Social Media: Does it Breach Patient Security and Confidentiality?

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Social Media: Does it Breach Patient Security and Confidentiality?
Rebecca Hall, Cheryl Helm, Christina Mouse
Missouri Western State University





















This paper was prepared for Applied Research 460, taught
By Ms. Stephanie Corder

Social Media: Does it Breach Patient Security and Confidentiality?
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ABSTRACT
The question for research study was: Social Media: Does it breach security and patient confidentiality? The
survey was created and sent using Survey Monkey. Distribution was to over 100 participants, consisting of
Health Information Professionals, Health Information students, clinical professionals, and general population.
The purpose of the study was to gain knowledge of the public and professionals opinion and thoughts on how
secure their health data is when social media is involved in the communication of their care and treatment


















Social Media: Does it Breach Patient Security and Confidentiality?
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INTRODUCTION
Social media surrounds us each day: social networks that allow people to keep in touch with friends and
loved ones both near and far and professionals linking with others of their field to increase their knowledge and
stature; media sharing where uploading pictures and videos of everything from little Suzy taking her first steps
to instructions on how to sew a wedding dress are becoming more common. There are social news services that
post news items and links to articles then actually allow you to vote on these items. It is the voting that is the
social aspect, as the items that get the most votes, are the ones that are displayed most prominently. Micro
blogging that provides short updates that is then provided to anyone who is subscribed to receive those updates
and blog comments and forums where members can hold entire conversations attached around a topic of a
particular post have become everyday occurrences for most people.
With the prevalence of social media and the ease of gaining information through this means, it is not
unheard of to see a post on Facebook seeking advice on a medical topic, Little E is running a fever of 101.2
tonight. What should I do? (Anonymous 2014), queried a young mother seeking help for her baby. The
answers were as varied as the people posting, yet how accurate were they? Little E was running a fever because
he was teething for the first time, a normal occurrence in the life of a little one, however his mother was
panicked and went to the source she knew she could get some answers.
Knowing this is an area in which patients are comfortable, some physicians are exploring and in fact
using social media as a way to not only increase patient engagement, but get correct answers out to those who
are seeking information for their medical issues, but what about privacy? The federal Health Insurance
Portability and Accountability Act of 1996 (HIPAA), is a law whose primary goal is to make it easier for people
to keep health insurance, protect the confidentiality and security of their healthcare information and to help the
healthcare industry control administrative costs. For the purposes of this paper, the focus will be on the

Social Media: Does it Breach Patient Security and Confidentiality?
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confidentiality and security of healthcare information. The question explored was: Social Media: Does it
breach security and patient confidentiality

REVIEW OF LITERATURE
A study published in the Journal of Medical Internet Research was conducted researching social media,
the benefits and limitations. It was found that In the United States, 61% of adults search online and 39% use
social media such as Facebook for health information (Moorhead, et al. 2013). Many, like the new mother are
not only turning to social media to find answers to their medical questions but are posting medical issues that
are faced by family members, putting this private information out in a very public arena. Using social media
is like riding a hospital elevator, there's no control over who hears the information you might share with another
practitioner or its context (McBride, 2012).
The question then became, what does HIPAA say about the use of social media for medical
communication between a physician and their patient? The HIPPA privacy rule provides an individual with
the right to access and amend protected health information, if text messages are used to make decisions about
patient care, then they may be subject to the rights of access and amendment (Greene 2012). Basically this
statement only said that IF a physician communicated with a patient through text messages, then the patient
might have the right to have access to that information. However, after further research it was found that, The
Privacy Rule allows electronic communication between the patient and covered healthcare providers as long as
reasonable safeguards are used during the exchange, such as verifying the recipient's email address (McWay &
Smith, 2014). Yet still, this does not address the privacy issues of using Instant Messaging, YouTube and other
forms of social media as a means of communication between a physician and patient.

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As more healthcare professionals are using their cell phones to do their dictations as well as other
actions within patient charts and IPads while in the office to make notes actually in the electronic health record,
patients may wonder if their health record is secure on their physicians mobile devices. Conceivably, the
health information generated by a mobile device could also be useful for many non-clinical applications that use
medical records - such as audits, health research, and information reporting (Washington 2012). Are the
physicians following proper security protocol for their mobile devicesthat of being encrypted and password
protected? How do their patients feel about their doctors using cell phones or IPads while discussing treatment
of their various ailments?
Social media users are growing increasingly accustomed to sharing personal information online. Users
comment on everything from a status update about their cold to a recent article on diabetes. Patients today are
actively engaging online with other patients and family members regarding treatment, ailments, and
prescriptions (Sareen 2013). This is the reality that each physician needs to face. Education of both physician
and patient alike needs to take place to prevent breeches of security of the patient health record. Social media
is hereYour organization needs both a social media policy and a social media strategy. You cannot afford to
take a wait-and-see approach or to sit idly by while the social media revolution overtakes the information
revolution and radically changes the way we communicate and accomplish healthcare goals (Computer
Services Corporation (CSC).
Yet when we take a real deep look at social networks, are they really all that new? Indeed, the way we
find doctors -- and our access to them -- has always revolved around networks; these new, online platforms
simply upend all tradition. As Jamie Heywood puts it, Social networks have existed in health care for 100
years -- as guilds, mailing lists, and simply who you knew (Bradley 2013). Perhaps the real problem is that
social networks are more visable than ever before. When a person posts to face book that their mother is having

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problems with kidney stones, it is like sending a postcard out into the vast world wide web, there for everyone
to view.
METHODS
The method used for data collection, was both cross-sectional and population convenience. The group
decided to send out approximately 33 surveys each, and having them distributed to friends, family, co-workers,
and persons in the medical field. Included in the study; taking advantage of social media ourselves as
submission of the questions to Facebook, and through the Griffon Weekly.
Group meetings were held via Google Hangout to discuss questions, based on criteria set from the
instructor. The first project was discussing a research question. The question asked was Does Social Medial----
keeping the demographics simple, short, and to-the-fact, keeping them limited to no more than 10 questions.
Examples of questions were: Are you male or female; your age group we broke down into 18-25; 26-32; 33-40;
and 41-above. Questions then became focused on the usage, owning, and various type of social media. Focusing
attention on a positive representation of the user numbers of smart phones over laptops. After the demographics,
then questions were asked delving into more of how the respondents felt, trusted or if they themselves if in the
medical (clinical) area would use social medial to access patient information
Our survey was limited, in time, as well as survey site, (it was required to use Survey Monkey) it was
felt a well formatted survey, encompassing pertinent, short and to the point questions. After approval was
received on the questions, designed the format for the questions. Using the basic mainly yes/no and disagree,
strongly disagree, neutral, very likely, likely questions. Some questions were ranked, using choices: agree,
strongly agree, neutral, dislike, strongly dislike. The respondents would answer the questions and depending on
the answer, answers then were set it to where it would be ranked to see how well social media would be used to
rank how respondents felt or agreed or disagreed with physician and/or medical facilities using social media to
enter and obtain, or access a patients medical information.

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Responses collected, was then disseminated by Survey Monkey in both numbers, and percentages. In
other questions such as (example) and the answer choices were strongly agree, agree, neutral, disagree, and
strongly disagree.
Do you feel/agree your health information is secure from others when physicians or other health care
related professionals text information back and forth on their smart phones?
5.45%
3
5.45%
3
12.73%
7
20.00%
11
56.36%
31

55

1.84

In findings, it was perceived that most respondents would text their physicians, but are unsure of their
Health Information put on Social Media. Other information found of note; most respondents would watch a
You-Tube video of a procedure, however, were unsure if they would want their procedures on Social Media.
That section contained five related questions, with results following the same format. Survey Monkey
showed us the response factor, incomplete and skipped answers. After results started coming in, we realized that
some parts of those questions could be misconstrued, and confusing. However, the responses did provide a
closer look at what patients, clinical, and non-clinical providers would see themselves as using.
RESULTS
Survey sent out totaled 100, which received 68 total responses. From the total of 68 responses, 55 of
those were complete, (13 skipped answers and 2 did not answer. Information was reviewed as a population
cross section sample. Information submitted breakdown:
100 surveys sent; 68 responded; 55 complete 13 skipped answers
1B.Population size: 4
Mean (): 59

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Median: 61.5
Mode: No
Lowest value: 13
Highest value: 100
Range: 87
Interquartile range: 68.5
First quartile: 23.5
Third quartile: 92
Variance (2): 973.5

The results were overwhelming, and surprisingly answered more by women. We showed that out of the
68 responses, were 2:15 female (male 8; female 60), with the age group; 41 and over the highest percentage
answered at 61.76$%, and the lowest age group: 26-32 was only 4.41%.
Questions that totaled responses based on answers, showed very interesting results. An example would
be the questions: How likely are you to access Social Media for personal use while at work?
Never 76.67%
23
3.33%
1
3.33%
1
3.33%
1
13.33%
4

30
Sometimes 42.11%
8
5.26%
1
31.58%
6
21.05%
4
0.00%
0

19
Always 36.36%
4
27.27%
3
0.00%
0
0.00%
0
36.36%
4

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Social Media: Does it Breach Patient Security and Confidentiality?
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As you can tell, the first response is the higher mark. If not answered, it demonstrates a 0 or 0.0%
Found was most interesting is the results of the question:
Do you feel/agree health privacy is breached (compromised) when medical procedures are placed on
You-tube or other forms of video Social Media?
Strongly Disagree 14.55%
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Neither Agree nor Disagree 27.27%
15
Strongly Agree 25.45%
14

The neither agree nor disagree could be interpreted that more education is needed, they did not
understand the question, or they really do not know what the outcome of videos of patients are on Social
Medial. Yet, only one person stands between the Strongly Agree and the neither response.
On survey question:
Would you use instant Messaging (IM) to communicate with your physician or other Health care
professional? Results were:
Very Unlikely 25.45%
14
Undecided 20.00%

Social Media: Does it Breach Patient Security and Confidentiality?
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11
Likely 27.27%
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A similar question from another survey (http://searchenginewatch.com/article/2169462/33-of-U.S.-
Consumers-Use-Social-Media-for-Health-Care-Info-Survey) stated that 33% of consumers use social media for
Health Information. As you can see, the results are reasonably consistent with other surveys.
According to the results of this particular survey: although Social Medial is welcomed in homes and
professionals feel like it would help them, most people were not sure, or still had some concerns. In light of
many of the breaches, and Health Information applied for insurance coverage, would that explain the results?

DISCUSSION/CONCLUSION
This research is conclusive to what other research has discovered when questioning the public about the
use of social media when relaying personal health information between providers or using social media to
communicate with their care provider. The public overall feels that breeches are likely when the use of social
media, such as YouTube and texting via cell phones are involved. But, on the contrary, when physicians use
tele-commuting and IPads for the use of one-to-one care, the public does not feel breeches are being performed.
The limitations of this studied included the following: short time frame for collection of data, limited
resources to send study to, limited responses from participants and technical issues when setting up the survey.
With the advancement of technology, social media will be a huge part in communication methods for the patient
and the provider. Currently with the development of the state affiliated patient portals, patients will be able to

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access their personal health information. More research needs to complete to see where possible breeches of
confidentiality could occur with these portals. For instance, how are mental health records going to be
protected?




Findings; such as in the chart above, found about all who responded to the survey, had employment Social
Media Policies.




0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
56.06%
21.21%
21.21%
1.52%
Does Your Employment Have a Social Media Policy?
Yes: 37 No: 14 Don't Know: 14 Not Sure: 1

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BIBLIOGRAPHY
Anonymous. 2014. Facebook. Jan 15.
Bradley, Ryan. 2013. "Social Media Comes to Health Care." CNN Money, April 15.
http://money.cnn.com/2013/04/11/technology/social-media-health-care.pr.fortune/index.html.
Corporation, Computer Sciences. 2012. Should Healthcare Organizations Use Social Media? A Global Update. March.
http://assets1.csc.com/health_services/downloads/CSC_Should_Healthcare_Organizations_Use_Social_Media_
A_Global_Update.pdf.
Greene, Adam H. 2012. "HIPAA Compliance for Clinical Texting." Journal of AHIMA 34-36.
McBride, M. 2012. "Ensure Your Social Media Efforts Are HIPAA-Compliant." Optometry Times, 1-9. Accessed February
19, 2014.
McWay, Dana and Smith Jody. 2014. "Social Media Exchanges are Sometimes Part of the Health Record." Journal of
AHIMA 28-32.
Moorhead, S. Anne, Diane E. Hazlett, Laura Harrison, Jennifer K Carroll, Anthea Irwin, and Ciska Hoving. 2013. "A New
Dimension Of Healthcare: Systematic Review of the Uses, Benefits, and Limitations of Social Media." Journal of
Medical Internet Research e85.
Sareen, Himanshu. 2013. "The Evolving Role of Social Media in Healthcare." Social Media today. December 7.
http://socialmediatoday.com/himanshu-sareen/1978876/evolving-role-social-media-healthcare.
Washington, Lydia. 2012. "Managing Health Information in Mobile Devices." Journal of AHIMA 58-60.