Digital Citizenship for Physicians

DIGITAL CITIZENSHIP FOR PHYSICIANS

Joyce Lee, MD, MPHTwit ter : @joycleewww.doctorasdes igner.com

Current: JAMA Pediatrics, Social Media, Web EditorUnitioPrevious: VerilySamuelsson Associates

@joyclee #hcsm

Q: Are there any other uses of social media in clinical medicine or research that you want to learn about?

A: “No. This is a complete waste of time. This is not real research. The fad will die out soon.”

Twittersuperuser.com

YOU ARE A DIGITAL CITIZEN

“A person ut i l iz ing information technology (IT) in order to engage in society, pol i t ics, and government part ic ipat ion.”

“The Good Old Days”

@joyclee #hcsm

DO YOU HAVE A CELLPHONE?(1) Yes(2) No

@joyclee #hcsm

PIECES OF YOU ARE ALREADY ALL OVER THE INTERNET

“A world of indiscriminatetracking where institutions are stockpiling data aboutindividuals

Manoush Zomorodiprivacy-paradox.org

@joyclee #hcsm

WHAT DOES YOUR PHONE KNOW ABOUT YOU?

Metadata=Data about data

Time of a cal l or text Incoming or outgoingDurat ion of the cal lLength of the text messagePhone # of senders & recipients

METADATA

@joyclee #hcsm

Metaphone=Android smartphone application

• The application automatically retrieved

– Historical call and text message [Short Message Service (SMS)] metadata from device logs

– Information from a participant’s Facebook account, to be used as ground truth for potential inferences.

• 823 participants volunteered their metadata, which included 251,788 calls and 1,234,231 text messages

We randomly selected 30,000 numbers from our dataset and queried free, public interfaces hosted by Yelp, Google Places, and Facebook using these numbers

31.9% of phone numbers can be reidentified (automated)

Random selection of 250 phone numbers• Manual query interface for an inexpensive

commercial database (Intelius; $19.95 a month ). • Manual Google web searches to look for

identifying information (70 min)

82% of phone numbers can be reidentified (automated & manual)

80% Accuracy in Identifying a Romantic PartnerStudied participants who according to their Facebook profile were single N = 148 or in a relationship N = 309.

“Part ic ipant A held conversat ions wi th a pharmacy specia l iz ing in chronic care , a pat ient serv ice that coord inates management for ser ious condi t ions , several local neurology pract ices , and a pharmaceut ica l hot l ine for a prescr ipt ion drug used solely to manage the symptoms and progress ion of re laps ing-remit t ing mul t ip le sc leros is .”

“Part ic ipant B received a long phone cal l f rom the card io logy group at a reg ional medical center, ta lked br ie f ly wi th a medical laboratory , answered several short ca l ls f rom a local drugstore , and made br ie f ca l ls to a sel f- report ing hot l ine for a card iac arrhythmia moni tor ing dev ice.”

“Part ic ipant E made a lengthy phone cal l to her s is ter ear ly one morn ing. Then, 2 days la ter, she cal led a nearby Planned Parenthood c l in ic several t imes. Two weeks la ter, she placed br ie f addi t ional ca l ls to Planned Parenthood, and she placed another short ca l l 1 month af ter.”

Metadata f rom an NSA request involv ing a s ingle suspect could uncover in format ion on approx imately 25,000 ind iv iduals .

Extend the search by one degree of separat ion — you, your f r iend and thei r contacts — and an agent could recover personal in format ion on 20 mi l l ion people .

@joyclee #hcsm

Challenge #1:TAKE BACK YOUR METADATA

@joyclee #hcsm

DO YOU USE GOOGLE?

(1) Yes(2) No

Incogni to mode only deletes your local search and browsing h is tory - just the content on your computer.

Websi tes , search engines , in ternet serv ice prov iders , and governments can s t i l l eas i ly t rack you across the web.

“BUT I SURF INCOGNITO!”

@joyclee #hcsm

DO YOU USE GMAIL, DRIVE, DOCS, MAPS, PHOTOS? (1) Yes(2) No

@joyclee #hcsm

WHAT DOESN’T KNOW ABOUT YOU?

http://www.pbs.org/wgbh/frontline/film/united-states-of-secrets/#video-2

http://www.pbs.org/wgbh/frontline/film/united-states-of-secrets/#video-2

@joyclee #hcsm

Challenge #2:DUCK GOOGLE FOR DUCK DUCK GO

“zero-data-retention policy”

https://myaccount.google.com/activitycontrols

@joyclee #hcsm

DO YOU USE FACEBOOK? (1) Yes(2) No

@joyclee #hcsm

YOUR IDENTITY IS BEING DEFINED & TRACKED BY AN ALGORITHMThe Facebook algorithm

https://chrome.google.com/webstore/detail/what-facebook-thinks-you/eoknmaajkanapojcdeccofmeimpddoim

1 . What you do on FB2. What you do on other websites3. Personal data purchased from

off l ine data brokers (mortgages, carownership and shopping habits)

@joyclee #hcsm

Facebook offers advert isers >1 ,300 categories for ad target ing:

Emai l , locat ion , sexual pre ference , communi ty in format ion , l ikes “grass”, l ikes “wax”; proper ty s ize less than .26 acres; households wi th 7 cred i t cards

@joyclee #hcsm

Orbi tz = h igher pr ices for hotels for Mac computer users Staples = h igher pr ices in cer ta in Z IP codes.The Pr inceton Review = Higher charges for onl ine SAT tutor ing course in cer ta in Z IP codes: $6,600 vs . $8,400.

@joyclee #hcsm

@joyclee #hcsm

Challenge #3:USE THE WHAT FACEBOOK THINKS YOU LIKE TOOL

What does this mean for your online identity as an individual/MD?

@joyclee #hcsm

DO YOU USE SIRI, ALEXA, ECHO, OR GOOGLE HOME? (1) Yes(2) No

There’s no user-accessible record of yourprevious queries because Apple associatesthem with a random ID number, rather thanyour email address or iCloud account. After sixmonths, both are deleted.

”Amazon maintains a database of yourconversations with the Echo, which you cansee and manage online. In addition, audio datais encrypted when it enters and leaves yourhome, to minimize the risk of interception byhackers”

@joyclee #hcsm

PIECES OF YOU ARE ALREADY ALL OVER THE INTERNET

@joyclee #hcsm

ARE THOSE PRIVATE PIECES OR PUBLIC PIECES?

@joyclee #hcsm

CAN YOU SEPARATE YOUR PRIVATE AND PUBLIC IDENTITY AS A PHYSICIAN?

(1) YES(2) NO

When a physician asks, “Should I post thison social media?” the answer does notdepend on whether the content isprofessional or personal but instead dependson whether it is appropriate for a physician ina public space

@joyclee #hcsm

YOU HAVE NO CONTROL OVER WHAT HAPPENS TO YOU ON THE INTERNET

@joyclee #hcsm

YOU ARE A PUBLIC PHYSICIAN

@joyclee #hcsm

YOU NEED TO MANAGE THE MECHANICS AND CONTENT OF SHARINGONLINE

Iceberg Tweeting@craigmod Link

Text

Date, Time

Retweet

Favorite

Individuals

Photo/Video

Replies

No risks outlined on the Youtube Twitter Card metatags!

@joyclee #hcsm

Challenge #4:RULES AND ETIQUETTE

“Due to your clenching and grinding habit, thisis not the first molar tooth you have lost due toa fractured root…This tooth is no different.”

I looked very closely at your radiographs andit was obvious that you have cavities and gumdisease that your other dentist hasoverlooked. … You can live in a world of denialand simply believe what you want to hearfrom your other dentist or make an educatedand informed decision

-Dentist1

“You brought your daughter in for theexam in early March 2014,” he wrote.“The exam identified one or more of thesigns I mentioned above for scoliosis. Iabsolutely recommended an x-ray todetermine if this condition existed; this x-ray was at no additional cost to you”

-Chiropractor

2

3

4

4

5

“5 nurses who worked at Tri-City MedicalCenter in Oceanside, CA used socialmedia to post their personal discussionsconcerning hospital patients. No photos,patients names, or other identity-compromising information were posted.”

6

7

8

9

10

11

Director, Chief Operating Officer of the Cleveland Clinic Wellness Institute12

12

”Hey I will send you an email with the patient’s info”

13

“I will add it to google drive”

14

“He wrote this opinion piece on his own and it does not reflect the position of the Cleveland Clinic whatsoever, and we strongly support vaccinations and the protection of patients and employees,”

said Eileen Sheil, executive director of corporate communications for the medical center.

EVERY HEALTHCARE PROFESSIONAL IS THE VOICE OF HIS/HER INSTITUTION

”Disclaimer or not, logo or no logo, the world knew that this doctor was leadership at The Cleveland Clinic.”

“Our public engagement is inextricably linked to our work and other aspects of our lives.”

“Welcome to the age of transparency.”

@Doctor_V

DO YOU EXIST IF YOU ARE NOT ONLINE?

GO FORTH AND BE A GOOD DIGITAL CITIZEN!

joyclee@med.umich.eduhttp://www.doctorasdesigner.com/Twitter: @joycleehttps://medium.com/@joyclee