Case Studies: Using #HCSM Tools to Enhance Patient Care

In medicine, much of how students are taught is through case studies.  Typically, the teacher “presents” a patient to the students (including history of current illness, past medical/family/social history, current medications, and relevant physical exam findings.  The students/learners are then expected to ask any clarifying questions that might be necessary, can ask for labs and imaging studies, and then puts together the list of possible diagnoses and possible treatment plans.  The goal is for the learners to actively participate in the process: rather than passively listening to a lecture, the back and forth discussion promotes learning.

In the next few months, I am fortunate enough to be presenting lectures about healthcare communications and social media (hcsm) at various state and national conferences.  In each case, part of the task will be to encourage physicians–who are often skeptical about hcsm–to consider exploring hcsm tools as a way to enhance patient care.  As part of preparing for these presentations, I thought I would brainstorm some ideas as to how hcsm tools can enhance patient care.  The basic question I am looking to address: How can hcsm tools and communication improve patient care, and what added value does hcsm provide to justify including it in an already busy day?

In the spirit of active learning, I present these ideas here as case studies: I have thought of ways that hcsm can be used, but I invite readers to comment, correct, or enhance these ideas.  Ask questions, seek clarification, or dispute the ideas–it is through this active learning that we can develop ideas that will encourage physicians to participate in hcsm.  Case studies and social media (SocMed) participation have similar goals: learning and reflection through social interactions and dialogue.  Adult learning occurs over time and is inherently social–social media and case studies both encourage this process.

I have chosen to present cases demonstrating the value of hcsm from the perspective of an individual physician, a medical practice, a large medical system, and a public health organization respectively.  A few ground rules:

  1. My focus will involve YouTube, Facebook and Twitter.
  2. Also included is a discussion of SMS and secure patient portals because of the need for private communication as part of providing healthcare services.
  3. Some ideas are somewhat simplistic, but I have included them for comprehensive understanding.
  4. There is some crossover: ideas listed under one category probably apply to others.  Unless there is incredible value in doing so, I have chosen not to repeat the same ideas to avoid redundancy.
  5. It is assumed you have at least some familiarity with SocMed.  I will use jargon like “followers”, “tweet”, etc without further clarification.  Please let me know if you require clarification.

Individual physician: example: my accounts, @RichmondDoc and RichmondDoc.blogspot.com.

  • Search for relevant health-related information that can you can forward to patients via who follow you.  This includes local health fairs, free or low-cost clinic information, health care screenings, etc.  This also includes forwarding links from national organizations such as American Diabetes Association, American Heart Association, American Medical Association, American Academy of Family Physicians, and other organizations.
  • Advocate for change/reform that you feel benefits patients by posting thoughts and links to important policy information.
  • Answer patients’ general health-related questions, and provide links to valid/trusted on-line resources that will help patients make decisions (such as linking to www.FamilyDoctor.org).
  • Use SocMed to keep on top of developments in medical care, health policy, and related health topics.
  • Participate in online Twitter discussions such as #hcsm, #MDChat, #hcsmLA to discover better uses for these tools, and to better understand what patients and other stakeholders expect from providers regarding hcsm.
  • Develop a YouTube channel where you can post discussions about relevant topics–either health-specific ideas, policy/politics discussions, etc.
  • Ask for help by surveying your account followers on questions they would like answered, and provide answers to others’ crowd-sourced questions.
  • Keep a blog that allows you to dig more deeply into complicated issues.  This can become a resource for patients seeking more information on certain issues.
  • Reach out to other SocMed users and develop productive and meaningful collaborations.  This very blog exists because of SocMed: the three authors “met” through Twitter and have communicated by e-mail and a few telephone calls, but have not actually met in person.  Similarly, three of the four presentations I am scheduled to give in the next four months will be shared presentations with people I met via Twitter: I have met @NickDawson in person but originally first met him through Twitter; I have only met @Miller7 via Twitter, e-mail and one phone call.  Even so, my involvement in hcsm has enhanced my professional skills and (I hope!) my position in the promotion/tenure process.
  • Each of these SocMed tools can be used for advocacy on behalf of patients, health reform, and health care delivery and payment reform.

Medical practice: example, MacArthur Ob/Gyn and its Facebook and Twitter accounts.

  • Broadcast information to patients who follow your accounts–this could include office hours, new services, vaccine availability, etc.
  • Send generic reminders to patients to take action for their health, such as checking blood sugars, taking medications, etc.  Patients can choose to follow your account and receive notification via SMS, meaning that your reminder could promote real-time action.  For added security, these messages could include encrypted SMS technology.  Small studies have already suggested that text message reminders can promote adherence to treatment plans.
  • Send “broadcast” messages to account followers tagged with certain hashtags, such as #bloodpressure or #diabetes.  Patients who choose to follow your account and who understand the hashtag (who have opted in) can then choose to contact the office for further action.  For example: Tweet “How have your blood sugars been running? #VCUHSDiabetes”  and patients who understand the hashtag may have already agreed to review their blood sugars and contact the office with the necessary information.  This could be a way to enhance disease self-management and to encourage better control of chronic illnesses.
  • Send direct messages via Twitter or Facebook to individual followers asking them to follow-up with the office via private portals or through traditional communication.  These messages do not align to HIPAA standards and would require discretion (and probably an in-house legal counsel review), but simply remind a particular person to contact the office through secure means.  For example, a message sent privately on Facebook or Twitter that simply asks a patient to contact the office could encourage follow-up without revealing any personal health information.
  • Engage in dialogue with patients about office practices and procedures, whether good or bad.  If patients have compliments, then one can respond positively.  If a patient has a concern or negative comment, this could be addressed and the conversation could be taken off-line for resolution.
  • Invite patients to contact the practice with general questions or comments, and use that information to respond either publicly or privately (as indicated) in order to enhance patient-centeredness and patient-connectedness.

Healthcare system: example, Bon Secours Richmond’s Facebook and Twitter accounts, or Mayo Clinic’s YouTube channel and  Facebook and Twitter accounts. 

  • Broadcast information about seminars, services, physicians, etc.
  • Connect with patients re: good and bad experiences with the system and/or its providers.
  • Develop a YouTube channel to highlight important information regarding the organization.  This would be easier for large systems than for individual providers, and can provide a great deal of information for patients in a very user-friendly way.  YouTube and other video services also provide patients with an opportunity to see the information being presented, which is an asset for patients who are more visual learners.
  • Reach out to consulting practices and referring providers to enhance the connections between those practices and your healthcare system.  This could improve referral patterns into one’s system (or a system’s hospital), and improve care for patients.
  • Reach out to public advocacy or local government agencies in order to provide the system’s expertise in addressing issues of health policy or health care.
  • Reach out to patient communities to offer information or speakers to promote the communities’ discussions about certain medical conditions.

Public health authorities: example, the Centers for Disease Control (CDC)’s YouTube channel, and its Facebook and Twitter accounts.

  • Provide information regarding healthy lifestyles and disease awareness and prevention messages.
  • Send out urgent information regarding developing health emergencies, epidemics, etc.  The CDC has a separate account dealing with healthcare emergencies, and this account could be used to push out information to the public in a very timely way.
  • Receive incoming information from the public (or from healthcare workers or lay health promoters) about patterns of illness that are present in a certain community.  The public health authorities can track these messages and look for any patterns that could indicate unusual events.
  • Actively develop a network of lay health workers and healthcare workers to act as surveillance  in the community.  This network could be linked by traditional SocMed tools, but can also use SMS notifications–especially in rural areas or developing nations.  Communication could flow both ways to note unusual patterns of illness or other signs of concern.
  • Linking lay health promoters with central agencies can also promote health outreach and health maintenance activities.  For example, a public health ministry in a developing nation could tweet its affiliated lay health promoters “Today is the day to provide anti-parasitic medications to your community.”  With one message, lay health promoters could receive the Tweet directly from Twitter or via SMS notification, and could then distribute the necessary medications throughout their target communities.
  • Similarly, public health organizations could use SocMed communication to address environmental emergencies such as floods, earthquakes, or tropical storms.  SocMed can be used for lay health workers to notify central authorities about events, and by central authorities to make communities of rescue and recovery plans.

Finally: any of these hcsm connections have to emphasize authenticity, relevance, trust, and bilateral communication and dialogue.  There is some role for broadcasting information, but at its heart hcsm/SocMed involves community.  Any user that is only sending information out without listening to any replies will be less successful than a user who is willing to talk with the target audience.  At the end of they day, all health care services exist to improve patients’ health.  In order to do that, we must listen to the patients’ voices.

Even if you choose to start working on only one or two of these ideas, you should start to see changes in your practice and your interactions with patients.  If you note and monitor these changes, you will be able to quantify them and adapt your hcsm use accordingly.

Please, feel free to comment/correct/debate/expand these ideas in the comments below.

6 Responses to Case Studies: Using #HCSM Tools to Enhance Patient Care

  1. carmen2u says:

    I would add to that list use IRB-approved messages for clinical study promotion where appropriate. Once a critical mass of followers is gathered, you have a ready-made audience that is receptive to such messaging and more inclined to share with their followers.

    There’s also value in using adjunct tools that enhance the functionality of social media tools. For example, if you as a health care provider are hosting a health fair, use http://schmap.it/ to announce your event on Twitter. Schmaps builds in a Google map into your message and essentially allows you to provide more details about your gathering than Twitter’s text limits would allow otherwise. Other tools, like Tvider.com, can allow you upload or record video and audio right from your desktop to Twitter. So if you want to create an on-the-fly medical message that is video and/or of you chatting, you now have an affordable way to do it.

  2. @NateOsit says:

    I believe social media can be a valuable resource for combating the stigma around certain health issues. I’m thinking about mental health in particular. Physician involvement in social media can help overcome some of the negative stereotypes associated with mental illness. This could also be applied to infectious disease, prostate exams, and other public health initiatives.

    • richmonddoc says:

      I think that more open discussion of these issues could be helpful. However, the public nature of the discussion could be an issue for specific people.

      One option could be the idea of secure online webchats (like the #hcsm or other chats, but behind a firewall). In theory, heading forward a practice could also have online virtual group visits where patients sign on to a secure forum and can discuss their issues with peers and providers.

      I wonder if these opportunities already exist?

  3. shahzad says:

    I am a PhD student and my dissertation topic is healthcare social media (HCSM). I am thinking about doing a case study on implementation and utilization of HCSM at Kaiser Permanente. Any insight you can provide regarding this topic is greatly appreciated.

    • richmonddoc says:

      I’m not sure that I have any specific insight into this, though it would be interesting to see how an integrated system would handle this. A closed/integrated health care system would be able to employ these tools in more robust ways.

      Good luck!

  4. richmonddoc says:

    During the MDChat this last week, @EllenRichter commented that “Most of my providers use text messaging for appointment reminders & frequent health tips. That’s a good start!”

    Setting up social media accounts with SMS notifications would allow health tips to be received my multiple patients from a single Tweet/update.

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