Social Media and Healthcare

At 38 years old and in generally good health, Katherine Leon was an unlikely candidate for a heart attack.

Yet, on April 30, 2003, just six weeks after giving birth to her second child, she experienced classic heart attack symptoms and was rushed to the hospital by ambulance. After a number of tests, doctors told her there was nothing wrong with her and sent her home.

"I cried to my husband when leaving the [emergency department]. I knew it was my heart. You just know when it's not right," Leon said.

Experiencing similar physical symptoms, Leon returned to the hospital just three days later. But this time, doctors conducted an angiogram that revealed a serious block that required immediate double bypass surgery. 

What Leon had was a rare condition called spontaneous coronary artery dissection, or SCAD. Potentially fatal, SCAD involves a suddenly developed split or separation between the layers of the wall of an artery that provides blood flow to the heart. The condition seems to predominantly affect young women, with about one-third experiencing their first episode either during or soon following pregnancy. According to the literature, SCAD could account for one out of 10 episodes of acute coronary syndrome in women younger than 50.

Yet, the condition is poorly understood; the exact number of those who suffer from SCAD is also unknown, though researchers now believe -- thanks in large part to Leon's efforts -- it affects many more than previously thought.

At the time of her diagnosis, Leon was told that getting SCAD was a "fluke." Still, she had expected to receive information about her condition and how to prevent another event. Her doctor told her that there is no research and offered very little in the way of advice.

"It really set me off," she said. Despite her doctor's insistence that she'd never again meet another person with SCAD because it was so rare, she believed otherwise. "All I could think about is I wasn't the only person in the world with this," she said.

Leon took to the Internet to find others with the condition. It took her until 2007 to find another SCAD patient, which she did by joining an online community for women with heart disease through the National Coalition of Heart Disease's WomenHeart.org website. Today, the community is the InspireWomenHeart Support Community.

Determined to push for research on SCAD, Leon began collecting clinical details shared online by participants on the message board and logging them in a Word file that included the age, general health history, artery affected, treatment, locale and concerns of each participant.

The board became more focused and active in 2009 after a fellow SCAD patient, Laura Haywood-Cory, encouraged a SCAD-specific  message board separate from that of general heart disease with a post requesting: "All the SCAD Ladies Put Your Hands Up", a play on Beyonce's "All the Single Ladies." The women in the group began calling themselves the "SCAD Ladies."

Soon after, Leon and Haywood-Cory met in person at the Women-Heart Science and Leadership Symposium at the Mayo Clinic, a workshop on women and heart disease led by Mayo Clinic cardiologist Sharonne Hayes.

Leon attended the symposium with the goal of persuading Hayes to investigate SCAD. Her efforts paid off; Hayes agreed to take on the research, impressed by the information Leon had collected on 70 SCAD patients -- more than most experts, including Hayes, knew existed -- and a well thought-out research agenda. The end result was a pilot study published in the September 2011 issue of Mayo Clinic Proceedings. The study, which had room for 12 patients, had 18 volunteers within a week of approval.

"This is truly patient-initiated research. It's not what I [as a researcher] want to study but what patients want to know about. Perhaps because I've spent the past 20 years doing patient advocacy work and active clinical practice, this resonated with me," Hayes said.

This pilot study has led to other SCAD-related research. "Once we finished [the pilot] but before it was published, we tried to scale up and get an IRB (Institutional Review Board) approval for a study with 200 patients," Hayes said.

In addition, the Mayo Clinic has created a database of SCAD patients aimed at identifying patterns that could guide future research. According to Hayes, she and her colleagues have been contacted by more than 300 individuals and have confirmed nearly 100 SCAD cases. They've also created a bio bank of DNA samples from people with SCAD and their families in an effort to uncover genetic factors contributing to the condition.

"We've had an amazing response. I no longer use the term rare, I use uncommon and under-diagnosed," Hayes said referring to SCAD.

Changing Clinical Research: Good and Bad

Health-related social media sites like Inspire, PatientsLikeMe.com and Curetogether.com have become trusted spaces where patients connect with, support and learn from one another about treatments and managing illness. And, increasingly, researchers have flocked to these and other social media sites as a way of expediting recruitment efforts for their research trials, in some cases with great success.

"If you look at the statistics, research in rare disease is so slowed and delayed by recruitment. How do you find people with rare diseases? It turns out that online communities are really good for that because geography disappears and people want to connect with each other," Inspire CEO Brian Loew said.

While eliminating geographical barriers is helping to create connections that prior to the advent of online social networks would have been impossible, it's also shed light on potential challenges that the research community must address going forward, particularly as it relates to blinded and randomized scientific studies, the industry gold-standard.

"We get excited when patients are engaged but when they are chatting online about the study, the research community needs to understand and adapt for that. It's a new space," Craig Lipset -- head of clinical innovation and worldwide research and development at Pfizer -- said.

According to Lipset, patients may coach each other online about eligibility for a study and how to qualify. In some cases, patients share information that exposes one treatment group or another, such as a rash that could suggest they're all in the same treatment arm.

These dynamics are not yet disruptive to studies today, Lipset said. But their effect likely will grow in significance. "Now is the time to understand it before it becomes a big issue," he said.

And when it comes to patients initiating research as in the case of the SCAD studies, Hayes suggests caution before rushing in.

"I think it's one thing for [patients] to approach the Mayo Clinic or [the University of California-Los Angeles] or Johns Hopkins -- institutions that will hopefully protect them. But some people with rare conditions are desperate. Desperate individuals could be exploited in a way that wouldn't be helpful to them or the disease," she said.

Still, there's no denying that Leon has managed to put a life-threatening condition that no one was paying attention to on the map. And her ability to persuade a leading research institution to study SCAD will likely be the difference between life and death for someone in the future.

"Our early findings already have generated new hypotheses that will be the source of future scientific inquiry for this condition," Hayes said.

The success of the SCAD Ladies points to real opportunity going forward, Loew said.

Hayes agrees. "It is evident that social networking tools can catalyze community action and that the energy and commitment of affected patients can overcome inertia and ignite excitement and commitment to new research."

Health reform will involve a blend of old and new as researchers suggest social media can improve clinical care for elderly patients.

Researchers from the University of Luxembourg believe the use of social media and online communities by older people can offer valuable additional support in cases of sickness and diseases.

In a new publication, investigators conclude that possibilities for a systematic application in clinical practice seem promising.

The findings come with Web-related caveats related to monitoring, policing and updating personal health information.

The emergence of mobile-health and user-friendly devices ranging from tablets to other web-enabled devices, interrelated with social media — such as online social networks, discussion boards, and online forums — provide older adults with a wealth of resources.

In the study, psychologist Dr. Anja Leist and colleagues reviewed existing studies to document the wide range of options available to older adults.

They discovered a welter of intervention possibilities, such as designing websites to provide information on hip fracture prevention where older adults can also discuss their experiences.

With the successful use of a computer or web-enabled device, older adults report enhanced feelings of control and self-efficacy, but social media provides even more benefits for older adults.

“For me, it was interesting to learn that there is evidence for a large potential of social media in clinical practice. Older adults can use social media to access health-related information and engage in patient-to-patient or patient-doctor conversations,” Leist said.

“There are many online forums where people in difficult life situations, such as informal caregivers of a spouse with dementia or individuals with depression, can exchange thoughts as well as receive and provide social support. Other positive consequences are that lonely older adults can overcome loneliness through contact to family and friends and other users with similar interests.”

But social media has its drawbacks, such as access to harmful or incorrect information and misuse of personal data. Besides the potential for clinical practice and other positive consequences in everyday use of social media, the researchers also addressed these possible negative consequences of social media use.

Other negative effects include unfavorable social comparisons due to overly positive self-representations of others displayed in online social networks.

In the study, researchers discuss posthumous management of online web content, i.e. ,when the user has passed away. Another crucial unresolved issue is data handling when a user develops an illness such as dementia which leads to compromised decision-making ability.

Unless the user has agreed beforehand to transfer decision-making, inappropriate behavior or displayed web content could pose a danger to others, but also harm the dignity of the user.

Source: University of Luxembourg

Hospitals may have been slow to use social media platforms but many are finally taking advantage of all they have to offer and seeking input from patients on how they can improve care and services, reported the Wall Street Journal.

The article cites examples of hospitals across the country turning to Facebook, Twitter, YouTube and Pinterest to recruit patients and their families to serve as advisors, asking for their opinions via questionnaires and surveys on planned improvements in care, new services and even facility names.

Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., for example, has set up a "virtual advisory council" on a private social network, so it can ask parents to voice opinions and advice regarding appointment scheduling, doctors' bedside manners and other hospital concerns, according to WSJ.

Similarly, the University of Michigan Health System, which encompasses three hospitals, 40 outpatient locations and more than 120 clinics throughout Michigan and northern Ohio, relies on "e-advisors" to answer approximately 35 online surveys a year, and a teen council communicates by responding to questions via its own Facebook page.

Concord (N.H.) Hospital, which includes 295 licensed beds and 238 staffed beds, is using social media to develop meaningful, two-way conversations and, in turn, build brand awareness and customer loyalty, according to the Concord Monitor. And Dartmouth-Hitchcock Medical Center, an academic medical center also located in New Hampshire, has hired a full-time social media coordinator to reach out to patients and their families.

These endeavors, while helpful on a local level, are part of a larger movement from the federal Medicare program to use patient satisfaction surveys, including questions on the hospital's responsiveness to concerns, to determine hospital payments.

According to a guide recently released by the Agency for Healthcare Research and Quality (AHRQ), patient engagement, including the incorporation of the patient's perspective into the planning, delivery and evaluation of healthcare services, is essential to eliminate communication gaps. Furthermore, AHRQ instructs hospitals to form patient-family advisory councils. The idea behind this recommendation is that getting to know patients facilitates focusing on the aspects of the hospital experience that mean the most to the patients.

Instead of having to recruit patients and family members to advise on services and facilities at the institutions, through social media, hospitals can obtain input from patients and families more efficiently. "The avenues through which patient voices can be captured and heard are expanding in rapid and creative ways," said Jason Wolf, president of the Beryl Institute, a membership organization providing grants and resources to help hospitals improve patient satisfaction, to the WSJ.

But Roddy Young, Dartmouth-Hitchcock's vice president for communications and marketing, said not all social media interactions are positive, reported Concord Monitor. Patients sometimes change their opinions from one day to the next, and often use the platform to voice complaints.

Read more: Hospitals turn to social media for 'virtual' patient advice - FierceHealthcare http://www.fiercehealthcare.com/story/hospitals-turn-social-media-virtual-patient-advice/2013-08-21#ixzz2do7z3oI0 
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Perhaps no term captures the 21st-century zeitgeist quite like “social media.” Facebook, Twitter, Yelp, LinkedIn, Instagram—the ability to share across broad networks instantly, unfettered by geographic distance, has changed how we do business and transformed our interpersonal relationships. Now, online reviews and ubiquitous mobile communications change the way people connect with their doctors. Rating sites such as Healthgrades, ZocDoc, and Vitals increasingly affect the reputation of health care professionals and the success of their work.

Last week, ColumbiaDoctors and the CUMC Office of Communications presented “Social Media for Health Care Professionals.” The event featured presentations and panel discussions with social media experts: Columbia University Chief Digital Officer Sree Sreenivasan; the editorial director of MedPage Today, Ivan Oransky, MD; the former surgeon and anonymous writer who blogs under the name Skeptical Scalpel; P&S professor, oncologist, and popular blogger Azra Raza, MD; Tamar Schiller, DDS, MBA, of the College of Dental Medicine; Gina Czark, director of social media for NewYork-Presbyterian Hospital; and, from the CUMC Office of Communications, Chief Communications Officer Doug Levy and digital strategist Michele Hoos.

Presentations focused on the basics of social media, how the modern medical professional can and should be involved in social media, and how to avoid embarrassing social media interactions that can affect the reputation of both the professional and the institution.

Top 10 tips offered at the event:

1. Consider social media a dialogue, not a monologue. Many mistakenly think of social media as a broadcasting platform, yet it is most useful for promoting conversation. For example, responding to Tweets and mentioning people in your posts via their Twitter handle draws them—as well as their followers—into the conversation.

2. Understand that the impact of social media is not in who follows you but who follows who follows you. Though you may have only a few followers, the reach of your posts increases exponentially with each person who shares your material. Focus also on the quality of followers, not just numbers.

3. Share useful information. Our primary goal in social media is to educate, which means you should share information that people beyond CUMC may find useful. This could be a new scientific finding, health advice, commentary on a medical or science story in the news—and much more.

4. Accept that the line between professional and private is eroding. Even if your social media bio does not identify you as a Columbia University affiliate, anything you say or post online can damage both your reputation and Columbia’s. Do not rely on disclaimers to protect you or Columbia. Remember that patients and research subjects count on us to keep their information private.

5. Be an early tester of technology but not an early adopter. It’s nearly impossible to stay abreast of the ever-changing world of apps and websites. Find a medium that suits your needs—be it a blog, Twitter, LinkedIn, etc.—and develop it. Each platform does different work; find what works for you.

7. Get noticed by standing out. We are bombarded with things to read and watch and listen to; the average person gives a blog post or Tweet only a glance. Make your material engaging and brief, with a dash of humor if appropriate.

8. Follow people you know who are already experienced in social media. Facebook and Twitter have an etiquette and lexicon that could easily confuse the neophyte. By following someone who is more experienced, you can familiarize yourself with the terrain and processes.

8. Work collectively. One of the benefits of being part of CUMC is that we are a large community with many people already active and successful on social media. Interested in blogging or setting up a Facebook page? Start with the CUMC Office of Communications. Trying to promote your clinical practice? ColumbiaDoctors has a marketing/communications expert who can help.

9. Doctors should expect online reviews. Not yet as universal as restaurant or hotel reviews, physician and dentist reviews are a fast-growing part of online media. Generally, patient experience influences online reviews more than the quality of the patient care. The best way to prevent negative online posts is to make sure that patients feel good about their experience. The last person to interact with patients has a disproportionate influence on their overall satisfaction. If a negative review is posted, consult the CUMC Office of Communications before responding publicly.

10. Use common sense online just as you do offline. There is no way to predict how your message will be read, or by whom. Be careful about posting content that might be offensive, just as you would use caution when speaking in person. Let your intuition be your guide; if it seems like a bad idea, it probably is.

In November, 2011 the AMA published a report on Professionalism in the use of Social Media.  A brief summary of the paper  was published in June, 2010.  The issues addressed by the AMA are reasonable and practical in my view.  There have been some excellent pieces written about the ‘ethical’ issues seen by others about physicians being on social media as well as reasons that physicians themselves give for not wanting to participate. The issue has also generated some excellent thought-provoking discussion in the Digital Health Linkedin group.    As an active participant is social media, I realize its value to patients, caregivers and providers. There have been many other articles and posts about physicians and social media.  I just thought it was time for me to put my perspective out there. I would like to touch on five reasons I believe that physicians should embrace social media.

1.    It’s where the patients are.  Social media is becoming part of the healthcare landscape.  Probably the largest growing sector is online health communities.  I feel that physicians can gain a keener insight into patient concerns (many of which might be very eye opening) by getting involved in social media.  Physicians in social media have been found to be more highly rated by patients so much so that engaging in social media has been recommended to improve online physician reputations.  What is interesting is that while older people (baby boomers) are OK with engaging social media to obtain information, they are far less likely to share personal health information than young people, according to a PwC Health Internet Research Survey.  “More than 80% of individuals ages18–24 would be likely to share health information through social media, while nearly 90% of individuals would engage in health activities or trust information found via social media. Less than half (45%) of individuals ages 45–64 would be likely to share via social media, while 56% would be likely to engage.  I believe this might change if physicians are in social media even in ways conforming to accepted guidelines.  It might add legitimacy, knowledge, and more trust in the space.

2.    It’s where hospitals and healthcare systems are.  The PwC survey also stated that more than 1200 hospitals participate in over 4200 social networking sites.  It would behoove physicians and other providers to know what information is being supplied by their own hospitals or organizations.  In this regard, they can perhaps partner with the institution and both gain some knowledge about what their patients are reading online as well as perhaps provide more targeted information (most hospitals use content provided by others) by offering collaboration.

3.    It makes for engaging and useful interactions with vendors and colleagues.  As physicians are busier than ever, they have less time to interact with Pharma and device companies (who have less and less access to providers) as well as colleagues.  Social media lends itself to interactions which occur in more relaxed and customized settings.  While online health communities can be a source of marketing research, they can serve as points of educational interactions with both patients and providers. Companies such as WCG, Liquid Grids, and others are using sophisticated analytics to translate conversations into useful data for providers and others. One must certainly differentiate between open and closed social media sites.  Open sites are ways in which physicians can either observe or interact (paying attention to the guidance cited above) with patients.  Closed platforms provide a more targeted audience for vendors and serve as a forum for more relaxed (HIPAA compliant) conversations among physicians.

4.     It’s social. Providing a humanistic side of oneself to the public as a physician is therapeutic to both the writer and reader.  Being social is not the digital equivalent of running into a patient at the supermarket, soccer game or restaurant and having him show you a skin lesion for examination or describe a symptom. One might ‘lurk’ or merely observe what is being discussed.  Patients are more candid with each other  (or even providers which aren’t necessarily their own) in social media than they are in real life.  Observing these discussions provides perspectives which might have been previously unknown or discounted. When I was in practice I found that it expanded my horizons.  It opened my experiences to previously compartmentalized areas of the healthcare ecosystem, incorporating new ideas, beliefs, and sentiments which became integrated with my daily practice.

5.   It’s not mandated.  So much of a physician’s practice is either directed towards satisfying regulatory mandates or indirectly related to them. Digital interactions with patients and colleagues might therefore be viewed as welcomed respite. It can be disease specifically related (as in online patient communities such as HealthTap, Wego Health, Treatment Diaries, or others) or not, perhaps via Linkedin groups representing multiple facets of healthcare. I have found interactions via Tweet chats with patient advocates and providers alike in a number of areas to be satisfying by contributing basic knowledge about navigation of the healthcare system which is both the most difficult patient problem these days and a potential contributor to morbidity and mortality. It is enlightening to realize how much a physician takes for granted how little it takes to contribute in a significant way to people’s knowledge. Participation in social media is on a person’s individual time schedule and therefore is neither stressful nor imperative.  It creates virtual friendships, respect, and collaboration.  Try it, you might like it.

–David Lee Scher, MD is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a former cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he is uniquely qualified to address both clinical and operational concerns of clients. Scher was Chair of Happtique’s Blue Ribbon Panel which established standards for certification of medical apps in the categories of safety, operability, privacy, and content. He is a well-respected expert in mobile and other digital health technologies and lectures worldwide on technology and its impact on patients and healthcare systems.

- See more at: http://www.physicianspractice.com/blog/why-social-media-matters-your-medical-practice#sthash.6DGcY5qE.dpuf

The imaging enterprise has a huge public relations problem. Since the advent of PACS and real-time speech transcription, radiologists have sequestered themselves in reading rooms and thrown away the key. The days of radiology rounds and daily interactions with referring providers are gone. 

To make matters worse, patients are not aware that physicians with specialized training are responsible for the acquisition and interpretation of imaging exams.

To help counteract this trend, the American College of Radiology launched the “Face of Radiology” campaign in 2008 to educate the public about what radiologists do.

In comes another disrupting technology: social media. It is almost impossible to view a print ad or website without being directed to a social media site. When the lights went out during the Super Bowl, the Twitter community was set ablaze with activity stealing thunder from the game.

How do radiologists use the social media playbook to develop digital trust with the healthcare community? Ironically, the ingredients to a successful social media presence are similar to the successful medical practice: availability, affability and ability.

Availability

An exponentially growing number of patient consumers are living, breathing and interacting 24/7 on social media platforms. In a recent poll from the Health Research Institute and PricewaterhouseCoopers, one-third of patient consumers reported using social media sites for health-related matters, including seeking medical information, tracking and sharing symptoms and broadcasting how they feel about doctors.

Clinicians and patients want same-day imaging results and access to imaging and reports on the digital device of their choice. 

It is essential that healthcare providers develop a social media apparatus that can communicate to and with their constituency. These platforms provide around the clock ‘availability’—which helps retain current, and recruit new, patient consumers.

Affability

Many providers have written off social media because of its novelty (inability to understand the technology), lack of security (fear of the HIPAA police) and transparency (fear of revealing skeletons in the closet). However, the affability and transparency of one’s practice rarely goes unnoticed by the patient consumer. 

Newer generations of patient consumers will demand full disclosure and transparency demonstrated by their willingness to share their most personal thoughts on social media. Will the radiologist be willing to reciprocate this level of transparency? Are we comfortable to engage patients on their terms?

Ability

The ability of a healthcare provider was traditionally the benchmark that distinguished practices. Ability has taken a back seat to availability and affability. However, practices can highlight and amplify their abilities through social media. We have seen providers jump into the social media maelstrom by Tweeting surgeries with video. My contention is making healthcare digitally accessible will inflate the perception of ability in patients’ eyes.

Getting in the game

What steps should a radiology practice take to plug into the social media machine? Success or failure will depend on: a willingness to connect to the patient consumer in non-traditional ways; a strategic plan; and dedicated personnel. 

Determine Your Objectives

• Identify the customers you want to engage (e.g. physicians, patients, employees)
• Offer transparent customer service
• Build upon and enhance your brand recognition
• Increase local, regional and national exposure

Know Your Target Market

• Make a list of 5-10 target markets
• Continue to reassess your targets and adjust accordingly
• Offer various platforms for different markets and various campaigns for different users

Follow Your Competition

• Develop a competitive analysis profile
• Go to competitors’ websites and follow their links
• Login to sites like Facebook and LinkedIn and search for competitors’ profiles

Craft Your Message

• Deliver content that is timely, engaging, entertaining, thought-provoking and educational
• Think outside the box
• Understand social media etiquette

We owe it to our patient consumers to adopt social media. This will undoubtedly help them feel more informed about their health and redefine the “Face of Radiology.”

Safwan Halabi, MD, is director of imaging informatics at Henry Ford Hospital. He is an active member of the Society for Imaging Informatics in Medicine (SIIM).

Three physicians are calling on organized medicine to change the standard industry guidelines on social media use that call on doctors to separate their personal and professional online personas.

Instead, they argue, guidelines should focus on what is appropriate to post.

Matthew DeCamp, MD, PhD, Thomas Koenig, MD, and Margaret Chisolm, MD, wrote a “Viewpoint” on the subject in the Aug. 14 issue of The Journal of the American Medical Association (link). They argue that it would be impossible from a technical standpoint to abide by current social media guidelines. In addition, they said, the guidelines are potentially harmful to physicians and patients. The physicians are ethics and psychiatry experts affiliated with the Johns Hopkins University School of Medicine in Baltimore. They held a live Twitter chat, with the hashtag #IDcrisis, on Aug. 16 to discuss their piece.

“In ethics, ‘ought’ implies ‘can,’ meaning that an ethical claim is binding only if a person is actually able to carry out the required actions. Separation of identities online is operationally impossible,” the authors wrote. They argue that an online search for a social media page would connect both personal and professional pages. “Despite the increasing availability of paid services to monitor and control a person’s Web presence, no current technology exists to overcome fully this particular barrier.”

The separation of personal and professional personae was a recommendation first made by the American Medical Association in 2010. Other physician organizations followed suit with their own guidelines, each promoting the same personal-professional separation advice. In April, the American College of Physicians and the Federation of State Medical Boards released similar guidelines (link).

The authors of the JAMA article say the draw to social media for many physicians was the intentional blurring of boundaries between professional and personal identities.

“Professional identity constitutes and is constituted by personal identity, perhaps as one of the many ‘subidentities’ or roles individuals might have, such as a spouse, parent and so on. Separation therefore verges on nonsensical,” the doctors wrote. They also make the argument that separation may be harmful. Depersonalized online interactions could lead patients to believe the doctor is hiding something. They also could lead to a physician’s inability to normalize a difficult situation or express empathy.

What should be stressed?

Instead of focusing on professional and personal boundaries, physicians should zero in on the boundary between what is appropriate and what is not, the authors wrote.

“When a physician asks, ‘Should I post this on social media?’ the answer does not depend on whether the content is professional or personal but instead depends on whether it is appropriate for a physician in a public space,” the article said.

Social media should be incorporated into medical education and professionalism curriculum, they argued. “Absent this approach, the professional transgressions motivating guidelines will persist, and the potential benefits of social media will remain unrealized,” the authors concluded.

While attending the 2nd ExL Digital Pharma Conference in Berlin in 2010, I listened to a dynamic presentation by a young physician from Hungary who talked about the ways that social media could – and would – make an impact on the practice of medicine.  His talk was the hit of the conference and he really excited everyone in the room about the potential for social media and medicine.  Afterwards, I caught him for a quick video interview and wrote a posting about it here on Eye on FDA – “The Places That Medicine Can Go – Fascinating Presentation by Dr. Berci Mesko“.

 
Bertaln Mesko, M.D., PhD. is a “medical futurist” and has aMedical Futurist website to prove it.  , He is a medical doctor, a lecturer and a visionary and founder and managing director of the robust site Webicina – which curates social media resources in medicine for both health care professionals and patients (I am on the Webicina International Advisory Board) and founder of The Social MEDia Course.  He blogs at Scienceroll.com. In other words, he does a real lot….

This includes writing a new book called Social Media in Clinical Practice. It is a very practical guide for a medical practitioner who wants to learn about how to use social media platforms in various ways to support communications with patients and other medical professionals.  It takes you through the how and the why.

Because social media and medicine has evolved so much since our 2010 meeting, I sent Dr. Mesko a few questions about the topic – questions that I thought might be posed from medical professionals who might be curious, but have not yet embraced social media in their practice.  Here is what he had to say:

While social media use among those in medical practice is growing, there are a lot of concerns on the part of practitioners that range from potential lapses of privacy to concerns about the return on investment.  How would you characterize the “risk-benefit” ratio of social media use by physicians?

I think there aren’t many essential differences between real-life and online communication.  I teach my students they should behave online just like they do in the offline world.  Therefore, social media can only make processes faster and more interactive, although if your offline communication as a doctor is bad, it’s going to be the same on any social media platforms as well.

There are risks, obviously, but if you know the limitations and potential problems related to the active use of social media, you know what you can do and what you should never do online.  That was the basic concept behind writing this handbook so then medical professionals worldwide would get a clear picture about the online channels and ways of communication.

Teaching tricks and rules about the Internet should get a huge emphasis in medical school, but it doesn’t get that kind of attention.  This is why I thought there is a niche for such a handbook which includes step-by-step instructions and tutorials focusing on all the major social media channels.

What do you see as the most important benefits to physicians and to patients respecting social media and medicine?

Communication between doctors and patients; or even among doctors; and patients could be more efficient, faster, more interactive and archivable.  As we tend to use such social media channels more and more in different areas of our lives from banking to shopping to making friends, it is quite inevitable that at some point it takes its place in practicing medicine and delivering healthcare.  In order to take its place in medical communication, we have to make sure all the stakeholders of medicine know how to use it properly and securely.  From my perspective, medical professionals should become guides for their patients online and as plenty of patients are quite web-savvy being up-to-date in their own conditions or therapies, it’s time for medical professionals to step up and educate themselves.  For this, they need to be even better at using digital channels than their own patients.  This is the area where I try to help them make their first steps.

There are many physicians who have embraced social media and are using it regularly in their practice, while there are still many others are not even using email.  Are we becoming a system of “haves” and “have nots” in medical practice and what are the consequences of that?

It was quite an expected phenomenon and it happens all the time when anything new is introduced as a new member of the range of technologies doctors should be able to use.  It took time to embrace e-mails – now it takes time to embrace social media.  But I must observe these processes from a neutral point of view.  I tell my medical students that my aim with the course is not to transform them into bloggers and Twitter stars, but to show them solutions so when they meet e-patients or will be challenged with digital-related problems, they will know where to find a solution.

While the practice of medicine is always human-based, some patients do want to use social media channels to keep in touch instead of many phone calls or unnecessary personal visits.  If new channels provide us with better methods in medical communication, why not use them?

How do you see the development of medical apps – both for patients and physicians – impacting the use of social media and the practice of medicine?

Medical apps are now on a different level and have the potential to play a crucial role in practicing medicine.  Patients will soon be able to measure almost any health parameters about their conditions at home from blodo sugar level to even genomic data; but physicians will have to be able to deal with the additional data patients will bring to the visits.

Although the number of health apps is skyrocketing, we should not forget the basics of evidence-based medicine and stick to this approach when implementing medical smartphone apps into medicine and healthcare.  There are more and more studies dedicated to this issue, but their number is still not enough.  The potential is clear, but as long as we cannot put evidence behind using these, this is just potential and nothing more.

Social Media in Clinical Practice is available from the publisher and on Amazon.

Rankings by EveryMove, a marketing and incentives company, suggest progress in health insurers' technology adoption, but further online community development is needed.

Health insurers have further to go in using mobile tools and social media to develop a community with consumers, according to EveryMove, a health rewards-based marketing and incentives company. It has released its EveryMove 100 Health Insurance Index, which ranked the top 100 health insurance companies in the United States on how they engage with consumers to manage their own health.

As more individuals will be shopping for health plans in health insurance exchanges (HIXes) as a result of the mandate in the Affordable Care Act to have insurance, more transparency will be needed in how insurers meet consumers' needs and interact with them, according to EveryMove, which released its rankings Aug. 27.

EveryMove listed both regional and national plans based on whether they offer mobile Websites and apps, how well they use social media and whether incentive programs help motivate patients to adopt healthier habits. The company also examined how insurers use SMS and live chat to provide customer service.

"I wouldn't say anybody is knocking it out of the park on an absolute basis relative to other industries," Russell Benaroya, EveryMove's CEO, told eWEEK.

Scores were based on 50 metrics that measure how well insurers meet consumer needs for accessibility, motivation, community activism and overall satisfaction. Topping the rankings was New York-based Capital District Physicians' Health Plan, with a score of 73.8. The health plan, which has 385,000 members, is running a photo sweepstakes to reward healthy activity, Benaroya said.

Independence Blue Cross (IBC) in the Philadelphia area took third place with a score of 71.9. IBC is working with Penn Medicine to see if Vitality's electronic GlowCap for pill bottles increases medication adherence. In fifth place, with a 71.6 mark was Humana, which uses Hewlett-Packard's Exstream communications management software and SundaySky SmartVideo technology to offer personalized video health plan statements.

Of the health plans ranked, 97 used both Twitter and LinkedIn, while 87 were on Facebook and 81 had a presence on YouTube.

The goal of the rankings was to create transparency and trigger a conversation between consumers and health insurers on how they're using technology, according to Benaroya.

"We believe that by creating some transparency around who is doing what and who is doing things well, we can start to push the conversation and hopefully be a catalyst for action," Benaroya said.

Health plans have more work to do to create this transparency using technology. They have a "long way to go around using these technologies to actively engage that population," he said.

Although any company can set up a social media account and say they have a Facebook page, insurance companies need to use these tools for "active dialogue as an important part of their business," Benaroya said.  "That's not happening right now. You would expect that to be the case at some level."

This would include actively monitoring social channels and promptly responding to comments, he said, while noting that active engagement using social media will allow insurers to build trust with consumers.

Many health plans offer mobile apps, but only 22 percent of health plans allow consumers to access their data on the mobile Web, according to Benaroya.

Although health plans need to encourage additional use of technology, consumers' adoption of these tech tools is not uncommon, according to Matthew Holt, co-chairman of Health 2.0, a conference organizer, and a member of EveryMove's advisory board.

"It's no longer rare for health care consumers or plan members to want to use social media and online tools on any device to improve their health care experience," Holt said in a statement.

"We're well into the medium adopter phase, and it's going to accelerate," Holt said.

Businesses in health care need to take the lead from those in retail, finance and travel, he said. "I think that the EveryMove 100 Index is going to help identify the insurers that are supporting this new consumer and will show the rest how to catch up," Holt said. "And it can't come too soon." - See more at: http://www.eweek.com/mobile/health-insurers-can-build-links-to-customers-with-social-mobile-tools/#sthash.0qCoZ8IM.dpuf

Hospitals that understand this impact and leverage them within their organizations will be better positioned to meet the needs of today’s consumers

Michelle McNickle, writing forHealthcare Finance News, referenced a report by the Health Research Institute atPwC US in outlining the impact of social media on the healthcare industry.  The information contained it the article is very useful for healthcare marketers.  The article is reprinted here:

According to a recent report by the Health Research Institute at PwC US, nine distinct uses of social media are helping companies to have an impact on the healthcare business, and to take a more active and engaged role in managing individuals’ health.

“Organizations should coordinate internally to effectively integrate information from the social media space and connect with their customers in more meaningful ways that provide value and increase trust,” the report read. “Insights from social media also offer instant feedback on products or services, along with new ideas for innovation. Organizations that can incorporate this information into their operations will be better positioned to meet the needs of today’s consumers.”

The report outlined nine additional ways social media is impacting the business side of healthcare.

1. Communication is shifting to public, more open forums. Which means less money spent on mailings, websites, and other marketing initiatives. According to the report, four characteristics of social media have altered the nature of interactions among people and organizations: user-generated content, community, rapid distribution, and open, two-way dialogue. “In the past, a company would connect with its customers via mail or a website, but today’s dialogue has shifted to open, public forums that reach many more individuals,” read the report. “Early adopters of social media in the health sector are not waiting for customers to come to them.” Ed Bennett, who oversees social media efforts at the University of Maryland Medical Center, agreed. “If you want to connect with people and be part of their community, you need to go where the community is,” he said. “You need to be connecting before you are actually needed.”

2. Patients (or consumers) are taking a more active role in their healthcare. Social media presents new opportunities for how individuals manage their health, the report noted, whether researching a certain illness or joining a support group. “The virtual aspect of social media enhances communications by creating a comfortable, often anonymous, environment for engaging and exchanging information.” In addition, patients are using tools like Facebook, Twitter, and Youtube to better educate themselves. When faced with an important health decision, the report read, social media can provide a new avenue of information and dialogue. “Some may share a health goal to generate support or engage in a patient community to interact with other patients,” it read.

3. Increased access to information means patients are demanding more transparency.  Laura Clapper, MD, CMO of the online community OneRecovery, compared healthcare’s use of social media with that of a bank’s. “As more people go online to interact with their banks and make purchases, they want to do this with their doctors, health plans, and condition and disease management as well,” she said. According to the report, many industry insiders referenced social media site PatientsLikeMe, an eight-year-old health data-sharing platform, as an example of how more than 140,000 patients are connecting with each other. “Social networks will peel back every corner of the health system and drive transparency on cost, value, and outcomes,” said Jamie Heywood, co-founder and chairman of PatientsLikeMe. “The information asymmetry that patients experience will be leveled, allowing the average patient to evaluate and improve his or her conditions, as well as the system’s performance.”

4. More instant feedback can help both consumers and organizations. With patients more actively taking to social media to express opinions, grievances, and experiences, they expect faster response times from organizations, the report read. “Truly social brands will listen to what customers are saying and feeling and use that insight to adapt and create products and services,” said Kelly Colbert, director of strategic advertising at insurer WellPoint. In addition to improving services and creating products to better meet the needs of patients, social media has taken on a more practical approach to basic, day-to-day operations within an organization. For example, according to the report, 49 percent of those polled expect to hear from their doctor when requesting an appointment or follow-up via social media within a few hours. 

5. Social information is impacting how and when patients select treatment and providers. It’s no secret consumers are increasingly turning toward social media to make healthcare-related decisions, like what physician to see and when to seek a second opinion. For example, according to the report, 40 percent of those polled said information found in social media would affect the way they coped with a chronic condition, their approach to diet and exercise, and their selection of a specific doctor. “Across the health industry, consumers seem to value information and services that will help them make their healthcare easier to manage,” the report read.

6. Social media allows for higher levels of trust. According to the report, consumer survey respondents said they would be most likely to trust information posted via social media (from doctors, hospitals, etc.) and, they’d be most likely to share information with providers via social media. The reason individuals trust their doctors the most? Human relationships, the report detailed. “You want to trust and connect with the people providing you the care,” said Kathryn Armstrong, senior producer of web communications at Lehigh Valley Health Network. “It’s easier to trust a person than an organization.” Healthcare providers have the ability to form human relationships and connect with their patients, the report added, which ultimately leads to increased trust.

7. Social media is evolving from a marketing tool into a business strategy. Although 82 percent of respondents said their social media efforts are managed by their marketing department, the report showcased how social media’s use is extending into customer service, innovation, and service/product development. “As people go through life events and their health journey, they have changing interests in health,” said Ann Sherry, senior director of Kaiser Permanente’s Internet services. “They want and need different tools and different interactions.” Having a social media strategy isn’t’ enough, she added. “It’s about social strategy.”

8. Providers can use social media as an outcomes-based measurement. The industry is shifting toward outcomes-based measurement, due in part to provisions in the Affordable Care Act, like Medicare’s Value-Based Purchasing and accountable care, read the report. “Social media can offer a unique mechanism for collaborating with other organizations/partners to coordinate care,” it read. The report advised using social media to support meaningful use efforts, all while defining a digital strategy and clear usage guidelines. “A hospital’s or physician’s first encounter with a patient is often through its online presence,” it read. “Providers should take advantage of the trust consumers have for them over other health companies.”

9. Health insurers can use social media to help focus on population health. According to the report, health insurers understand that focusing on the individual population will be key, as more partnerships in population health are formed and insurance exchanges bring in 12 million newly insured individuals in 2014, and up to 28 million by 2019. By casting your company as a “patient advocate,” it continued, you’ll get a jump start on understanding the needs of potential members and determining which needs can be met through social media. Additionally, it noted, organizations should begin to determine an approach to data aggregation and understanding the direct and indirect benefits of social media.

Several years ago I wrote a white paper called The Social Physician. Back then, it was relatively easy to keep track of the socially engaged doctors because there were so few. Today all that has changed as more and more physicians flock to Twitter, Facebook, YouTube, Pinterest, blogs, and beyond. Here are six doctors I follow in social media, all of them practicing and all worthy of your attention. I focused on practicing doctors because they choose to engage on top of all their clinical responsibilities. For them, social media is an important way to stay connected with patients, peers, and the world outside their office.

Dr. Wendy Sue Swanson
Website: http://seattlemamadoc.seattlechildrens.org/
Twitter: @SeattleMamaDoc

Known to her legion of fans (of which I am one) as SeattleMamaDoc, Dr. Swanson is one of the most eloquent medical writers in the social sphere. A pediatrician, she is an avid blogger for Seattle Children’s Hospital where she covers everything from swimming safety to measles outbreaks. Her recent post on the hiring of Jenny McCarthy on The View is indicative of her passion and willingness to take a stand on important, even controversial, issues. She also uses video effectively to educate, such as teaching parents about bike helmets. Dr. Swanson is pretty amazing.

Dr. Zubin Damania
Website: http://zdoggmd.com
Twitter:  @zdoggmd

Known by his alter ego ZDoggMD, this Las Vegas-based internist and hospitalist is a wannabe rapper/comedian/reality show star in scrubs. He is funny, sometimes hilarious, as he sings about everything from insurance paperwork to prostate cancer. My favorite video is one in which he gets his psychiatrist mother ZMommMD to “lay down the smack” on his internist father ZDaddMD. Seriously, though, I think that ZDogg makes medicine more accessible and relevant to the public and that’s a good thing.

Dr. Nina Shapiro
Website: http://www.drninashapiro.com/
Twitter: @drninashapiro

Parenting young children is hard enough, and when they start with the constant coughing, noses that ooze, and ear maladies it’s time for a visit to Dr. Nina Shapiro’s website. While the Internet is never a replacement for a visit to the doctor, as director of pediatric otolaryngology at UCLA, Dr. Shapiro blogs, tweets, and updates Facebook with practical, trustworthy content for parents struggling with snot, boogers, and beyond. One of my favorite posts was Am I a Mean Mom? which challenges parents to let their kids experience the world – even if hurts a little – instead of constantly shielding them from it. Most recently, Dr. Shapiro joined the vaccine conversation with an op-ed in the L.A Times called With fewer vaccinations, is your child’s school safe? Can you tell I follow strong, smart women?

Dr. Mike Sevilla
Website: http://drmikesevilla.com/
Facebook: https://www.facebook.com/drmikesevilla

This early adopter has gone from being Dr. Anonymous to being…Dr. Mike Sevilla. In between he used Family Medicine Rocks as his home base, where he tirelessly advocated for his specialty – and primary care in general. Recently, he took a break from social media to regroup (many of us were sad), but came back stronger than ever (which made us happy). Dr. Sevilla uses every form of social media: blog, podcasts, YouTube, Facebook, Twitter, Vine, Instagram – name it, he’ll try it. Wherever he is, he’s one to follow for his honest, funny, human musings about family medicine and life in general.

Dr. James Salwitz
Website: http://sunriserounds.com/
Twitter: @DRSALWITZ

He is a recent addition to my list based on a poignant piece he wrote for KevinMD. It is a story of his angst about a patient who died a terrible cancer-stricken death after enduring a tragic life of untold abuse from her husband. The patient’s children wouldn’t let her go even though an earlier departure would have been – in a sad twist – more humane. “There was no happy ending. I failed to appease their pain during Ellen’s life, so she died terribly,” wrote Dr. Salwitz. I read more of his posts on KevinMD and discovered what a compassionate and steadfast advocate for patients he is. Dr. Salwitz seems to be everything you would want in an oncologist (and I’ve met some who were everything you wouldn’t want).

Dr. Leslie Saxon
Website: http://www.uscbodycomputing.org/
Twitter: @DrLeslieSaxon

Dr. Saxon is a health tech rock star on a coast full of them, yet most are male. She is both chief of cardiovascular medicine at USC Keck School of Medicine and executive director of USC’s Center for Body Computing. Known as the Digital Heart Doc, she is a pioneer in the evolving world of wireless and digital health. Her research using a smartphone-based ECG recorder for inexpensive, continuous heart rate monitoring helped the AliveCor device gain FDA clearance, one of the first mobile applications to do so. Dr. Saxon’s social media posts are generally on major news outlets like CNN – Leading the Charge in Wireless Health was fabulous. She tweets, too, so if you’re interested in where digital is going, she is one to follow.

Bunny Ellerin (Twitter: @BunnyEllerin) is Senior Vice President at Intouch Solutions, a privately held marketing agency specializing in digital and mobile solutions for the pharmaceutical and health care industries. She is also co-founder and president of NYC Health Business Leaders, a cross-sector network of senior executives that showcases NYC’s position as a thriving center of health, medical and life sciences innovation.

Newswise — From the small-town doctor to the Freud—Ferenczi debate over sharing personal anecdotes, controversy over physicians’ professional identity is nothing new. The question of physician conduct on social media is simply a new context for an old debate, but ethics and psychiatry experts at Johns Hopkins say current guidelines are misframing the issue of physician professionalism online, missing the opportunity to shed new light on the evergreen issue of physicians’ role in society.

In a JAMA Viewpoint opinion published August 14, the experts say that current guidelines, including the recentlyreleased by American College of Physicians and Federation of State Medical Boards, are asking the wrong question about medical professionalism online; it’s not a question of whether content is professional or personal, but whether it is appropriate of a physician in public.

“Resolving the online identity crisis requires recognizing that social media exist in primarily public or potentially public spaces, not exclusively professional or exclusively personal ones,” write authors Matthew DeCamp, MD, PhD, Thomas Koenig, MD, and Margaret Chisolm, MD.

The authors assert that it is “operationally impossible” and therefore “nonsensical” to separate personal and professional identities, as many guidelines suggest. They will underscore their point by participating in a live Twitter chat scheduled for 2:00 PM on Friday, August 16, with the hashtag #IDcrisis, hosted by the Johns Hopkins Berman Institute of Bioethics(@bermaninstitute).

“Professional identity is a component of personal identity, much as a person can identify both as a colleague and parent in different contexts,” says Chisolm, a professor in the department of Psychiatry and Behavioral Sciences.

“The internet is a reimagined small-town square for the digital age, where a comment made casually to a friend can suddenly spread like wildfire,” says DeCamp, a practicing general internist at Hopkins and faculty member at the Berman Institute. “Social media presents an opportunity for physicians to connect with their community, and they can maintain an appropriate professional identity while doing so by keeping in mind they are speaking in a public forum. So rather than something completely novel, social media is simply a new forum for professional conduct in public, which physicians negotiate all the time,” DeCamp says.

The authors warn that attempts to adhere to existing guidelines and “depersonalize” their identity online may backfire, reducing trust of physicians who are attempting to hide something, and increasing patient stress in response to a physician perceived to be impersonal and unsympathetic.

About the Johns Hopkins Berman Institute of Bioethics

One of the largest bioethics centers in the world, the Johns Hopkins Berman Institute of Bioethics is the home for collaborative scholarship and teaching on the ethics of clinical practice, public health and biomedical science at Johns Hopkins University. Since 1995, the Institute has worked with governmental agencies, nongovernmental organizations and private sector organizations to address and resolve ethical issues. Institute faculty members represent such disciplines as medicine, nursing, law, philosophy, public health and the social sciences. More information is available at www.bioethicsinstitute.org

The primary challenges with adopting social media for makers of prescription products are operational. Though much is made of the absence of an explicit Food and Drug Administration guidance on social media, we know the answer to most of the questions about the regulatory requirements for social media activity. 

Making claims about a product’s benefits requires providing appropriate risk information to ensure that the claim is balanced regardless of where the claim is made – be it on Twitter, YouTube, a television commercial, or a print ad. Using the brand name requires the use of the generic name with no intervening matter, regardless of how long the brand name or generic names are or how space-limited the context. There certainly are issues that FDA guidance could address, but no further FDA guidance is likely to change these and other basic parameters.

The operational issues, however, present a different set of obstacles to marketers of prescription products. Those issues can be addressed, and makers of prescription products can engage in social media compliantly and effectively, but first they have to understand the challenges.

What are the unique challenges of social media? Three lead the list:

1. Adverse event reporting

2. Responsiveness

3. FDA filing requirements

One of the five questions from the 2009 FDA hearings on social media was about adverse event reporting and how sponsors should address any Adverse Events (AEs) they come across in social media. While waiting for the FDA to deliver guidance on this issue, industry has already adopted a position. It reports adverse events that meet FDA’s definition of a reportable event, and it does so regardless of the medium where those events are uncovered. Social media is being treated as just another medium and companies have adapted their AE reporting processes to accept social media incidents. Vendors who engage in social media listening and other activities are regularly trained on a company’s AE reporting requirements. 

This has proven far less apocalyptic than some feared. The incidence of AEs in social media has been far greater than a few well-known analyses predicted, but companies actively engaged in social media have not been overwhelmed. No company has yet withdrawn a social media initiative because of an excessive volume of AE reports.

The second and the third issues are closely connected. Expectations in social media are not set primarily by the makers of prescription products. The expectations for how any company, regardless of industry, will engage socially are being set by Comcast, Delta, General Motors, American Express, and other highly social enterprises. A consumer who mentions a delayed flight on their Twitter feed has become accustomed to receiving a response from the airline in minutes, and consumers expect the same from companies that make pharmaceuticals and other prescription products.

That level of responsiveness can be difficult and the idea of generating a custom response to a social media post can seem daunting. Just getting the response through the medical-legal-regulatory promotional materials review process can take several days (or weeks), and when a product is discussed the response has to be sent to the FDA before use. 

Marketers already know how to deal with these challenges in their non-social media activity. Many of those interactions are scripted with a variety of appropriate responses approved and submitted to the FDA well in advance. By thinking through the most likely scenarios, developing the appropriate possible responses, and establishing a decision procedure for choosing among the options, marketers will be able to provide the same level of responsiveness as other, less regulated industries.

Understanding the challenges of social media enables marketers to overcome them and provide information to people in the channels they prefer. As social media’s importance continues to grow, makers of prescription products need to adopt these same channels and do so compliantly. Otherwise, they face the far greater risk of becoming irrelevant to people’s health discussion.

Read more: http://www.mediapost.com/publications/article/206180/overcoming-social-medias-challenges.html#ixzz2dL02fNbN