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In the world today, smartphones are becoming the “norm”, with basic phones becoming nearly obsolete in recent years. Pairing the overwhelming presence of social media with the rise in usage of smartphones brings to light an entirely new set of problems and challenges regarding patient privacy. According to a 2010 study conducted regarding various boards of nursing, 67% of executive officers surveyed reported receiving complaints about nurses misusing social media (Spector & Kappel, 2012). Incidentally, social media use in healthcare has garnered many positive results as well. One study found that 67% of doctors use social media for professional use, and of their followers, 60% of social media users trust posts by their doctors and 55% of users trust posts by hospitals (Skram, n.d.). However, the question remains, with social media does the good outweigh the bad, and how do hospitals foster the good while impeding the bad?
Due to the sensitive nature of the information kept by healthcare providers about their patients, principles were put in place to reduce the risk of breeching patient privacy. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) set national standards and regulations regarding the protection of patients’ privacy and personal health information (U.S. Department of Health and Human Services [HHS], n.d.). Under The Privacy Rule enacted by HIPAA, protection is governed over all, ‘Individually identifiable health information’ [which] is information, including demographic data, that relates to: the individual’s past, present or future physical or mental health or condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. (HHS, n.d., p. 2).
There are instances outlined in HIPAA that permit a healthcare provider to disclose a patient’s personal health information which include disclosing information to the individual receiving treatment, information for treatment, payment, or healthcare operations, and information for uses and disclosures with opportunity to agree or object, such as in cases in which a patient is incapacitated in the emergency department (HHS, n.d.). Also, disclosure is permitted for incidental use and disclosure and in a limited data set in which all personal identifiers have been removed (HHS, n.d.).
Furthermore, personal health information may be disclosed for public interest and benefit activities such as those required by law, those to ensure safety of victims of abuse, information for decedents, information for tissue donation, information for research studies, if there is a serious threat to health or society, and in cases of workers’ compensation (HHS, n.d.). If health information is released in discordance with the rules and regulations set forth by HIPAA, legal action, both civilly and criminally, can be taken against the individual responsible as well as the healthcare organization with which the individual is involved.
Advantages of Smartphones and Social Media in Healthcare
Smartphones in the healthcare setting can be very useful both for patients and providers. One advantage of smartphones in the healthcare setting is the overwhelming presence of medical applications that can be accessed and downloaded on smartphones (Wyatt & Krauskopf, 2012). Nurses, physicians, and other medical professionals can quickly access a host of medical reference material straight from their smartphones. Several applications are also available that are useful for patients, giving information about chronic conditions, health and wellness, and fitness (Wyatt & Krauskopf, 2012). Many applications such as MyFitnessPal and iFitness™ are tailored to help individuals keep track of nutritional intake and exercise habits (Wyatt & Krauskopf, 2012). This can be extremely useful for people wanting to make lifestyle changes regarding nutrition and fitness, especially those aiming to lose weight and become healthier overall.
Moreover, social media can be very beneficial to patients suffering from chronic conditions as well as their family and friends (Norton & Strauss, 2013). For rare diseases local community support groups may not be available. Social media steps in to fill this void by offering users a variety of different online support groups, blogs, newsletters, and networks. Individuals can use such resources to reach out to others with similar issues, find much needed support during difficult times, and become aware of treatments and medications that worked for others with their same illness that may prompt them to contact their doctor about other possibilities in treatment options. When used properly, smartphones and social media can be very beneficial to healthcare providers and patients.
Disadvantages of Smartphones and Social Media in Healthcare
Unfortunately, along with the good must come the bad. For every positive aspect of smartphones and social media in healthcare related settings, there is an equally negative aspect. One pitfall of smartphones in healthcare is directly related to one of the positive aspects of smartphones: the availability of medical applications. While the majority of medical applications are produced by reliable sources with accurate, researched information, there are still medical applications in existence that supply untrustworthy and erroneous information. Gagglioi (2012) observes that, “[medical] apps have not been subject to rigorous testing” (p. 512) the reason for which being, “that most of these apps reach consumers/patients directly, without passing through the traditional medical gatekeepers” (p. 512). When patients base future interventions on these erroneous applications, such as seeking treatment or using home remedies, there can result harmful and even fatal consequences.
Another undesirable characteristic of smartphone usage in healthcare settings is the tendency of smartphones to be distracting (Gill, Kamath, & Gill, 2012). Smartphone usage can cause a disruption in workflow which can lead to medical errors and negligence. A study in Australia found that of 439 perfusionists surveyed, 49.2% admitted that they had sent text messages while performing a cardiopulmonary bypass (Gill, Kamath, & Gill, 2012). The
interference in diligent attention to patient care caused by smartphones can present contamination, infection, and hygiene risks as well as impeding the ability of the healthcare provider to recognize potential complications or downward trends in their patients (Gill, Kamath, & Gill, 2012). In healthcare, even momentary distraction can lead to fatal consequences.
Lastly, a huge problem concerning smartphones in healthcare related settings involves the usage of cameras and social media. As seen in the scenario presented, the nurse on duty abused her smartphone and violated HIPAA by sending pictures of her patient to her friend via text message. Privacy is extremely important in healthcare because patients are less apt to share important information with the provider if they fear that the information could be disclosed or disseminated without permission (Spector & Kappel, 2012). Sharing pictures of a patient or any information regarding a patient without express written permission is a direct violation of HIPAA regulations and is therefore subject to the consequences set forth.
Since the nurse on duty knowingly violated HIPAA by sending photos to her friend via text message, she should be investigated and penalized. As mentioned above, in a study conducted of boards of nursing, 67% of executives have encountered complaints about nurses regarding social media (Spector & Kappel, 2012). Of those surveyed, all 67% who had complaints took disciplinary action against the responsible party (Spector & Kappel, 2012). Based on the precedent set in the previous study, the hospital should discipline the nurse in the scenario for her inappropriate behavior. Furthermore, the hospital has a legal obligation set forth by national law demanding that disciplinary action be taken when the administration becomes aware of a staff member violating HIPAA policy.
Conclusion and Recommendations
Based on the information presented about HIPAA rules and regulations, the fourth conclusion is the only choice able to be deemed as ethically and legally appropriate. The fourth conclusion involves an extensive investigation into the HIPAA violation by the hospital, and the implication of legal action being pursued against the responsible party and the hospital. For her unsuitable behavior, the nurse at the very least should incur a formal investigation and write-up as well as suspension from her duties.
The nurse violated HIPAA by sharing individually identifiable health information (HHS, n.d.). Legally, in the case of a violation in which the perpetrator was unknowing and would not have known even by exercising reasonable diligence, the consequence ranges from a $100 to $50,000 fine for each violation, with a maximum fine of $1.5 million for identical provisions within a calendar year (“Penalties for violating HIPAA”, 2014). However, in the case of the nurse in the scenario, supposed to have extensively learned the encompassment of HIPAA violations previously, the nurse likely would not be considered to be unknowing which would therefore result in more severe consequences.
Furthermore, the nurse violated the Code of Ethics for Nurses by violating her patient’s right to privacy. The nurse violated Provision 1 set forth by the Code stating, “The nurse, in all professional relationships, practices with compassion and the respect for the inherent dignity, worth, and uniqueness of every individual” (Fowler, 2010). More specifically, she violated Section 1 of Provision 1 regarding respect for human dignity (Fowler, 2010). The nurse also violated Provision 3 of the Code of Ethics which states, “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (Fowler, 2010).
Section 1 of Provision 3 regards privacy and Section 2 of Provision 3 regards confidentiality, both of which the nurse dishonored by sending a picture of her patient without his knowledge (Fowler, 2010). The nurse in the scenario not on violated the law regarding HIPAA, she also violated the Code of Ethics for Nurses set forth by the American Nurses Association. In all respects, what the nurse did was ethically, morally, and legally wrong.
A lot can be learned from this assignment. It is clear that the use of smartphones and social media needs to be monitored carefully by nurses and other healthcare professionals. Any impropriety in patient privacy with smartphones or social media can become widespread and far-reaching in a matter of minutes. What seems small at the moment can turn into a huge ordeal involving investigations, legal implications, fines, and civil lawsuits. For that reason it is of the utmost importance to be diligent in considering patient privacy and HIPAA before any post made to social media or any text message sent.
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