HIPAA and its challenges with the use of mobile devices

The use of smart phones especially in hospitals and other healthcare facilities has gone up considerably over the years as more doctors, nurses and other clinicians embrace it. The reason for this is smart phones enable better coordination and communication of healthcare, they allow for direct patient management, they improve on efficiency and they reduce healthcare costs (Mayes & White, 2016). The purpose of this paper will be to look at the law that governs the use of smart phones in the work place, their advantages and disadvantages and the professional, ethical and legal considerations.

To prevent health information from being accessed by the wrong people, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was created with a goal to protect the health information of people from being accessed and disclosed by the wrong people, at the wrong time and for the wrong reason (Sullivan, 2004, p.27). In healthcare, the use of smart phones and social media presents compliance challenges with the regulations of HIPAA (Zabel, 2016).

With regards to the scenario, the ending that will be discussed is conclusion four where an investigation is being conducted for HIPAA violations on a celebrity who had been admitted to the hospital. It is mentioned that the nurse sent the photos to her best friend who it can be assumed sold them to Gossip Gazette. Alternatively a member of staff or a patient might have accessed her phone without her knowledge, saw the photos and sold them. The nurse at this point needs to present herself to the investigating authority, informing them of everything that she did from when the patient was admitted to when the photos were released by the Gazette. Most importantly, she needs to mention that she shared the photos with her friend and no one else. However the outcome, the nurse is in direct violation of the HIPAA act because she took a photo of his personal information, took a picture of him while unconscious and unable to give his consent. The legal ramifications for this exist in the HIPAA Privacy Rule which all healthcare personnel are required to follow (Zabel, 2016).

The Privacy rule is meant to give patients control over the use and release of their information, establish appropriate safeguards that all healthcare providers must adhere to and it holds people who violate this rule accountable in criminal and civil penalties which range from $100 to $1.5 million (HHS.gov, 2013). According to Zabel (2016), a healthcare employee who discloses patient information to friends and/or co-workers is in violation of the HIPAA Privacy Rule and risks losing their job.

It doesn’t matter that her friend or someone else sold the photos to Gossip Gazette. The nurse violated professional, ethical and legal codes of conduct that govern patient confidentiality which all healthcare employees should follow. Posting and sharing pictures of the patient with others, while harmless, is a HIPAA violation because in this case a lot of people will recognise the patient because he is a celebrity, they will know the doctor treating him, and they will know his current health condition (Zabel, 2016).

Legal, ethical and professional considerations for smartphone use in healthcare

What the nurse should have done is restrict the conversation about the patient to her friend, regardless of whether he is a celebrity or not (Zable, 2016). If she followed the code of ethics for nurses, she should have known that she has a duty of care and is required to professionally and ethically keep patient information confidential. This means she cannot release any personal data on the client without his consent or the authorization of a legal authority. Also, knowing that she had photos of her patient in her phone, she should have put in safeguards such as a password and encryption software to prevent anyone from accessing her phone without her knowledge (Zabel, 2016).

The introduction of mobile devices in healthcare has improved the follow-up process after discharge with patients where doctors and nurses are able to better coordinate and communicate with the patient. Mobile technology has also made it possible to have seamless data flow in the health care setting as doctors, nurses and pharmacists have more control on information dispersion because the healthcare system is complex and there is continuous dataflow (Kathooria, 2017).

While it might seem that smartphone technology is mostly a preserve of developed countries, developing countries such as India have incorporated this technology to monitor and manage the millions of people suffering from diabetes, HIV and Hepatitis (Mayes & White, 2016). The Health Tablet, created by an Indian public health doctor, is a portable diagnostic device that can be used to record diagnostic tests such as blood sugar levels, Hepatitis B and HIV status and also complete blood counts. This will allow doctors and nurses in rural parts of India to diagnose and treat their patients at the point of care (Mayes & White, 2016).

According to Martinez-Perez, Torre-Diez and Lopez-Coronado (2014), health-apps pose data privacy risks where there is a failure to secure the collection and management of people’s data by mobile health-apps. Also, mobile phones present some risks to health care providers some of which are; they lack authentication where users don’t have passwords or biometric identification making it easy for anyone to access health  information on the device, the data stored in phones is not encrypted and can be easily retrieved and shared by those who have access to the device, phones that use a public wireless network to send and receive information increase the risk of exposing a patient’s information (Barrett, 2011).

Nabulyato, Jeyaseelan, Malagelada and Heaton (2016), carried out a study on the professional, legal and ethical considerations of smartphone use in orthopaedics. They identified the following as issues related to patient confidentiality; there was no patient consent especially when taking photos of wounds, the photos of patients had identifiers present, the storage and management of patient information was not secure because most smartphones like the iPhone have automated “cloud” systems that backup all data to mainframes where external companies that have no direct role in patient care have access to sensitive data (2016, p.255).

To mitigate breaches in health information clinicians should gain consent from the patient and allowing them to participate in decisions, making sure that patient privacy and dignity are followed especially during visual/audio recordings. They should also explain the purpose of these recordings to patients before obtaining their consent (2016, p.255) and get consent from a person of legal authority when recordings are necessary in unconscious patients (2016, p.256).

To conclude, the nurse in question should have maintained patient confidentiality and acted in a professional manner while providing care by following the law on patient privacy and being aware of the professional, legal and ethical issues related to smartphone use in the workplace.

References

Barrett, C.(2011). Healthcare providers may violate HIPAA by using mobile devices to communicate with patients. ABA Health Esource, 8(2). Retrieved from https://www.americanbar.org/newsletter/publications/aba_health_esource_home/aba_health_law_esource_1110_barrett.html

HHS.gov(2013). What does the HIPAA privacy rule do? Retrieved from https://www.hhs.gov/hipaa/for-individuals/faq/187/what-does-the-hipaa-privacy-rule-do/index.html

Kathooria, M.(2017). 8 benefits of mobile devices in healthcare that you need to know. Retrieved from https://kaysharbor.com/blog/healthcare/8-mobile-device-benefits-in-healthcare

Martínez-Pérez, B., Torre-Díez, I. & López-Coronado, M. (2014). Privacy and Security in Mobile Health Apps: A Review and Recommendations. Journal of Medical Systems 39(1). Retrieved from https://www.researchgate.net/publication/269289798_Privacy_and_Security_in_Mobile_Health_Apps_A_Review_and_Recommendations

Mayes, J. & White, A.(2016). How smartphone technology is changing healthcare in developing countries. Retrieved from https://kaysharbor.com/blog/healthcare/8-mobile-device-benefits-in-healthcare

Nabulyato, W.M., Jeyaseelan, L., Malagelada, F., & Heaton, S.(2016). Legal, ethical and practical considerations of smartphone use in orthopaedics. Royal College of Surgeons, 98(6), 252-257. Retrieved from https://publishing.rcseng.ac.uk/doi/pdf/10.1308/rcsbull.2016.252

Sullivan, J.M.(2004). HIPAA: A practical guide to the privacy and security of health data. Illinois: American Bar Association Publishing

Zabel, L.(2016). 10 common HIPAA violations and preventative measures to keep your practice in compliance. Retrieved from https://www.beckershospitalreview.com/healthcare-information-technology/10-common-hipaa-violations-and-preventative-measures-to-keep-your-practice-in-compliance.html