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Rogue IT and Clinical Text MessagingSession 227, February 23, 2017

Eric Swirsky J.D., M.A., Clinical Assistant Professor, University of Illinois at Chicago

Matt Byrd, MSHI, Institutional Account Specialist, Pfizer

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Speaker IntroductionEric Swirsky J.D, M.A.Clinical Assistant ProfessorDirector of Graduate Studies

University of Illinois at Chicago College of Applied Health Sciences

• Ethics education

• CAHIIM Director

• Clinical ethics

• Scholarship areas: HIT, social media, clinical research, infonomics

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Speaker Introduction

Matt Byrd, MSHI Institutional Account Specialist

Pfizer

● Masters in Health Informatics from University of Illinois at Chicago

● Capstone project is basis for our discussion

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Conflict of Interest

Eric Swirsky, JD, MA

Has no real or apparent conflicts of interest to report.

Matt Byrd, MSHI

Has no real or apparent conflicts of interest to report.

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Agenda

• Case study

• Health-related use of mobile technology

• Some of the benefits and burdens

• Legal and policy considerations

• A path towards compliance

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Learning Objectives• Describe the statistics associated with the use of mobile technologies in

clinical interventions and communicationsUnderstand the statistics associated

with the use of mobile technologies in clinical interventions and

communications.

• Describe the application of text messaging as a tool for communication

between provider and patientOutline best practices for the implementation of

text messaging for provider-patient communication.

• Analyze the ethical and legal issues attendant to the use of mobile

technologies in clinical practice

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Learning Objectives

• Recognize the benefits and burdens of using this technology and its

implications for the provider-patient relationship

• Outline best practices for the implementation of text messaging for provider-

patient communication

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Case Study—The Provider• Dr. John Hinkle

–37 years old

–Family practice with 6 physicians

–Looks to technology to help with patient care

• Ohio River Health System

–2 hospitals

–950 beds

–5 infusion centers

–60 stand alone offices

–2,000 physicians

–Has email and texting policy

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Case Study—The Patient• Avery

– 16 year old female

– Suffers from an eating disorder

– Concern she will be begin self-destructive behavior again

– Wants more contact with her primary without going through parents

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Case Study—Text Messaging Initiative

• Dr. Hinkle would like to use texting for

– Real time conversations with patients when they need him

– More efficient communication and information dissemination

– Increased and enhanced patient access

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Case Study—Text Messaging Initiative• Hinkle’s Plan

– Code patients in his personal cell phone

– Strict communication rules with patients

• Alerts parents if he believes child is at risk

– Believes text conversations are protected

• Child can discuss anything they want with parent

• At appointments conversations may come up

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Benefits and Value of Clinical Texting

• Increased Access

• Provider-Patient Relationship

• Compliant Texting

• Patient Outreach

• Efficient Communications

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Audience Poll

Do you use your personal phone for professional activities?

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Problem 1

Rogue IT is a Reality

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17Pew Research Center, Cell Phone Activities

Available at http://www.pewinternet.org/data-trend/mobile/cell-phone-activities/

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Question

Does your employer have a text messaging policy?

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Rogue IT

“Fully 77% of workers report using social media regardless of whether their employer has a policy in place.”

Pew Research Center. (2014). Social Media in the Workplace.

Available at http://www.pewinternet.org/2016/06/22/social-media-and-the-workplace/

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Problem 2—HIPAA Privacy and Security

81%

Four in five doctors use smartphones at work

(Kantar Media, 2016)

• 49% take no security measures

• Less than 24% use encryption

(Jackson & Coker)

OCR reports that 4,531,569

individuals have been impacted by

breaches via mobile device since

2010.

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Other Risks of Rogue Mobile IT

• Shadow record

• Indelibility

• Authentication

• Inherently insecure

– Mobile apps and networks

– Weak personal security

• Professional boundary blurring

– Minors

• Student use

• Patient expectations

• Photos and meta-data

• Bad apples

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Solution: Compliance

Opportunities abound

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HHS’s 5 Steps

Decide

Assess

Identify

ManageTrain

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Follow Through

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The Value of Compliant Text Messaging

• Patient preferences

• Patient outcomes

• Policy, protocol, and proactive management

• Patient engagement

• Physician time and patient well-being

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Rethinking the case – What went wrong?

• Is there secure texting?

• What is compliant texting?

–Administrative safeguards

–Physical safeguards

–Technical safeguards

• Is verbal consent enough?

• How is text communication documented?

• Is leaving parents out of communication chain a mistake?

– Can provider contact parent in time when something goes wrong?

• Is offering constant contact through text messaging misleading?

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“The old art cannot be possibly be replaced by, but must be incorporated in, the new science.”

--Sir William Osler

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Questions

Please complete online session evaluation

Eric Swirsky, JD, MA

Clinical Assistant Professor

Director of Graduate Studies

(312) 996-8237

eswir@uic.edu

Twitter @HI_EthicsGuy

Matt Byrd, MSHIInstitutional Account Specialist

Pfizer

Matthew.Byrd@pfizer.com