It’s Not What You Think You Know, It’s Who You Trust Maximizing Our Collective eHealth Knowledge

May 18, 2011

Internet Skills Performance Tests: Are People Ready for eHealth?. This recently published study by van Deursen, Ph.D and van Kijk, Ph.D points to some fundamental issues in eHealth and the Internet that affect SMHC group think.

During our Sunday 8PM central time #HCSM (Healthcare Social Media) Tweet chats SM (Social Media) is sometimes positioned as a solution to various HC problems, needs, and audiences. Many of us see SM as part of a larger strategy or program. I’m firmly in the camp of the later; SM is part of a larger strategy. I see SM’s biggest benefit as part of an eHealth learning strategy. (Later this month, I will post a view of SM, learning, and consciousness.)This study and the recent data presented by Pew Research points to a goal: improve the ability of all patients to access HC (healthcare) knowledge/information and apply it to their HC needs and goals. We don’t need more data. We need more knowledge translation.

The Deursen and Kijk study is an amazing read with each paragraph holding a nugget of information, a reference, or data that refines a currently held belief, or changes a long held belief. Highlights from the study that I found compelling were:

People frequently search online for health information when prescribed a new medication or course of treatment, dealing with a medical condition, having an unanswered questions post MD visit, or when to change diets/exercise.

Search engines and basic search terms do not seem to provide efficient access to health information. Finding fast and not evaluating is the rule along with exploring only a few links.

The study measured four skill sets: operational, formal, information, and strategic Internet skills

The principle results from this study are:
In the domain of healthcare having sufficient levels of information and strategic skills is important especially when the information is questionable or taken for granted.

They further found that operational, information, and strategic Internet skill do not grow with the years (bad habits are retained). Participation in a course had a minor positive influence on level of information and Internet skills while getting help from peers was a negative influence. (People reinforce bad habits among each other)

The most important skills when using the Internet for health purposes are information and strategic skill sets when making decisions based on retrieved information. The gap between content found and application must be improved.

Pew Research Center just published The Social Life of Health Information, 2011.

The Social Life of Information is another great read with reams of data and information regarding who and why people search the Internet for Health Information. The Summary of Findings section opens with the following quote “’I don’t know, but I can try to find out’ is the default setting for people with health questions”. This fits well with my view on adult learning: adults will only learn when they are seeking a solution to a problem they are having. It supports the Deursen and Kijk study.

Some of the key findings are:
80% of Internet users have looked online for information about any of 15 health topics such as a specific disease or treatment. This translates to 59% of all adults.

18% of Internet users, or 13% of adults, have gone online to find others who might have health concerns similar to theirs.

16% of Internet users, or 12% of adults, have consulted online rankings or reviews of doctors or other providers.

15% of Internet users, or 11% of adults, have consulted online rankings or reviews of hospitals or other medical facilities.

15% of social network site users, or 7% of adults, have gotten any health information on the sites.

“I know, and I want to share my knowledge” is the leading edge of health care. (Consider this in light of the Deursen and Kijk study. Are we reinforcing suboptimal knowledge?)

4% of Internet users, or 3% of adults, have posted their experiences with a particular drug or medical treatment.

4% of Internet users, or 3% of adults, have posted a review online of a doctor.

3% of Internet users, or 2% of adults, have posted a review online of a hospital.

These two studies that tell us: a whole lot of people are using the Internet for eHealth, social media is the currency of the realm, and people do not have the skills necessary to find the right information, qualify it, and apply it.
In my view the Pew data demonstrates the massive reach of the Internet for healthcare patients and its frequency in HC use. The Dutch study shows we may not be maximizing the user online experience (e.g. by not ensuring the quality of data and the application of knowledge). eHealth patients may not know what they don’t know. Those of us familiar with HC, the Internet, and SM should strive to improve patient skills at finding, assessing, and applying HC knowledge.

If healthcare professionals and those interested in HCSM are to improve patient outcomes we should strive to improve the ability of all to find and use knowledge. We need to stop talking to ourselves and begin to understand the needs of the majority of people seeking and applying HC knowledge from the Internet. We need to help improve learners’ skills at finding data and the ability of the user to apply new knowledge to their HC needs.

The Pew data shows respondents trust and respect their physicians. Doctors who are involved in SM and eHealth should strive to bring more of their patients online and participate in SM. This is not a call to practice medicine online. Rather it is a call to have those who know how to use the Internet for HC teach others how to become better patients and caregivers. We need to help people find the best information possible and apply it to their problems.

Hospital systems and/or departments may want to offer courses in online HC searching and how to critically appraise data. For example an OB/GYN department may offer this course and invite to ePatients, former patients, and outpatients for a general tutorial. This activity can be extended after the course to help create a working community of patients with common interests and problems. The department should take the lead as a learning community. Own the channel in teaching patients how to improve their ability to translate and apply knowledge.

Your department or practice can serve as a patient model of eHealth. Don’t think 500 users hits on your Web site. Think 50 newly trained and skilled HC and Internet users/patients who can each teach one or two more. It’s not the size of the community, but the collective knowledge and skill that ultimately improves outcomes. Healthcare is a team sport.

The future for eHealth is not the large aggregate models like WebMD, pharma web sites, or Facebook. The real future that will bend the HC cost curve and improve outcomes are small discreet communities of knowledge and expertise built around a trusted resource and health partner, my physician and his patients.

I trust my physician to care for me. It is only a small step to trust him/her for his/her links, documents, community, etc. If my physician makes me a better patient better at acquiring knowledge it’s as important to me as a fast, accurate, and cheap diagnosis. And what’s better I don’t have to talk to him (conversely he doesn’t have to spend hours teaching, texting, emailing, calling). He just has to help me know where to go, where to learn, what to trust, and how to use it. And he doesn’t have to do it all himself. He simply has to leverage his community. He will see the results in my outcomes.
What are your thoughts?

Measure Twice, Tweet Once

February 1, 2011

I confess I’ve been the lagging indicator on this blog for any number of reasons. My goal was to post a multipart examination of how to measure outcomes in Social Media (SM). In my genius moment, I wanted to interview a number of experts in outcomes measurement, market research, and users who would share their knowledge and expertise. Two trusted colleagues took the time to respond to my questions and thoughts on outcomes and SM. This is a starting point for this discussion.

I do not view SM in and of itself as a major driver of change in healthcare (HC). It is a tactic, a tool, and one element of any number of strategies (e.g. marketing, sales, awareness, listening, etc.). In my estimation, SM is a powerful tactic within a learning strategy. Measuring outcomes in SM will aid in understanding what works, what doesn’t, and why. With that knowledge we will be able to create strategies that include targeted SM in HC to drive change through learning and application of knowledge. And further analysis of hard clinical outcomes can follow.

The best definition I could find on outcomes is from a statistical glossary:
“An outcome is the result of an experiment or other situation involving uncertainty.

We are uncertain what works in HCSM, the degree to which outcomes are a function of other variables, and why.

The two colleagues I asked to help me with outcomes are:

Derek Dietze is the founder and owner of Improve CME ( During the past 10 years Derek has focused on measuring outcomes in CME and finding unique ways to measure learning.

Scott Fishman is a well-regarded market researcher and principal of Ethos Lifescience Advisors (, which supports market development in the life sciences, and provides guidance on the clinical and commercial value of new technologies.

Derek and Scott each looked at the topic in a slightly different fashion but overlapped in some critical areas. I will share their comments and thoughts before my own.

Derek offered the following regarding HCSM:

“For many years, we in the CME community have agonized about how to measure the effects of learning interventions on performance change in healthcare professionals and patient outcomes in practical, objective ways within reasonable budget limitations.

While methods and means to do this have come some distance, I’ve discovered that you really have to walk before you run with respect to measurement, both in an individual organizational sense, and in a community of practice sense. I’ve found it most productive to build on a strong foundation of simple measurement, easily understood by the consumers of the results, than advance to higher forms of measurement based on experiential learning. So initially, we focused on measuring changes in knowledge, confidence, and intention to change behavior (called “competence” by many in the CME community). These are still our staple forms of measurement, but now we have advanced to self-reported performance change and self-reported observations of patient outcomes based on CME activity participation. We are also piloting studies using national scope medical claims data to objectively measure performance change for national scope CME initiatives.

While ultimately the goal might be to measure how the use of SM results in better patient and community health, I would recommend starting at lower measurement levels, such as changes in knowledge, attitudes, confidence, and intention to change behavior among those interacting through SM. An article by Moore et al 2009 provides a good frame of reference for measuring changes in physicians and other healthcare professionals, and the Transtheoretical Model may prove to be of some help with respect to changes in patients.

Initially, I thought of SM as an “intervention” (like an educational intervention or activity in CME) when it’s focus is bringing about increases in knowledge, reshaped attitudes, and intention to change behavior. While I suppose it could be considered an intervention or “treatment” for the purposes of measurement, I realize it has many other functions that might be measured. SM seems to be a facilitator, and also has empathic and emotive characteristics, given its relative immediacy and potential frequency of use.”
A reasonable starting point for measuring the outcomes of social media (SM) in health care would be to clearly define:
• The different characteristics/uses of SM in healthcare
• What reasonably might be expected to change through its use in each of those circumstances
• In whom those changes are expected to occur, and
• What’s important about outcomes for the people/organizations invested in the results.

Scott Fishman responded to HCSM and some specific questions with this response:

I asked Scott:
Should our outcomes be qualitative or quantitative? Would you use combinations? Would we want to measure just clinical outcomes? His answer:

“Definitively both. Clinical outcomes measures are obvious and you’ll find them in any clinical paper or meta-analysis of a given condition. But there will also be references to “softer” metrics such as QOL scales, and I would suggest incorporating such measures. Of course, you will have to deal with the issue of generally accepted (e.g. “faces” pain scale) vs. novel metrics. The latter are also useful, but will need to be correlated with improvement in quantitative clinical and accepted QOL measures, which is another whole task in itself, and has the potential for either an “aha” moment or to entirely
undercut your hypotheses.”

Scott also addressed the health care provider (HCP). What would we measure there to determine outcomes in SM?

“Fewer phone calls from unsatisfied or frustrated patients. Shorter visits. Fewer changes in medication or dosages, less agita, fewer slaps from, and more incentives provided by insurers. Then, of course, there are all the “I’m a good doctor I have healthy patients” social acceptability measures.”

I asked him to address the question of what measures are most appropriate for patients?

Happiness. Does the patient feel better holistically? Do we see improvements on ADL scales? Of course we can measure condition-dependent clinical improvement (e.g. Hemoglobin A1c, BP, memory performance, and health). Are patients satisfied with their health care provider? Change in the number of days of lost work. Hospital admissions.
I might also include the quality and content of communications between HCP and patient as a potentially valuable measure for the effect of SM on outcomes.”

Both Scott and Derek have started the discussion that I would like to continue with you.

In healthcare SM’s most powerful application is as part of a learning strategy. HC is driven by knowledge and application of knowledge to improve an outcome. Knowledge is the locus for medicine. The physician is an intermediary in knowledge and treatment. Add to that these evidence-based conclusions about learning:

• Adults want to learn solutions to problems they already have (and, conversely, they seldom learn solutions to problems they do not have),
• Adults want to participate in their own learning, and
• Instruction for adults must respect the multiple demands in their lives.

Derek added the following comment:
“Mark, these measure a patient’s PERCEPTION of their own knowledge level and how it might have changed, which I admit may be valuable. However, when measuring physicians, I don’t trust them to self-evaluation whether they are knowledgeable. Instead I ask knowledge questions to test their knowledge. Anyone of use may be confidently misinformed or have incorrect perceptions regarding our illness/disease. A really simple way to validate correct knowledge (without making the patient feel like they are being tested), is to use “clinical assertion” agreement scale questions. Make a correct statement about a disease or condition, then ask for their level of agreement with the statement using a Likert scale or semantic differential.”

If we accept the fact HCSM is first and foremost a learning tool I believe Derek has presented a way to begin to understand HCSM strength and its potential. We can observe what happens to those patients engaged in SM with a HCP or others. Has the patient (caregiver)/learner: improved/increased knowledge, gained confidence, and intention to change behavior.
Patients get ill, get a diagnosis, and want to avoid an illness*. All of these are triggers to begin a process of learning. They come into the moment with a specific set of information. Patients will surf, call, read, tweet, FB and more. At some point they either stop adding to their personal compendium of knowledge because they have changed or are satisfied they have the knowledge they need. They have closed a personal knowledge gap. If we can measure changes in that gap comparing those who use social media against those who don’t in HC we can begin to understand SM as a learning tool and its value. We can compare it to non SM learning.

Areas of inquiry we may ask patients, caregiver, and HCP using SM in HC are:
• What is their current level of knowledge regarding the illness/dx/treatment you are seeking information on?
• Has their knowledge or understanding changed?
• Which formal and informal information of the following sources provided the greatest knowledge to them? (e.g. web sites, physicians, friends, others with similar conditions, networks on FB, tweeting, chat rooms)
• Based on what they have learned, how are they changing their behavior and/or approach to your care and management? What actually happens when we measure longitudinally from intent to behavior?

This is not an exhaustive analysis of HCSM and outcomes. It is a starting point to an open source discussion. What are your thoughts on how to measure outcomes in SM? Can we determine its relative value within HC? Are strict clinical outcomes the only measure we should make? This is one hypothesis on SMHC and outcomes. How can we dive into this area and improve it?

*I am fascinated by the idea that those patients who are heavy users of HCSM represent a small subset of all patients and are patients who are pre-disposed to learning etc.

Social Media in Healthcare is More Effective When It Drives Knowledge Not Marketing

December 1, 2010

Topic 1 for the Sunday nights #HCSM Chat: There’s been a lot of talk about physicians and patients in HCSM lately – but what about HC organizations?

Let’s define social media:

Wiki: ”Social media are media for social interaction, using highly accessible and scalable publishing techniques. Social media uses web-based technologies to turn communication into interactive dialogues.” This is what happen Sunday night during our #HCSM chats, in our Tweeter feeds and posts.

Wiki also identified:
Social Media Marketing “Social media marketing is a recent addition to organizations’ integrated marketing communications plans. Integrated marketing communications is a principle organizations follow to connect with their targeted markets. Integrated marketing communications coordinates the elements of the promotional mix; advertising, personal selling, public relations, publicity, direct marketing, and sales promotion.” This is using SM as part of business plan. It is the intersection of SM and marketing,

Many of the comments Sunday night captured the essence of these definitions.

nickdawson @bjoconnell agree. “Some still haven’t left the 1-way push and use the “we” voice non-stop.”

@RichmondDoc T1: “The only orgs I follow are those that provide me w/useful and consistently valuable info; I follow relatively few for that reason.”

@HealthSocMed “I’m not sure I *do* want to engage with the organization. I want to engage with people, maybe orgs should B blind?”

@jacquehealth: “Agree with @quality1 – Use SM to increase awareness, understanding, and health behaviors, not mktg.”

Brands and corporations realized that various SM platforms are valuable listening tools to identify trends, find loyal customers, drive brand messages into conversations, etc. And that is what SM became to these organizations, part of their marketing mix. Social media for brands is a way to use people/patients as extensions of marketing plans.

How active are HC organizations in SM? Ed Bennet continues to compile a frequently updated list of Hospital Social Networks. As of October 19, 2010 there are 2,259 Hospital Social Networking Sites. His page has it broken down by various media (e.g. YouTube, FB, Twitter, LinkedIn, and Blogs) and by state. This is a great resource worth monitoring.

Frequently SM in HC organizations takes on a single goal and strategy: business development. A HC organization might look at a SM strategy based on a narrowly focused set of objectives: increase awareness, improve image, change census, increase use of a new piece of equipment, etc. This is not 100% of the time, Mayo Clinic uses SM to drive knowledge and improve patient-care as do other HC organizations.

Consider the following segments of a marketing plan: Broadcast (print, radio, outdoor), Digital Marketing (banners, Web sites, e-mail, search, etc.) and Social Media (networks, communities, blogs, microblogs). Each segment serves a specific set of strategies within a marketing plan. These are not fixed. They are flexible but their power to achieve objectives is maximized when they are applied appropriately. Broadcast is passive and used to promote messages. It can be used to engage readers but engagement is less effective. SM offers higher engagement between participants but has a low broadcast potential.

I believe HC organizations may be short sighted when they use SM to drive a message that can be best achieved via Broadcast and to fail to use SM to achieve what it can do best, actively engage participants in knowledge seeking behaviors.

SM is all about dialogue, interactivity, spontaneity, people and technology. It offers HC organizations the chance to not only listen and market, but to position itself at the center of HC knowledge and information for a unique network, their patients’ current and future knowledge and behavior. I have advocated that we need to help patients and people who are seeking solutions to HC problems move beyond WebMD etc. as single sources of knowledge and have them learn instead from their MD, their hospital, specialty societies, and networks of friends who share similar HC concerns. Make no mistake that patients are reaching out for answers using all of these resources. HC organizations should step in and become the final resource for them. A place to focus what they want to solve and what they have solved. Who do patients trust more than their own physician and the hospital they are affiliated with? If they don’t, then HC organizations need to position themselves that way in the mind of the patient and caregiver community.

For example, there is no reason why an oncology department in a regional hospital cannot create a network for breast cancer patients. This network uses resources in and outside the hospital to improve and share knowledge. Bi-monthly the department can hold tweet chats to discuss issues in breast cancer. Results and reviews of the topics can be posted with references. This site becomes a resource for patients and the hospital. It is less about marketing and more about knowledge. It is a resource for patients seeking solutions to problems in HC. HC organizations are not pushing a message they are the message. The medium becomes the message.

HC organizations should consider SM as a tool to educate and improve patient care, not an extension of the marketing department. Ultimately patients will trust and respect where they find knowledge, understanding, and people they share common problems with. Success, if measured in marketing terms will follow.

In Pinball a TILT Stops the Game. In HCSM a TILT Expands the Value.

November 18, 2010

TILT is a Web Site that addresses a key aspect of learning: Reflection in Practice.

TILT is a place for a HCP to record their clinical learning experiences within a community. A member records a summary of what they learned with references. That entry becomes a personal learning log shared within a community. Users maintain a record of what they have learned, input received from colleagues, highlights of a learning need (problem), and solutions. TILT is social and it has an affective. It’s an ideal tool to reflect on learning in order to apply it in practice. Experiences that are reflected upon become action.

Donald Schon introduced Reflection in Practice. It is based on the fact that in education and medicine practitioners are engaged in life-long learning. At the center of life-long learning in medicine is experience. Experiences are continuous touch points in learning for HCP. When HCPs have a clinical experience (problem) they use that experience to learn through reflection.

Reflection in Practice is a way for learners to reshape what they have learned while applying it in practice. The learner reflects on what is happening as s/he tries out the skills (called reflection-in-action) and after s/he is finished (called reflection-on-action) (Schön, 1989). In both cases, the goals are insights that facilitate both continued learning and application after learning is over.

Reflection in Practice is associated with improved quality of care, personal and professional growth, and closing the gap between theory and practice.

What struck me about this site beyond its importance for clinician learning and their practice is its application for patients.
Think about our #HCSM chats on Sunday night. After those chats you go to a site to log what you’ve learned. Others comment. Now imagine that taking place over time. It becomes a log of your HCSM learning specific to topics/problems you are interested in. You and others in your community are sharing experiences and putting those experiences into action. For me I get input on solving the problem of identifying a methodology to measure SM outcomes in clinical practice. And I put it into a grant and a study. Experience, reflection, and action.

Now imagine a site similar to TILT where patients can maintain a log of their disease specific learning experiences that is part of a larger learning community. It offers great benefits.

This type of site gives SM an added dimension. Patients can track learning based on experiences within their healthcare world or track problems they are seeking to solve. They can monitor changes in their knowledge based on their experience over time and apply what they’ve learned to their HC. It is also a place patients can receive input from others who have similar experiences. They can search for knowledge from others who have solved similar problems.

It is a community of practice for patients built around an ever-evolving set of experiences and reflection. It is not a static source of knowledge but a dynamic place for reflection on experiences that becomes knowledge put it into action. In my estimation this is a next step in SMHC. This can become a place to monitor and manage a personal continuum of knowledge in healthcare within a community of learning.


The Health Care Revolution Will Be Tweeted

October 13, 2010

When asked about the large bronze camel on his desk LW Frohlich owner of a design/advertising agency during the 1950’s and 60’s (one of the first in the world to do advertising for the pharmaceutical industry) would say, “It’s a horse designed by committee.” A sentiment apparently shared by Gladwell on the impact social networking sites like Twitter yield on society, expressed in his latest New Yorker article:

On October 3rd 2010, participants in the Health Care Social Media (#HCSM) chat on Twitter were challenged to take up Gladwell’s opinion:
“ Malcolm Gladwell said FB/Twitter can’t change the world ( or solve ‘human problems’ of motivation. So, can Twitter and Facebook really impact healthcare (and motivation)? (Gladwell theorizes no).”

It appears the #HCSM participants felt differently:
• MeredithGould Consider this: Gladwell might be wrong.

• sixuntilme @HealthSocMed The diabetes community is VERY motivated through FB and Twitter connections. Patient communities = better outcomes, IMO

• @MHoskins2179: Communicating w/my D-tweeps keeps me accountable, sane, healthier. I am in better health becuz of Fcbk/Twitter/blogging.

• RichmondDoc I think the extent to which SM will influence motivation & behavior will depend on the extent to which we make meaningful connections

• @kstansberry: T3: FB and Twitter won’t cure disease, but can be great tools for collab. & attitude change. Many small changes lead to better health

• @hgazay: #hcsm T3 obviously! In cases such as orphan disesases FB might be the only way to connect with similar patients and share

• doctoranonymous #hcsm T3 Advocating change is done in the digital world. Performing change is done in the analog world

Gladwell sums up his thoughts nicely when he says, “Are people who log on to their Facebook page really the best hope for us all?” For those of us in the medical field, is social media (SM) the best hope for health care (HC)? Will participants in HC and SM drive changes to patient outcomes? Will SM change HC behavior?

To answer these questions, let’s begin with Gladwell’s premises, boiled down to the key points below:
• SM will not change the world because activism that can motivate population changes will not occur through SM. True activism is based on a different type of network and participants.
• The key to successful activism are strong ties to others who are active and reside within a hierarchy.
• SM is driven by weak links. Weak links are the source for new ideas and information. But weak links do not create strong ties that drive activism and change.
• Living , breathing networks have a hierarchy. SM by design has a very weak hierarchy and is, in most cases, leaderless.
• SM succeeds best when you don’t ask much of the network participants. To drive change participants must be highly active and reside in a hierarchy.

Can SM change the world? In my mind, “no,” especially when Gladwell uses the definition of activism as that of the 60’s Greensboro, NC version as the standard. A Tweet-up will not drive racial equality. A Tweet-up can bring those who are true activists together but, as Gladwell asserts, Tweeters are not the highly motivated “Red Brigade activists.”

Recent data indicates a small percent of participants in SM/networks are creators (see Josh Bernoff’s article on Social Technographics ). The vast majority of participants in SM watch, listen and learn (spectators). Since there is not centralized leadership or hierarchy motivating and driving the majority into taking action, change is difficult. Joiners must be highly motivated so change can occur or to even move up the ladder to creators. Mr. Gladwell, you do not have to be a creator to be motivated, active, learn and change.

Science tells us that there are self-reported differences in empowerment between “lurkers” and “posters” in online patient support groups, according to a recent study conducted by researchers in the Netherlands (read the full study at “Lurkers” (those who do not actively participate by sending postings) scored significantly lower than “posters” (those who actively contribute by sending postings on patient support group web sites) with regard to “the empowering process,” “the exchange of information,” and “finding recognition.” The outcomes between lurkers and posters did not differ in regard to, “feeling more confident in the relationship with their physician,” “improved acceptance of the disease,” “feeling more confident about the treatment,” “ enhanced self-esteem,” etc. (p<.0011). The conclusion of this study established that lurkers benefit from support groups and networks. This is important because it supports the idea that communities or network participants can rise equally in knowledge and understanding, no matter their level of participation. So, weak connections count online.

The chart below is from a 2008 report written by Noah Elkin from iCrossing based on research by Opinion Research Corporation. This presents a pretty compelling argument about the importance of SM for patients seeking to access health data. We see patient online behavior before a physician visit and afterward. The patient gleans information, researches more and participates online. Hence, learning is occurring. It is interesting to note that “health care provider” is not surveyed in the chart. If there was a physician resource that patients could access, I wonder what this data would look like?

Some additional facts about healthcare and the web, taken from Kantar Media (
• 89% of the 178 million Americans who have gone online in the past month have performed health research.
• Reasons for going online: 71% seek knowledge about a condition, 59% are researching a symptom for themselves or someone else
• 56% of respondents said a health care provider makes a health web site trustworthy. 46% look for inclusion of academic articles or scientific research to indicate trustworthiness.
• 79% feel the web offers a wealth of resources in HC and 74% are cautious about which web sites they access for HC
• 77% of recently diagnosed patients turn to online sources for information, while 81% turn to a HCPs, and 51% rely on traditional print media

I agree with Gladwell and believe SM is primarily made up of weak links that are not especially capable of achieving activism that changes society. Still, SM remains a place to learn and listen. Because it is a weak link, it exchanges new knowledge and information quickly and efficiently. (See the post titled “SM in HC is More Than a Cute Name” to learn more about weak links and strong links in networks.) Members of networks absorb vast amounts of knowledge and information. This is one reason SM and HC works as well as peanut butter & jelly. I see patients involved seeking to solve health care problems as varied as they are.

Health care motivates us differently. Health care in many instances is about survival. Health care is complex and fraught with problems not easily solved. People with illnesses are more motivated than people without illness. Someone fighting cancer is as motivated for themselves or their family member as anyone in the Red Brigade. Health care activism is about one’s own self. The shortsightedness of Gladwell’s statement is that when it comes to social media and health care, the transformation concerns one person—yourself—not a landscape or a society.

As an advocate of SM, I know the power of patients who help each other, who tweet, blog, chat and challenge their health care providers with new ideas and questions. But this is not the activism Gladwell speaks about. It is one patient at a time multiplied by thousands every day. HC now is about individuals advocating for themselves and each other. It is a movement of one created by a vast network of information, knowledge and experience.

Let’s return to Gladwell’s quote: “Are people who log on to their FB page really the best hope for us all?” I see his words differently; people who log onto FB have the best hope for themselves in learning to solve their HC problems. They are doing it. What we are not seeing are the outcomes. It is easy to see outcomes or movement when 10 people sit in at a Woolworths. We can’t see outcomes if one patient lowers his blood pressure and that change over time when measured against someone not active in SM. Was it the diagnosis, the diet learned online, the friends on the network nagging the patient to exercise or the physician? Outcomes take time and need to be designed. As a group, we should be recommending and pushing for outcomes to measure the effect of SM on HC.

In the end, Gladwell is right that SM will not save the world. But SM, networks and other technologies, when used within a smart HC strategy, can improve patient outcomes. Patients want to change and get better and live and learn—the research data demonstrates that. The weaknesses Gladwell identifies are real but can be overcome to improve HC if we leverage the elements in health care, social media, and our primary care providers (PCP). SM networks for HC should be smaller and more functional to increase patient participation. SM networks for HC need to have some type of hierarchy in order to keep growing at a steady pace. SM networks for HC should welcome “long ties” for new information, as in offering a space for new information to be shared from external sources, while also supporting “short ties” among influencers, as in providing greater means and opportunities for key stakeholders to offer their insights and wisdom.

How can we achieve this? The revolution in HC can, in part, happen with SM if we identify strategies that focus on smaller units of measure. Functional networks should be built around a physician’s practice base. The physician becomes the natural leader of the online network. (Physicians should not practice here, but they should participate.) It becomes a “Red Brigade” cell. Members are highly motivated and active in their HC because they share a common need to solve their HC problems. They are motivated by each other, guided by their PCP. At its core, it involves one patient and one practice applying SM to drive change. It shares knowledge and experience from the Web. It is not WebMD but MyMD, the home of my HC network. That is the best hope we have to change HC.

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?

Why is social media so powerful?

August 20, 2010

The success of H1N1 vaccinations and prevention was driven in large part by the huge broadcast media component. It was the lead story for weeks if not months and, true to the media, it was sensationalized to the nth degree. There were many critics of the government’s SM component. But there existed a strong non-government SM component. People, parents, families, everyone was interested in not contracting H1N1. We were all washing hands, taking children out of school, avoiding riding subways, and going online chatting. I would say there was an AFFECT from all media sources both traditional, digital, and social that drove learning and outcomes.

Broadcast drove the social aspect, which in turn drove the affect, and resulted in outcomes.

The question for me comes down to this, how can H1N1 success and the agencies become a model for collaboration and improved outcomes on a smaller scale without the media driving the message? How can we leverage the problems patients, consumers, HC professionals want to solve and multiply the affect? What do we need to learn about digital learning in order to improve HC outcomes?

The topic was “What should collaboration (in social media) between public health agencies and the broader public health community look like?”

I saw the topic differently “What should collaboration (in SM) do and why?’

Many comments and opinions focused on the word collaboration and the need for public health agencies to foster dialogue with the public. Many opinions stated that collaboration does not exist.

@CarissaO: In a word, dialogue. Public health agencies need to improve their listening skills, translate listening into action.

@AndyKetch: Broadcast of info and request for feedback to improve how info is broadcast and turned into action. It’s collaborative/action!

@RichmondDoc: T3: a good model would be if govt/agencies provide info they have, but also are willing to accept reports from public

@Miller7: Dissemination! Public health can learn a lot about how to use social medical for spreading info.

Let’s look at social media. To paraphrase Janice Joplin, ‘collaboration is just another word for affect’. SM is social. It expects an exchange of knowledge, opinions, understanding, experience, and reflection in order for it to succeed. This social aspect is a powerful motivator for learning because it creates bigger affect. A library, digital or otherwise, of information where the user is left to find what they need and make their own judgments about what is valuable what is not, what to use and what not to use is an important tool. But motivation and drive comes from the need to find solutions to problems and the affect I believe is less then it is in a social situation. Affect increases memorability.

Do not mistake the above for my belief that reading and engaging in learning is without affect, cannot drive change, or improve knowledge (outcomes). It happens; we all know the emotional power when we are engaged in that OMG moment in learning. What happens in a social environment is a powerful multiplier of that affect. There is a greater and many times more positive affect. Learning is not just the reader reflecting but also the individual drawing on another’s experience to create an additive affect, which upon reflection changes knowledge. Reflect on the #hcsm chats and your experience and what you’ve learned. Did you leave pumped? Are you reflecting on what you heard today? How did you incorporate it into your work or life?

There were many comments regarding where public health agencies can improve their function in SM:

@pfanderson: I am HUGE fan of public health agencies/advocates in social media, but find they R largely undiscovered resources by target audience

@CarissaO: Health agencies/orgs need to invest in better understanding the behavior and needs of their audience

CarissaO made a very important observation. The question I have is do we define understanding in regards to the health behavior and needs of learners or do we examine the learning behavior and educational needs (i.e. problems) of learners? Which one will have a great effect on improving outcomes in HC?

It is well documented, health agencies/orgs know what behaviors need to be changed, less sugar and salt. Exercise more, stop smoking, lower your cholesterol, etc. are all well known and understood. What I think we don’t know enough about is how learners access and incorporate knowledge in this digital world. We know how adults learn. What we may have to do is study how adults learn on the web and what they do with their knowledge and how they incorporate that knowledge into behaviors, and finally what are the outcomes of that. Is it different in a social setting vs. search and read.

Finally, let me present an idea on how we may create a better tool for quality HC search, improve the ability of agencies to leverage SM and improve affect in learning.

We are all familiar with Pandora Music? They have an algorithm to help you find the music you like associated with something you currently like. Say you put in Prince Royce, they will find other musicians who share the Bachata roots, etc.

Why can’t we create algorithms for diseases or illnesses like Pandora’s radio stations? The algorithm would be written around diabetes. As with Pandora, each song (content) gets reviewed by some parameters and is meta-tagged. This algorithm would do the same on the content, assessing where is it from, author, references, child or adult, etc. And like Pandora, it would serve up information (chats, articles, groups, papers, etc.) according to your profile, education, needs, and problem you are looking to solve. And like Pandora the content is in a library, not a Google search, which rates by top hits of others who may or may not be good at selecting information. This library of content is based on a HC associated algorithm and your profile. Will this solve the problem of reliable information, improving SM and learning affect?

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