The capacity to record, store and transmit information in electronic format brings responsibilities to those working in healthcare with respect to privacy of personal health information and ensuring public trust in hospitals, institutions and practices. Significant educational benefits can be derived from this technology but Residents need to be aware that there are also potential problems and liabilities associated with its use.
Material that identifies patients, institutions or colleagues and is intentionally or unintentionally placed in the public domain may constitute a breach of standards of professionalism and confidentiality that damages the profession and institutions.
Guidance for postgraduate medical trainees and the profession in the appropriate use of the internet and electronic publication is necessary to avoid problems while maintaining freedom of expression.
Residents remain governed by the same professional and ethical standards online, as in personal encounters.
Respect for privacy and confidentiality is fundamental to the development of trust between physicians and their patients. All involved in health care have an obligation to maintain the privacy and security of patient records under The Health Information Protection Act which defines a record as “information in any form and includes information that is written, photographed, recorded, digitized or stored in any manner”.
Respect for colleagues and co-workers in an inter-professional environment is essential, as is the respect for law, copyright, and fair use.
The tone and content of electronic conversations and presence should remain professional at all times.
Social media can be defined as a set of web-based and mobile technologies that allow people to monitor, create, share or manipulate text, audio, photos or video, with others. Social media places particular emphasis on interactive, user-driven communication. (Canadian Medical Association, Social Media and Canadian Physicians- Issues and rules of engagement).
Scope of this Policy
This policy applies to all Residents registered with the College of Medicine, University of Saskatchewan.
This policy is relevant to all electronic communications and electronic networking which may include, but is not limited to: the internet, social networking sites, posting on blogs, online forums, wikis, texting, instant messaging, email and listservs, posting to public media sites, mailing lists, and video sites. It also includes use of mobile electronic devices (e.g. cell phones, smart phones, tablets, etc.) which have various application features, including photography.
Postgraduate Medical Residents are reminded that they must meet multiple obligations in their capacity as University students, as members of the profession and College of Physicians and Surgeons of Saskatchewan, and as employees of the University and other institutions, where applicable.
Postgraduate Residents also agree to abide by all bylaws, rules and regulations in force and effect within the Saskatchewan Health Authority and at any health care facility in which they receive their training/employment.
This policy was developed with reference to existing laws, standards and policies as set out in The Medical Profession Act, The Health Information Protection Act; The College of Physicians and Surgeons of Saskatchewan Regulatory Bylaws; the University of Saskatchewan Standard of Student Conduct in Non-Academic Matters and Regulations and Procedures for Resolution of Complaints and Appeals, Social Media Guidelines and Discrimination and Harassment Prevention; and the College of Medicine Resident Assessment policy. It was also developed with reference to standards of the profession related to professionalism as defined within the two national accrediting authorities – The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada.
1. Respecting Privacy and Confidentiality
Residents should never communicate or post personal health information about an individual.
Personal health information means any information about an individual (living or deceased) in oral or recorded form, where the information identifies an individual or for which it is reasonably foreseeable in the circumstances that it could be utilized, either alone or with other information, to identify an individual.
This applies even if the individual patient is the only person who may be able to identify him or herself on the basis of the posted description.
Residents should ensure that anonymized descriptions do not contain information that will enable any person, including people who have access to other sources of information about a patient, to identify the individual described. Resident must recognize that in the small area of medicine it is easy to unintentionally identify individuals leading to patient care and must take all precautions to assure anonymity.
Appropriate uses of information may include: situations where the express written consent of the patient or substitute decision-maker is obtained; sharing within secure internal hospital networks if expressly approved by the hospital or institution (and following the policies of the hospital or institution); sharing within specific secure course-based environments that have been set up by the University of Saskatchewan and that are password-protected or have otherwise been made secure (as long as individuals are anonymized, there are no patient identifiers associated with presentation materials; and objective rather than subjective language is used to describe patient behavior, without using derogatory or judgmental language); entirely fictionalized accounts that are so labeled.
Residents must always be mindful of responsibility to assure that patient confidentiality will not be breached and understanding that there could be potential legal implications in case of a breach.
Faculty, Instructors and Residents are reminded that portable devices are not secure and that personal health information should not be communicated outside of the official channels provided by the health care institution/University of Saskatchewan, or removed from the health care institution.
As a general rule all photos, audio recordings and videos of patients are inappropriate for online posting. Photographing a patient for any purpose requires clearly documented written consent from the patient or substitute decision-maker. Consent obtained for educational purposes does not extend to consent for public dissemination.
Respect for the privacy rights of colleagues and co-workers is important in an inter-professional working environment. If there is doubt about whether it is appropriate to post (share) any information about colleagues and co-workers, it is recommended to ask for their explicit permission, preferably in writing.
2. Upholding Professionalism Online
The same professionalism principles and standards that apply to Residents in person apply to them online.
Residents are encouraged to act online in the same manner in which they would be comfortable observing their own physicians acting away from clinical duties. In particular, Residents should avoid posting media that portrays them or their peers participating in what could be perceived as unprofessional behaviour, such as profanity, substance abuse, inappropriate sexual behaviour, illegal activity, etc. (CFMS Guide to Medical Professionalism: Recommendations for Social Media)
Residents should be proactive in removing the material which could be perceived as unprofessional.
Respect for colleagues and co-workers is important in an inter-professional working environment. Addressing colleagues and co-workers in a manner that is insulting, abusive or demeaning is unprofessional behaviour. Such communication may also breach the University policy on Discrimination and Harassment Prevention.
3. Offering Advice and Contact with Patients
Residents should be aware that offering diagnoses, providing medical advice or support online, would mean entering into physician-patient relationship. The same obligations and limitations apply to online medical advice as to advice offered in person.
Educational license with the College of Physicians and Surgeons of Saskatchewan limits the provision of medical advice within the context of the teaching environment. Provision of medical advice by Residents outside of this context is inconsistent with the terms of educational registration.
Residents must not misrepresent their qualifications.
In general, Residents should avoid entering into dual relationships with patients by connecting with patients or their family members over or through social media platforms or networks.
4. Sharing Information about University, Hospitals or Other Institutions
Sharing Information concerning University of Saskatchewan, hospitals or other institutions must be in compliance with the current University, hospital or institutional policies with respect to the conditions of use of technology and of any proprietary information.
Residents must not represent or imply that they are expressing the opinion of the University, hospital or other institution. Residents should be aware of the need for a hospital, other institution and the University to maintain the public trust. Consultation with the appropriate resources, such as Public Relations Department of the hospital/health region, Postgraduate Medical Education Office, or institution who can provide advice in reference to material posted (shared) on the web that might identify the institution, is recommended.
Misrepresenting the standards of care of a hospital or other institution could result in disciplinary action.
The individual is responsible for the content and posts on their (own) social media, and should be mindful of the risks, as anything posted or communicated electronically is traceable even if posted anonymously, and should consider the permanency of the material published online.
All professionals have a collective professional duty to assure appropriate behavior, particularly in matters of privacy and confidentiality.
A person who has reason to believe that another person has contravened this policy should approach his/her immediate supervisor/Program Director for advice. If the issue is inadequately addressed, s/he may complain in writing to the Associate Dean, Postgraduate Medical Education, or to the College of Physicians and Surgeons of Saskatchewan through designated processes.
Complaints about breaches of privacy may also be filed with the Office of the Saskatchewan Information and Privacy Commissioner.
The penalties for inappropriate use include: Remediation, Probation or failure to promote by the Postgraduate Medical Education Office, College of Medicine, University of Saskatchewan; discipline for breach of hospital, Health Authority or institutional policy; prosecution or a lawsuit for damages for a contravention of the HIPA; a finding of professional misconduct by the College of Physicians and Surgeons of Saskatchewan.
Coordinator for Academic and Non-academic Processes, PGME Office