Sunday, May 11, 2008

Probably not even worthy of the C list: HMO searching for Web 2.0 mentions and responding

In the midst of celebrating Mother's Day and packing for a trip tomorrow, I noticed an article in the paper today that reminded me of a bioethics librarian's recent post about privacy concerns with social bookmarking on a medical library website.

What, if anything, would you write differently in your blog, bookmark on, tweet on Twitter or otherwise communicate online if you knew your physician was reading it? What if you were part of a 'daily roundup' of mentions of your health maintenance organization (HMO) measured by your site traffic and 'comment tone'?

According to the Seattle Times, if you belong to my HMO you may be part of the roundup.

[The HMO] monitors cyber chatter with more vigilance than most major health plans in Washington. A staff member compiles a daily roundup of postings that mention the co-op. Each Web site is ranked by traffic volume. (Major news sources such as are on the A list, while obscure blogs rate a C.) Each comment is rated for tone: negative ("Shame on you, [HMO]"); positive ("I feel like a human being here, not a number"); neutral; or mixed.

Note how I am carefully not mentioning said HMO by name here. Also note the newspaper's bias by word choice in the headline. However, this section regarding physicians does not settle well with me.

[Dr. E], the [HMO] physician, goes as far as to believe that blogs could offer direct clinical benefits. [Dr. E] has read patients' personal blogs, in which, he said, they reveal information they never would share with their doctors.

If doctors can find a way to harness such hidden insights, they can better tackle the root causes of ailments, [Dr. E] said. He added that doctors ought to welcome patients who seek health information elsewhere — even if they sometimes consult dubious sources.

I certainly stand by First Amendment rights to free speech and the fact that the internet is anything but private, but am very concerned about the possible integration of said free speech into my print or electronic medical records (EMR). In other words, if I "reveal information" I "never would share with" my physician in my blog and my physician reads it, is he or she then permitted to paste it into my EMR without my knowledge or consent? Send me an email or post a comment about it? EMR records are available to quite a few other entities besides my physician I have a strong relationship with, ranging from insurance agencies to snooping hospital employees. If I bookmark a bunch of websites about Dance Dance Revolution or bacon in that are easily accessible via a widget in my blog, will I be asked about any lifestyle or dietary changes at my next office visit?

If I do happen to make the C list at my HMO, can you please tell me my medlib colleagues there are not the ones conducting this daily search and while these roundups probably don't hold up to the same level as protected health information (PHI) that they aren't left in the break room for casual discussion either?


Mary said...

Much of what I post on LJ is friends-locked, and most of that is filtered to sub-levels. My general health stuff isn't for general consumption. My twitter is locked. I don't particularly want my insurance company knowing details of my life, but they'd probably also have a hard time tying my internet presence to my name in their files.

My doctor's another matter. I can't think of anything I tell the internet that I don't tell her, except that sometimes I waffle for a period of time trying to decide whether to go see her. If she could read those waffly posts, she'd probably tell me to get off my ass and come see her.

Jere said...

An interesting wrinkle! I hadn't thought about how one's doctor might use or misuse a patient's personal information gleaned from Web 2.0 sites. I wonder where patients are the most accurate - online or ond the clinic bedside? Many patients, for example, under-report pain in the clinic ... I bet Facebook and Twitter users are more honest with their social networks!