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New Media: Same Old Potential Pitfalls Harnessing New Media Tools PRMS Session at Oklahoma Hospital Association Annual Meeting November 12, 2009 David Harlow JD MPH THE HARLOW GROUP LLC

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<ul><li>“ On the Internet, nobody knows you’re a dog.” </li></ul>THE HARLOW GROUP LLC

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Uses of Social Media <ul><li>Preliminary questions: </li></ul><ul><ul><li>What are your strategic goals? </li></ul></ul><ul><ul><li>How can social media help you achieve them? </li></ul></ul><ul><ul><li>What resources will you devote to this effort? </li></ul></ul><ul><ul><li>How will you structure this effort? </li></ul></ul><ul><li>Involving the lawyers early on can help avoid costly retrenchment and/or errors later </li></ul>THE HARLOW GROUP LLC

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Elements of Common-Law Legal Liability <ul><li>A duty that one party has to another party </li></ul><ul><li>A breach of that duty </li></ul><ul><li>Harm to the second party </li></ul><ul><li>Causal link between the breach of the duty and the harm </li></ul><ul><li>Example: A physician has a duty to provide services according to a standard of care; if she provides lesser services and her patient is injured as a result , that’s malpractice </li></ul>THE HARLOW GROUP LLC

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Liability under regulatory schemes . . . like HIPAA, just for example <ul><li>If you violate the letter of the law (or regulation), and disclose information that you should not, you are liable to the federal government </li></ul><ul><ul><li>Fines </li></ul></ul><ul><ul><li>No third party liability </li></ul></ul><ul><li>Under state law there may be liability to patients as well for violating confidentiality </li></ul><ul><ul><li>And remember, patient claims that go to court will be heard by a jury </li></ul></ul>THE HARLOW GROUP LLC

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Common Law & Regulatory Liability: Based on Definitions of Relationships <ul><li>Therefore . . . </li></ul><ul><li>Must clearly define the relationship between health care providers and social media users </li></ul><ul><ul><li>Terms of Service </li></ul></ul><ul><ul><li>Policies and Procedures </li></ul></ul><ul><li> Must be tailored to your organization </li></ul><ul><li>Must stay within the bounds of that relationship </li></ul><ul><ul><li>Shalts </li></ul></ul><ul><ul><li>Shalt Nots </li></ul></ul>THE HARLOW GROUP LLC

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Keys to avoiding liability <ul><li>Patient consent where relevant </li></ul><ul><ul><li>Notice of Privacy Practices (HIPAA NPP) should address social media </li></ul></ul><ul><ul><ul><li>How it is used </li></ul></ul></ul><ul><ul><ul><li>Degree of privacy that may be expected </li></ul></ul></ul><ul><ul><ul><li>Express notice not to use for emergencies; statement that channel; is not monitored 24/7 </li></ul></ul></ul><ul><ul><ul><li>NPP and internal P & P should be consistent </li></ul></ul></ul><ul><li>Remember: the fact that a patient-provider relationship exists is itself PHI </li></ul>THE HARLOW GROUP LLC

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Keys to avoiding liability (cont’d) <ul><li>Good judgment </li></ul><ul><ul><li>Do not practice medicine on line . . . </li></ul></ul><ul><ul><ul><li>Unless the patient has given informed consent in advance (and even with consent, clinical interactions should not be in a public forum) </li></ul></ul></ul><ul><ul><ul><li>Emergency exceptions? </li></ul></ul></ul><ul><ul><ul><ul><li>Similar to what we would do “IRL” </li></ul></ul></ul></ul><ul><ul><li>Do not try to establish clinician-patient relationship online . . . </li></ul></ul><ul><ul><ul><li>Unless through a secure, private portal </li></ul></ul></ul><ul><ul><li>Clinician-patient communication should end up in EHR </li></ul></ul>THE HARLOW GROUP LLC

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Who will be judging me? <ul><li>Patients and potential patients </li></ul><ul><li>Regulatory bodies </li></ul><ul><li>A jury of your peers? </li></ul><ul><ul><li>Think about what policies and procedures you want to have on the books and fully implemented before you end up on trial in front of a jury made up entirely of twentysomething Facebook users who expect everyone to live their lives online 24/7 </li></ul></ul>THE HARLOW GROUP LLC

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Sample situations <ul><li>Disclosure of a child’s HIV status by a parent </li></ul><ul><li>Posting PHI in a hospital-hosted community </li></ul><ul><li>Live-tweeted surgery going south </li></ul><ul><li>Accepting negative comments on hospital website </li></ul><ul><li>Responding to a patient’s tweet </li></ul><ul><ul><li>Positive: “I’m cancer free one year later” </li></ul></ul><ul><ul><li>Negative: “I’ve been waiting in the ED for hours” </li></ul></ul><ul><li>Emergency communication on a Facebook page </li></ul><ul><li>Notice of a GSW via Twitter to an MD (mandated reporter) </li></ul>THE HARLOW GROUP LLC

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It’s a journey, not a destination <ul><li>Policies and procedures will be revisited and revised </li></ul><ul><ul><li>As you gain experience </li></ul></ul><ul><ul><li>As your comfort level increases </li></ul></ul><ul><ul><li>As technologies evolve </li></ul></ul>THE HARLOW GROUP LLC

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Resources <ul><li>HCSM legal roundtable bit.ly/HCSMlegal </li></ul><ul><li>HCSM legal tweetchat bit.ly/HCSMlegalchat </li></ul><ul><li>#HCSM homepage healthsocmed.com </li></ul><ul><li>HealthBlawg social media posts j.mp/HealthBlawgSoMe </li></ul><ul><li>HealthBlawg on Twitter twitter.com/healthblawg </li></ul><ul><li> You should follow me on Twitter . . . </li></ul>THE HARLOW GROUP LLC

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Contact <ul><li>David Harlow JD MPH </li></ul><ul><li>THE HARLOW GROUP LLC </li></ul><ul><li>harlowgroup.net </li></ul><ul><li>healthblawg.typepad.com </li></ul><ul><li>twitter.com/healthblawg </li></ul><ul><li>[email_address] </li></ul><ul><li>617.965.9732 </li></ul><ul><li>for contact info in an sms, txt dharlow to 50500 </li></ul>THE HARLOW GROUP LLC