Texting Among Academic Psychiatrists: What Does HIPAA Allow?
The texting of protected health information (PHI) has raised concerns about breach of privacy as it relates to the Health Insurance Portability and Accountability Act (HIPAA). Within psychiatry, limited guidelines exist on HIPAA-permissible texting. Given the legal implications of a breach, we sought to better understand texting patterns among psychiatrists by surveying members of the Association for Academic Psychiatry, 53 of whom responded. Only 63% of respondents felt confident in their knowledge of HIPAA. While 64% reported that texting PHI is prohibited, most (53%) still used texting to communicate PHI. Currently, HIPAA is technology neutral and texting PHI is not explicitly prohibited, provided safeguards are taken and physicians securely communicate PHI.
Electronic Communication of Protected Health Information: Privacy, Security, and HIPAA Compliance.
PURPOSE
Technology has enhanced modern health care delivery, particularly through accessibility to health information and ease of communication with tools like mobile device messaging (texting). However, text messaging has created new risks for breach of protected health information (PHI). In the current study, we sought to evaluate hand surgeons' knowledge and compliance with privacy and security standards for electronic communication by text message.


METHODS
A cross-sectional survey of the American Society for Surgery of the Hand membership was conducted in March and April 2016. Descriptive and inferential statistical analyses were performed of composite results as well as relevant subgroup analyses.


RESULTS
A total of 409 responses were obtained (11% response rate). Although 63% of surgeons reported that they believe that text messaging does not meet Health Insurance Portability and Accountability Act of 1996 security standards, only 37% reported they do not use text messages to communicate PHI. Younger surgeons and respondents who believed that their texting was compliant were statistically significantly more like to report messaging of PHI (odds ratio, 1.59 and 1.22, respectively).


DISCUSSION
A majority of hand surgeons in this study reported the use of text messaging to communicate PHI. Of note, neither the Health Insurance Portability and Accountability Act of 1996 statute nor US Department of Health and Human Services specifically prohibits this form of electronic communication. To be compliant, surgeons, practices, and institutions need to take reasonable security precautions to prevent breach of privacy with electronic communication.


CLINICAL RELEVANCE
Communication of clinical information by text message is not prohibited under Health Insurance Portability and Accountability Act of 1996, but surgeons should use appropriate safeguards to prevent breach when using this form of communication.
Nurse responsiveness to cancer patient expressions of emotion.
OBJECTIVE
This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient.


METHODS
This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness.


RESULTS
Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness.


CONCLUSION
Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse-patient communication, has implications for interventional studies.


PRACTICE IMPLICATIONS
Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.