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.
Text Messaging and Protected Health Information: What Is Permitted?
The first short message service (SMS) “text message” was sent in 1992 from a computer to a mobile phone. It read: “Merry Christmas.” Since then, mobile-to-mobile SMS has become one of the most popular means of electronic communication worldwide, with more than 20 billion messages transmitted daily. In a 2013 survey of 2076 US adults, 91% reported owning a cellular phone, and 81% reported using their device for texting—making SMS the most commonly used mobile application.1 Not surprisingly, several small studies including 45 resident and 28 faculty general surgeons and 97 pediatrics hospitalists found that more than half (60%80%) of physicians use text messaging for clinical communications.2,3 However, there is little guidance regarding appropriate use of this technology in the health care setting. In addition, some physicians may have the misconception that text messaging of protected health information is prohibited by law.
Use of viber app: a fast, easy and cost effective method of communication in neurosurgery.
OBJECTIVE
Neurosurgeons often have to rely on judgments of junior staffs to decide on patients whom they cannot attend immediately. Viber is a free to use application for image transfer on Internet. We evaluated the use of viber in neurosurgical scenario, to show it is cheap, fast, accessible, reliable and feasible.


MATERIALS AND METHODS
We conducted a prospective study from March 2013 to July 2013. Residents were taught to take sharp pictures and upload them immediately using viber on Internet. Primary endpoints were discordance between opinion of residents and consultants on viber images and subsequent actual image evaluation and time delay in decision-making. Discordance was considered significant if it changed management decision.


RESULTS
During the study period, 120 (mean age: 42 years, 58% males) patients were enrolled. Wi-Fi is freely available in the institute and thus no costs were involved. Decision could be made on images received on viber at an average of 20 min. There was discordance in 56.7% cases between residents' reports and images on viber, which was significant in 88.2% cases. However in 5% cases decision changed after actual images were reviewed. Of all imaging modalities, computed tomography angiographic images were associated with statistically significant discordance (P <0.05).


CONCLUSION
This study suggests that the use of viber app in neurosurgery can be an easy fast reliable and almost free mode of communicating images enabling a quick decision. However this cost-effective method should be used with caution particularly with imaging modalities, which require processing and review on console.