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Electronic Communication in Plastic Surgery: Surgery: in Plastic Communication Electronic Copyright © 2017 American Society of Plastic Surgeons

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Electronic Communication in Plastic Surgery: Surgery: in Plastic Communication Electronic Copyright © 2017 American Society of Plastic Surgeons SPECIAL TOPIC Downloaded Electronic Communication in Plastic Surgery: from Guiding Principles from the American Society https://journals.lww.com/plasreconsurg of Plastic Surgeons Health Policy Committee Kyle R. Eberlin, M.D. Background: With the advancement of technology, electronic communication Galen Perdikis, M.D. has become an important mode of communication within plastic and recon- Downloaded Lynn Damitz, M.D. by from structive surgery. This can take the form of e-mail, text messaging, video con- BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3wxNooCNzZvhCPLdW9NJ2mv6dqe+oOWSEH0yQQpVcu8c= https://journals.lww.com/plasreconsurg Dan J. Krochmal, M.D. ferencing, and social media, among others. There are currently no defined Loree K. Kalliainen, M.D. by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3wxNooCNzZvhCPLdW9NJ2mv6dqe+oOWSEH0yQQpVcu8c= American Society of Plastic Surgeons guidelines for appropriate professional Steven C. Bonawitz, M.D. use of these technologies. ASPS Health Policy Methods: A search was performed on PubMed and the Cochrane database; Committee terms included “telemedicine,” “text messaging,” “HIPAA,” “metadata,” “video Boston, Mass. conferencing,” “photo sharing,” “social media,” “Facebook,” “Twitter,” and “In- stagram.” Initial screening of all identified articles was performed; the level of on 03/26/2018 evidence, limitations, and recommendations were evaluated and articles were reviewed. Results: A total of 654 articles were identified in the level I screening process; after more comprehensive review, 41 articles fit inclusion criteria: social net- working, 12; telemedicine, 11; text messaging, 10; metadata, four; video con- ferencing, three; and Health Insurance Portability and Accountability Act, one. SUPPLEMENTAL DIGITAL CONTENT IS AVAIL- General themes were identified from these articles and guidelines proposed. ABLE IN THE TEXT. Conclusion: Electronic communication can provide an efficient method of information exchange for professional purposes within plastic surgery but should be used thoughtfully and with all professional, legal, and ethical con- siderations. (Plast. Reconstr. Surg. 141: 500, 2018.) lectronic communication has become an increasingly common mode of sharing clini- Disclosure: None of the authors has any financial on 03/26/2018 Ecal images and information within plastic interest in any of the products or devices mentioned surgery. The broad category of electronic commu- in this article, or any other conflict of interest to dis- nication includes the modalities of text messaging, close. Neither this article nor the example consent e-mail, video conferencing, smartphone applica- form is intended to provide legal advice. Rather, phy- tions, and social media, among others. Electronic sicians should consult their attorneys with specific communication can provide an efficient method questions regarding electronic communications with of information exchange between health care pro- patients and prospective patients. viders, and between patients and their providers. Plastic and reconstructive surgery is an inher- ently visual specialty; inspection is a key component Supplemental digital content is available for of clinical evaluation and contributes highly to diag- this article. A direct URL citation appears in nosis and treatment. Visual assessment can take the text; simply type the URL address into any many forms. Electronic communication, including Web browser to access this content. A clickable the sharing of pictures and videos, can be useful link to the material is provided in the HTML at many stages of patient care, including the initial text of this article on the Journal’s website (www.PRSJournal.com). From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School. Received for publication January 12, 2017; accepted August Official Peer-Reviewed Publication 4, 2017. from the AMERICAN SOCIETY of Copyright © 2018 by the American Society of Plastic Surgeons PLASTIC SURGEONS. DOI: 10.1097/PRS.0000000000004022 500 www.PRSJournal.com Copyright © 2017 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. Volume 141, Number 2 • Electronic Communication consultation, formulation of an ongoing treatment An initial search was performed of each afore- plan, and postprocedural monitoring and follow- mentioned term, and potentially relevant cita- up. Recent studies have shown that an increasing tions were identified (level I screening). A title number of physicians directly communicate elec- and abstract search was then carried out and the tronically with their patients1–4 and that there is a sig- full text of each article was reviewed for appropri- nificant interest among patients for communication ateness. For each topic, a list of articles meeting with their providers by means of e-mail and social the inclusion criteria was created (level II screen- media.5 The value of telemedicine, as an overall tool ing). The level of evidence for each study was within the domain of plastic and reconstructive sur- noted and a summary of the evidence, challenges, gery, has been previously reported in the literature.6,7 and limitations was created. This process was per- As technology has evolved, patients have formed separately for each search term. become increasingly facile with the use of smart- phones and digital technology. However, a num- RESULTS ber of ethical and medicolegal considerations germane to these modes of communication have A total of 654 citations were identified in the arisen and are of paramount importance to the initial (level I) screening process. There were 245 practicing plastic surgeon. These include com- citations identified for text messaging, 178 for pliance with the Health Insurance Portability video conferencing, 115 for social networking, 60 and Accountability Act related to transmission of for telemedicine, 32 for metadata, 18 for Health secure medical information, concerns related to Insurance Portability and Accountability Act, and establishment of the doctor-patient relationship six for photographs. Critical appraisal of these through virtual means, privacy with storage of citations and their appropriateness for this topic electronic files, and concerns about provision of pared down the list. interstate medical care without appropriate licen- After complete application of inclusion and sure. Given the relative novelty of many of these exclusion criteria (level II screening), 41 articles technologies, there is significant practice variabil- were identified: social networking, 12; telemedicine, ity and no consensus exists among practitioners. 11; text messaging, 10; metadata, four; video confer- This study sought to investigate the evidence encing, three; and Health Insurance Portability and and previously described guidelines for plastic sur- Accountability Act, one. General themes were iden- geons to safely and effectively use electronic com- tified from articles related to each search term. munication, and to better define the associated With the identified articles for social net- ethical and medicolegal considerations. General working, the majority were composed of patient guidelines regarding the communication between and physician surveys. General themes included medical professionals, and between the medical a developing familiarity and comfort with these professional and patient, are then offered. technologies among surgeons, and the perceived importance of having an online presence for one’s practice. Most social networking interac- MATERIALS AND METHODS tions appear to be initiated by patients, and many A literature search was performed on PubMed physicians either decline to interact or admit to and the Cochrane database relevant to several interacting with patients on a case-by-case basis. topics in electronic communication in January One identified concern is the potential for mis- of 2015. Specific search terms were collectively representation of credentials through social net- chosen by members of the Electronic Guiding working and the implications for care delivery. Principles subcommittee of the American Soci- Within the search term telemedicine, arti- ety of Plastic Surgeons Health Policy Committee. cles indicated that this technology might be ben- Search terms included “telemedicine,” “text mes- eficial for patients in rural areas, particularly for saging,” “HIPAA,” “metadata,” “video conferenc- wound care and management of burns. There ing,” “photo sharing,” “social media,” “Facebook,” was a noticeable concern about the veracity of the “Twitter,” and “Instagram.” transmitted information through telemedicine, Inclusion criteria were articles published in and worry about missed diagnoses (such as digital the English literature from 2004 to 2014; narrative nerve injury in the setting of a finger laceration) reviews, case reports, patient experience surveys, requiring additional or more urgent medical care. and physician surveys were also included. Meet- Challenges noted by the authors of these studies ing abstracts and articles published in a language included medicolegal issues related to provision other than English were excluded. of medical care between states, potential Health 501 Copyright © 2017 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. Plastic and Reconstructive Surgery • February 2018 Insurance Portability and Accountability Act viola- will monitor the telemedicine
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