Those interested in the potential for social media to help improve healthcare and the community’s health are expressing concerns about a preliminary consultation paper on social media policy from the Australian Health Practitioner Regulation Agency (AHPRA).
It seems that the document hit the Twittersphere ahead of a planned wider release for public consultation.
The document is causing a deal of consternation, especially among contributors to the Healthcare Communications and Social Media in Australia and New Zealand or #hcsmanz Twitter chat group (as per some of the tweets at the bottom of this post).
It says the policy aims “to provide clarity for the public and health practitioners about the expected standards of social media use for registered health practitioners regulated under the National Law” and has been developed in response to requests from health practitioners and professional associations seeking guidance from the National Boards.
The document takes a fairly dim view of social media, focusing mainly on its potential to breach laws and guidelines relating to the advertising of regulated health services: “Some use of social media by registered health practitioners may contravene the code of conduct, the Advertising Guidelines and other relevant legislation.”
It says registered health practitioners “should be aware of the risks and implications of using social media”. It fails to acknowledge the potential benefits for service delivery and improvement, public health efforts, and for enabling greater public participation, whether in research, services or policy.
Croakey also wonders what the draft policy might mean for the ability of health professionals to engage in online activism – such as the recent excellent efforts of surgeon Dr Jill Tomlinson (as per the tweet below) and other doctors in contributing to the #destroythejoint social media campaign. This arose in response to an Alan Jones complaint about female leaders “destroying the joint”. (An example of humour being the best medicine, perhaps…)
The AHPRA document states:
The definition of advertising under the Advertising Guidelines is broad. It includes use of social media such as posting an online message or group comment on a practitioner’s Facebook page or LinkedIn connection.
The National Law provisions on advertising apply to:
• practitioners registered under the National Law
• employers of practitioners and
• other persons who provide services through the agency of a registered health practitioner.
A person advertising a regulated health service may contravene the National Law even if they are not themselves a registered health practitioner. As a result, a person may be found to have ‘advertised’ a health service even though they did not intend to advertise or promote their health service.
A practitioner who contravenes the National Law, the code of conduct or the Advertising Guidelines may face disciplinary action that could affect their registration.
In summary, the document says:
When using social media, health practitioners should remember that the National Law, Advertising Guidelines and the code of conduct apply.
Registered health practitioners should only post information that is not in breach of these obligations by:
• not breaching professional obligations
• not breaching confidentiality and privacy obligations (such as discussing patients or posting pictures of procedures, case studies, patients or sensitive material)
• presenting information in an unbiased, evidence informed context and not making unsubstantiated claims and
• not using testimonials or purported testimonials in any capacity on any medium.
***
Croakey is keen to hear from readers about the policy – and will post a compilation of responses to help inform AHPRA’s consultation process.
Some specific questions to consider:
• What are the implications of the draft policy for current and future uses of social media by health professionals and services?
• What might be some of the unintended consequences of the policy?
• What do you think the policy should cover and recommend?
• What advice would you give AHPRA? How can a balance be achieved that enables positive use of social media while stopping uses that are not in the public interest? Is there a need for a review of relevant legislation and guidelines?
• Are there any relevant policies, from Australia or from overseas, from the health sector or other sectors, that you would recommend to AHPRA?
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Further reading
In the meantime, the following resources might help inform a wider debate about the use of social media for health:
• From the London School of Economics: Using Twitter in university research, teaching and impact activities: A guide for academics and researchers
• The US Centers for Disease Control and Prevention social media portal
• A recent presentation from the George Institute about the potential public health benefits of engaging with Twitter
• A US perspective on Using YouTube for patient education and information
• We need more health professionals online, says US doctor, because that’s where the people are
• A US presentation about best practices in social media (it’s not about marketing but about improving care)
• Webicina: a wealth of resources on social media and healthcare
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A small sampling of the concerns being raised on Twitter…
This draft policy reflects a lack of understanding on how social media IS and can be used by professionals in a professional capacity…even if they chose to comment/reflect/ critique on matters pertaining to their area of professional…or even worse- provide opinion or ‘biased’ views about something. The power of social media is its capacity to allow content creation, sharing, linking, editing etc. What’s urgently required is not really a policy statement but a comprehensive guideline for the National Boards and their members to be able to easily understand, tweak for their specific specialities and implement.
Is this really what the National Boards wanted because ultimately this document suggests or even strongly guides health practitioners to turn their back on social media for fear of contravening ‘advertising’ laws- which by the way, probably needs to be urgently reviewed to consider the broad reach of social media. This document does not provide a realistic signal to practitioners about how to use social media safely and professionally. In fact after reading it several times I still did not have a clear picture of what I could and could not do- except- obviously- reveal information about patients and their treatment/ health issues etc. The sections about professional boundaries are spot on- disclosing any information about patients is not on – ever. This point cannot be emphasised enough!
I suggest AHPRA look outside of Australia where some major health orgs have embraced social media and have instead focussed their attentions on education and support and up skilling health professionals e.g. NHS and The Mayo Clinic and Kaiser Permanente to name but a few. Even within our borders Australian healthcare groups have braved the “national laws” and the Advertising laws to leverage off the true power of social media- its capacity to reach and engage. What use are we as healthcare workers if we cannot engage with our community about their health and wellbeing?? What do we do when a patient comments positively on the fantastic service they received from an obstetrician at Liverpool Hospital on Sydney Sth Western Sydney Local health District’s Facebook page? https://www.facebook.com/#!/SWSLHD According to this document it represents a form of advertising because in a way it’s a ‘testimonial’…at least I think that’s what it’s telling me.
This document also unintentionally sets up hundreds if not thousands of health professionals to break the laws. In a survey I conducted of Australian healthcare professionals in 2011 (unpublished…yet!) over 60% already owned a personal Facebook account and at least 40% of them visited it daily! How on earth does APHRA or the National Boards intend to police that? There will be plenty of personal information on their accounts…
I strongly suggest that any policy document written and endorsed by the National Boards be reviewed yearly as it is unrealistic to expect that the social media landscape will remain static for more than few minutes! As frightening as it seems- even the ‘norms’ of social media behaviour are quickly changing. Not always for the best…but changing nevertheless. Worldwide trends in social media usage point to social, local and mobile. It will become increasingly difficult for healthcare workers to separate their professional life from the ease with which they can tap into social networks and social media applications and take part in online activities or conversations.
I also believe the punitive nature of this draft document will prevent healthcare workers from providing the much needed credible voice on social media- especially in relation to public health messages and general health and well being information and advice. In a 2011 publication Wayne Usher of Griffith Uni (Developing Policies for e-Health: Use of Online Health Information by Australian Health Professionals and Their Patients – Health Information Management Journal) presented results from an Australian survey of allied health professionals which showed that the websites most frequently most recommended to patients were government supported ones such as Beyond Blue, Cancer Council NSW and Diabetes Australia. These and many other health websites provide opportunity for content creation, comment and sharing via their blogs or discussion forums. Many have set p social media pages- such s this one form Beyond Blue http://www.facebook.com/beyondblue How does a policy document such as this support health professionals to be part of these important conversations? I don’t believe it does. And that’s a real shame…
There is no doubt that there are dangers in the use of social media by health professionals, and it is AHPRA’s job to advise us of them and police our practice. Nevertheless, I wonder if rather than solely pushing the down side, a more forward thinking and collaborative way of regulating Australia’s health practitioners would be to recognise the enormous benefits available to patients and practitioners alike and guide social media use towards these.
My practice is a great deal richer for my use of SM. I have learned huge amounts from the people I follow on Twitter, people with huge expertise in fields I am interested in who I could never have hoped to connect with in another way. And my Facebook page allows me to extend the service I provide to outside my consultation room.
I read a lovely blog post recently entitled “We need more doctors online.” http://childrenshospitalblog.org/we-need-more-doctors-online/ The main reason for this? Because that’s where the patients are. If we are not with our patients when they seek medical information then we will cease to be relevant in their medical decisions.
For those of us who are already using social media there is simply no going back. With there being a number of published guidelines on social media including the one from the Australian Medical Association which can be viewed via http://ama.com.au/socialmedia along with a number of people who have real life experience, there is plenty of expertise available for AHPRA to tap into.
The way forward perhaps? For AHPRA to convene a working group which includes members of the health sector currently active in social media. We know about managing our professional reputation, credibility and medicolegal risk whilst being online!
Deb Verran
twitter @VerranDeborah
As the CEO of the Australasian College for Health Service Management, although our membership does not specifically represent a registered profession, we do represent Health Administrators and leaders of healthcare in Australia. It is our view that AHPRA’s social media policy does not reflect the position of our organisation. Although we absolutely believe that patient confidentiality, respect for fellow health workers, and prudence in sharing commercial in confidence info should always be maintained (as it is currently), we recognize the incredible potential of social media to contribute to a transformed health system which values openness, transparency and patient/practitioner/community engagement. I recommend referring to a blog I posted in regards to social media in healthcare http://www.achsm.org.au/Blog.html?year=2012&month=3&ItemID=40&count=1
There are now many good examples of social media policies in healthcare which AHPRA could look to to benchmark against. I recommend working with hcsmanz to provide details and advice on such matters.
It’s early days for coherent thought about the questions you have raised and the implications – but some random thoughts that occur to me are:
* Clearly maintaining patient confidentiality is paramount
*It is difficult to work out if the policy is directed at individuals in their personal capacity, or individuals as professionals, or assuming that these are the same thing.
*Some comments apply to everybody not just health professionals and are kind of common sense (one would hope) eg “Practitioners need to seriously consider whether the information they are posting or uploading to social media is appropriate in the public domain”. Would not this advice apply to any communication via any channel by anybody?
*It is unclear what the personal information is that could breach professional boundaries and how this information would be accessed (i.e via personal or professional accounts) – yes photos of embarrasingly inappropriate behaviour (apply imagination here) would be compromising, but how are photos of a family picnic on a personal Facebook page relevant? Is the intent that once a health professional then an individual can have no other identity or communication channel? Plently of health professionals share opinions in traditional (print) media. Why not forbid writing to the letters page over (say) a political issue – this would be the same wouldn’t it? i.e. making personal opinions/information available in a place where patients/people may read them.
*Issues of advertising and testimonials have been dealt with eloquently by other posters
*It would be helpful for the policy to provide constructive guidance on how health professionals and organisations can engage positively with the community on issues related to health and health care.
*AHPRA does not appear to have any social media presence on Facebook, Twitter or elsewhere
So random thoughts from me – looking forward to further productive discussion on this important issue
AHPRA has to be congratulated for acknowledging the emerging influence of social media within Australian health care. This is a big step in the right direction.
It’s the job of the National Boards to develop “standards, codes and guidelines for the health profession, including the development and approval of codes and guidelines that provide guidance to health practitioners registered in the profession.”
Guidance involves support and leadership. Most health professionals using social media are aware of the risks. However, the current AHPRA draft policy does not go much more than that: reminding us what can go wrong.
The draft policy does not assist health professionals how to respond to patients via social media. There are many open ends, for example: Social media is all about engagement and interaction, but how exactly should our practice respond when patients post comments? Testimonials are not allowed, but what exactly is a testimonial? Any positive comment? A Facebook ‘like’? A Twitter re-tweet? I have to decline friend requests from patients on Facebook, but what about my Twitter followers? Everybody is free to follow me on Twitter. And what about feedback to blog posts?
We don’t need more rules. What the profession really needs is answers to the day-to-day challenges of social media in health care. Help us interpret the law and how to stay out of trouble. It’s not exactly rocket science, especially for health professionals. After all, we not only tell our patients what the risks are of e.g. certain behaviour, we also tell them what they should do to get better.
Edwin Kruys (@EdwinKruys)
General Practitioner at Panaceum Group, Geraldton WA
http://www.panaceum.com.au
The four posts previously articulate the sentiments I share, so aptly. As the former CEO of RCNA, I was pleased that the organisation was able to consider the techno era we are fortunate enough to be part of. RCNA believed by developing some simple and user friendly guidelines we would be able to assist people to consider how to use SoMe responsibly, effectively and professionally. I agree a good way forward would be to engage with those of us who have already embraced SoMe (and not just by feedback to a document – but meaningful and engaging dialogue) and let us help formulate a policy with APHRA. A policy that is logical and acceptable to the health professionals who will be monitored against that policy and still protect the public that I believe all responsible health professionals also want to protect. Go back? I never could and I think there are a lot of us who see the positive benefits of SoMe that will enhance our health sector.
Great to see some much discussion here and I agree with above comments. I’d like to add to the discussion with some questions about applying the policy:
Professional Boundaries:
• Is it practical or possible to check if people who “friend” us on twitter are current or past clients.
• There is very little distinction between the private citizen who just happens to be a health professional and the health professional “on duty”. Does this policy mean to imply that we are not private citizens in the social media space?
Confidentiality and privacy
Sharing personal information/interesting stories/case studies is what makes social media so engaging. The guidelines as they stand make it difficult to distinguish between published case studies (surely these don’t breech confidentiality even if they are based on a client?) and why this would be any different to sharing a case study or case example at a public talk to demonstrate the benefits of support or care?
Advertising and Testimonials
How might we practically decide if a comment on a website or blog is a “testimonial” that breeches policy? Who would regulate this? And what purpose would it serve? It would likely impede the way we interact in the blogisphere for example, or at the very least create anxiety for everyone. Carolyn provides a great example above – does praise for a particular doctor on a facebook page count as a testimonial and if so what is the impact of deleting this comment for the patient? Could this be harmful?
I’d also like to ask the question – is a SoMe policy even needed from AHPRA?
Does the healthcare sector actually need a ‘policy’ explaining Social Media obligations? Who is going to monitor the application of the policy? Do practical guidelines about how to apply professional codes of conduct and other laws, codes and guidelines make more sense? Confidentiality for example, it’s a basic ethical principle and it exists online or off. A policy doesn’t guide my practice it just tells me what I shouldn’t do. I’m with Edwin on this, I’m inclined to think we don’t need more rules, give us some guidelines sure and please consult beyond the AHPRA member groups to those who are actively participating in social media.
Like others here have already said, theres no going back once you’ve embraced engaging with social media. The benefits of social media in the healthcare space are enormous and health practitioners are developing innovative and creative ways to communicate about health and wellbeing. Whatever happens the policy needs to support this innovation and recognise the benefits of social media.
Kerrie Noonan
Twitter @KezNoo
Psychologist and PhD Candidate
My full blog response and critique of the woeful @AHPRA ‘Consultation Paper’ is here:
http://philipdarbyshire.com.au/blog/entry/the-ahpra-consultation-paper-on-social-media-as-bad-as-it-gets
Comments welcome.
The comments before mine more than adequately express my concerns about much of this consultation paper. I have great concern to the punitive nature of the document which really fails to understand the benefits of social media. Just look at he websites of Impacted Nurse, Life in the Fast Lane and Broome Docs to name but three. All have multiple platforms and engage in significant discussion of and education within our health system. The AHPRA document does nothing to support this.
Having spent most of my health career working rural and remote locations there are particularly disturbing aspects to this document in relation to the ability of the rural/remote health professional to have a social life outside of their professional life. Unfortunately quite frequently the rural/remote health professional may have to provide care to a friend or family member. This is most often well managed by the health professional within already existing guidelines. What the AHPRA document would add is that you couldn’t be a facebook friend with them and you can’t discuss the local footy league with them on twitter.
Ultimately the document fails to understand social media and assumes that health professionals are unable to abide by already existing guidelines regarding privacy and professional behavior.
Great comments, I have learned a lot! Reading the feedback it seems there are 3 main problems:
First of all it’s not in the patients best interest. Social Media are a great opportunity for health professionals and practices to be in contact with patients and receive feedback. It is an opportunity for the health profession to provide more openness and transparency and to show patients what specialties we have and what we can do for them. What is actually wrong with a testimonial? (As long as it is not misleading). Patients have the right to know what their doctor or health professional can do for them. It is the ultimate customer feedback platform and gives patients co-ownership. As such it can improve quality of care and improve patient safety. And its also cheap and effective!
Secondly, we dont need more red tape. Why create another policy, another layer of bureaucracy that APRAH has to police. It will become bigger than ben hur, create a lot of anxiety and will cost more and more money (? higher APRAH fees).
Thirdly, we don’t need more rules. Like many have said, there is already regulation in place that deals with issues like privacy & advertising. Why do we need more? It is duplication of laws and will lead to more legal costs for health practitioners and practices. I’m concerned this policy endangers self regulation of the profession. It’s a threat to health professionals and does more harm than good. As long as we have some broad guidelines like the AMA published some time ago. We dont need microlegislation.
I think I may know what AHPRA are trying to get at but the wording so far needs more clarification. For instance how would a professional breach their professional obligations on social media? Some cases or examples? What if a patient gives consent for their case material to be used by a health professional on social media? What if a professional references their claims for biased but evidence informed content? Why ban all testimonials if they can be recognised as legitimate? Mork work on this please AHPRA.
Agree with all of the above comments. My main issue is that in an exciting (and constantly developing) area like social media, guidelines should permit innovation. If this new area of medicine has the blinkers applied too generously, we may miss out on novel public health benefits. Short opinion piece after attending the recent GPET convention in Melbourne:
http://ruralflyingdoc.wordpress.com/2012/09/08/socialmediamed/
Gerry
@ruralflyingdoc
I’m one of a surprising number of law graduates working in health promotion; I hated law because legal thinking ignores the social determinants of health and I wanted to have a more upstream impact. I never practiced and I don’t hold a legal practice certificate, so nobody should rely on this remark as legal advice. I’m mainly interested in the philosophical differences between different disciplines, e.g. legal, medical, evidence, practice knowledge, etc.
Some of the comments here reflect a misunderstanding about the role of AHPRA — they’re essentially there to prevent and police professional malpractice and misconduct, not to evangelise about the benefits of and best practices for social media use.
Some are also complaining that it’s very negative, and at first glance I thought that reflected a misunderstanding of prohibitory regulation, i.e. where everything not prohibited is allowed.
But on a closer reading of the consultation draft, I think the drafter doesn’t understand that paradigm. It isn’t in any way valid to say ‘careful or you could fall foul of standards we haven’t expressed here’; disciplinary action brought on that basis would be arbitrary, and as such, outside the regulatory authority delegated to AHPRA.
Feedback
1. Professional Obligations
I agree that the professional standing of clinicians is no different in responsibilities in the online environment. There is a growing emphasis on teaching “eprofessionalism” to medical students and training registrars. There are still only a few clear guidelines for Professional conduct in an online environment that can be referenced, and AHPRA has an opportunity to provide an authoritative work in this context.
AHPRA guidelines could assist in the development of appropriate curriculum for Medical Schools and Specialist Training.
There are some key challenges to the formulation of a proscriptive Regulatory Framework that will not benefit many Regulated Health practitioners.
1.1 Professional Boundaries:
Social Media is characterised by the potential for rapid dissemination of information in an uncontrolled environment, rapid recall of content without contextual information using search tools and permanence of records over time.
AHPRA must recognize that a significant proportion of graduating clinicians have embedded the use of social media into their personal and professional lives. Contextually most have both personal and professional identities in that world. Newly graduated clinicians often have a different scale with respect of “friendships” in a social media context (e.g. having several thousand Facebook friends), the robustness of those linkages and the understanding of the use of Social Media Commentary by others can be confounding .
AHPRA should respect that clinicians will have a private as well as public identity, and as such recognise where the clinician has placed boundaries to mitigate the possibility of cross boundary relationships, rather than declare that there is no possibility of a boundary distinction.
Personal interpretations of Social Medial comment by other readers and bloggers is complex and often beyond the capability of the Clinician to control. The ability for comments to lose their context or to be reinterpreted through dissemination, cut and paste activity or the simple display of posts in Key Word searches (e.g. Google) should be recognised in the application of a regulatory social media policy.
Social Media is not an easily definable medium, with the rapid development, promotion and subsequent obsolescence of media tools a characteristic. The specific management of privacy within each SM tool can be quite opaque and hard for the Regulated Health practitioner to manage, let alone influence policy changes e.g. Release of the Facebook Wall or a group change in Privacy Policy that affected visible content in 2008.
1.2 Professional Behaviour:
Removing Posts is difficult if not impossible due to the caching of data by several large enterprises. The ability to recall data that is unrelated to the current professional context of the clinician is a risk that is not easily mitigated and should be considered in any regulations.
Unwanted comments, abuse, flaming or high jacking and creating aliased accounts is impossible for the clinicians to control as is the ability to remove, restrict or block those persons accounts. AHPRA must recognise that often intent is important in the context of representing professional comment, and that responses often do not reflect the intent, spirit or context of clinicians initial comment.
Further it should not be the Regulated Health providers responsibility to police the use of Media beyond their own contributions. (By way of example the purchase of Domain Names by unauthorised or unknown parties with the intent of spoofing or presenting incorrect information to those owned by a Regulated Health Provider )
The Permanency of Social Media Commentary also means that publications including commentary and inappropriate photography made at a time when the Regulated Practitioner was not registered as a member of their profession could be used in an action against them. AHPRA must provide guidance on the temporal nature of the definition of professional behaviour such that the youthful exuberance, and an ill considered action is not later used to convict a mature professional person.
2/. Confidentiality and Privacy
I agree entirely, but AHPRA should provide guidance on the formulation and structure of Clinical cases for Education and Training and advise on acceptable mechanisms for rapid transfer of clinical information.
3/. Advertising and Testimonials
I am concerned that the unique nature of Social Media creates some significant challenges in the application of traditional provisions on advertising:
Patient/Group Engagement:
Social media presents tremendous opportunities for Patient and community engagement. Closed Facebook groups and demonstrated the power of social media in assisting patients to manage various chronic diseases such as diabetes. Youth engagement strategies are strongly aligned with Twitter, Facebook and other forms of electronic media such as texting. The use of Websites and blogs to present information is a very powerful tool for providing evidence based information to interested groups. Online forum have been successfully utilised for the support of minority groups such as gay and lesbian youth to provide de-identified support and counselling in a non threatening, highly accessible environment.
As such Regulated practitioners will often has a need to engage in this environment and even publish video and audio through services such as You-tube to assist in the education and support of various groups. Regulated Health professionals should be recognised as having a social imperative to be involved in this Media.
To place significant restrictions on the use of Social Media risks losing a key vehicle for minority and difficult to engage social groupings as well as potential powerful tools to facilitate changes in Health Status.
Membership, News & Information Services:
Social Media provides Craft Groups, Colleges, and Memberships a rapid and expedient way to disseminate information. The News media are rapidly adjusting to the online environment as a means to respond to News Events. The News Media also monitor and will contact clinicians using SM for comment about acute events. SM is widely used by Government for Policy announcements and for Politicians to engage with their constituents or attack opposition policy.
AHPRA should have some understanding of the context of the use and dissemination of clinical and other information in a timely manner and the risks of information being misconstrued and misrepresented in a way that is beyond the control of the regulated health practitioner.
AHPRA should be acknowledge the right to free speech in engaging in Political Dialogue or Social Commentary on popular policy issues (Where the Regulated practitioner is an identified representative of for example a lobby, craft or educational grouping)
AHPRA should consider supporting Regulated Health Practitioners to identify themselves in a Social Media Context rather than by over-regulation force practitioners into using pseudonyms or altered identities that both reduce the professional standing of the practitioner and encourage inappropriate behaviours (where the practitioner holds a false belief that they retain any privacy).