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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