportunities of using social media is from the
patient relations standpoint – humanizing the practice.
• When a patient looks up a prospective doctor or knows their
doctor on a professional level, it can often be a fairly cold
relationship.
• They don’t know much about him or her from a human side.
And one of the strengths of social media is to humanize the
doctor.
• Doctor can take control of what and how much is shared.
Social Media – Doctor’s Concerns
Doctors – Reputation
• You likely have an online reputation right now
whether you know it or not.
• Google yourself to see what comes up – reviews,
articles, etc.
• If you’re not engaging in social media, your online
reputation is being created for you – about you,
without your participation.
• One compelling reason for doctors to get involved
with social media – helps shape who they are
online.
Doctors - Reputation
• People looking for a physician may use Facebook as a research tool
• If a doctor or a practice creates a positive impression on Facebook or other social media, that can be an advantage in wooing these patients.
• But doctors can also generate a negative image by posting or tweeting something inappropriate—and that impression will linger.
• Doctors need to be as professional on the web and on social media as they are in a room face to face with a patient.
On-Line Protection Resources• Reputation.com (Example)
– On-line reputation management
– Assists by helping clean up inaccurate, misleading or outdated
material
– Can help protect personal data, monitor search results for you, and
monitor where you are being discussed on the internet
• ReputationX.com (Example)
• Reputation911.com (Example)
• Google Alerts (Example)
– Can enter in a search query you wish to monitor such as your name
or clinic name
– Will send you automated email with updates of the most relevant
Google results (as it happens, daily or weekly)
Patient Utilization
• Patients utilize social media in various ways when it
comes to healthcare.
• Empowerment over their health decisions• A desire to gain medical knowledge
• Treatments, alternatives, resulting issues and danger associated with
treatment process.
• Self diagnosis .. “Dr. Google”
• Patients seeking emotional support from others with the same or
similar ailments
• Patients trying to raise awareness through telling their own story
• Patients looking for general health tips• Exercise
• Diet
• Ergonomics
• Sleep
• Etc.
Copyright 2017 - NCMIC Insurance Company
Why is Social Media Effective
9 out of 10 people don’t trust advertising
8 out of 10 trust recommendations from people they know
Doctors, Patients and Social Media
• Should you “friend” or add patients to your
personal social media networks?
– What would the benefits be?
– What are the potential issues?
• Patient’s view physicians on a professional
basis not a friendship
Professionalism/Confidentiality
• Not exactly as it sounds
• Any contact; stranger, spammer, friend,
enemy, family member or lover, etc, asking to
add you to their list or address book
(contact)
• Simply a request to form a network
connection between your profile and theirs
Friend Request
• Be clear to your patients about your
boundaries. Have a standard response
ready in case they make a request.
• Be clear about your professional boundaries
upfront with your staff
– Staff may not think about the complications you
face with them being your patient’s “friend”, so
talking with them openly can illustrate your point
Suggestions
Doctors, Patients and Social Media• Electronic Media – Risk Management
• Before using digital media (social media, e-mail, text, etc.),
weigh and consider possible issues:
– How often are the messages viewed/answered?
– Are the communications captured and made part of the
patients file?
– All devices used to communicate with patients become
“discoverable” during malpractice litigation. Devices run
the risk of being confiscated and sorted through – likely
all information, not just that pertaining to the case.
– Patient correspondence via electronic media can be
difficult to gauge/discern since the doctor is unable to
see non-verbal cues.
– Always a HIPAA concern
• Phone call returned within 8 hours
• Email should be answered within 24 hours
• Social networking sites lowest priority-no set response time
• Email and/or phone call is seeking specific questions. Social networking wide-open forum (for all to view) & communication is less targeted at one individual
Social Media: Office/Clinic Communications
• Face to Face –
– Can see, hear, perceive
– Careful about the volume and nature of the information
disclosed – aware of audience
• Internet –
– Not able to hear tone/voice inflections
– Cannot see body language & non-verbal communication
– Not so careful. Lack of awareness or obliviousness
about who will view. Millions of unknown users may
stumble upon the information.
Pitfall: Communication Style
• Presenting material clearly in person, reacting to them in clinic
personally and being available for discussion
• Using social media cannot replace YOU!
Technology Secondary to Face/Face
Pitfall: Questions & Social Media
• Doctors should avoid answering any personal medical questions on Facebook or any other social media platform.
• Social media is a great way to educate many patients, but not to answer individual patient questions.
• Clinics should create a standardized message telling patients who have medical questions to call 911, make an appointment with the office or send a secure message to a patient portal.
• Safeguard – Doctors should warn patients not to post information about their medical conditions and always guards against it.
• Patient Health Information:
• Lack of security offered both by sites and
electronic devices
• PHI duty to protect regardless if spoken
gossip, a misplaced chart, an overheard
hallway consultation, a lost laptop, in a chat
room, a Tweet or a Facebook posting
• Users share personal info regarding their
daily lives, hit SEND, without thinking about
the ramifications
Pitfall: HIPAA
• Kaufman & Armstrong
• University of PA studied 271 medical blogs
and found:
– Individual pts describe in 42.1% of blogs
– Positive pt portrayal 15.9% & negatively in 17.7%
– PHI to identify patient in 16.6% of blogs
– Three blogs had pt. photographs
– Healthcare products promoted in 11.4%
HIPAA continued
Pitfall: HIPAA violations
• HHS reports that the majority of HIPAA violations from
recent years have occurred from employees mishandling
PHI – many from the misuse or inappropriate social media
sharing.
• HIPAA civil penalties can range in fines from $100 -
$1,500,000
• Criminal penalties can also be assessed resulting in fines
from up to $250,000 and 10 years in prison.
• Loss of license or termination of employment are also
consequences that could be faced.
• Posted to Facebook: CA 60 year old male stabbed 16 times in the neck by nursing home roommate. EMS and ER personnel posted the photos.
• Cawley-Jean, N. Why is it so hard for hospital staff to follow HIPAA rules when using social media?
More HIPAA Violations
• Psychiatrist on trial for disclosing PHI without
authorization
• Patient treated by psychiatrist
• Patient complains about psychiatrist
• Psychiatrist finds out and tells her employer
to put her on a “psychiatric hold”
Virginia
Copyright 2014 - NCMIC Group, Inc.
• Certified nursing assistant took a picture of a
paraplegic patient in a compromising position
• CNA says to her co-worker; “This is too funny. I
need to take a picture of this”
• Coworker: “Please don’t take the picture. Coworker
notices picture on Facebook wall. Reports to
employer (as required under HIPAA/HITECH)
• CNA fired, arrested and facing voyeurism charges
Indiana
Copyright 2014 - NCMIC Group, Inc.
• Four nursing aids allegedly participated in a video of the
resident, who is a stroke survivor with dementia. The video
shows the resident in bed, holding a diaper, surrounding by
employees who are harassing him. One of the caretakers is
heard yelling “Take off your pants, [resident name].”
• This example poses HIPAA concerns and abuse concerns.
Without a patient authorization, it is a potential HIPAA
violation to record the resident and share that recording
with third parties. In addition, CMS made it clear in
its Survey & Certification Memo 16-33 that humiliating or
demeaning photos or recordings of nursing home residents
are mental abuse.
Illinois
Copyright 2014 - NCMIC Group, Inc.
Georgia• Three employees of a Georgia long term care
facility were asked to monitor a patient until
hospice arrived. Instead of monitoring the patient,
the employees made a video titled “The End,”
using Snapchat, of themselves vaping, using
profanity, and making obscene gestures. The
patient – who was dying – is visible in
the background. Another employee saw the video
and reported it. The three caregivers were arrested
and charged with exploiting an elderly and disabled
person. They face 20 years in prison and a fine up
to $50,000.
HIPAA – Things to Watch Out For
• Beware of reposting or redistributing photos of patients sharing all the details of their medical issues on their own social media accounts –this is likely a violation.
• Speaking to patients as a collective on social media should steer providers away from any privacy risks. Make sure it’s not specific to one patient!
• If an unknown patient reaches out via social media asking questions – take that conversation offline with the standard response asking the patient to contact the office for an appointment OR seeking emergency treatment (911) if the situation warrants it.
HIPAA
• Don’t make the mistake of thinking that
posts are private or disappear once they
have been deleted – Search engines and
screen captures (screenshots) can make
even deleted posts permanent.
HIPAA
• Your HIPAA Privacy and Compliance procedures should
include policies pertaining to social media.
• Training should occur at the time of hiring and periodically
after (annually).
HIPAA – Clinic Policy
• Social media policy should include a definition of social
media, mentioning of specific sites, and a description of
what information employees are allowed to post and what’s
off-limits (on both practice and personal pages).
HIPAA Breach…
• If a breach occurs, the following should take place:
– Report the incident to your compliance officer, office manager, or
practice owner. A brief description of the breach, date of incident
and the date of discovery are key pieces of information.
– If a breach has occurred, covered entities and their associates are
required to provide notification. The notifications are required
without any unreasonable delay and in no case more than 60 days
after the discovery of breach.
– If the breach included PHI of 500 or more individuals, a notice to
HHS and media are warranted.
HIPAA
• Federal Prosecution
– Pennsylvania 2010
– Employee of Shadyside Hospital selling PHI for
personal gain (names, DOB, ss#)
– 14 count indictment HIPAA
– Possible punishment: 80 years, $4,730,000.00
or both
Examples of Prosecution
Copyright 2014 - NCMIC Group, Inc.
Personal Pitfalls
YOUR DIGITAL FOOTPRINT IS
WIDE AND ALWAYS
LEFT BEHIND
Patient Communication – Personal Concerns
Social Media – Personal Concerns• Usage on your personal social media accounts will
always reflect upon your professional title.
• You are always known as or associated with your
job/career/employer
• Posts, tweets, pictures, video, etc., may not only have
an impact upon you and your character, but the
perception of the profession.
• The public can have a tendency to attribute certain
traits and behaviors to an entire group based upon
the actions of one.
Personal Pitfalls
– Pictures
– Political Views
– Cultural/Religious Views
– Opinions
– Posts, articles, pictures that damage your
credibility as a professional
– Personal issues, arguments, rants
• Before entering into a social media platform, be sure you
understand the privacy settings in detail! Ask friends,
colleagues, or consult books or other references. Be sure
to check frequently for changes!
• Crucial component of keeping your private life as private as
possible
• Allow staff and patients to see only limited information (if
any at all)
• Case law varies by state – many courts have ruled that by
virtue of it being “social media”, there should be no
expectation of privacy.
Know Your Privacy Settings!
Social Media – Personal Concerns• Think through - every post, upload, tweet, etc.
– Is it necessary – what’s the benefit? What are the potential
consequences?
– Who’s the audience? Do you have the audience filtered? Who is
your audience’s audience?
– Have you set it up to know if others are posting about you?
– Keep in mind when making statements or sharing pictures/videos –
what seems like a strong stand, a funny joke, a cool thing to do now,
may not be so in 6 months, a year, two years …
– Cliché saying – but true: Would you be ok with this published on the
front page of your local newspaper?
– Repeating myself .. The internet is forever
Copyright 2014 - NCMIC Group, Inc.
Employees and Social Media
They are cognizant of the
vulnerability of their reputations
on digital media
but are unwilling to sacrifice
internet participation
Copyright 2017 - NCMIC Insurance Company
Copyright 2017 - NCMIC Insurance Company
Employee Pitfalls
and
Employer Techniques
Patient Communication: Social Media & Employment
Employee and Social Media
• Currently on the lookout for a lost old person
#NursingHomeProbz
• Today we had a terrible fall with a serious
head injury and lots of blood. Calls for
subway and some beers. ray@rachelm93
• Sucking down coffee like its my job in order
to function for this 8hr shift I am working…by
myself. erinm@eske7
• How to set boundaries online?
• Throughout your staff’s years in your clinic,
why would you want to be;
– Their “friend”
– Their “online buddy”» As their employer – the boundaries are firmly set
What to Share & With Whom
Copyright 2017 - NCMIC Insurance Company
• Employers increasingly using job applicants social networking profiles to supplement job applications
– 2010 study reported that 75% of recruiters used the internet as part of their applicant screening process (Walker).
• Individuals see “junk” as a joke to be only viewed by “friends”, prospective employers are another story
• Employers need to tread carefully if making an employment decision based on “profiles”
– Should have a neutral third party (other than the hiring party) screen the profiles of the candidates. They should be trained in what to look for and convey back to hiring party. They should also be trained in what not to report back to hiring party so they are avoiding information that could trigger laws in place.
Employer Advantages/Risks
• Almost 30% of job applicants denied employment when
potential employers discovered information about them
posted over the internet
• Employee posts – In personal use of social media,
employees can post information that prompts disciplinary
action
– How information is obtained is key. If it’s public,
employers who become aware can exercise discipline.
“Employers are Watching”
• Once you send/post you can’t UNSEND/POST
– If it’s posted on the internet, consider it permanent – even if you
delete posts, emails, picures, etc.
– You may limit it to an audience with your privacy settings, but that
doesn’t mean your audience won’t share, repost, or even copy and
save (screen cap).
– WayBackMachine – http://archive.org
• Internet archive with over 402 billion webpages saved
– All attorneys are aware this site exists and use it everyday they can
in the court room
Problem?
Malpractice Cases
Social Media
concerns and
Before and After and Texting
Facial Nerve Injury Case
Patient alleges poor informed consent leading to
nerve injury
Complaints of facial sensitivity to hot/cold,
drooling, pain upon drinking
Public Awareness
• Nursing Home case
• Juror problems case
• Hospital case
Avoiding Pitfalls
1. Social Media policy
2. Maintain privacy on public and private channels
3. Consequences!
•You need to have something in place!
•To protect your patients’ rights
•To instill professionalism throughout your
enterprise
•To protect you and your organization from liability
•To protect your employees from liability
Social Media Policy
• If the doctor or organization does not know
that employees are posting PHI but knows of
the popularity of social networking websites
and that its employees use such websites;
• Under Proposed HIPAA changes – may be “willful
neglect” if no policies and procedures are in place
• In the HIPAA proposed rule, HHS focused on lack of
policies and procedures
Why have the Social Media Policy?
Social Media Analysis
• Prior to implementing a policy – conduct a social
media analysis
• Identify types of social media currently being used• Is a defined purpose (goal) for the clinic – are the goals being
met?
• Do you understand privacy features?
• What level of engagement are you at – do you want to be at?
• Who monitors the site(s)?
• Do you have interactive sites, if so, do you set specified time to
respond? Do you have a plan in place for negative comments?
• Answering these questions will help you move forward
• Establish written policies re; security of
information, include policies on photos and
social networking sites
• Include policies prohibiting against posting
of clinic business or day-to-day clinic issues.
• Strong orientation program for new hires and
new associates
Steps to Take
• Post security reminders in areas around the clinic
• Inform all personnel/students of the consequences of violating the policies
• Make it clear that the business systems and company-issued equipment maybe used only for lawful and appropriate business purposes
Further Steps to Take
• Identify “appropriate business use” and incorporate into guidelines and policy
• Be sure that employees understand employer has a right to inspect and confiscate any devices issued to or used by employees
• Require signed employee/student acknowledgement of receipt of policy
Further Steps-cont.
• Update Confidentiality Policies
• Update annual HIPAA training to include Social
Media
• Address staff access to Social Media sites during
working hours, including access via the office PC or
an e-device for personal or practice-related
purposes
• Document training and have staff initial completion
What Should Be Included
• http://sharing.mayoclinic.org/guidelines/for-
mayo-clinic-employees/
• https://ww2.mc.vanderbilt.edu/socialmediat
oolkit/26838
• http://socialmediagovernance.com/policies/
(this site has 251 policies available)
Policy Examples
• Hand out to patients during their first
assessment with the doctor
• Describe whether you accept patient email,
and social networking “friend” status
• Consistency – patient’s are not a
professional’s “friend”
• Fiduciary Responsibility
Internet & Email Policy
• Check your privacy settings on social networks
• Remember doctors are held to higher standards of
personal conduct than other groups in society
• Malpractice allegation? Don’t talk about it on a
social networking site. Remember any social
networking site can be used against you in any
litigation and displayed on a large screen before a
jury in court.
Recommendations
Copyright 2017 - NCMIC Insurance Company
In case of FIRE …
EXIT building
before
posting it on
Social Media
QUESTIONS?
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today’s risk management
seminar
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