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November 2010

The 2010 Interim Meeting of the AMA House of Delegates recently published guidelines for physicians on the use of Social Media. The items listed below were discussed in the guidelines.

• Physicians should recognize and maintain standards of patient privacy and confidentiality in all environments, including online, and must refrain from posting identifiable patient information online.
• Physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate. 
• When interacting with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context.
• Physicians should consider separating personal and professional content online in order to maintain appropriate professional boundaries.
• Physicians have a responsibility to bring content posted by colleagues that appears unprofessional to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. The physician should report the matter to appropriate authorities if the behavior appears significantly above the norm, or if they fail to take action to resolve the situation. 

• Physicians must recognize that:

  • their actions online and content they post may have a negative affect on their reputations among patients and colleagues
  • their online actions may have consequences for their medical careers (particularly for physicians-in-training and medical students)
  • their actions online can undermine public trust in the medical profession

Additional Commentary

The above guidelines are worthy of careful consideration of any medical professional online. A good rule of thumb is to consider applying safe privacy settings on certain social media tools, an example of which is Facebook. You can set your privacy settings on Facebook to restrict who sees your personal information, and views your pages. If you have any question about posting something, then it is probably best to follow your instinct and NOT do so. And, consider that once you post something, consider it permanent. That will help you decide what to post, and what not to post.  

Another thing to consider is how you talk to others online, and respond and comment to others. Always be courteous, watch your language (you would be surprised), and use the rule of thumb of treating others online as you would want others to treat you... The Golden Rule still applies on the web! 

Final Words

As medical professionals, we have a wonderful opportunity to utilize a huge social network of other medical professionals, healthcare workers, and students to expand our sharing of educational information, challenges, and interesting cases with little effort. Through your mobile phone/iPhone, netbook/iPad, or web browser, in just minutes, you have access to the richest source and opportunity of dynamic knowledge in existence. Take advantage of it...get online...get involved...and HAVE FUN ! 

The Latest "Buzzword"- Cloud Computing 

In a recent article, Sagoo and Weber1 begin by briefly describing that "...Cloud computing is no longer a technological dream – it's the buzz concept of 2009...." In their article, they do a nice job at "...demystifying the technology to explore the legal and commercial risks." This new technology is being fueled by cost efficiency and flexibility of use2.  

Introduction

To simplify the definition, "...cloud computing is typically understood to mean a computer network that provides on-demand scalable IT resources over the Internet. ...".1 This requires a computer, and internet access. The user does not have to have any knowledge of how this works...it is invisible to them. IT support is carried out by the cloud which supports them. An example of this is Google Apps (ie. google docs). Google provides the support for this cloud, not your local IT department. They are responsible for the network communication, ie. computer network and internet access. These cloud services are either provided at no fee (open-source), or are rented by the end-user.  The adoption of this technology is predicted to be huge, although it is limited at this time by concerns over security. The articles by Sagoo and Weber1 and Chow, et. al2 provide a detailed discussion of these security concerns. Certainly, as it relates to health care, and the government's strong momentum to the development of the electronic medical record (EMR), this is an important and essential consideration in assuring not only individual privacy but corporate privacy as well. 

Legal Concerns ²

• VM-level attacks: vulnerabilities mitigated with monitoring and firewalls
• Cloud provider vulnerabilities: platform level, ie. SQL injection attacks or cross-site scripting
• Phishing cloud provider: a new attack vector
• Expanded network attack surface: the cloud user must protect the infrastructure used to connect with the cloud.
• Authentication and Authorization: enterprise does not extend to the cloud. How does company merge this with the cloud provider?
• Forensics in the cloud: investigators allowed to seize and recover data.

• Uptime: can the cloud provider scale to meet the needs to handle certain applications, ie. a large utility company billing millions of consumers in the cloud.
• Single point of failure: not there are more single points of failure and attack
• Assurance of computational integrity: can the cloud provider assure validity of statistics or data retrieved/computed?

• Due diligence: subpoena or other legal request, can the cloud user compel the provider to respond in the time required? Issues of enterprise retention policy, assurance of destruction by cloud provider.
• Auditability: SOX and HIPAA requirements, how do you perform on-site audit? how to assure data is properly isolated and cannot be viewed by those without a need to view
• Contractual obligation: beware of "non-assertion" clauses in cloud provider, need to address via contracts areas related to patent and intellectual property
• Cloud provider espionage: worry about theft of company proprietary information by cloud provider.
• Data lock-in: in no data standardization format, a particular vendors format may pose a problem if they go out of business, leaving cloud user scrambling for a solution. 
• Transitive nature: the cloud provider may use subcontractors for services, for which they have less control. This affects trust between cloud user and provider. 

Summary Presentation

This is a nice summary slideshow to perhaps help understand the overall concept.  

References

1. www.osborneclarke.com/publications/commercial/Hot_Topic/11768.asp
2. www.parc.com/content/attachments/ControllingDataInTheCloud-CCSW-09.pdf
3. 1105govinfoevents.com/events/2009/VM09/CurtAubleyPresentation.pdf 

CYTOPATHNET is now on Facebook!!

For those of you who like the social interaction of the web, and the ability to quickly stay in touch with friends and colleagues, I am happy to announce that CYTOPATHNET is now on Facebook! To visit us there and interact with other CYTOPATHNETeers, come join us at http://www.facebook.com/group.php?gid=75552272754.

Would love to have you join us if you are currently on Facebook.

A Few Reasons to Join US on Facebook:

1. put a face with a name

2. build friendships or catchup with long lost friends in the community

3. communicate with others in the field WORLDWIDE

4. help spread the word about us

Did you know that CYTOPATHNET has been at the forefront of the WEB 2.0 trend?....since 2005?

I suspect that most of you are thinking, "uh....what is WEB 2.0?"

According to Wikipedia, "WEB 2.0 is a�trend in World Wide Web technology and web design that aims to facilitate creativity, information sharing, and, most notably, collaboration among users. With these advanced capacities, a second generation of web-based communities and hosted services, such as social-networking sites, wikis, blogs, and folksonomies, are evolving. These applications are heralding a new era of the World Wide Web."

There are four levels of applications or products defined as based on their degree of WEB 2.0-ness, shown in the following table. (radar.oreilly.com/archives/2006/07/levels-of-the-game.html)

CYTOPATHNET would be categorized as a Level 3, although certainly we aren't as big as the examples listed....but we should be (wink). I have always envisioned that CYTOPATHNET could be a common ground for anyone involved with cytology, from a global perspective, to share their experiences and their collective knowledge. Certainly, their are and have been obstacles to that, because of either company policies restricting user participation (real and imagined), or limiting the extent of participation, and even the question about the content provided, in assuring that no proprietary information be disclosed. That is certainly understandable, and I think with time, the community will open up, as our society and the world as a whole become more innovative in its approach to information sharing and intellectual knowledge sharing.

Whew...ok, I am not used to excercising that right brain! Anyway, I wanted to share with you some buzz words that you may (or may not) hear thrown around. But, just so you know, if you have been using this site, you are participating in a relatively new trend. The age of Web 1.0 technology, or static web content, with the web designer/owner providing information to the user without ability for active end user input is changing, and I thought you ought to know you have been a part of it from early on.

http://content.nejm.org/cgi/reprint/357/11/1154.pdf

The NEJM recently had some editorial discussion raising some questions and unanswered questions regarding HPV vaccination (http://content.nejm.org/cgi/reprint/356/19/1991.pdf). More to follow once I have digested each of the original articles. But I would point everyone to NEJM for the original articles regarding HPV vaccination, and start from there.

Link to search:
http://search.nejm.org/search?p=UK&srid=S9%2d1&lbc=nejm&ts=subs&pw=Raab&pu=33874&uid=319219852&isort=score&w=hpv%20vaccine&rk=1

I would encourage everyone to read this information. It contains very useful information regarding the HPV vaccine, and will be helpful in understanding how this may have an impact on cervicovaginal screening in the future.

I will be posting my thoughts on HPV vaccination here in a bit, but at least thought I would throw out a tickler in case anyone wanted to put in their two cents. So, stay tuned, I will post some more in a bit.

1. Should mandatory vaccination be implemented? (ie. Texas governor's mandate)
2. What are the repurcussions:

• socially
• medically
• ethically