For the last 8 months or so I have regularly participated in the Sunday evening #HCSM Twitter conversations. These chats are a tremendous gathering of individuals from around the US and, increasingly, from around the globe. I have noticed, though, that the trend is that few of the active participants are medical providers or medical professionals. It seems to me that the diversity of opinion that is the strength of the sessions (in that they include physicians, patients, marketing professionals, educators, social media experts, etc) also makes it difficult to discuss how Twitter, Facebook and other social media tools can enhance medical practice and what challenges will present themselves. I began engaging in the HCSM conversations because I truly believe that social media will enhance how health care providers and patients interact and engage with each other, but I also see many pitfalls and hurdles that need to be honestly evaluated and addressed in order to make that happen.
If you follow health care policy you know that there are major issues facing our current health care system. Now that health care reform has been passed, more Americans will have access to health insurance than ever before. At the same time we already face a shortage of primary care providers, meaning that many newly insured people will be unable to find a doctor. This comes at a time when primary care physicians are feeling increasingly burned out by their practices. Our health care delivery and payment systems undervalue face-to-face doctor/patient interactions, and insurance company restrictions and other administrative obligations throw up roadblocks that interfere with the core of medicine: the doctor/patient relationship. Increasingly, doctors are seeking to provide patient-centered care, and patients are becoming more aware of the value they are getting for their health care expenses. As these trends converge, patients will more actively seek better care and more efficient ways of obtaining access to that care. Likewise, physicians will find new ways to reach these patients.
One of the answers to these challenges is a rethinking of medical care under the “patient-centered medical home” (PCMH) model. This model ideally allows physicians to change the nature of health care encounters by allowing “on-demand care” to develop: providing care through e-visits, communicating through texts and e-mail, and enhancing communication through social media techniques. There are limits to doing this (eg HIPAA privacy requirements mean that physicians will not be able to provide diagnosis and treatment online) and there are plenty of gray areas (eg are texts private?), meaning that on-demand care will require expanding what we think of as social media to include secure e-mails and secure patient portals.
This expanded paradigm of patient-centered care will require blending payment models to include traditional fee-for-service, patient management fees (where physicians are paid for coordinating care) and on-demand care reimbursement. This affords physicians the freedom to stop running on the “see-more-patients-to-make-more-money” treadmill. If the PCMH model is put in place as envisioned, more and more care will be provided to patients who are outside of the office, and office visits will be used for new patients, patients with new problems, and patients who are have medical problems complicated enough that they cannot be cared for without face-to-face encounters. This model would allow doctors to spend more time seeing, speaking with, and communicating with patients. And this is where I think social medial will have an influence.
To effectively enhance access to patients’ health care providers, the PCMH principles must include some form of social media communication. This will become more and more important the older the “millenial” generation gets– they include today’s college and medical students and tomorrow’s health care consumers. Physicians and medial providers will need to adapt communication to accommodate those for whom even e-mail is too slow a method of communication.
I can foresee a time when physician offices communicate with patients through a combination of techniques: face to face visits when needed; secure e-mail when more detailed on-demand care is needed; texts to communicate blood sugar or blood pressure readings and medication adjustments or reminders; Twitter to allow physicians to provide information to the community; Facebook to provide practice information and some patient interaction online. Consequently, physicians need to start thinking about redefining social media and enhancing the “health care” in HCSM now in order to be adequately prepared for the future. The focus should remain on how to make doctor/patient communications improve outcomes and quality of care for patients.
Being that the use of social media is still in its infancy, many physicians and other health care providers have hesitated in fully diving in. Issues of privacy, professional boundaries, reimbursement, and how to achieve work/life balance without perpetually being “on the clock” are as yet unresolved. However, by moving physicians off the current high-volume treadmill, and by integrating social media as part of the PCMH model, the practice of medicine can be reinvigorated and the promise of health care reform made a reality. I believe that patient-centered medical communication (PCMC) is a core element of making patient-centered care a reality. I think that PCMC tools will support enhanced doctor/patient communication. Finally, I believe now is the time for serious thought and action to spur their implementation in delivering better care for all patients.