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.
Human exposure to methylmercury from crayfish (Procambarus clarkii) in China
Methylmercury (MeHg) accumulation in aquatic food raises global concerns about human exposure to MeHg. Crayfish is the world’s third largest farmed crustacean species and a favorite aquatic food in many countries. However, human health hazard due to MeHg exposure via crayfish consumption is unclear, partly because appropriate survey data are lacking. We report on mercury concentrations and speciation in edible tail muscle of crayfish collected from restaurants in 23 Chinese cities. On average, MeHg constituted 99.1 % of mercury in tail muscle, and MeHg concentrations were comparable with those reported for fish in China. Variation in MeHg concentrations was not attributable to broad geographic region (i.e., provinces) or tail length. For different populations, potential health risk (characterized by hazard quotient or HQ) of MeHg exposure through crayfish consumption depended largely on crayfish consumption rates. In particular, a health hazard (HQ > 1) was found for high-rate consumers (i.e., 95 %ile or higher) in some cities in the middle and lower reaches of the Yangtze River (MLYR), during the peak consumption season. Our results suggest that more attention should be paid to dietary MeHg intake via crayfish consumption in China, particularly for communities with high consumption in MLYR.