Re-defining Terms

Many of us work in settings where policies exist regarding the use of social media, but how many have policies that address accessing publicly available information online? To adequately discuss the implications and ramifications of using an Internet search engine, we generally define it for the purposes of this article as: the use of Internet-based tools that allow communication, sharing of information and ideas, and media-sharing sites. These tools can be used to improve professional networking and education, patient education and/or public education, and general information gathering.

Before utilizing these tools, however, an understanding that there are professional limits to their use is important, such as confidentiality and privacy of those whose care we are responsible for. Privacy relates to the patient’s expectation and right to be treated with respect and dignity. Confidentiality refers to the fact that any information learned regarding the patient must be safeguarded, not shared with others outside of those caring for the patient at that time, and should be shared only for the purpose of providing care for the patient. Informed consent is defined as permission granted with the knowledge of the possible consequences, typically that which is given by a patient to a care provider with full knowledge of the possible risks and benefits.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established national standards to protect patients’ medical records and other personal health information and applies to health plans, healthcare clearinghouses, and those healthcare providers who conduct certain healthcare transactions electronically. HIPAA requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures of such information that may occur without patient authorization. It also gives patients’ rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections. Sharing information with patients via the Web, holds its own legalities. Professional caregivers need to be sure that information shared is accurate and reliable. They must also determine that the way information is shared is appropriate. For example, sending a patient information regarding his/her own diagnosis and/or treatment through an unprotected email server or website is not HIPAA compliant.

Where to Draw the Line

We must first ask ourselves if others need to know information about our patients gathered from sources outside of health care. For example, when caring for a patient with a criminal record who has completed required incarceration time or civic duty, whether the medical team knows what the crime was is not important unless it directly affects medical decision-making for the patient. Consider the patient who violates probation or parole and must serve time as a result: This poses challenges for completing prescribed treatment and thus requires seeking additional information, such as: whether your patient will be allowed to complete treatment at your facility; how to arrange for a transfer of care, perhaps due to distance between the correctional facility and the patient’s treatment team; or maybe even how to keep a patient with a compromised immune system or who has a port in place safe in a correctional facility. Quite honestly, the actual violation or reason for the arrest is not a vital piece of information for making necessary treatment-related decisions, although it may pique the interest of members of the healthcare team.

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However, what if a young patient with newly diagnosed, advanced-stage cancer and has struggled with an addiction is the person you recall hearing on the morning news has been arrested for an alleged crime? If this patient must begin treatment within a certain time frame, per recommended treatment guidelines, a decision has to be made on whether sharing what was learned in a public forum is vital to making treatment decisions within the multidisciplinary care team that best support the patient. There are certainly gray areas, depending on the situation. The question becomes one of ethics.