Mental health professionals, like all healthcare providers, must comply with the Health Insurance Portability and Accountability Act (HIPAA), which sets standards for the protection of patient information. Googling a patient or using social media to find information about them raises ethical and legal concerns related to privacy and confidentiality.
Understanding HIPAA and PHI
What is HIPAA?
HIPAA, enacted in 1996, is a federal law designed to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. HIPAA’s Privacy Rule sets standards for the protection of PHI, which includes any information that can be used to identify a patient and relates to their health status, provision of healthcare, or payment for healthcare.
What constitutes protected health information (PHI)?
PHI encompasses a broad range of information, including:
- Demographic data
- Medical histories
- Test and laboratory results
- Insurance information
- Other data collected by healthcare providers to identify an individual and determine appropriate care
- PHI is protected under HIPAA regardless of the medium it is stored or transmitted in, including paper, electronic, and oral formats.
Learn more: What are the 18 PHI identifiers?
Patient-targeted Googling (PTG)
Patient-targeted Googling (PTG) occurs when healthcare professionals use online search engines, social media, or other internet resources to collect patient-specific information for reasons such as understanding their background better, confirming provided information, and evaluating their current state of mind.
A review that looked at the prevalence of PTG found that the prevalence of PTG “ranged from 20% to 98%, with rates of non-consent ranging from 60% to 84%.” This demonstrates that PTG is a common healthcare practice. PTG was motivated by “curiosity to gather new information and to verify existing information.” However, PTG is not without consequences. “Consequences of PTG included enhancing the therapist's sense of safety and causing harm to the therapeutic relationship.”
Ethical considerations
- Patient confidentiality and trust: Confidentiality is a cornerstone of the patient-provider relationship, especially in mental health care. Patients must feel secure knowing their personal information is safe and their privacy is respected. Googling a patient or searching for them on social media without their consent can breach this trust, making patients feel violated and potentially jeopardizing their willingness to be open and honest in therapy sessions.
- Boundaries and professionalism: Mental health professionals are expected to maintain clear, professional boundaries to avoid dual relationships or conflicts of interest. Searching for patient information online can blur these boundaries, leading to ethical dilemmas and potentially harming the therapeutic relationship.
- Informed consent: If a mental health professional believes there is a legitimate clinical reason to search for information about a patient online, this should be discussed with the patient, and their informed consent should be obtained. Transparency in this process ensures patients are aware of how their information is being used and can make informed decisions about their care.
Professional guidelines
- American Psychological Association (APA) guidelines: The APA’s Ethical Principles of Psychologists and Code of Conduct advise against searching for patient information online without their knowledge and consent, emphasizing the importance of protecting patient privacy and maintaining trust.
- National Association of Social Workers (NASW) guidelines: The NASW Code of Ethics similarly enforces the importance of maintaining confidentiality and professional boundaries. It recommends that social workers avoid using social media or other online resources to search for client information without clear clinical justification and the client’s informed consent.
Practical considerations and risk management
- Documenting online searches: If a mental health professional deems it necessary to search for information about a patient online, they should document the reason for doing so and ensure it is clinically relevant. Documentation should include the rationale for the search, the information sought, and how it will be used in the patient’s care. Proper documentation helps to maintain transparency and accountability, reducing the risk of ethical and legal violations.
- Avoiding unnecessary searches: Mental health professionals should avoid performing online searches on patients without a clear, clinical justification. Instead, they should rely on information provided by the patient and obtained through standard clinical assessments and interactions. This approach helps to preserve patient privacy and maintain professional boundaries.
FAQs
Is patient-targeted Googling legal?
While there is no specific law that explicitly addresses PTG, it must comply with broader legal standards, such as HIPAA. Under HIPAA, the use of PHI must be minimized and should only be accessed for legitimate purposes related to patient care. PTG without patient consent may violate privacy laws and ethical standards.
How can googling patients impact the therapeutic relationship?
PTG can impact the therapeutic relationship by:
- Breaching Trust: Patients may feel violated if they discover their provider has searched for them online without their consent.
- Blurring Boundaries: Accessing personal information not disclosed by the patient can blur professional boundaries and alter the dynamics of the therapeutic relationship.
Tshedimoso Makhene
