How Edward Snowden and PRISM affect health care social media

How Edward Snowden and PRISM affect health care social media

Edward Snowden’s whistleblowing on the NSA’s PRISM program raises some interesting questions regarding social media in healthcare. I had a few physicians both inside and outside of the community I manage ask, “Is the government watching what I say about my clinical experiences?” The answer is of course “Not yet,” but the sentiment weighs heavier than the question, and the weeklong dip in physician activity in social media means it’s time to for us to talk: Do we continue the mobile health revolution knowing it’s going to be “televised?”

Recently, HHS announced its wishes to amend HIPAA for the purpose of cross-referencing psychiatric PHI with traditional background checks. The proposal comes amidst cries for some sort of response to the rise in gun-fueled killing sprees like Newtown and Aurora, but is now being met with resistance from both the American Psychiatric Association and the American Psychological Association, the AMA, and a host of other physician groups. In light of recent events, the backlash seems more than understanding.

Engaging online under HIPAA has always been a risk each physician has had to assess in building their practice. Care can be cheaper and more comprehensive by taking advantage of recent strides in technology. However, every opportunity to heal more, learn more, and do more can become another piece of evidence in a malpractice suit against you. It is with Snowden’s revelation that the specter of a criminal investigation becomes a possibility for forward-thinking practitioners. Does this mean docs should reject these new tools?

First, you must embrace the fact that the revelation does nothing to help change your past. The data has already been captured, and a quick glance at the website “Three Felonies a Day” will show you that you’re already guilty. That’s all of us. Going back to the way your grandfather practiced medicine is not going to save you from what you did before you read about the leak in The Guardian.

Secondly, acknowledge that PRISM is not yet being used to target doctors’ EHR for violating HIPAA, the Espionage Act, or any other form of criminal activity. That won’t be a problem for you for at least another four years. In fact, knowledge of this federal snooping presents an opportunity for you and your fellow early-adopters to stretch this time of détente out. A government seeking to implement universal healthcare in a society facing a PCP shortage will most likely bend to the wishes of a well-informed, tech-savvy medical community.

All of this is leading to a counterintuitive, yet necessary response: For the sake of your practice, your patients, and the future of medicine, you must engage in online healthcare more than you did before. To cast plans for a patient portal aside because of a knee-jerk response is not only detrimental to your patients, but also to health innovators striving to cut through the more practical and immediate threats of government intervention on these new tools of business and healing.

Of course, caution is still necessary, and not every innovation will be a necessary or even good one – Bryan Vartabedian posted a review on the severely-hyped “Instagram for doctors” app, Figure 1, debating its security and even relevance. But, where would we be today if Figure 1 decided that, despite physicians stating a desire for crowdsourcing solutions with image-sharing technology, the risk of being monitored means it’s not worth a try? Where would we be if Dr. Vartabedian didn’t have a platform to provide reviews of these innovations to his peers?

Worrying about Big Brother invading your practice is not your problem right now. However, it will become your problem if you withdraw from the conversation, and pretend he’s not there.

T.J. Derham is social media community manager, and can be reached on Twitter @SociallyMD.

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  • buzzkillerjsmith

    So you have it on good authority from the NSA that it is absolutely inconceivable that it is snooping on us. Ah human gullibility knows no bounds.

    • TJ Derham

      At the moment, I think the amount of data and where current priorities are means that the snooping on docs is minimal. For now.

      • C.L.J. Murphy

        As long as you were good little soldiers, donating to the Obama campaign and pushing the Obama line on healthcare, you should be safe for now.

        • TJ Derham

          Didn’t say “safe” for now. There is no “safe for now” with data that’s hoovered and shelved. There is an opportunity to tell this administration and future ones that nothing less than real transparency is acceptable. No doc should be afraid to use these tools to become better doctors.

  • C.L.J. Murphy

    With first the IRS revelations, and now the NSA ones, I hope you understand now why so many patients are thinking twice about the wisdom of letting their doctor consign all of their private medical records to Obama’s much-vaunted (and taxpayer-stimulated) universal electronic medical record systems.

    Republican taxpayers, aka “enemies of the state”, have already been targeted for punishment and had their private income tax forms given to left-wing think tank Pro Publica, among others; now, between the IRS administering their Obamacare and the NSA hoovering up all their data including their universal electronic medical records, one can’t wait to see how they will be punished for Wrong-Thinking next.

    “If Bush had done this to Democrats….”

  • Clink Shrink

    See also my recently posted column on the RAND think tank report on national security use of digital media:

    • TJ Derham

      Good read. Nowhere, I think, is this more immediately relevant than in your specialty.

  • doc99

    It’s curious how image sharing via DICOM is standard and informal image sharing is commonplace, yet physician medical record sharing via EMR, often even within the walls of the same hospital, is still problematic.

    • TJ Derham

      Hmm. My guess is that most EMRs, in their attempt to deliver a single-box solution, miss the finer points that specific solutions companies like DICOM and Figure 1 specialize in. Would you prefer it if your EMR collaborated to provide third-party support for resolving such problems, or is it not that simple?

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