Assignment Prompt & Instructions
All information are provided below I attached the 2 articles i want you to use and a portion of the textbook as well
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**## pdf_download_6A4D5CD2-5399-4EC0-8B63-1E8607D7DF2F.pdf**
HIPAA Violations on Social Media:
THINK Before You Post!
by Dorothy Bouldrick
44
Unfortunately,
students are often
unaware of the
professional
repercussions
unprofessional
conduct on social
media can have on
their careers/'
In tro d u c tio n
Social networks such as Facebook
and Twitter are used by healthcare
professionals and students pursu
ing health careers to communicate,
collaborate, network with col
leagues, market healthcare ser
vices, and share personal and pro
fessional experiences. Social media
technologies have provided users
with new and engaging communica
tion tools such as Instagram, Vine,
and blogs that have changed the
way people communicate. This
change provided a platform to
enable its users to reach large audi
ences in a matter of seconds!
However, the ease with which users
can transmit information to the
masses has presented challenges in
the form of unauthorized disclosure
of patients’ health information on
social media sites. The increase of
patient privacy violations on social
media has healthcare and academic
leaders struggling to find ways to
combat the problem. After all,
HIPAA (Health Insurance Portability
and Accountability Act) training is a
staple in allied health programs and
the healthcare industry; yet, unau
thorized disclosure or protected
health information on social media
continues to make headlines (see
Table 1).
Healthcare professionals and
scholars (Kwoh, 2012; Chretien et
al, 2011; Ressler & Glazer, 2010;
Thompson & Bell, 2007) have
framed the conversation surround
ing patient privacy violations on
social media. Some have expressed
the need for social media policies to
be developed and implemented by
institutions of higher learning
(Chretien et al, 2010; Thompson &
Bell, 2007). Subsequently, Chretien
et al (2010) stated “finding balance
in expression of free speech and
medicine’s social contract with
society may require consensus
gathering among all stakeholders:
the public, practicing physicians,
medical educators, and students.”
Unfortunately, students are often
unaware of the professional reper
cussions unprofessional conduct on
social media can have on their
careers. In some cases, a student’s
career can be over before it gets
started (Woodley, C., & Silvestri, M.,
2014).
H IP A A V io la tio n s v ia S oc ia l
M e d ia A re on th e R ise!
There have been several well-pub
licized cases of HIPAA violations
regarding patient privacy breaches
on social media sites such as
Facebook and Twitter. While previ
ous incidents were found to be
unintentional, the more recent
cases are showing signs of mali
cious intent and that the problem is
escalating. In a case involving a
community college in Kansas, one
of four students was dismissed
from a nursing program for posting
photos of themselves in a lab with a
human placenta on Facebook. The
student that posted the photo pro
claimed that she was given permis-
24 AMT Events March 2015
sion by her instructor; however, the instructor denied
the allegation. The student sued the college for viola
tion of her due process and was reinstated into the
program. The judge’s ruling in this case favored the
student on the grounds that the college failed to clearly
define that the student violated professional conduct
(Chronicle of Higher Education, 2011). This ruling high
lights the importance of discussing social media do’s
and don’ts with students before beginning a practicum/
intemship/extemship. It also revealed a need for allied
health faculty and administrators to develop social
media policies with clear guidelines for its use both in
and out of the clinical setting along with clear conse
quences for violators.
HIPAA’s Privacy Rule
HIPAA’s Privacy Rule set the guidelines for the use and
disclosure of protected health information. The Privacy
Rule protects all “individually identifiable health infor
mation” held or transmitted by a covered entity
(e.g., health providers, health plans, healthcare clearing
houses) or its business associate, in any form or media,
whether electronic, paper, or oral. (HHS, 2006). This
identifiable information can relate to (a) the individual’s
past, present or future physical or mental health or con
dition; (b) services provided to the individual, or, the
past, present, or future payment for services rendered to
the individual. Unauthorized disclosure of this informa
tion can lead to a breach of HIPAA’s Patient Privacy Rule
(HHS, 2006). A breach is impermissible use or disclosure
of protected health information that can cause signifi
cant risk to the affected individual.
Consequences for Violators
Healthcare facilities that do not comply with HIPAA
regulations can be excluded from participation in the
Medicare/Medicaid programs, disciplinary action by the
hospital board, and other professional licensing and cer
tifying agencies. The unauthorized disclosure of protect
ed health information (PHI) knowingly or unknowingly
on social media or any other form can result in civil and
criminal penalties with fines and possible imprisonment.
Penalties are:
• $100 per violation, up to a $25,000 maximum per
year for repeat offenders
• $50,000 per violation; 1.5 million dollar maximum
• Certain offenses can result in up to 5 -10 years in
prison if the information obtained is found to be
used for personal gain or commercial profit.
Please visit the American Medical Association’s HIPAA
Violation and Enforcement website for more detailed
information on fines and penalties.
Table 1
Cases of HIPAA Violations via Social Media
Institution Case Overview
University of Cincinnati Medical
Center
Patient claimed a financial ser
vices employee posted a
screenshot of her medical re
cords including diagnosis and
other identifying information
on social media
Johnson County Community
College
One of four nursing students
dismissed from nursing pro
gram for posting photos of
themselves in a lab with a
human placenta on Facebook
Westerly Hospital in Rhode Is
land
Emergency room doctor termi
nated, reprimanded by the
state medical board, and fined
$500 for posting information
online about a trauma patient
St. Mary Medical Centers in
California
Four staff members terminat
ed, three disciplined for post
ing photos of a dying patient
on Facebook. Two of the em
ployees involved were nurses
Tri-City Hospital in California Employees utilize social media
to post personal discussions
of patients
Mercy Walworth Medical Cen
ter in Wisconsin
Nurses were terminated for
posting photos of a x-ray
showing a sex device lodged
in the patient’s body on Face-
book
University Medical Center
Nursing School Mississippi
Administrative Assistant termi
nated for a tweet expressing
her dislike for the Governor
having the facility staffed on
Saturday when it is normally
closed, instead of scheduling
an appointment during normal
operating hours.
Richmond University Medical
Center Staten Island
EMT posted picture of a mur
der victim who had been
strangled with a hair-dryer
cord on his Facebook page
Is it a HIPAA violation if my post does not
include patient identifiers (nam e, address,
DOB, medical record number, etc.)?
A common misconception concerning unauthorized
disclosure of protected health information involves
HIPAA’s Privacy Rule de-identification methods. To
avoid privacy breaches using de-identification, “the
removal of specified individual identifiers (as well as
absence of actual knowledge) that the remaining infor
mation could be used alone or in combination with
other information to identify the individual must be
utilized to prevent unauthorized disclosure of health
information (HHS, 2013). Therefore, if a post contains
snippets of information such as place of incident, date,
and time of incident where others in your network
familiar with the incident can determine the patient’s
(continued on page 26)
AMT Events March 2015 25
HIPAA VIOLATIONS
(continued from page 25)
identify, a breach has occurred (Cromwell, 2011).
These types of privacy violations often occur during
times of catastrophic events such as major accidents,
natural disasters, or other unusual medical events that
make headline news. Other instances of unauthorized
disclosure of protected health information occur
during clinical rotations by students who inadvertently
disclose protected health information on personal
social networks, class blogs using proprietary hosting
sites, instead of the firewall protection of the college’s
learning management system (LMS) (Chretien et al,
2009).
Best Practices for Social M edia Use
The enormous potential of social media technologies
for dissemination of health information, marketing
healthcare services, patient feedback and community
building is extremely valuable in healthcare. There are
hundreds of blogs, wikis, Facebook pages, and other
social networking sites that focus on medical and health
topics. The most popular health websites reported by
eBizMBA (2013) are Yahoo! Health (21.5 million),
National Institutes of Health (20 million), WebMD (19.5
million), MedicineNet (10.5 million), MayoClinic (7 mil
lion), and Drugs.com (6 million). The Mayo Clinic Center
for Social Media is the leader in demonstrating how the
appropriate use of social media can foster collaboration,
patient education, professional development, and
improved patient outcomes. By all means, utilize social
media to foster good patient outcomes, but consider the
following to safeguard patient privacy:
1. Review your college and/or employer’s social media
policy to become aware of the do’s and don’ts of
social media use. If your college and/or employer do
not have a social media policy, review
“Professionalism in the Use of Social Media” by
American Medical Association and/or “A Nurses
Guide to the Use of Social Media” by the National
Council of State Boards of Nursing (NCSBN).
Although these guidelines are geared toward physi
cians and nurses, they encompass the professional
behaviors expected of all healthcare professionals
using social media. You may also review the NCSBN
Social Media YouTube channel for videos to gain a
clearer understanding of appropriate and inappro
priate use of social media.
2. Review your privacy settings and get a clear under
standing of privacy policies before posting content.
Deleting a post does not mean it was not read and
shared with others online.
3. Identify yourself. If you communicate via social
media about a healthcare provider, disclose your
connection with the provider and your role at the
facility. Use good judgment and be accurate.
4. Although you may have a personal social media
page, remember that you share a connection with
your employer and anything you post about your
workday or patients can be linked back to the pro
vider.
5. Do not post photographs of patients, healthcare set
tings, lab procedures, specimens, or anything involv
ing patient care on social media.
6. Do not use social media to discredit or air grievanc
es with your employer. Resolve conflicts in-house
with the help of your supervisor and human
resources.
7. If you become aware that another extern has posted
patient information on a social media site, report it
to your clinical coordinator and program director
immediately!
8. Think before you post! Ask yourself, how would I
feel if I were the patient? How would my family feel?
The Golden Rule always applies!
The Takeaway…
Incidences of unprofessional conduct via social media
by students present continuous challenges for allied
health faculty and administrators. Some have expressed
the need for social media policies to be developed and
implemented by institutions of higher learning (Chretien
et al, 2010; Thompson & Bell, 2007). As providers of
care, clinicians and administrative staff are charged with
not only delivering quality care and services, but being
an advocate for patients. Students and healthcare work
ers must display professional, ethical behavior at all
times. Unauthorized disclosure of patient information
on social media is not only a HIPAA violation; it is a vio
lation of TRUST between the patient and the healthcare
provider. Students performing practicums/intemships
for program completion must demonstrate the high pro
fessional standards expected of healthcare workers by
protecting patient privacy and report incidences of pri
vacy breaches found on social media to their supervisor
or clinical coordinator to determine the appropriate
course of action. Remember, the Department of Health
& Human Services (HHS), Office of Civil Rights (OCR) is
responsible for investigating complaints of privacy
breaches. For more information about filing a com
plaint, visit HHS at http://www.hhs.gov/ocr/privacy/
hipaa/complaints/index.html. ■
26 | AMT Events March 2015
[http://www.hhs.gov/ocr/privacy/](http://www.hhs.gov/ocr/privacy/)
References
American Medical Association (2011) Professionalism in the Use of Social
Media. Retrieved from http://www.ama-assn.org/ama/pub/physician-
resources/medical-ethics/code-medical-ethics/opinion9124.page?
American Medical Association (2009). HIPAA Violations and Enforcements.
Retrieved from http://www.ama-assn .org/ama/pub/physician-resources/
solutions-managing-your-practice/coding-billing-insurance/hipaahealth-
insurance-portability-accountability-act/hipaa-violations-enforcement.
page?
American Society of Registered Nurses. (2010). When Facebook Goes To The
Hospital, Patients May Suffer. Retrieved from http://www.asm.org/joumal-
nursing/july-2010.html
Chretien, K. C. MD, Faman, J. M. MD, Greysen, S„ MD &; Kind, T. MD
(2011). To friend or not to friend. Academic Medicine, 86 (12), pp 1545-
1550 doi: 10.1097/ACM.0b013e3182356128
Chretien, K.C. MD, Goldman, E. F„ Beckman, L. & Kind.T. (2010). It’s your
own risk: Medical students’ perspectives on online professionalism.
A cadem ic M e d ic in e , 8 5 (1 0 ), S 6 8 -7 1 . do i: 10 .1097/
ACM.0b013e3181ed4778.
Chretien, K.C., Greysen, S. R„ Chretien, J. & Kind, T. (2009). Online posting
of unprofessional content by medical students. JAMA, 302 (12), 1309-
1315.doi:10.1001/jama.2009.1387.
Clark, K., & Kearns, S. (2010). Hospital Seek to Terminate Hospital Workers
for Privacy Breaches on Social Media. Retrieved from http://www.
healthleadersm edia.com /page-l/H R -252540/H ospital-Seeks-To-
Terminate-Five-Hospital-Workers-For-Privacy-Breaches-on-Social-
Media##
Conaboy, C. (2011, April, 20). For doctor, social media a tricky case. Boston
Globe. Retrieved from http://www.boston.com /lifestyle/health/
articles/201 l/04/20/for_doctors_social_media_a_tricky_case/
Cromwell Communications (2011, July 1). Avoiding HIPAA violations in
social m edia [Web log post]. Retrieved from http ://w w w .
cromwellcommunications.com/content/avoiding-hipaa-violations-social-
media
HIPAA Security & Privacy Advisors, LLC (2011, May 31). Allina terminates
32 employees [Web log post]. Retrieved from http://w w w .
hipaasecurityandprivacy.com/201 l_05_01_archive.html
KWOH.L. (2012, October, 29). Beware potential employers are watching you.
The Wall Street Journal, Retrieved from http://online.wsj.com/article/SB 1
0000872396390443759504577631410093879278.html
Lipka, S. (2011, January 7). Nursing Student Dismissed for Placenta Photo
Sues Community College in Kansas. Chronicle of Higher Education.
Retrieved from http://chronicle.com/blogs/ticker/nursing-student-
dismissed-for-placenta-photo-sues-community-college-in-kansas/29460
Mayo Clinic Center for Social Media (2012). Retrieved from http://network.
socialmedia.mayoclinic.org/mccsm/
National Council State Boards of Nursing (NCSBN) Social Media guidelines
for nurses YouTube channel retrieved from http://www.youtube.com/
watch?v=i9FBEiZRnmo
National Council State Boards of Nursing (NCSBN) A nurse’s guide to the use
of social retrieved from https://www.ncsbn.org/Social_Media.pdf
Ressler, P. & Glazer, G. (2010). Legislative: Nursing’s engagement in health
policy and healthcare through social media. OJIN: The Online Journal of
Issues in Nursing, 16(1). doi: I0.3912/OJIN.VolI6No01LegCol01.
Schuman, E. (2014). Feds begin HIPAA probe in Cincinnati. Retrieved from
http://www.healthcareitnews.com/news/feds-begin-hipaa-probe-cincinnati
Straw, J. (2013, February 18). Woman out of a job after sending tweet to
Governor Barbour. MS News Now. Retrieved from http://www.
msnewsnow.com/Global/story ,asp?S=l 1713360
Thompson, P. E„ & Bell, P. L. (2007). Potential student abuse of technology in
the clinical setting. Nurse Educator 32(4) pp. 145-146. doi: 10.1097/01.
NNE.0000281090.65958.12
U.S. Department of Health & Human Services (2006). Health Information
Privacy. Retrieved from http://www.hhs.gov/ocr/privacy/
Woodley, C., & Silvestri, M. (2014). The internet is forever:
Student indiscretions reveal the need for effective social media
policies in academia. The American Journal of Distance Education,
2 8 (2 ), 126. R etrieved from h ttp ://sea rch .p ro q u es t.c o m /
docview/1532765677?accountid= 14872
Dorothy Bouldrick, DMA, MRA, RMA (AMT), is Medical
Assisting Program Director and Instructor, Medical University o f
South Carolina.
AMT Events March 2015 | 27
[http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page](http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page)
[http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page](http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page)
[http://www.ama-assn](http://www.ama-assn/)
[http://www.asm.org/joumal-nursing/july-2010.html](http://www.asm.org/joumal-nursing/july-2010.html)
[http://www.asm.org/joumal-nursing/july-2010.html](http://www.asm.org/joumal-nursing/july-2010.html)
[http://www](http://www/)
[http://www.boston.com/lifestyle/health/](http://www.boston.com/lifestyle/health/)
[http://www](http://www/)
[http://www](http://www/)
[http://online.wsj.com/article/SB](http://online.wsj.com/article/SB)
[http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460](http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460)
[http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460](http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460)
[http://network](http://network/)
[http://www.youtube.com/](http://www.youtube.com/)
[https://www.ncsbn.org/Social_Media.pdf](https://www.ncsbn.org/Social_Media.pdf)
[http://www.healthcareitnews.com/news/feds-begin-hipaa-probe-cincinnati](http://www.healthcareitnews.com/news/feds-begin-hipaa-probe-cincinnati)
[http://www](http://www/)
[http://www.hhs.gov/ocr/privacy/](http://www.hhs.gov/ocr/privacy/)
[http://search.proquest.com/](http://search.proquest.com/)
Copyright of AMT Events is the property of American Medical Technologists and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright
holder's express written permission. However, users may print, download, or email articles for
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**## pdf_download_6A4D5CD2-5399-4EC0-8B63-1E8607D7DF2F.pdf**
HIPAA Violations on Social Media:
THINK Before You Post!
by Dorothy Bouldrick
44
Unfortunately,
students are often
unaware of the
professional
repercussions
unprofessional
conduct on social
media can have on
their careers/'
In tro d u c tio n
Social networks such as Facebook
and Twitter are used by healthcare
professionals and students pursu
ing health careers to communicate,
collaborate, network with col
leagues, market healthcare ser
vices, and share personal and pro
fessional experiences. Social media
technologies have provided users
with new and engaging communica
tion tools such as Instagram, Vine,
and blogs that have changed the
way people communicate. This
change provided a platform to
enable its users to reach large audi
ences in a matter of seconds!
However, the ease with which users
can transmit information to the
masses has presented challenges in
the form of unauthorized disclosure
of patients’ health information on
social media sites. The increase of
patient privacy violations on social
media has healthcare and academic
leaders struggling to find ways to
combat the problem. After all,
HIPAA (Health Insurance Portability
and Accountability Act) training is a
staple in allied health programs and
the healthcare industry; yet, unau
thorized disclosure or protected
health information on social media
continues to make headlines (see
Table 1).
Healthcare professionals and
scholars (Kwoh, 2012; Chretien et
al, 2011; Ressler & Glazer, 2010;
Thompson & Bell, 2007) have
framed the conversation surround
ing patient privacy violations on
social media. Some have expressed
the need for social media policies to
be developed and implemented by
institutions of higher learning
(Chretien et al, 2010; Thompson &
Bell, 2007). Subsequently, Chretien
et al (2010) stated “finding balance
in expression of free speech and
medicine’s social contract with
society may require consensus
gathering among all stakeholders:
the public, practicing physicians,
medical educators, and students.”
Unfortunately, students are often
unaware of the professional reper
cussions unprofessional conduct on
social media can have on their
careers. In some cases, a student’s
career can be over before it gets
started (Woodley, C., & Silvestri, M.,
2014).
H IP A A V io la tio n s v ia S oc ia l
M e d ia A re on th e R ise!
There have been several well-pub
licized cases of HIPAA violations
regarding patient privacy breaches
on social media sites such as
Facebook and Twitter. While previ
ous incidents were found to be
unintentional, the more recent
cases are showing signs of mali
cious intent and that the problem is
escalating. In a case involving a
community college in Kansas, one
of four students was dismissed
from a nursing program for posting
photos of themselves in a lab with a
human placenta on Facebook. The
student that posted the photo pro
claimed that she was given permis-
24 AMT Events March 2015
sion by her instructor; however, the instructor denied
the allegation. The student sued the college for viola
tion of her due process and was reinstated into the
program. The judge’s ruling in this case favored the
student on the grounds that the college failed to clearly
define that the student violated professional conduct
(Chronicle of Higher Education, 2011). This ruling high
lights the importance of discussing social media do’s
and don’ts with students before beginning a practicum/
intemship/extemship. It also revealed a need for allied
health faculty and administrators to develop social
media policies with clear guidelines for its use both in
and out of the clinical setting along with clear conse
quences for violators.
HIPAA’s Privacy Rule
HIPAA’s Privacy Rule set the guidelines for the use and
disclosure of protected health information. The Privacy
Rule protects all “individually identifiable health infor
mation” held or transmitted by a covered entity
(e.g., health providers, health plans, healthcare clearing
houses) or its business associate, in any form or media,
whether electronic, paper, or oral. (HHS, 2006). This
identifiable information can relate to (a) the individual’s
past, present or future physical or mental health or con
dition; (b) services provided to the individual, or, the
past, present, or future payment for services rendered to
the individual. Unauthorized disclosure of this informa
tion can lead to a breach of HIPAA’s Patient Privacy Rule
(HHS, 2006). A breach is impermissible use or disclosure
of protected health information that can cause signifi
cant risk to the affected individual.
Consequences for Violators
Healthcare facilities that do not comply with HIPAA
regulations can be excluded from participation in the
Medicare/Medicaid programs, disciplinary action by the
hospital board, and other professional licensing and cer
tifying agencies. The unauthorized disclosure of protect
ed health information (PHI) knowingly or unknowingly
on social media or any other form can result in civil and
criminal penalties with fines and possible imprisonment.
Penalties are:
• $100 per violation, up to a $25,000 maximum per
year for repeat offenders
• $50,000 per violation; 1.5 million dollar maximum
• Certain offenses can result in up to 5 -10 years in
prison if the information obtained is found to be
used for personal gain or commercial profit.
Please visit the American Medical Association’s HIPAA
Violation and Enforcement website for more detailed
information on fines and penalties.
Table 1
Cases of HIPAA Violations via Social Media
Institution Case Overview
University of Cincinnati Medical
Center
Patient claimed a financial ser
vices employee posted a
screenshot of her medical re
cords including diagnosis and
other identifying information
on social media
Johnson County Community
College
One of four nursing students
dismissed from nursing pro
gram for posting photos of
themselves in a lab with a
human placenta on Facebook
Westerly Hospital in Rhode Is
land
Emergency room doctor termi
nated, reprimanded by the
state medical board, and fined
$500 for posting information
online about a trauma patient
St. Mary Medical Centers in
California
Four staff members terminat
ed, three disciplined for post
ing photos of a dying patient
on Facebook. Two of the em
ployees involved were nurses
Tri-City Hospital in California Employees utilize social media
to post personal discussions
of patients
Mercy Walworth Medical Cen
ter in Wisconsin
Nurses were terminated for
posting photos of a x-ray
showing a sex device lodged
in the patient’s body on Face-
book
University Medical Center
Nursing School Mississippi
Administrative Assistant termi
nated for a tweet expressing
her dislike for the Governor
having the facility staffed on
Saturday when it is normally
closed, instead of scheduling
an appointment during normal
operating hours.
Richmond University Medical
Center Staten Island
EMT posted picture of a mur
der victim who had been
strangled with a hair-dryer
cord on his Facebook page
Is it a HIPAA violation if my post does not
include patient identifiers (nam e, address,
DOB, medical record number, etc.)?
A common misconception concerning unauthorized
disclosure of protected health information involves
HIPAA’s Privacy Rule de-identification methods. To
avoid privacy breaches using de-identification, “the
removal of specified individual identifiers (as well as
absence of actual knowledge) that the remaining infor
mation could be used alone or in combination with
other information to identify the individual must be
utilized to prevent unauthorized disclosure of health
information (HHS, 2013). Therefore, if a post contains
snippets of information such as place of incident, date,
and time of incident where others in your network
familiar with the incident can determine the patient’s
(continued on page 26)
AMT Events March 2015 25
HIPAA VIOLATIONS
(continued from page 25)
identify, a breach has occurred (Cromwell, 2011).
These types of privacy violations often occur during
times of catastrophic events such as major accidents,
natural disasters, or other unusual medical events that
make headline news. Other instances of unauthorized
disclosure of protected health information occur
during clinical rotations by students who inadvertently
disclose protected health information on personal
social networks, class blogs using proprietary hosting
sites, instead of the firewall protection of the college’s
learning management system (LMS) (Chretien et al,
2009).
Best Practices for Social M edia Use
The enormous potential of social media technologies
for dissemination of health information, marketing
healthcare services, patient feedback and community
building is extremely valuable in healthcare. There are
hundreds of blogs, wikis, Facebook pages, and other
social networking sites that focus on medical and health
topics. The most popular health websites reported by
eBizMBA (2013) are Yahoo! Health (21.5 million),
National Institutes of Health (20 million), WebMD (19.5
million), MedicineNet (10.5 million), MayoClinic (7 mil
lion), and Drugs.com (6 million). The Mayo Clinic Center
for Social Media is the leader in demonstrating how the
appropriate use of social media can foster collaboration,
patient education, professional development, and
improved patient outcomes. By all means, utilize social
media to foster good patient outcomes, but consider the
following to safeguard patient privacy:
1. Review your college and/or employer’s social media
policy to become aware of the do’s and don’ts of
social media use. If your college and/or employer do
not have a social media policy, review
“Professionalism in the Use of Social Media” by
American Medical Association and/or “A Nurses
Guide to the Use of Social Media” by the National
Council of State Boards of Nursing (NCSBN).
Although these guidelines are geared toward physi
cians and nurses, they encompass the professional
behaviors expected of all healthcare professionals
using social media. You may also review the NCSBN
Social Media YouTube channel for videos to gain a
clearer understanding of appropriate and inappro
priate use of social media.
2. Review your privacy settings and get a clear under
standing of privacy policies before posting content.
Deleting a post does not mean it was not read and
shared with others online.
3. Identify yourself. If you communicate via social
media about a healthcare provider, disclose your
connection with the provider and your role at the
facility. Use good judgment and be accurate.
4. Although you may have a personal social media
page, remember that you share a connection with
your employer and anything you post about your
workday or patients can be linked back to the pro
vider.
5. Do not post photographs of patients, healthcare set
tings, lab procedures, specimens, or anything involv
ing patient care on social media.
6. Do not use social media to discredit or air grievanc
es with your employer. Resolve conflicts in-house
with the help of your supervisor and human
resources.
7. If you become aware that another extern has posted
patient information on a social media site, report it
to your clinical coordinator and program director
immediately!
8. Think before you post! Ask yourself, how would I
feel if I were the patient? How would my family feel?
The Golden Rule always applies!
The Takeaway…
Incidences of unprofessional conduct via social media
by students present continuous challenges for allied
health faculty and administrators. Some have expressed
the need for social media policies to be developed and
implemented by institutions of higher learning (Chretien
et al, 2010; Thompson & Bell, 2007). As providers of
care, clinicians and administrative staff are charged with
not only delivering quality care and services, but being
an advocate for patients. Students and healthcare work
ers must display professional, ethical behavior at all
times. Unauthorized disclosure of patient information
on social media is not only a HIPAA violation; it is a vio
lation of TRUST between the patient and the healthcare
provider. Students performing practicums/intemships
for program completion must demonstrate the high pro
fessional standards expected of healthcare workers by
protecting patient privacy and report incidences of pri
vacy breaches found on social media to their supervisor
or clinical coordinator to determine the appropriate
course of action. Remember, the Department of Health
& Human Services (HHS), Office of Civil Rights (OCR) is
responsible for investigating complaints of privacy
breaches. For more information about filing a com
plaint, visit HHS at http://www.hhs.gov/ocr/privacy/
hipaa/complaints/index.html. ■
26 | AMT Events March 2015
[http://www.hhs.gov/ocr/privacy/](http://www.hhs.gov/ocr/privacy/)
References
American Medical Association (2011) Professionalism in the Use of Social
Media. Retrieved from http://www.ama-assn.org/ama/pub/physician-
resources/medical-ethics/code-medical-ethics/opinion9124.page?
American Medical Association (2009). HIPAA Violations and Enforcements.
Retrieved from http://www.ama-assn .org/ama/pub/physician-resources/
solutions-managing-your-practice/coding-billing-insurance/hipaahealth-
insurance-portability-accountability-act/hipaa-violations-enforcement.
page?
American Society of Registered Nurses. (2010). When Facebook Goes To The
Hospital, Patients May Suffer. Retrieved from http://www.asm.org/joumal-
nursing/july-2010.html
Chretien, K. C. MD, Faman, J. M. MD, Greysen, S„ MD &; Kind, T. MD
(2011). To friend or not to friend. Academic Medicine, 86 (12), pp 1545-
1550 doi: 10.1097/ACM.0b013e3182356128
Chretien, K.C. MD, Goldman, E. F„ Beckman, L. & Kind.T. (2010). It’s your
own risk: Medical students’ perspectives on online professionalism.
A cadem ic M e d ic in e , 8 5 (1 0 ), S 6 8 -7 1 . do i: 10 .1097/
ACM.0b013e3181ed4778.
Chretien, K.C., Greysen, S. R„ Chretien, J. & Kind, T. (2009). Online posting
of unprofessional content by medical students. JAMA, 302 (12), 1309-
1315.doi:10.1001/jama.2009.1387.
Clark, K., & Kearns, S. (2010). Hospital Seek to Terminate Hospital Workers
for Privacy Breaches on Social Media. Retrieved from http://www.
healthleadersm edia.com /page-l/H R -252540/H ospital-Seeks-To-
Terminate-Five-Hospital-Workers-For-Privacy-Breaches-on-Social-
Media##
Conaboy, C. (2011, April, 20). For doctor, social media a tricky case. Boston
Globe. Retrieved from http://www.boston.com /lifestyle/health/
articles/201 l/04/20/for_doctors_social_media_a_tricky_case/
Cromwell Communications (2011, July 1). Avoiding HIPAA violations in
social m edia [Web log post]. Retrieved from http ://w w w .
cromwellcommunications.com/content/avoiding-hipaa-violations-social-
media
HIPAA Security & Privacy Advisors, LLC (2011, May 31). Allina terminates
32 employees [Web log post]. Retrieved from http://w w w .
hipaasecurityandprivacy.com/201 l_05_01_archive.html
KWOH.L. (2012, October, 29). Beware potential employers are watching you.
The Wall Street Journal, Retrieved from http://online.wsj.com/article/SB 1
0000872396390443759504577631410093879278.html
Lipka, S. (2011, January 7). Nursing Student Dismissed for Placenta Photo
Sues Community College in Kansas. Chronicle of Higher Education.
Retrieved from http://chronicle.com/blogs/ticker/nursing-student-
dismissed-for-placenta-photo-sues-community-college-in-kansas/29460
Mayo Clinic Center for Social Media (2012). Retrieved from http://network.
socialmedia.mayoclinic.org/mccsm/
National Council State Boards of Nursing (NCSBN) Social Media guidelines
for nurses YouTube channel retrieved from http://www.youtube.com/
watch?v=i9FBEiZRnmo
National Council State Boards of Nursing (NCSBN) A nurse’s guide to the use
of social retrieved from https://www.ncsbn.org/Social_Media.pdf
Ressler, P. & Glazer, G. (2010). Legislative: Nursing’s engagement in health
policy and healthcare through social media. OJIN: The Online Journal of
Issues in Nursing, 16(1). doi: I0.3912/OJIN.VolI6No01LegCol01.
Schuman, E. (2014). Feds begin HIPAA probe in Cincinnati. Retrieved from
http://www.healthcareitnews.com/news/feds-begin-hipaa-probe-cincinnati
Straw, J. (2013, February 18). Woman out of a job after sending tweet to
Governor Barbour. MS News Now. Retrieved from http://www.
msnewsnow.com/Global/story ,asp?S=l 1713360
Thompson, P. E„ & Bell, P. L. (2007). Potential student abuse of technology in
the clinical setting. Nurse Educator 32(4) pp. 145-146. doi: 10.1097/01.
NNE.0000281090.65958.12
U.S. Department of Health & Human Services (2006). Health Information
Privacy. Retrieved from http://www.hhs.gov/ocr/privacy/
Woodley, C., & Silvestri, M. (2014). The internet is forever:
Student indiscretions reveal the need for effective social media
policies in academia. The American Journal of Distance Education,
2 8 (2 ), 126. R etrieved from h ttp ://sea rch .p ro q u es t.c o m /
docview/1532765677?accountid= 14872
Dorothy Bouldrick, DMA, MRA, RMA (AMT), is Medical
Assisting Program Director and Instructor, Medical University o f
South Carolina.
AMT Events March 2015 | 27
[http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page](http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page)
[http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page](http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page)
[http://www.ama-assn](http://www.ama-assn/)
[http://www.asm.org/joumal-nursing/july-2010.html](http://www.asm.org/joumal-nursing/july-2010.html)
[http://www.asm.org/joumal-nursing/july-2010.html](http://www.asm.org/joumal-nursing/july-2010.html)
[http://www](http://www/)
[http://www.boston.com/lifestyle/health/](http://www.boston.com/lifestyle/health/)
[http://www](http://www/)
[http://www](http://www/)
[http://online.wsj.com/article/SB](http://online.wsj.com/article/SB)
[http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460](http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460)
[http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460](http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460)
[http://network](http://network/)
[http://www.youtube.com/](http://www.youtube.com/)
[https://www.ncsbn.org/Social_Media.pdf](https://www.ncsbn.org/Social_Media.pdf)
[http://www.healthcareitnews.com/news/feds-begin-hipaa-probe-cincinnati](http://www.healthcareitnews.com/news/feds-begin-hipaa-probe-cincinnati)
[http://www](http://www/)
[http://www.hhs.gov/ocr/privacy/](http://www.hhs.gov/ocr/privacy/)
[http://search.proquest.com/](http://search.proquest.com/)
Copyright of AMT Events is the property of American Medical Technologists and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright
holder's express written permission. However, users may print, download, or email articles for
individual use.
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**## pdf_download_6A4D5CD2-5399-4EC0-8B63-1E8607D7DF2F.pdf**
HIPAA Violations on Social Media:
THINK Before You Post!
by Dorothy Bouldrick
44
Unfortunately,
students are often
unaware of the
professional
repercussions
unprofessional
conduct on social
media can have on
their careers/'
In tro d u c tio n
Social networks such as Facebook
and Twitter are used by healthcare
professionals and students pursu
ing health careers to communicate,
collaborate, network with col
leagues, market healthcare ser
vices, and share personal and pro
fessional experiences. Social media
technologies have provided users
with new and engaging communica
tion tools such as Instagram, Vine,
and blogs that have changed the
way people communicate. This
change provided a platform to
enable its users to reach large audi
ences in a matter of seconds!
However, the ease with which users
can transmit information to the
masses has presented challenges in
the form of unauthorized disclosure
of patients’ health information on
social media sites. The increase of
patient privacy violations on social
media has healthcare and academic
leaders struggling to find ways to
combat the problem. After all,
HIPAA (Health Insurance Portability
and Accountability Act) training is a
staple in allied health programs and
the healthcare industry; yet, unau
thorized disclosure or protected
health information on social media
continues to make headlines (see
Table 1).
Healthcare professionals and
scholars (Kwoh, 2012; Chretien et
al, 2011; Ressler & Glazer, 2010;
Thompson & Bell, 2007) have
framed the conversation surround
ing patient privacy violations on
social media. Some have expressed
the need for social media policies to
be developed and implemented by
institutions of higher learning
(Chretien et al, 2010; Thompson &
Bell, 2007). Subsequently, Chretien
et al (2010) stated “finding balance
in expression of free speech and
medicine’s social contract with
society may require consensus
gathering among all stakeholders:
the public, practicing physicians,
medical educators, and students.”
Unfortunately, students are often
unaware of the professional reper
cussions unprofessional conduct on
social media can have on their
careers. In some cases, a student’s
career can be over before it gets
started (Woodley, C., & Silvestri, M.,
2014).
H IP A A V io la tio n s v ia S oc ia l
M e d ia A re on th e R ise!
There have been several well-pub
licized cases of HIPAA violations
regarding patient privacy breaches
on social media sites such as
Facebook and Twitter. While previ
ous incidents were found to be
unintentional, the more recent
cases are showing signs of mali
cious intent and that the problem is
escalating. In a case involving a
community college in Kansas, one
of four students was dismissed
from a nursing program for posting
photos of themselves in a lab with a
human placenta on Facebook. The
student that posted the photo pro
claimed that she was given permis-
24 AMT Events March 2015
sion by her instructor; however, the instructor denied
the allegation. The student sued the college for viola
tion of her due process and was reinstated into the
program. The judge’s ruling in this case favored the
student on the grounds that the college failed to clearly
define that the student violated professional conduct
(Chronicle of Higher Education, 2011). This ruling high
lights the importance of discussing social media do’s
and don’ts with students before beginning a practicum/
intemship/extemship. It also revealed a need for allied
health faculty and administrators to develop social
media policies with clear guidelines for its use both in
and out of the clinical setting along with clear conse
quences for violators.
HIPAA’s Privacy Rule
HIPAA’s Privacy Rule set the guidelines for the use and
disclosure of protected health information. The Privacy
Rule protects all “individually identifiable health infor
mation” held or transmitted by a covered entity
(e.g., health providers, health plans, healthcare clearing
houses) or its business associate, in any form or media,
whether electronic, paper, or oral. (HHS, 2006). This
identifiable information can relate to (a) the individual’s
past, present or future physical or mental health or con
dition; (b) services provided to the individual, or, the
past, present, or future payment for services rendered to
the individual. Unauthorized disclosure of this informa
tion can lead to a breach of HIPAA’s Patient Privacy Rule
(HHS, 2006). A breach is impermissible use or disclosure
of protected health information that can cause signifi
cant risk to the affected individual.
Consequences for Violators
Healthcare facilities that do not comply with HIPAA
regulations can be excluded from participation in the
Medicare/Medicaid programs, disciplinary action by the
hospital board, and other professional licensing and cer
tifying agencies. The unauthorized disclosure of protect
ed health information (PHI) knowingly or unknowingly
on social media or any other form can result in civil and
criminal penalties with fines and possible imprisonment.
Penalties are:
• $100 per violation, up to a $25,000 maximum per
year for repeat offenders
• $50,000 per violation; 1.5 million dollar maximum
• Certain offenses can result in up to 5 -10 years in
prison if the information obtained is found to be
used for personal gain or commercial profit.
Please visit the American Medical Association’s HIPAA
Violation and Enforcement website for more detailed
information on fines and penalties.
Table 1
Cases of HIPAA Violations via Social Media
Institution Case Overview
University of Cincinnati Medical
Center
Patient claimed a financial ser
vices employee posted a
screenshot of her medical re
cords including diagnosis and
other identifying information
on social media
Johnson County Community
College
One of four nursing students
dismissed from nursing pro
gram for posting photos of
themselves in a lab with a
human placenta on Facebook
Westerly Hospital in Rhode Is
land
Emergency room doctor termi
nated, reprimanded by the
state medical board, and fined
$500 for posting information
online about a trauma patient
St. Mary Medical Centers in
California
Four staff members terminat
ed, three disciplined for post
ing photos of a dying patient
on Facebook. Two of the em
ployees involved were nurses
Tri-City Hospital in California Employees utilize social media
to post personal discussions
of patients
Mercy Walworth Medical Cen
ter in Wisconsin
Nurses were terminated for
posting photos of a x-ray
showing a sex device lodged
in the patient’s body on Face-
book
University Medical Center
Nursing School Mississippi
Administrative Assistant termi
nated for a tweet expressing
her dislike for the Governor
having the facility staffed on
Saturday when it is normally
closed, instead of scheduling
an appointment during normal
operating hours.
Richmond University Medical
Center Staten Island
EMT posted picture of a mur
der victim who had been
strangled with a hair-dryer
cord on his Facebook page
Is it a HIPAA violation if my post does not
include patient identifiers (nam e, address,
DOB, medical record number, etc.)?
A common misconception concerning unauthorized
disclosure of protected health information involves
HIPAA’s Privacy Rule de-identification methods. To
avoid privacy breaches using de-identification, “the
removal of specified individual identifiers (as well as
absence of actual knowledge) that the remaining infor
mation could be used alone or in combination with
other information to identify the individual must be
utilized to prevent unauthorized disclosure of health
information (HHS, 2013). Therefore, if a post contains
snippets of information such as place of incident, date,
and time of incident where others in your network
familiar with the incident can determine the patient’s
(continued on page 26)
AMT Events March 2015 25
HIPAA VIOLATIONS
(continued from page 25)
identify, a breach has occurred (Cromwell, 2011).
These types of privacy violations often occur during
times of catastrophic events such as major accidents,
natural disasters, or other unusual medical events that
make headline news. Other instances of unauthorized
disclosure of protected health information occur
during clinical rotations by students who inadvertently
disclose protected health information on personal
social networks, class blogs using proprietary hosting
sites, instead of the firewall protection of the college’s
learning management system (LMS) (Chretien et al,
2009).
Best Practices for Social M edia Use
The enormous potential of social media technologies
for dissemination of health information, marketing
healthcare services, patient feedback and community
building is extremely valuable in healthcare. There are
hundreds of blogs, wikis, Facebook pages, and other
social networking sites that focus on medical and health
topics. The most popular health websites reported by
eBizMBA (2013) are Yahoo! Health (21.5 million),
National Institutes of Health (20 million), WebMD (19.5
million), MedicineNet (10.5 million), MayoClinic (7 mil
lion), and Drugs.com (6 million). The Mayo Clinic Center
for Social Media is the leader in demonstrating how the
appropriate use of social media can foster collaboration,
patient education, professional development, and
improved patient outcomes. By all means, utilize social
media to foster good patient outcomes, but consider the
following to safeguard patient privacy:
1. Review your college and/or employer’s social media
policy to become aware of the do’s and don’ts of
social media use. If your college and/or employer do
not have a social media policy, review
“Professionalism in the Use of Social Media” by
American Medical Association and/or “A Nurses
Guide to the Use of Social Media” by the National
Council of State Boards of Nursing (NCSBN).
Although these guidelines are geared toward physi
cians and nurses, they encompass the professional
behaviors expected of all healthcare professionals
using social media. You may also review the NCSBN
Social Media YouTube channel for videos to gain a
clearer understanding of appropriate and inappro
priate use of social media.
2. Review your privacy settings and get a clear under
standing of privacy policies before posting content.
Deleting a post does not mean it was not read and
shared with others online.
3. Identify yourself. If you communicate via social
media about a healthcare provider, disclose your
connection with the provider and your role at the
facility. Use good judgment and be accurate.
4. Although you may have a personal social media
page, remember that you share a connection with
your employer and anything you post about your
workday or patients can be linked back to the pro
vider.
5. Do not post photographs of patients, healthcare set
tings, lab procedures, specimens, or anything involv
ing patient care on social media.
6. Do not use social media to discredit or air grievanc
es with your employer. Resolve conflicts in-house
with the help of your supervisor and human
resources.
7. If you become aware that another extern has posted
patient information on a social media site, report it
to your clinical coordinator and program director
immediately!
8. Think before you post! Ask yourself, how would I
feel if I were the patient? How would my family feel?
The Golden Rule always applies!
The Takeaway…
Incidences of unprofessional conduct via social media
by students present continuous challenges for allied
health faculty and administrators. Some have expressed
the need for social media policies to be developed and
implemented by institutions of higher learning (Chretien
et al, 2010; Thompson & Bell, 2007). As providers of
care, clinicians and administrative staff are charged with
not only delivering quality care and services, but being
an advocate for patients. Students and healthcare work
ers must display professional, ethical behavior at all
times. Unauthorized disclosure of patient information
on social media is not only a HIPAA violation; it is a vio
lation of TRUST between the patient and the healthcare
provider. Students performing practicums/intemships
for program completion must demonstrate the high pro
fessional standards expected of healthcare workers by
protecting patient privacy and report incidences of pri
vacy breaches found on social media to their supervisor
or clinical coordinator to determine the appropriate
course of action. Remember, the Department of Health
& Human Services (HHS), Office of Civil Rights (OCR) is
responsible for investigating complaints of privacy
breaches. For more information about filing a com
plaint, visit HHS at http://www.hhs.gov/ocr/privacy/
hipaa/complaints/index.html. ■
26 | AMT Events March 2015
[http://www.hhs.gov/ocr/privacy/](http://www.hhs.gov/ocr/privacy/)
References
American Medical Association (2011) Professionalism in the Use of Social
Media. Retrieved from http://www.ama-assn.org/ama/pub/physician-
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Dorothy Bouldrick, DMA, MRA, RMA (AMT), is Medical
Assisting Program Director and Instructor, Medical University o f
South Carolina.
AMT Events March 2015 | 27
[http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page](http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page)
[http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page](http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page)
[http://www.ama-assn](http://www.ama-assn/)
[http://www.asm.org/joumal-nursing/july-2010.html](http://www.asm.org/joumal-nursing/july-2010.html)
[http://www.asm.org/joumal-nursing/july-2010.html](http://www.asm.org/joumal-nursing/july-2010.html)
[http://www](http://www/)
[http://www.boston.com/lifestyle/health/](http://www.boston.com/lifestyle/health/)
[http://www](http://www/)
[http://www](http://www/)
[http://online.wsj.com/article/SB](http://online.wsj.com/article/SB)
[http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460](http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460)
[http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460](http://chronicle.com/blogs/ticker/nursing-student-dismissed-for-placenta-photo-sues-community-college-in-kansas/29460)
[http://network](http://network/)
[http://www.youtube.com/](http://www.youtube.com/)
[https://www.ncsbn.org/Social_Media.pdf](https://www.ncsbn.org/Social_Media.pdf)
[http://www.healthcareitnews.com/news/feds-begin-hipaa-probe-cincinnati](http://www.healthcareitnews.com/news/feds-begin-hipaa-probe-cincinnati)
[http://www](http://www/)
[http://www.hhs.gov/ocr/privacy/](http://www.hhs.gov/ocr/privacy/)
[http://search.proquest.com/](http://search.proquest.com/)
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