ie8 fix

Between the Lines

Larry Dignan, Andrew Nusca and Rachel King

When HIPAA and Twitter collide: Can you blab away your privacy rights?

By | September 15, 2009, 9:40am PDT

Summary: What happens when a patient Twitters a hospital stay and the institution can’t respond to allegations because of privacy laws? Maybe transparency should be a two-way street.

Should patient-doctor privacy policies be a two-way street?

That question rattles around my head after reading Michael Krigsman’s account of Sarah Cortes, a patient that Twittered through a hospital consultation in rural Pennsylvania.

Krigsman writes:

Technology writer and blogger, Sarah Cortes, went by ambulance to Robert Packer Hospital, a facility located in rural Pennsylvania, after she suffered a serious spinal fracture. The story takes an unusual turn because Cortes says Twitter helped her escape from the clutches of hospital staff whom, she claims, tried to intimidate and coerce her into accepting unnecessary spinal surgery.

The account gets into details of Cortes’ stay quickly. The rub: Robert Packer Hospital can’t really respond much to Cortes’ take due to the Health Insurance Portability and Accountability Act (HIPAA), which is partially designed to keep information private. As a result, you have a one-way account of Cortes’ stay. Doctors can’t talk. The hospital can’t talk. Nurses can’t say what happened.

The hospital cited HIPAA in its thin response to Cortes’ claims. Here’s the question: Should privacy procedures be waived by a patient’s actions, say updating Twitter or Facebook during a surgery?

It’s unclear, but as Krigsman notes the boundaries for standard operating procedures are falling due to new technologies. Nevertheless, I’d like to see a point-by-point rebuttal from the hospital to Cortes’ allegations. Transparency should be both ways.

Kick off your day with ZDNet's daily e-mail newsletter. It's the freshest tech news and opinion, served hot. Get it.

Topics

Larry Dignan is Editor in Chief of ZDNet and SmartPlanet as well as Editorial Director of ZDNet's sister site TechRepublic.

Disclosure

Larry Dignan

Larry Dignan has nothing to disclose. He doesn’t hold investments in the technology companies he covers.

Biography

Larry Dignan

Larry Dignan is Editor in Chief of ZDNet and SmartPlanet as well as Editorial Director of ZDNet's sister site TechRepublic. He was most recently Executive Editor of News and Blogs at ZDNet. Prior to that he was executive news editor at eWeek and news editor at Baseline. He also served as the East Coast news editor and finance editor at CNET News.com. Larry has covered the technology and financial services industry since 1995, publishing articles in WallStreetWeek.com, Inter@ctive Week, The New York Times, and Financial Planning magazine. He's a graduate of the Columbia School of Journalism and the University of Delaware.

For daily updates, follow Larry on Twitter.

Related Discussions on TechRepublic

Did you know you can take part in these discussions with your ZDNet membership?
59
Comments

Join the conversation!

Just In

hippa laws
jackfred 21st Sep 2009
in minnesota there is a clear or clean desk policy if the desk can be viewed by public no charts can be placed open, also when conferming info from the patent there is a set distance that next in line can stand and it is like 10 or more feet away, so your info cant be over heard.
0 Votes
+ -
NO!
safesax2002 15th Sep 2009
As an IT professional in a hospital I firmly say that a patient's actions should not be a way circumvent HIPAA. Now all the patient has to do is sign a release of information and specify what information is released.

While the hospital and its staff are obeying the law, they are really only using it as a curtain to hide behind (which is convenient for them). It would be interesting if Sara Cortes authorized some information to be released and see what the hospital really has to say.
0 Votes
+ -
If she signed a release
snafu_77 15th Sep 2009
they'd still decline to respond since the Joint Commission is probably investigating or there may be legal issues pending or there is an internal investigation pending.

As for making it easy to do away with HIPAA rights, Larry should watch Gattica.
0 Votes
+ -
Gattaca
tikigawd Updated - 16th Sep 2009
Guanine
Adenine
Thymine
Thymine
Adenine
Cytosine
Adenine
But it's not okay for them to give their side of
the story? That's pretty bias..


If you choose to talk about something on a public
forum, it's obviously no longer a private matter.
0 Votes
+ -
a parrelel to this
midenginedrift 16th Sep 2009
is discussing a legal situation on an online forum / message board. This is a little different though because the reporter is making negative accusations regarding the hospital, so I don't think it's quite the same. I mean, are we all going to distrust the hospital right away? Some might, but I think most of us are reasonable enough to take what she says with a grain of salt, or to wait for more details to come to light. She is a reporter, she might be exposing something. She might not. We'll see.

Regarding the headline, if a patient chooses to waive their own privacy in their own manner then I think that's fine as long as they also accept responsibility for any repercussions and consequences stemming from their own choice.
0 Votes
+ -
Sorry bub, if you choose to be like the "most people" you refer to, that's your choice.
0 Votes
+ -
Nope.
AzuMao Updated - 17th Sep 2009
I'm not siding with those people. I'm saying, that
most are like that, so this hospital's reputation
is going to take a huge hit from this, since they
aren't allowed to defend themselves against her
accusations.
0 Votes
+ -
blame the government.
Al_nyc 17th Sep 2009
And keep in mind that old saying " it is better to have people think you are fool than to open your mouth and confirm their suspicions".

Also ask Richard Jewell about cooperating with authorities when you are a suspect. The right to remain silent and the right to counsel are two EXTREMELY important rights and you should be very careful about giving up those rights.
0 Votes
+ -
The hospital isn't under arrest, though.
AzuMao Updated - 17th Sep 2009
It's being publicly accused of wrongdoing, but not
being allowed to refute the accusation, so most
people are now thinking "oh that poor woman, let's
send her gifts" and "oh that evil hospital, I'll e
sure to never go there now"..
0 Votes
+ -
Absolutely not
Michael Kelly 15th Sep 2009
The most the hospital should do is cite HIPAA and promise a private resolution. That is all they need to do in public. If they do resolve the problem to satisfaction, most people who are willing to complain about a health problem in public would acknowledge that in public. And if there is slander or libel involved, there are legal channels to correct this.
0 Votes
+ -
No
bmgoodman 15th Sep 2009
Who confirms that the real patient is the one tweeting? Seems like a big loophole to me. If I need to know the medical details on John Doe, I sign up for Twitter and start tweeting all sorts of tales about "my" poor medical treatment. Then I wait for the hospital to serve up lots of details in rebuttal. "We told John Doe that he has syphilis, not AIDS!"

And I suspect the hospital can use libel/slander laws to sue the patient if the statements are particularly egregious.
0 Votes
+ -
they dont defemate the company or person without anything to back it up.

As with most things like this.. it will be handled by lawyers behind the scenes.
There is absolutely no lee-way under HIPAA for a hospital to respond unless the patient signs a legal consent allowing them to do so. If you haven't worked in healthcare you can't comprehend the seriousness with which HIPAA regulations are taken. Nurses are routinely reprimanded or fired if they get caught discussing a patient's case in an elevator or public area where they might be overheard. So the idea that a hospital would respond to a patient's Tweets is completely ridiculous.
0 Votes
+ -
hippa laws
jackfred 21st Sep 2009
in minnesota there is a clear or clean desk policy if the desk can be viewed by public no charts can be placed open, also when conferming info from the patent there is a set distance that next in line can stand and it is like 10 or more feet away, so your info cant be over heard.
0 Votes
+ -
The question....
JB King 15th Sep 2009
at least to my mind should be whether journalists and others that cover this kind of story have a responsibility to get authorization from Cortes and then talk to the hospital so that while HIPAA can be an initial cover, it isn't insurmontable. If Cortes' OKs the hospital to talk then it could be interesting to see what else comes to light. Or is that just a thin slice of life in a hospital as all the other patients' privacy has to be protected?

Could be interesting if someone is checking with Cortes and then the hospital as it could be that she wants the hospital to not be so tight-lipped.
...she has more wrong with her than just a bad back and HIPAA concerns.

Maybge a "check-up from the neck-up" is in order?
If the health providers ever get sued, or want to bring their own lawsuit for defamation if their reputations have been damaged by the patient's blogging, the HIPAA privacy rule provides an exception for litigation that will allow them to proceed. See http://www.hhs.gov/ocr/privacy/hipaa/faq/permitted/judicial/704.html for more info. Until and unless they do, though, the right to control disclosure of health information belongs to the patient, which makes sense; the alternative could look a lot like what happened with this lawyer (https://www.iardc.org/09CH0089CM.html). {ProfJonathan}
You'd "like", would you? Why should anyone rebut anything just to satisfy your curiosity? How is this your business?
0 Votes
+ -
She made it everybodys business....
dunn@... 16th Sep 2009
By publishing what should be protected patient data.

That's how it's anybodys business that reads her tweets if it names people, procedures, institutions, and/or policies covered by HIPAA.
0 Votes
+ -
The only thing that's everybody's business
tikigawd Updated - 16th Sep 2009
is whatever she voluntarily put out there (in this case, through Twitter). The hospital has no obligation or right to comment on what services they provided her.

She is free to publicly comment as much as she wants about what happened to her, but the hospital is not.

It's not like there was no way for patients to divulge information about their medical conditions and procedures before Tweeter... Tweeter is just one more way of communicating. This is already covered by HIPA.

Nothing new here, move along.
0 Votes
+ -
Tweeter?
cgarrett 16th Sep 2009
Is that supposed to be read with a Speedy Gonzales faux accent? Or are
you directing people to a defunct online speaker store?
0 Votes
+ -
lol nt
midenginedrift 16th Sep 2009
 
0 Votes
+ -
yes
tikigawd 16th Sep 2009
Typo fixed

Thx for the heads up!

I had written something that had "tweeted" and changed it to Tweeter instead of Twitter. oops
0 Votes
+ -
It really should be a 2 way street if the patient publishes details of an instance involving a medical professional or institute then the "other side" SHOULD be able to answer the allegations.

But under HIPAA they can't.

I agree with you. If she makes allegations and includes names and details of what would appear in her protected data then they should be able to defend themselves to the extent of the information the patient voluntarily made public.

She is not being professional and they are.
0 Votes
+ -
But where do you draw the line?
skottieg 16th Sep 2009
Ok so she blabbed about her opinion/view of the situation so now the hospital should have the right to respond however they want because she waived her HIPAA rights? There are too many gray areas. What if the doctors suggested the treatment they did because she has some condition (say, a particular STD or mental illness) that could affect the outcome? Even though SHE didn't bring it up, something like that could still be a factor.
..but she makes those complaints public anyways,
then she must not mind that being made public as
well.
0 Votes
+ -
The problem here is...
cslycord@... 16th Sep 2009
the statement "to the extent of the information
the patient voluntarily made public." What exactly
does that mean? Does it mean they can defend
themselves against the info released as long as
they provide no knew info or something?
When you receive a service, you have the right to discuss its quality. HIPAA is for the privacy of patients. Patients should be able to discuss their quality of care in order to make informed choices among health care professionals, and so those professionals don't have the opportunity to do a shoddy job (though this is the exception) behind a veil of secrecy.
The doctor/facility should be able to deny the allegations in general terms, and have recourse to a slander suit, though. Probably a similar issue comes up in any malpractice case, so there are probably some precedents to look at...
0 Votes
+ -
What the patient chooses to do with the information is irrelevant. HIPAA rules prevent the hospital from divulging any of that information, even in their own defense.

Depending on the publication media and the type of commentary, the hospital can chose to sue the patient for libel, slander, or defamation. The only way that they can produce the HIPAA protected information would be by court order; or by written permission of release by the patient.

Since the patient is the one complaining, it's not in her self-interest to allow the hospital to divulge information in their defense in a public setting. It's her choice, not theirs; unless they choose to make it a legal case.
Oh God, I need a doctor my sides are splitting with laughter.
My title says "Senior System Administrator". The actual functions I perform are actually DBA, data mining, statistical analysis, and report generation, and toss in occasional help desk computer technician.

The biggest conflicts are over the statistics and reports. Keeping them honest in the face of people pushing to portray themselves in the best light is a constant battle. Every so often you get someone who absolutely insists that something be called an eclair when it's really a dog turd. Or even more funny, want's us to call the Christmas tinsel the dog swallowed, "silver-lining."

If it smells like crap, and tastes like crap, it is crap. You have to accept it before you can start working on real solutions.
0 Votes
+ -
This is the kind of situation that really requires better judgment on the part of "listeners." If someone were to come to me and tell me some story like this, my response would be,"PROVE IT!" Unless I already had inside information regarding the hospital in question, I would not assume the person relating the story, especially a journalist, is correct. Too many journalists take liberties that are not theirs to take, regardless of what they claim the constitution says. Yes, you have the right to speak, but that right is only to speak the truth; any other response is an act of self-incrimination. Unfortunately, the truth is hard to find these days without an open court.
What information you choose to disclose is up to you. It is not up to some back-office weenie to say "s/he talked about it first so we can tell anyone anything!"

At the risk of sounding cliche, what happens at the doctor's or hospital stays there unless you choose to talk about whatever parts, small or large, of it you wish to share.
Sounds to me as if the hospital should sue for defamation.Unless her allegations are true.If true,then why should we hear any details?
0 Votes
+ -
No... but that's not what's wrong here...
mhbowman@... 16th Sep 2009
I've been in IT at hospital for the past 10 years, and can attest to the stringent policies in place because of HIPPA regulations. As a patient you have every right to tell everyone you meet your personal business if you are so inclined.

However, for a hospital employee that has access to medical records, it's against policy to view your OWN records much less anyone else's that you don't provide care for, regardless of what they blab.

Paraphrasing: "Cortes had a serious spinal fracture, and said Twitter helped her escape from intimidation, and coercion to accept unnecessary spinal surgery".

How does that work?

I'm not sure I agree with the diagnosis. Let me tweet somebody and describe what's going on to get a second opinion. Never mind that this person may not be qualified, and hasn't even seen my back.

What happened then? Sorry, TweetDr23 says you're full it, and I don't need surgery. Just give me a back brace and some pain meds. I'm going home.

Interesting topic, but still one of the most ridiculous things I've read in a while. I hope for her sake she doesn't end up in a wheelchair.
The transparency of new media tools raises a number of
new questions around boundaries and ethics in many
scenarios. In this instance, the hospital was right to
abide by HIPAA; a patient has every right to disclose
their own information but it does not change the
responsibility of the institution. However, it is unfair
that this one way conversation took place and if the
information from the patient was erroneous and damaging
the hospital should be afforded some recourse.
People have been talking trash about hospitals ever since there was the first hospital. Twitter is just another avenue for the blahblah. The hospital should just ignore it. If she is taking the hospital to court for the way she was treated then the hospital will have to be bound by the HIPAA laws just like all other lawsuits hospitals deal with.
Not a technology issue
This is not a technology issue -- the same situation for the hospital would arise if Cortes wrote a letter to the local newspaper airing her complaints. It is also not strictly a HIPAA or doctor-patient issue -- for example, when she was administrator of a private school my wife had to make decisions to not renew teachers' contracts but could not discuss the reasons with irate parents (on the advice of the school's attorneys). Meanwhile, the ex-teachers were free to disseminate their versions.
So -- it is an interesting topic to discuss and no less relevant for a technology forum than any other forum, but it might be sensible to see what the people who have been wrestling with this issue for the past 30 years have concluded before calling for a point-by-point rebuttal. And to conclude that this is evidence that this case is evidence that "the boundaries for standard operating procedures are falling due to new technologies" is fallacious.
0 Votes
+ -
alih_eng@hotmail.com
alih_eng@... 16th Sep 2009
I hack windows 7

but I want to be white hacker

I love microsift and computer technology

I with the antihacker

good mornning staff
0 Votes
+ -
Impossible! Not during spinal surgery!
w4htx@... 16th Sep 2009
I've had spinal surgery, and I am a CompTIA/A+
certified computer technician.

Your question was: "Should privacy procedures be
waived by a patient?s actions, say updating Twitter or
Facebook during a surgery?"

First, no physician or surgeon licensed in the USA
would allow a handheld or laptop device in surgery
because it would violate the sterile field requirement. Sterilization of personal computer
equipment (handheld or laptop) would be pretty much
impossible, since an autoclave uses steam to sterilize
and would melt components. Chemical sterilization
would likely use chemicals harsh enough to compromise
circuits in the keyboard or even within the system
itself. Liquids and computers don't mix well. Very
basic info...

Second, after they give you the Versed cocktail, I
defy ANYONE to try to think of Tweeting or Facebook
posting. It makes you completely intoxicated beyond
any level you might experience outside and operating
room. The versed cocktail is a pre-anesthesia drug
combination given before pretty much all major and
lots of minor surgeries. After a few moments of
administration, you can't even recall why you're
there...

No way during a surgery. It just wouldn't happen. A
hospital or surgeon would not be able to get
malpractice insurance if they allowed it in surgery.
0 Votes
+ -
You're right on all counts except....
mhbowman@... 17th Sep 2009
She didn't have the surgery. It plainly says:

Twitter helped her ESCAPE from the clutches of hospital staff whom, she claims, tried to intimidate and coerce her into accepting unnecessary spinal surgery
As much as I agree with the idea that someone should be able to blab away their privacy rights, the perverted language of the HIPAA privacy regulations make it impossible. The "security" and the "consent" concepts in HIPAA are distinct. e.g. Someone could sign a consent form to allow their doctor to print their medical record on a billboard in Manhattan, but if the doctor did so, s/he would violate the HIPAA security regulations. In essence, lawmakers created a situation where your consent - and certainly your blab - is irrelevant.

Paul
paul@privacy-panic.com
http://www.privacy-panic.com
0 Votes
+ -
From a Person with Chronic Illnesses
Headspin 16th Sep 2009
Hospitals and Clinics are becoming way too private minded to protect their own selves. They have you sign wavers "in your own interest" so that all remains private, but in the end, they are covering their own ends. It gets to the point where certain departments of one hospital cannot share information on a patient without the patient's consent, even if it is in the patient's own well being. This "Patient Confidentiality" has gotten way too out of hand.
0 Votes
+ -
It's called HIPAA. They have to have you sign the notice of privacy practices BY LAW.
0 Votes
+ -
waivers and privacy
steve@... 17th Sep 2009
dont confuse the privacy statement with the waivers for surgery. The waivers are so you understand the risks involved (you might die for example)this is funny since it does not stop people from suing them anyway. However i have met a lot of people that think because they sign a waiver that they sign away their rights to sue.
Most people miss what HIPPA is designed to do. It was enacted to prevent hospitals and doctors from sharing information, but mainly insurance companies. They used to be able to share information freely. Like say you had cancer, they could ask your old carrier. Now they have to ask the patient. Privacy laws and ethics prevented the patient prevent the sharing of information with the media etc. Now HIPPA prevents both. That being said, nurses, doctors, hospital administrators CAN talk about anything that does not describe specific treatments or diagnoses. Patient restrictions are not covered under HIPPA. Patient behavior and how they interacted and behaved is not covered under HIPPA. They could legally comment, but someone would probably use their job.
If something happened which was illegal, the law allows authorities to force the hospital to disclose matters normally protected under such laws. Otherwise, the issue is moot....
0 Votes
+ -
So, they can shoot anyone who talks about what he says in surgery.

Join the conversation!

Formatting +
BB Codes - Note: HTML is not supported in forums
  • [b] Bold [/b]
  • [i] Italic [/i]
  • [u] Underline [/u]
  • [s] Strikethrough [/s]
  • [q] "Quote" [/q]
  • [ol][*] 1. Ordered List [/ol]
  • [ul][*] · Unordered List [/ul]
  • [pre] Preformat [/pre]
  • [quote] "Blockquote" [/quote]
ie8 fix

The best of ZDNet, delivered

ZDNet Newsletters

Get the best of ZDNet delivered straight to your inbox

Facebook Activity

White Papers, Webcasts, & Resources
ie8 fix