Electronic Communications with Patients: Practical, Ethical and Legal Considerations

1. Electronic Communications with Patients: Practical, Ethical and Legal Considerations Michael Sacopulos, JD Erik Southard, CFNP, DNP

2. More than 500m active users on Facebook Hospitals such as Kaiser Permanente & Mayo Clinic use social media to benefit: patients, employees and practitioners In 2010, Physicians spent 8 hours a week online 13% of med student found violating their patients confidentiality 60% of med students found to have unprofessional online behavior

3. HITECH Act Decrypted HIPAA enacted 1996 -little to no prosecution HITECH Act enacted in 2009 - increase HIPAA confidentiality -tougher penalties -notification of breach -includes business associates

4. HITECH Act Decrypted Penalties: Prior: No more than $100 for each violation or $25,000 for all identical violations of the same provision. Currently: Established tiered ranges of increasing minimum penalty amounts, with a maximum penalty of $1.5 million for all violations of an identical provision. Future: Office of Civil Rights has asked $5.6 million in addition to their $46.7 million budget in 2012 to enforce the HITECH Act

5. How “you” communicate with a patient HITECH Act requires all communications involving ePHI be encrypted • Healthcare providers may seek their patients consent to communicating via unencrypted e-mail • Get patients consent in writing • Don’t give patient a binary choice • Consent document should note that the patient may withdraw his or her consent at a later time

6. How “you” communicate with a patient • Physician may be held responsible • Use an auto response feature • Don’t assume patient initiated e-mail is consent • Double check the e-mail address • Add e-mail correspondence to patient’s chart

7. & patients moiety12Matty Lucas @owenpallettmypatientlast night was named Patrick Owens, thought you'd appreciate that#TruFan l TryToppingTria Sun Kiss.  Ytf is mypatient here?! PeruvianGodess alexandra  i so badly wanna strangle mypatient!?! tryin to remain calm. this is testin my patience && tolerance to a whole other level gs2782 gav smith  Wonder if mypatient who had been waiting for 9 hours has actually seen a dr yet!!!,

8. Shark victim photo taken without consent

9. American Medical Association • Use privacy settings • Monitor internet presence • Maintain appropriate boundaries • Separate personal and professional content • Recognize online content can affect reputation with patients

10. Ohio State Medical Association • Employees should distinguish their own opinions • Don’t post negative comments about your co-workers • What you say online may be held against you at work • Monitor others internet behavior • Include employees when writing social media policy • Does your malpractice insurance cover social media? • Provide worthwhile company information and perspective

11. “Emerging Issues” • Defamation on Internet • Physician sued for plastic surgery procedure • Then launched website www.mysurgerynightmare.com • California courts: • Surgeon was public figure • No remedy from Internet Service Provider (ISP)

12. “Solution” Signed Contract

13. “Web Reality” This was one of the worst doctor's visits I've ever had. Dr. XXXX was unconcerned with how scared I was and seemed arrogant. Her staff treats you like you're a moron, particularly on the phone.

14. “Web Ratings”

15. Controlling your online reputation • Find out where you stand • Sign up for Google alerts • Purchase your name or practice’s domain name • Implement Social Media policy for your employees • Ask patients to review you on a reputable website • Consider asking patients to sign an agreement

16. Contact: Mike Sacopulos, JD Mike_Sacopulos@Sacopulos.com Erik Southard, CFNP, DNP