HealthBlawg

Health Care Social Media – How to Engage Online Without Getting into Trouble (Part II)

I have been asked to write up some of the core takeaways from the health care social media presentations I have been giving recently, so I am sharing a version of this narrative on HealthBlawg, in two parts.  You may wish to begin with Part I.  

Professional responsibility and malpractice liability

The American Medical Association has promulgated a social media policy; so has the Veterans Administration.  The two represent very different approaches.  The AMA essentially advocates proceeding with caution, and being cognizant of the damage that one’s own social media activities – and one’s colleagues’ – may do to the profession.  The VA, on the other hand, is out in front on this issue – just as it was with electronic health records – encouraging the use of social media tools to disseminate information and engage patients and caregivers in productive dialogue likely to improve overall wellbeing and health care outcomes.

Patient care should not be provided in open social media forums, but appropriate disclaimers on blogs, Facebook pages, YouTube channel pages, and the like, should be sufficient protection for providers seeking to use these tools for sharing of general advice and information.

As in other settings, there are emergency exceptions.  If the only way to communicate lifesaving information to a patient is via a public social media channel, then a clinician should not refrain from doing based on a concern about a privacy violation.

Daily deal websites

Groupon, Living Social and other daily deal websites are being used by health care providers -- though thus far mostly by those that are not covered by traditional commercial or governmental health insurance (e.g., dental, chiropractic, acupuncture services).  This may change as the health insurance landscape changes over time.  There are a number of legal issues, and their resolution will depend, in part, on where you are situated, since many of the relevant rules are state laws, which vary.  For example:

• Groupon collects 50% of the price of the groupon as its fee; is that illegal fee-splitting under applicable state law?
• Is the 50% fee an illegal kickback in exchange for a referral?  Are you subject to federal laws in this area in addition to any state laws?
• Do provider agreements with third party payors prohibit the offering of discounts to plan subscribers?  (If you can get over the first two issues, you may need to screen out patients who are insured by carriers who limit your ability to discount or risk being in default under an agreement with your biggest customer.)
• There is at least one more issue to consider, as well:  State laws on gift certificates and their requirements touching on expiration dates.  Lawsuits have been filed alleging that the relatively short life of the daily deal violates state gift certificate laws. 

With the proliferation of high-deductible health plans, and FSAs, HSAs and the like, the general public is becoming more price sensitive in paying for health care services; while health care providers need to become more creative in order to address this issue, they must also remember that they are subject to a wide-ranging set of regulations above and beyond other consumer-facing businesses.

Social Media Policies and Procedures

Despite the legal landscape, it is possible for a health care provider to develop a robust social media program.  The critical first step is developing a set of policies that respects the legal and regulatory limits, and that is consistent with the organization's level of readiness to engage through social media.  Establishing clear guidelines will allow clinicians and staff to participate in the online conversation without having to review individual posts on a regular basis with legal and regulatory advisors. An existing policy from another organization may be used as a starting point in the development process, but local customization is key. 

An external-facing social media policy should set limits and expectations for people who come to the organization's web properties – web site, Facebook page, blog, YouTube channel, Twitter stream, etc. -- so that, for example, a poster who violates the terms of service will be on notice that a hospital whose staff should be monitoring social media accounts at least daily may decide to take down a post (on a forum such as Facebook) if it does not comply with the policy.

An internal set of policies and procedures is also needed to address internal operational and policy issues for both official and unofficial channels. Staff need to be sensitive to the fact that they are, in effect, brand ambassadors on a 24/7 basis, and that if they mention their employer in their own posts on their personal Twitter accounts or Facebook pages, they should do so consistent with company policy – noting that “tweets are my own” or words to that effect.  Some organizations may desire to insist on all employees' “radio silence” except for designated spokespersons.

The best policies are those that are developed through an inclusive process, rather than a top-down process, so that the employees most likely to be active on social media may offer input to the process sand also feel ownership of the final product in a way that will promote adherence.

No matter what the tenor of an individual organization’s policies may be, they must be implemented – they do no good up on the shelf.  Staff must be trained on the policies, and are retrained as policies are updated on at least an annual basis.  Adherence to the social media policies should be a condition of employment, just the same as adherence to any other employer policy, and the distribution of policy documents and training may be integrated with a broader employment process within your organization.

Sine this is a rapidly changing arena – and since social media comfort levels in an organization may change relatively rapidly – social media policies should be reviewed on a regular basis, at least annually.

Conclusion

The cat is out of the bag.  Even if you wanted to avoid social media entirely, it is simply too late to attempt to do so.  Even if your practice or institution does not have an active social media presence, it is likely that others are already discussing you on line.  It is important to set up a social media monitoring program right away, if you do not already have one in place, so that you may respond in the real world to issues flagged in cyberspace.

You can become an active participant in health care social media and stay on the right side of the law, and these days it is becoming more and more imperative to use this toolset for marketing, patient communication and care management.

 

Be sure to check out Part I of this two-part series on health care social media, which lays out the range of issues and concerns and goes into greater detail on HIPAA issues.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting  

Health Care Social Media – How to Engage Online Without Getting into Trouble (Part I)

I have been asked recently to write up some of the core takeaways from the health care social media presentations I have been giving recently, so I am sharing a version of this narrative on HealthBlawg, in two parts.  Check back later this week for Part II. 

Introduction

“Why do you rob banks?”

“That’s where the money is.”

The legendary bank robber Willie Sutton, when asked, gave this straightforward response explaining his motivation.  A similar motivation may be ascribed to the early adopters among health care providers who have established beachheads on various social media properties on line.  Why be active in on line social networks?  That’s where the people are: patients, caregivers, potential collaborators and referral sources, like many, many other people, are using social media more and more.  Facebook has become nearly ubiquitous, and its user base is growing not only among the younger set, but also among the older set, who are signing up so they can see pictures of their grandkids.  In today’s wired society, on line social networking is the new word of mouth.  Word-of-mouth referrals, personal recommendations, have always been prized; we have simply moved many of those conversations on line.

Over half of Americans rely on the internet when looking for health care information.  Many on line searches are conducted on behalf of another person.  Most people expect their health care providers to be on line, providing trustworthy information – and the day of the static website has passed.  In addition, a growing subset of the population is comprised of “e-patients” – the “e” stands for educated, engaged and empowered – who seek out health care providers prepared to engage with them both in person and on line.

Only about twenty percent of U.S. hospitals have a social media presence, and likely a similar proportion of other health care providers.  Thus, while some health care providers have been using social media for years, there is still an opportunity to reap the benefits of being an early adopter.  Whether or not a provider is on line, others are likely discussing that provider – on review sites, on Facebook, even on Twitter – so whether or not one establishes a social media presence, it is imperative to establish a listening post to keep abreast of what is already being posted on line – complaints, recommendations and other information will come to light, and steps may be taken in the real world to ameliorate situations giving rise to complaints and to capitalize on praise and referrals.

Finally, health care reform is pushing health care providers into social media.  The Meaningful Use regulations will soon require that providers seeking incentive payments for adoption of electronic health records must make greater use of personal health record portals, and programs like the Medicare Shared Savings Program, or Accountable Care Organization program, require patient-centeredness and patient engagement, which in this day and age require the use of online social tools.

With all of these motivating factors, why are health care providers reticent, and slow to adopt the use of social media tools?  There are numerous legal and regulatory issues triggered by the use of social media and some health care providers are put off by the perception of the risk involved.  However, there are legal and regulatory risks (and attendant market and business risks) to the decision to remain uninvolved.

The key issues for consideration include the following:

• Privacy and security rules, under HIPAA as well as other federal and state laws, and the ever-diminishing ability to fully de-identify protected health information
• Professional responsibility codes, including both professional society codes of ethics and state regulations promulgated by boards of registration in medicine
• Malpractice liability for professional advice rendered via social media
• Issues raised by daily deal sites such as Groupon and Living Social, including anti-kickback, fee-splitting, insurance contracts, state insurance laws and gift certificate laws
• Liability under Federal Trade Commission rules for failure to disclose a financial relationship in conjunction with an online rating, review or other commentary
• Trouble with the National Labor Relations Board if employee discussion of working conditions in unreasonably limited (even in non-union shops)

If not managed appropriately, it is clear that these issues may lead to significant liabilities, ranging from civil and administrative fines, to negative publicity, to private lawsuits predicated on HIPAA or state law violations.  (Even though HIPAA does not provide for third-party liability some state laws do, and creative lawsuits may seek to bootstrap private liability on a HIPAA violation as well.)

However, it is possible to manage all of these issues through the development of comprehensive social media policies – both outward-facing (i.e., to patients and the general public) and inward-facing (i.e., to physicians, other clinicians, and other staff) that are tailored to a specific medical practice or other health care organization.  The policies themselves must be tailored to local conditions, because each practice, each health care organization is at a slightly different point on its own health care social media journey, its comfort level with social media tools, and its thoughts about how to use these tools, and to what end.

Here is further detail about several of the key categories of legal issues identified above:

HIPAA and other privacy concerns

Privacy concerns arising from HIPAA and state privacy laws start from the proposition that only a patient has the right to authorize the release of his or her own private health information.  Thus, while an individual patient is free to blog about her medical condition or experience with the health care system without implicating HIPAA or other privacy rules, provider-generated social media content with identifiable patient information used without consent would raise red flags.  Provider discussions of cases on social media should follow the “elevator rule” or the “coffee shop rule” – If you wouldn’t say it in a crowded elevator or coffee shop, don’t post it online.

As one emergency room physician recently learned the hard way (she was dismissed by her employer and sanctioned by her state medical board), even a de-identified Facebook post about a patient may easily be re-identified using information from third-party sources.  The HIPAA rules list eighteen categories of identifying information that must be stripped from a record or patient story in order for it to be considered de-identified. Number eighteen is, essentially, anything else that may be used to re-identify the de-identified information.  Since we are, collectively, doubling the amount of information posted online on a regular basis, that which is de-identified today may well be easily re-dentified tomorrow. 

Thus, the best practice would be to write about composite/fictionalized patients, or simply get patient consent.  Providers may wish to rewrite their HIPAA NPPs (notice of privacy practices) to include some level of consent to communication with or about a patient on Facebook, for example, if that is something that would make sense, and that might happen on a regular basis. 

Other disclosures made inadvertently may lead to difficulties as well.  For example:

• A cell phone photo taken in a hospital emergency room of a friend proudly displaying a newly-stitched wound may inadvertently capture the image of another patient in the background. That post may be a HIPAA violation attributable to the hospital, even if it did not post the photo. 
• An employee of a public hospital tweets her displeasure in seeing a clinic staffed up for the convenience of a political figure seeking service off-hours.  Her public sharing of identifiable health information led to her being fired.
• Positive test results posted by a patient on Facebook might invite response on a human level, but the response must be more measured.  For example, if a patient posts on a hospital Facebook wall after getting some good test results, “I'm cancer free one year later,” hospital staff can't post much more than “Congrats; everyone should check out our cancer center's web page.”  Even in a situation like this, where the patient self-identifies first, there is no consent to unlimited public discussion of his condition.

 

Please check back later this week for Part II, which will touch on professional responsibility and malpractice issues, daily deal sites and the development of policies and procedures for provider organizations engaged in the use of health care social media.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 

David Harlow quoted on HIPAA and Health Care Social Media in AIS Health's Health Business Daily and Report on Patient Privacy; Speaking at HANYS Social Media Conference Today

I was interviewed for an article on AIS Health that came out last week. The title of this article -- on health care social media and regulatory and legal issues that health care providers may face in using these tools -- struck me as being tinged with hysteria (hence the selection of the artwork accompanying this post):

HIPAA Dangers Lurk on Facebook; Ongoing Policy Revisions Are Advised

Cooler heads should prevail.

There are clearly things to be concerned about when embarking upon the implementation of social media tactics in the service of broader strategies and organizational goals.  Decisions about goals must be made.  Terms and conditions for staff, on the one hand, and patients, families and caregivers, on the other, need to be clear and comprehensive.  And expectations regarding employee use of social media, whether as an "official" voice of the organization, or as a person known to be associated with the institution and therefore acting as a brand ambassador whenever on line or in real life, need to be carefully developed and communicated.

I'm speaking today at the Healthcare Association of New York State (HANYS) social media conference, about these and related issues.  Just this morning, in my hotel-delivered newspaper, there's a front-page story on Facebook and privacy concerns.  These issues are persistent, no matter what platform you are using, or are considering using. As I have said before, at a policy level, your approach needs to be platform-agnostic.

Overall, careful planning will improve the chances that a health care provider will be able to effectively leverage the reach of social media for its message without running afoul of legal and regulatory land mines.

David Harlow 
The Harlow Group LLC
Health Care Law and Consulting 

David Harlow presents two webinars this week: one on health care social media, the other on accountable care organizations

I am presenting two webinars this week, one on health care social media and the other on accountable care organizations, or ACOs.

Details:

Health Care Social Media: An Introduction to Engaging Intelligently and Legally

(Title links to registration information)

Webinar: Tuesday, October 25, 2011 

Time: 12:00 p.m. to 1:30 p.m. ET

Health care organizations, professionals and patients alike are embracing the social media movement with vigor as online tools like blogs, Facebook, Twitter and YouTube grow in popularity. It is no longer a question of whether you should be using social media tools to promote your practice and institution and connect – effectively, legally and ethically -- with patients and referral sources; it is a question of when, and how.  

A skilled user of social media has the opportunity to become a trusted source, a convener, an influencer; and can effectively and efficiently utilize these tools for reputation enhancement and building strong relationships with existing patients and referral sources while “expanding the sales funnel” to attract new patients and referral sources.  However, the use of these tools requires interaction and engagement at a level that many health care organizations find uncomfortable. Balancing the inherent tension between transparency and privacy, openness and control, can be difficult. While the legal land mines are there, you can make your way through and emerge unscathed if you have a clear understanding of HIPAA and other relevant rules – and how they apply to social media initiatives.  

Learn more during this interactive 90-minute webinar about the value of social media tools, the range of issues they present, and some key strategies for using these tools effectively while steering clear of trouble by social media expert and charter member of the Advisory Board of the Mayo Clinic Center for Social Media, David Harlow.  Become comfortable with social media for your facility!

Learning Objectives:

• Gain greater familiarity with social media tools and tactics and their value to the health care enterprise.
• Achieve understanding of legal, regulatory and risk management issues related to the use of social media in health care.
• High-level introduction to best practices.

Accountable Care Organizations, Bundled Payments, and the Future of Health Care

(Title links to free registration information)

Webinar: Thursday, October 27, 2011

Time:  1:00 p.m. to 2:00 p.m. ET

David Harlow previews HCPLive Webinar on ACOs

In the future (starting tomorrow!) health care providers will have to do more with less. Total reimbursement by both public and private sector payors is dropping, and the metrics for success are changing. Instead of thinking about this as a zero-sum game, payors and providers are moving away from fee-for-service payment systems to bundled payment systems. The health reform law spells out one such program in detail -- the ACO, or shared savings, program -- and created the CMS Center for Innovation, and funded it with $25 billion. The Center for Innovation’s mandate is to run experiments on how to do more with less, and to scale up successful experiments quickly.  

In this webinar, noted attorney, consultant, blogger and speaker David Harlow will describe the future contours of the health care market, defined by emerging federal and private sector programs in a post-fee-for-service environment, and identify ways in which provider organizations should be preparing themselves in order to succeed in this brave new world.

Join the simultaneous tweetchat at #ACOchat.

See you later this week.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 

Health Care Social Media Summit - Mayo Clinic Center for Social Media - Wrapup

I'm back from my pilgrimage to Rochester, MN for the Third Annual Health Care Social Media Summit at the Mayo Clinic, presented by Ragan Communications.  I had a great time, and want to share the experience with you.  So please take a look at the archived #mayoragan tweets, my presentation on health care social media and the law, and my blog posts about the pre-conference and the summit itself posted at HealthWorks Collective.  Here are some excerpts:

Mayo Ragan Social Media Summit Pre-Conference: 

A recurring theme in my hallway conversations [today] was that it is impossible to transplant a successful program from one location to another without taking into account myriad local conditions (social media program, heart transplant program – same problem).  As I always say to folks who just want to copy, say, the Mayo Clinic’s, or the Cleveland Clinic’s, social media policy, change the names and be done with it, it is critical to take the measure of local conditions and customize an approach.  As I discuss[ed] in my presentation later in the conference, there are risks – manageable risks – inherent in the use of health care social media, but the risk tolerance of each organization is different, born of a whole host of factors, and those differences must be respected.

Mayo Ragan Social Media Summit:

This was multimedia day at Mayo Clinic.

Lee Aase, Director of the Mayo Clinic Center for Social Media, kicked off the meeting with a rundown of the Mayo Clinic’s experience with social media, highlighting the “MacGyver” (i.e., jerry-rigged) approach he advocates, using free and low-cost tools.

He then premiered a soon-to-be viral video produced as part of the Mayo clinic's Cardiac health "Know Your Numbers" campaign:

Know Your Numbers Video

Chris Boyer closed out his presentation with a little song he wrote (he accompanied himself on the ukulele), about social media ROI.

Mayo Ragan Social Media Summit - Final Day

My gloss on the imperative to pursue [the] lofty goals [articulated by e-Patient Dave in his closing keynote, summarized in an understated way as "Let Patients Help"] is born of a stark economic reality: in the future (the very near future), health care providers will have to do more with less.  (Consider, for example, impending deep Medicare cuts.)  [Consider, also, the patient-centeredness and patient engagement laid out in the final ACO regulations.]  In order to do so successfully, they will need to work collaboratively with patients – and with each other -- in ways that many have not (in large part) to date, because economic incentives to do so have not necessarily been there.  Social media will be a part of the solution to this problem.

I enjoyed meeting up with my fellow MCCSM external advisory board members, and I look forward to continuing the conversation with so many of you whom I met in person at the conference, including many folks whom I've known for years - but only online.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 

David Harlow speaks at Third Annual Health Care Social Media Summit

I am speaking today on legal and regulatory issues related to health care social media at the Mayo Clinic Health Care Social Media Summit.  I look forward to keeping in touch with folks I've had the opportunity to meet in real life this week at Mayo.  For my take on the rest of the conference, please see my posts here and here.  Feel free to peruse the #mayoragan tweetstream, too.

Here are my slides:

Health Care Social Media - The Lawyers Don't Always Say No

View more presentations from David Harlow

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 

Health Care Social Media Summit at Mayo Clinic

The Third Annual Social Media Summit takes place this week at the Mayo Clinic. There's a pre-conference on Monday, summit sessions on Tuesday and Wednesday, and other events rounding out the week. Follow the tweets right here from Monday through Wednesday. I'll be speaking, as a member of the external Advisory Board of the Mayo Clinic Center for Social Media. If you are on site please be sure to track me down and say hello.

Update 10/21/2011:  Here's my wrapup post: Health Care Social Media Summit - Mayo Clinic Center for Social Media - Wrapup.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 

Health 2.0 Fall 2011

I attended Health 2.0 in San Francisco this week, and participated in the new Health Law 2.0 pre-conference, moderating a lively panel discussion about reviews posted on listings and ratings websites, featuring attorneys and an entrepreneur.

Please take a look at the posts I've written about the conference, here at HealthBlawg, and on HealthWorks Collective:

Health 2.0 San Francisco, September 2011, "Son et Lumiere"

"This post comes to you from the Health 2.0 conference in San Francisco.  The main conference kicks off today, but it has been preceded by a week of code-a-thons and a variety of other events, including HealthCamp and the four-track pre-conference yesterday (Health Law 2.0, Patients 2.0, Doctors 2.0, Employers 2.0).  I moderated one of the Health Law 2.0 panels, and shook up some of my brothers and sisters at the bar by wearing my new Regina Holliday jacket -- I've joined the Walking Gallery.  (Follow the links, including the walking gallery back story, to learn more about who Regina is, and what this means.) ..."  (Read more on the Health 2.0 pre-conferences.)

Health 2.0 Kicks Off in San Francisco

"Todd Park, the HHS CTO, is a vigorous champion of data liberation.  He has moved the government to open its vast repositories of data (e.g. Medicare claims data) to sharing with the public to solve health care problems.  Data liberation is one of the watchwords of the participatory medicine movement, and is a goal that will be reached more easily through the proliferation of online tools that will facilitate health information exchange.  While we would hope that, in the future, this would be a core functionality of interoperable EHRs, It seems we just aren’t there yet.  Meanwhile, however, there are Health 2.0 companies ready to bridge the gap, and ensure that data from whatever source regarding an individual patient will be available to her clinicians...."  (Read even more on the Health 2.0 pre-conferences.)

Health 2.0 - Focus on High Quality, Low Cost & Connectivity

"The health care payor and provider worlds are concerned with access, cost and quality.  The federal government adds a population health gloss, and calls it the Triple Aim – better care for individuals, better health for populations, at reduced per-capita costs.  Those fundamental drivers are now having a clearer effect on the Health 2.0 ecosystem.  The demos and discussions I’ve observed thus far at this year’s conference are more consistently focused on addressing these issues than they have been in the past.  Early-stage, and more established, companies’ products are also notable in that they are focused on connectivity in a broader sense than before – whether that’s connectivity for data, so that sensors can share data with your personal tracking software, your doctor or your community, or connectivity for individuals, who can use online social tools to improve their own health status through online interactions in a number of different ways...." (Read more on Health 2.0 Day 1.) 

       Health 2.0 Conference: Data Liquidity Can Improve Care and Reduce Cost

"On the last day of Health 2.0, the key takeaway was this: data liquidity can improve health care and health status, and reduce cost.  Hey, we knew this already; the cool thing about hearing this message at Health 2.0 is that you get to hear it (1) while seeing the tools that will actually create that data liquidity that are ready for prime time, or almost ready for prime time and (2) from federal officials who are visibly excited about this stuff...." (Read more on Health 2.0 Day 2.)

In addition, please take a look at the Health 2.0 Fall 2011 vlog with David Harlow, featuring 18 mini-interviews on Health 2.0 and "data liberation" with some of your favorite Health 2.0 and ONC figures -- including Matthew Holt, Jane Sarasohn-Kahn, Farzad Mostashari and Lygeia Ricciardi -- and some new faces as well.

The conference was jam-packed, and of course there were many more worthwhile demos and presentations that I was not able to include in these brief collections of highlights.  I hope to see more of you at the next conference.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 

Health 2.0 and American Academy of Orthopaedic Surgeons

I will be speaking at two conferences over the next week:

    (1) AAOS Practice Forward: Managing your Practice in an Era of Health CareTransformation (PDF; also see AAOS webpage) in Chicago, where I will be giving two presentations - one on shared savings programs including accountable care organizations and bundled payment initatives and one on the effective (and legal!) use of social media by health care providers together with my colleague Jamie Verkamp (with whom I have presented a number of health care social media webinars; and

    (2) Health 2.0 in San Francisco, where I will be moderating a Health Law 2.0 panel discussion on managing online reviews of health care providers and services:

Legal Concerns with Provider and Product Ratings, Rankings and Reviews

Moderated by: David Harlow, The Harlow Group LLC

Many Health 2.0 based companies either directly or indirectly provide information on providers, products or services. Companies or consumers often post candid reviews. An expert panel will discuss the legal implications of offering information on providers. They also will give some examples of problematic information and tips on how to avoid defamation claims and other legal actions.

SPEAKERS INCLUDE:

Karl Olson, Ram, Olson, Cereghino & Kopczynski

David Johnson, Crowell Moring

Mitch Rothschild, CEO, Vitals

I hope to see some of you out there -- in the heartland and on the left coast.  Feel free to tweet me - @healthblawg.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

David Harlow presentation on Health Care Social Media featured on SearchHealthIT.com

I spoke on health care social media and regulatory compliance at the Health Care Compliance Association's New England Regional Annual Conference last week.  As you may expect, the room was full of the folks who, generally speaking, are the folks who block social media sites on health care organization networks.  I sent a link to an online bio to one of the session organizers in advance, and even that site was blocked by his facility's network.  Clearly, we have a long way to go in educating health care compliance professionals about the risks and benefits of using health care social media, and an appropriate approach to balancing these risks and benefits so as to establish an appropriate social media presence for each health care organization.  

My talk was followed by a presentation by two federal prosecutors, one of whom reminded the audience that they may need to produce copies of all online postings in response to government document requests or subpoenas.  We may quibble about the scope of material that might be covered by such a production request, but the key takeaway from this comment should be that we all need to be very careful about what materials we post online (or allow to remain posted on web properties we administer or own), because they may be found online indefinitely and, to quote the Miranda warning, anything you say may be used against you.

Having said all that, there are tremendous opportunities available to health care organizations that choose to join the vanguard using social media effectively.  For a sense of the challenges and opportunities, please check out Don Fluckinger's piece on my presentation, entitled The latest mashup: Health care social media and HIPAA compliance, and related posts on health care social media.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting