SM in HC is More Than a Cute Screen Name

September 27, 2010

Last Sunday in the NYT Natasha Singer published an article titled ‘Better Health, With a Little Help from Our Friends’ She presented compelling information that social networks can aid in influencing and changing healthcare behavior for both good and bad. As I read and reread that article I was struck by the implications of the research she presented for SM and how it may be applied locally to improve outcomes. I want to look at some of the data supporting her writing and what it may mean for SM in HC.

The work Singer presented was focused on live networks of people and communities and their effect on HC behaviors. A NEJM of article by Fowler and Christakis titled ‘The Spread of Obesity in a Large Social Network over 32 Years’ “the chance of becoming obese was influenced not only by the weight gain of friends but also by friends of friends who gained weight.” In this article Fowler and Christakis said, “People are connected, and so their health is connected.” This is the key to improving outcomes in HC. Can we create hubs of influence where patients congregate to find solutions to their common HC problems?

During chats and posts of HCSM the primary premise is SM is an answer to HC that can drive change. But it is not simply establishing networks and SM. It is the way the network is structured, who is in it, how it functions, and what it does to reinforce change. I have a strong bias toward adult learning in that adults want to find solutions to problems they are having and that learning has two fundamental aspects for it to be successful. It must have affect and must be social. I have posted on this. In my mind the Singer article demonstrated tools that can be applied to SM in HC in order to increase the effectiveness of learning, which will improve outcomes.

Singer presented recent work by Damon Centola who examined the structure of social networks and how fast people adopt and stick to health habits. His work is summed up in this quote from Singers article “It makes a big difference how you connect people than who is there in influencing desirable behaviors. His recent article in Science ‘The Spread of Behavior in an Online Social Network Experiment’ examined this issue. It is a very technical read and built on his earlier work “Complex Contagion and the Weakness of Long Ties” AJS 113 No. 3 November 2007 702-34.

Singer examines ties within networks and how they influence participants. Strong ties are close friends and family who are highly important to us, family, friends, our PCP who we are seeing to manage our health. Weak ties (long ties) are those we are connected with less frequently and do not highly influence us. Lady Gaga’s 6 million friends on FB is an example of weak (long) ties. Strong ties (wide bridges) influence more powerfully. Weak ties offer the ability to rapidly spread information.

I want to quote from Centola’s conclusion, “We found that long ties do not always facilitate the spread of complex contagions and can even preclude diffusion entirely if nodes have too few common neighbors to provide multiple sources of confirmation or reinforcement. While networks with long, narrow bridges are useful for spreading information about an innovation or social movement, too much randomness can be inefficient for spreading the social reinforcement necessary to act on that information, especially as thresholds increase or connectedness declines.”

How does this work apply to HC outcomes and SM? What are the practical applications relevant to our #HCSM chats and our collective interest?

First there are two assumptions I want to make:
•What is presented will be within HIPAA guidelines.
•The work to do this does not fall on the physicians shoulders but is done via an outsourced model that is at worst revenue neutral but hopefully positive.

HC is Local: There are 900 million physician office visits each year compared to 35 million hospital admissions/visits. HC is in the office not in the hospital. Hospitals treat patients, physicians manage patients. It stands to reason the key locus for patients and outcomes is the office.

When adults seek solutions to HC problems they go to Bing, Google, WebMD, national organizations, their friends, etc. I would offer a different model,, a PCP web site/portal built to focus the physicians’ patients to find information and links. It is a place for patients to go that is trusted. It’s local with high HC value. (Who is more trusted than your MD?) The physician and the web site/portal become a hub for patients in search of information. These are not huge sites like WebMD but sites with links and basic trusted information and articles built around patient/practice demographics. MyMD is local, patients are local, it’s a HC neighborhood that can reinforce knowledge and outcomes.

Networks: Use the MyMD web site /portal as a place where patients with similar diseases (HTN, diabetes, obesity, etc.) can build small communities around their PCP. Offer Tweet ups for patients with similar issues. Allow them to meet and chat based on the articles and thoughts of their PCP. Again, to be clear, this is not a place to treat and Rx. It is a place to learn and share with clear rules of engagement. Knowledge coalesces around their physician.

Maximize diffusion: Using the work cited above create wide and long ties. Invite patients from national organizations to participate in order to diffuse new knowledge quickly. Include trusted patients and experts who would offer wide ties of influence. Create discussions around problems patients want to solve and ask them to share experiences and knowledge in order to create reflection.

Larger portals: Carmen presented a review and look at the Mayo Clinic patient portal ‘Patient Portals: Socially Wired to Future Health Care. Tie patients back to their hospital based patient portal if it exists.

Measure and Monitor: Examine the actions and behavior of patients participating in the local PCP knowledge portals. Learn what problems patients within the practice are seeking solutions in order to offer ideas and knowledge and most of all allow them to share experiences and knowledge in order to reflect and include new behaviors in their HC lives. And most of all look to measure outcomes and identify change.

Hospital Benefits: Hospitals have a vested interest in improving outcomes at the referring physician’s office. In the not to distant future as HC reform takes hold hospitals will be measured on outcomes. X number of patients enter the hospital each year. As an administrator I am hoping to get them in, treat, discharge quickly and have no readmission. Therefore, I want patients admitted in a better state of health. I want diabetic ulcers not gangrene. The latter may be more expensive but effect’s my outcomes. MyMD web site/portal is a way for me to help referring physicians better serve hospital goals.

Revenue: Perhaps a local bike shop would want to place an ad on the site. Maybe Trek would want to been seen here. What should not be done is have pharma or others with a commercial interest in HC products participate. This cannot work without some revenue.

These are just a few ideas on taking the work presented above and applying it to real world practice to improve HC outcomes. MyMD site/portal does not have to be complex. It needs to be a place, a waiting room with information and like-minded friends both old and new who share knowledge and help each other to learn and make the changes they want to make within their ‘HC neighborhood’. Most of those 900 million patient visits last year were for check ups and routine healthcare and those visits are not driven by problems that need solutions. Therefore the audience using this MyMD web/portal is smaller and wants and needs to make changes. They may or may not be motivated but from the data it seems we can use networks and social media to drive change. But what we cannot do and what frosts my ass is this assumption that the pretty little toy called SM will in and of itself drive HC change or improve outcomes or make coffee and cure acne. SM is a tactic; it needs a strategy and principles in order to succeed. There appear to be hundreds of research papers examining networks and how they function. Apply them to SM.

I am a GED in a roomful of PhDs who dares to quote Centola, Fowler, and Christakis. I worry my logic may be ill and I’ve misunderstood their work but I think I’ve got the idea right. We need to use science and knowledge in SM to drive change. My hope is that comments, questions, and interest will spur discussion. Bless Steve Jobs’ rented liver. iTunes and now iPing are interesting models of knowledge and SM. Maybe just maybe we’ll interest someone, some HC provider, etc. to build this as a model and test it. I know I’m ready.

Must Physicians Engage In Social Media?

September 23, 2010

The latter half of September 12th’s #hcsm chat brought up the issue of what value social media (SM) can provide to physicians.  In particular, the discussion focused on whether the group felt SM involvement was necessary for physicians–what would one say if their physician indicated they had no interest in SM communication, and would physicians who declined to become involved in SM find themselves obsolete?  It is is worth noting at the outset that the group’s opinions and thoughts were not conclusive, though general trends were apparent.

“I’m a doctor; I don’t do social media.

Various suggestions were made as to how patients could broach the topic of SM engagement with their physician.  One option I presented was to point skeptical or uncertain physicians toward doctors with strong online presences.  This way physicians could see how their peers use SM and can determine how they might use the technology and techniques themselves.  @JanelleBowden had a similar approach: “I would Q further what doc perceptions of SM are, so they can be addressed. Not everyone well informed of potential of SM yet”; after physicians learned more about SM capabilities they could make their own decisions as to what extent they would like to use SM.  One option, presented by @Julian_Bond, would not try to push physicians beyond their comfort level: “Think if docs dont want to use SM as tool for comm, they should at least be aware of HC discussions going on there”.  Another option, separate from physicians being personally involved in SM, would be to leverage this method of communication: “for starters, instead of all the snail mail and reminder calls, you first figure out where pts want to be reached?” (@mcbennett6).   @MacObGYN felt that “Social media extends the doctor patient relationship beyond the four walls of the office” and that one way to get doctors to consider SM would be to explain that “SM is an opportunity to spread info in your specialty to lots of people, increase education, build loyalty and increase connection.”  @MHoskins2179’s opinion reflected that feelings I suspect are shared by many patients: “We have too little time in office, Dr. SM will help us better utilize the little time we have, save u time, & lead to better care.”

However, not all participants felt that physician involvement in SM is necessary: @CureT1Diabetes noted “not every doctor has time 2talk to people online – I just want a brilliant physician who keeps up w/medicine.”  @RAWarrior replied to @MacOBGYN’s by noting that not all patients or doctors are ready to have the doctor/patient relationship extended beyond the office visit.  In each case, the comments focus on the need to keep current with information and to determine when and how patients wish to engage with physicians.

SM and obsolescence: should physicians worry?

The accompanying question was whether physicians who do not engage in SM will find themselves obsolete as time moves forward.  My initial reaction to this question was to comment that as patients become more comfortable with SM as a means of communication, physicians will need to develop a level of comfort using SM.  @JanelleBowden took a broader view, writing “We all have to learn. Those that don’t will become obselete, no matter the profession.”  A number of participants felt that it would just be a matter of time before physicians used SM more readily: @joshdbrett commented “Eventually, yes. But there are still populations who won’t or can’t use those technologies. U need to know ur audience”, while @DermDoc took a more practical view that physicians “Risk losing their share of patients. Ultimately, practice marketing will drive most physicians to social media”.  @MHoskins2179 also took a pragmatic view: “Once docs can start getting reimbursed for SM/online patient interaction, I see that as motivating many.”

Again, there was not uniform demand that physicians be actively involved in SM or a sense that physicians who avoided SM would become obsolete: @CureT1Diabetes felt that physicians uninvolved in SM would not be obsolete “if they truly listen to their patients,read the literature, attend conferences”.  @pfanderson felt this question required flexibility: “Back to different strokes for different folks. Docs who don’t get/use #hcsm will likely find patients who agree”.  There was also an expressed belief that SM engagement could not take the place of in-office care: “Need a physician who is 100% present & engaged with patient in office; not one with online presence but dismissive w/10 min off. visit” (@CureT1Diabetes).

Although we can’t force doctors to engage in SM, physicians should consider getting involved.

At this point, it appears that we are still in a transition point regarding physicians using SM.  Many people active in this discussion see great value in SM involvement and would encourage physicians to become involved while noting potential issues if physicians decline to engage.  At the same time, this opinion was not uniform: doctors who do not use SM will not be hurt so long as they stay up to date on current developments, and they will still likely find patients that are comfortable working with them.  I think it is also important to realize that many of the potential benefits for physician involvement in SM are potential benefits.  There are not many actual benefits while the time needed for SM engagement is significant.

I think that reformed health care delivery and payment and more patient-focused care will lead to physicians becoming more involved in SM over time.  In the meantime, physicians should be open to considering SM as a way to be resources to their patients.  Those physicians already engaged should be willing to discuss SM with their colleagues and encourage their peers to become involved: SM isn’t going away, and it could provide significant benefits to patient care in the future.

Patient Portals: Socially Wired to Future Health Care

September 20, 2010

In Mark Ryan’s recent post, “How Social Media Can Enhance Medical Practice,” he suggested that the Patient-Centered Medical Home (PCMH) model would allow doctors to provide e-care (e.g. texts and email) because it enhances the communication between doctor and patient.  In a serendipitous coincidence, Gisela Nehring, Manager of Information Technology at the Cleveland Clinic, recently composed an insightful blog on what her organization is doing in harnessing patient portals and how they are actually improving patient satisfaction, lowering costs and reducing physician workloads (Read it here:  Patient Portals). Many aspects of the Cleveland Clinic program are a wish list of services that would make any patient not in their system envious. As it is presently constructed, the Cleveland Clinic offers around-the-clock access online to health summaries (including procedures), test results (except for the most sensitive which are conveyed directly by the physician), medication lists, allergy lists, immunization lists, problem lists, prevention reminders and health trends (a feature that allows patients to graph their weight, blood pressure, pulse, respirations and lab results). On the horizon, the institution will offer remote monitoring, patient scheduling  and anesthesia risk analysis.

The idea of remote monitoring got all of us here at HCSM blog central brainstorming ideas we’d like to see Cleveland Clinic and all other health care providers consider.  We offer a short list of additional services that would work well within the patient portal framework:

  • Support Groups: Linking patients together as an opt-in function would allow new opportunities for sharing and support between patients, founded on the trusted relationship with the health organization.  One example could be for patients to pair up as buddies who are seeking mutual goals (e.g. weight loss or improved dietary adherence). This notion is supported by a recent study from UCSD researchers on the effect social networks have on obesity. Other conditions also appear to be affected (Read here).
  • Patient Co-mentoring:  Patients who have triumphed over their diseases (e.g. cancer survivors) are in a unique position to offer support and insight on coping with disease to the newly diagnosed. Expanding access to this portal to veteran patients to reach out to new patients would add a great deal of value to patients who understand “where they come from.”
  • Group Visits: If the portal model could allow for live hosting of group visits, then general information in a larger group setting could be supported. Such visits would be led by a doctor, and perhaps even recorded for later viewing. Broad disease topics could be entertained in these forums. Individual visits would not be held in this setting.
  • Public Conversations: If there were a way to hold public forums on prevention or current health issues as webinars through such portals, we see new bonds that could be established between health care providers and their communities.
  • External Discussion Groups, Led by Physicians: Building off the Group Visit idea, physicians could lead discussions among related patient-oriented audiences (e.g. caregivers, children of patients, etc.) to explore how improved care can envelop these social networks.
  • Physician /Hospital Alliances: If an organization, like the Cleveland Clinic, opened its portal to neighboring physicians, such a relationship could mutually support the interests of both parties while advancing improved care for the patient.
  • Data Mining:  While the current model expressed by the Cleveland Clinic mentions the use of data to build trending graphs, we urge a greater use of data mining to perform needs assessment and gap analysis. These twin activities would help health care providers identify changing needs while improving treatment strategies.
  • Provider Knowledge Library:  We also believe there is untapped potential in opening access to the database among patients for broader health care learning, serving as a trusted “WebMD.” The source could be enhanced by other general health care information, vetted and validated by the health care provider’s medical librarian. The  medical library would provide reliable content and enhance a patient’s ability to critically evaluate medical information.

These are just our initial thoughts, so we invite you for your ideas on how to make patient portals more social to enhance health care delivery and outcomes.

A Case of Chronic Otitis Media Walks into an AA Meeting: Shortening the adoption curve for social media.

September 8, 2010

Consider the parent of a three year-old who is part of your pediatric practice. This is the second visit within six months. During the first visit you confirmed uncomplicated acute otitis media. An antibacterial was prescribed. The parents reported that the symptoms appeared to resolve within three days and did not complete the 10-day regimen. Upon examination you could not confirm a certain dx of acute otitis media. You recommend observation with an analgesic. The parent is concerned about missing work and the need to resolve the pain. During the next 48 hours your office receives multiple calls from the parent asking for Rx. There are many parents experiencing this scenario.

What does otitis media have to do with Topic 3 in the Sunday evening #HCSM chat? “How do you infiltrate a health care organization with social media? What people (positions or types) make the biggest difference?”

I would not argue that perhaps I was hung-up by the word infiltrate. Do we need to approach SM in a covert fashion? Sneak in and co-op key players to make it happen? That is a long hard row to hoe especially with the risk adverse.

It has taken me a few days to sort out my thoughts on this topic. This, in some fashion, extends the post by @richmondDoc 1…2…2… Lift Off? Launching a new account on Twitter or FaceBook, etc.

Two comments summed up my feelings and offered a view of how I would move organizations to more quickly adopt social media.

@miller7: There is an interesting top down vs. bottom up approach with social media. Often it begins at bottom, but needs buy in from top.


nickdawson T3: wellness, administrators, experts and social media zealots. Get them, you are home free. Get one person passionate about the patient experience and you are golden.

@miller7 captured the feeling I have long held that HCSM is not about large, global Pepsi type SM programs but, small discreet exercises that are developed in parallel with the organizations’ mission and corporate goals. It’s about the pediatric department serving up information regarding otis media to help anxious parents. Not the ped department marketing themselves to gain larger share of the local market. (That will happen over time as the word is spread on how you’ve solved problems) SM is being effectively sold as a mass marketing tool to garner buzz that converts to sales, when in point of fact, SM is a highly focused tool that can effect change.

In healthcare we are walking a fine line between marketing and helping. I found the following quote from Jay Baer in his article The Key to Social Media Success is Just Two Letters: “The difference between “selling” and “helping” is only two letters, but the gap is in reality, much larger.” The basic premises here is to reduce friction and uncertainty with your customers. In healthcare it is solving problems patients are seeking solutions to. Here is the link to this article:

Demonstrating how SM can better solve problems patients are seeking solutions to is the key to shortening the adoption curve. Helping patients solve problems to improve their healthcare is the overriding goal in healthcare. That’s what patients are seeking in healthcare, not being one of 16m FB fans of Lady Gaga.

Identifying how SM can advance the mission statement or corporate goals of an organization is the first step. What can you do to change patients understanding, knowledge, use, etc. that will meet corporate goals? What are the problems and issues patients want solved? (I hope to post a short article on needs assessment in SM development). We need to approach the adoption of SM not from the current vista of the large marketing companies that get all the media attention but demonstrate that SM is the digital extension of a community with greater benefits.

Once you understand what problems patients are seeking solutions for and I am not talking about large issues everyone wants to solve but small important topics patients seek solutions to every day. You then identify ways to solve them with traditional media compared to SM.

Let’s consider otitis media again as either a department in a hospital or a large group practice. You’ve identified a small group of parents with children who have chronic otitis. They are anxious and demanding. They require additional time, more office visits, overuse of antibiotics etc. Solutions to changing behavior or improving knowledge for the group would be patient aids in the waiting room, bi-monthly newsletters, emails, posters in the office, extended visits, etc. All of these will have some effect over time but do they achieve two key features of SM? They do not offer interaction and engagement with the parents. SM is engaging and dynamic and as such it builds advocates of your service.

Perhaps you create a FB page for just this group and other parents who have successfully navigated otitis. Offer the same information you would’ve offered in your patient aids or emails and allow the group to share their experiences and knowledge. Monitor and guide as needed with the proper constraints and cautions required. Over time the effect of this dynamic will be greater in achieving the outcomes you’ve set as they relate to the corporate mission and goals.

What is happening here is you are demonstrating what SM can do. Not trying to create an advocate by overcoming objections that are based on mass media driven knowledge. In healthcare we need to carve out our own language and use model for SM. We should not rely on the larger marketing demonstrations. Those larger marketing forays can offer insight into behavior, ideas for use, and metrics but they are not the building blocks of changing outcomes in HC.

Again I want to draw from Jay Baer Web site because I think he has captured some key points. I am going to take the liberty of adding HC language to his quotes “Trust takes time, creating healthcare advocacy takes time.”
“Social media isn’t about quickly building weak bonds between a HC professional and large portions of its patient base, it’s about slowly building strong bonds between healthcare knowledge and a select portion of patients.”

There’s a powerful example of SM who’s that’s been at work since the 1930s. Its success is unparalleled. AA (Alcoholics Anonymous).is the best example of SM in action. Discreet groups of people meeting to help each other with problems they are seeking solutions to.

AA meetings are not about how many Facebook fans they have. It is about the experience I have in groups and how it relates to others. It might be as small as 10 in a meeting working as individuals in guiding each other to an outcome. I believe the same model can work in HCSM if we approach those in power to consider how SM can advance the corporate mission and meet our goals. Don’t try and compete with a Pepsi FB page. Consider what problem you and others can solve, helping the mother of a child with otitis media, for example. Your SM goal is that patient sitting across from you today. What are other ways to shorten the adoption curve of SM?

Social Media: Match Made in Health?

September 8, 2010

While there are the online health care pioneers making a way for themselves in reaching patients, not everyone is happy to see them. At the #HCSM chat on Sept.5, 2010, several participants openly discussed if there is anyone who should not use social media in this arena, and several indicated that some candidates fit the bill. For openers, @nickdawson stated, “people who have no interest in listening, learning, helping, healing or engaging should not use SM.” That pretty much ruled out single-minded marketers who are interested in their promotional material, rather than sharing value.

Not exactly a controversial view, but it is tell-tale sign of what the expectations are in this space. For companies and individuals unprepared to have true exchange, their goals will be limited at best. However, even for those who might not make the best fit for SM, there is some activity in which they can partake. One of the most generous voices was that of @epatientdave who remarked, “I can’t imagine anyone who should not, under any circumstances, use SM. Not even listen?” This is the best kept secret of social media. By simply listening, neophytes to this cyber playground can learn a great deal about those they seek to help, inform, and influence.

Still, the HCSM crowd seemed to agree that health insurance companies are persona non grata in this venue. Given that one of the key ingredients is genuine trust in building relationships online, that industry is at a disadvantage in entering the realm. Its practices are notorious, tainting even the most timid explorations on social media as being suspect. Consequently, until its goals are viewed to assist people rather than deny claims, the public perception will persist and their SM efforts will necessarily be thwarted.

Even if health insurers could somehow transform their current reputations, not every activity would be welcome online either. @sixuntilme remarked during the chat, “IMO, I don’t want to be informed about a claim denial through Facebook.” This leads to a more subtle point: assuming you think you ought to use social media what is appropriate?

I will take the liberty of exploring this topic using pharmaceutical companies as an example. On this score, I think drug development firms can benefit most from listening as @epatientdave intones. I would encourage these firms to establish a rapport with patient groups online in pure listening mode. If drug companies were to ask online patient social networks about what information they need to make informed decisions about clinical trial participation, for example, and integrate their findings into their direct-to-patient materials, they would be more successful, I suspect. They could even inquire about the biggest hurdles to clinical research participation right from the patients and learn to adopt better solutions to meet their needs. This is where listening has its greatest benefits without incurring risks in this highly regulated space.

Should pharma companies do more on the clinical side of the equation with SM? I don’t think so. When it comes to openly soliciting clinical trial participants, that is where I think drug firms should support local clinical sites to establish their own social media footprint. Aside from running the risk of tainting their patient pools and otherwise contaminating their data, pharma companies would be the biggest targets by the legal community poised to monitor their undertakings with an eye towards prospective litigation and a waiting hostile public. These are not the ingredients for beneficial social media engagement. There is a more important reason for pharma to step away from social media in the clinical recruitment area too. All clinical study enrollment is local, so helping neighborhood sites recruit more effectively makes sense. Plus, sites don’t carry the anti-corporate baggage of pharma companies. As they develop their SM profiles, their ability to recruit only becomes more sophisticated. In my mind, this activity clearly belongs to research sites.

What are other examples of companies and professional categories in health care that should not engage in social media? We welcome your ideas on this question and feedback on the comments presented above. If we have learned anything from our past HCSM chats, one patient’s social media heaven is another’s hell.

The Doctor Might Tweet You Now–If He’s Allowed

September 7, 2010

As I mentioned in my recent post, physicians are not as well represented in the weekly HCSM Twitter conversations as other professions are.  My ears perked up, when during September 5th’s conversation when the first topic was “Is it OK for a doctor to talk to patients online? When? What if they’re not his/her own patients? What sites are OK vs. not?”  As an physician actively participating in the dialogue who is also active on Twitter and in the blogosphere, this topic is very relevant to me.  The discussion that ensued followed two general paths, discussing when and how physicians should  engage patients on-line in general, and when and how doctors should enter and participate in online patient communities.

For me, the answer to the first issue was fairly clear: I think physicians have every right to interact with patients online, and I don’t think it matters if the interaction is with one’s own patients or not.  So long as physicians are interacting as people–not in a professional capacity–then we should feel free to converse with whomever we choose.  The necessary balance (for me, at least) is to be a resource to the community as a health care provider without offering diagnosis or treatment online.  I can provide information so long as I do not practice medicine.  If someone asks me something about a medical condition, I feel safe speaking in general terms, referring them to trusted resources on-line (, for example), and referring them back to their own provider.  This is the same thing that I would do if someone I met in the grocery store asked me something of a medical nature.

There seemed to be a general consensus in favor of that approach, but with some provisos.  @sixuntilme noted “I like the concept of docs talking to patients online. Preferably after they cover their rear, liability-wise”.  @scottkjohnson added “I think marketing = no, specific medical advice = no, general information sharing = probably ok. Building relationships is good” and “Specific patient advice?In their office. General advice (ie, you should probably see your HCP)?More flexible.”

There were some concerns, though, both from providers and from other participants.  @latta expressed their concern that if a provider gave medical information on-line, even in a general form, and a patient had a bad outcome then the transcript of that information could come back to haunt the provider.   Those concerns are  valid, but I think one can communicate as a physician on a public forum so long there are guidelines in place.  Of course, there are no formal guidelines in place, so each of us has to make our own decisions.  My rules are to “be general, guide patients toward trusted resources, and emphasize the need for evaluation by a physician.” This seems like a safe approach.  And there are potential significant rewards as expressed by @hillarts: “The more drs communicate, the less nervous everyone will be, and the liability issue will be less of a concern”, and “Several studies have shown that drs. that are more open and transparent with their patients get sued less often”.  I think the best approach is to proceed with caution, but to become part of conversations and to contribute to dialogue.  It seems that many of the HCSM participants felt the same way.

The discussion of where physicians should interact with patients quickly focused on the roles physicians could/should play in online patient communities.  Here the verdict was decidedly mixed.  There was a great deal of concern about the appropriateness of physicians participating in these communities, especially if there is the perception that physicians are trying to advertise or influence discussion without disclosing their identities.  @danamlewis noted that “Personally, I think online communications are peachy..when I say so. I’m iffy on docs going in2 communities 2 ‘market themselves’ 2 me”, and @MuhammadInc agreed that “Doctors should not be using these communities as a marketing venue.”  @ePatientDave commented that “ACOR communities are quite careful about avoiding docs who might sabotage or skew. It’s happened, I hear”.  @MeredithGould asked “Isn’t it your experience that those into self-promotion usually reveal that & are monitored by the community?”, and noted that “I think anyone who participates in an online community ought to disclose his/her agenda — if there is one.”  Previous HCSM discussions indicated that doctors should not participate as doctors (as opposed to participating as patients if they have a specific illness) unless officially invited do to so.  @MeredithGould’s final thought which seemed to summarize much of the discussion: “How’s this for a guideline: Either be a positive contribution to community and commit to learning or shut up and go away!”

Physician involvement online is necessary, and will become increasingly so.  In the absence of any formal guidelines we must all follow our own consciences–both as physicians and as online patients.  Physicians can judiciously engage in social media dialogue, and can participate in online patient communities within the norms those communities establish.  This is a good start, and I do believe that further involvement will break down barriers and establish norms that protect all involved.

So, physicians: get to it!

How Social Media Can Enhance Medical Practice

September 5, 2010

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.

Expanding The Reach

September 5, 2010

If you are watching this site, you know that many of our posts are inspired by the Sunday night #HCSM chats.  And you might be wondering why there have not been any posts this week.  Rest easy: we intend to continue trying to contribute to that discussions with these longer and more detailed posts and we encourage you to add your thoughts and your opinions to the comments.

However, we are looking to expand the blog’s purpose beyond that.  This blog’s contributors have different backgrounds and different interests for a reason: we all have different perspectives to offer.  Taking a cue from last week’s HCSM discussion (about transparency on-line, about burnout, etc) we intend to discuss what we think future roles for social media in health care could involve.  It will take a few posts to develop the discussion, so look for a series

Stay tuned: the first post in that series will be up soon.  And stay engaged.

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