CUA 2018: eCommunications – Using Email, Texting and Social Media Wisely

Halifax, Nova Scotia ( LeGrand-Westfall, MD, the Chief Privacy Officer from the Canadian Medical Protective Association provided an interactive and informative State-of-the-Art lecture at the CUA 2018 annual meeting, discussing appropriate use of email, texting and social media. Dr. LeGrand-Westfall notes that privacy 101 includes confidentiality (a patient expectation), privacy (a legislated right), and security. Physicians should be encouraged to use eCommunication and to leverage technology, as this allows one to provide the best care for their patient and to engage each other as colleagues. Dr. LeGrand-Westfall notes that with regards to patient consent, implied consent is within the “circle of care”, whereas expressed consent is outside the “circle of care”. When discussing what we can do as physicians, Dr. LeGrand-Westfall states that we should routinely do self-privacy checks: (i) Do I need to have access or share this information? (ii) Do I have or can I reasonably assume consent? 

For the remainder of her talk, Dr. LeGrand-Westfall engaged the audience in interactive scenarios, in a question and answer format. 

Scenario 1: As a physician, you want to set up a blog/portal to allow patients to book appoints online, share clinical information with patients, and alert patients regarding follow-up care. Are there any concerns? Dr. LeGrand-Westfall notes that physicians should ensure the portal is secure and access to the blog is limited to patients only, and that we should be cognizant of managing the patient’s expectations. If a physician is unsure or unable to properly secure the portal/blog, use should be limited to scheduling, educational, and general health promotion activities, and not used for clinical advice without proper security agreements in place.

Scenario 2: You are alerted by a colleague to a post on a physician rating website that disparages you as a physician and a person. What should you do? Dr. LeGrand-Westfall highlights that we should take reasonable steps to monitor these online physician-rating websites, but to be measured in any response and to never respond online. However, we should be objective about feedback and implement changes when appropriate. Finally, we should not ask patients to post positive results or ask them to agree not to post any comments. 

Scenario 3: You compose a tweet highlighting a patient’s obesity and symptoms of shortness of breath – one of your followers is able to identify the patient. Dr. LeGrand-Westfall notes that in this situation, this is a breach of privacy and an inappropriate use of social media. Generally, the disclosure of de-identified information is not a privacy breach, but often times we have to do more than remove a patient’s name, etc as a patient may be identified for instance by a tattoo or other identifiable marking. 

Scenario 4: You as a physician suspect a patient is withholding information and search Facebook and discover the patient has an open profile. Is it appropriate to review the patient’s online profile? Dr. LeGrand-Westfall states that despite an open profile, the patient has an expectation of privacy and social media should not be used to “snoop” on patients. 

Scenario 5: You want to use your smartphone to take photos of clinical encounters with patients. Can you and if so, what needs to be done? Dr. LeGrand-Westfall notes that the CMPA has recommendations for these situations based on their privacy legislation as follows:

  • Obtain express consent from patients to use clinical photographs and videos for educational or promotional purposes
  • If the consent is provided verbally, document the discussion in the patient’s medical record
  • As a precaution, ask the patient to sign a written consent form, particularly if the photographs or videos are to be used for promotional purposes
  • Remove any personal identifiers and protect the patient’s confidentiality
Scenario 6: Clinics routinely rely on email to communicate with patients, primarily about administrative matters. On Monday morning, you learn that a patient emailed Friday evening and is requesting an urgent appointment. What should you and/or the clinic do? Dr. LeGrand-Westfall notes that we should follow-up with the patient ASAP, as well as take time to review the clinic emailing procedures. To reduce further issues, patients should be aware that email is not for urgent matters, and Dr. LeGrand-Westfall stresses that it is important to use “auto-reply notifications”, including when email is checked and instructions for seeking urgent care. 

Scenario 7: You want to use your smartphone to video clinical encounters. Can you? Dr. LeGrand-Westfall states that the answer relies on what the purpose is for the recording. Acceptable reasons include documentation, quality improvement or education, whereas recording encounters to share an interesting story with your friends is not acceptable. 

Scenario 8: You see a patient with an unusual rash and send a text message to a dermatologist asking for advice. The dermatologist provides feedback via text and does not offer to see the patient face-to-face. What should be done with these texts? Dr. LeGrand-Westfall notes that it is important to assess whether the text contains personal health information and that information via text is just as important as if it were sent via email. In these cases, the texts should be deleted as soon as possible.

Dr. LeGrand-Westfall provided several final take-home messages:
  • eCommunication can be effective if used properly
  • It is important to educate yourself and to know the limits of technology and the legal ramifications
  • It is important to discuss with patients and to get documented consent.
Presented by: LeGrand-Westfall, MD, Chief Privacy Officer, Canadian Medical Protective Association, Ottawa, Ontario, Canada

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia