Tuesday, December 13, 2011

5 Reasons Why Physicians Should Use Social Media

This post was originally published on HealthWorksCollective, an editorially independent, moderated community for thought leaders in health care. 

Physician participation in social media is a health care imperative according to Dr. Kevin Pho, a practicing internist and the founder of KevinMD.com, a leading online health portal; however, many physicians remain skeptical about the value of social media.  At an Ethics Forum hosted by the Massachusetts Medical Society on December 2, 2011, Pho suggested several reasons why physicians need to embrace new ways to communicate. 

A social media epiphany

Pho began blogging in May, 2004 as a way to share links to health care resources and talk about health care reform.  In the fall of 2004, when the Merck drug Vioxx was recalled, Pho’s office was flooded with patient phone calls.  In response Pho decided to write a blog post about the recall.  When one of his patients mentioned that the blog post had reassured and comforted him, Pho recognized the tremendous potential of social media.    He realized that patients want health information but are overwhelmed, frustrated, confused and even frightened by what they find online.  Health care professionals, Pho noted, can play an important role by becoming a reputable source of online information or by directing patients to reliable sources. 

Making the case for social media participation

Pho offered five reasons doctors should participate in social media:
  1. Provide context.  Pho pointed out that every day new health stories are published.  Social media is a powerful way for physicians to provide context and meaning to the news items that patients read and view.
  2. Dispel myths.  Online health information can be medically and factually inaccurate.  To maintain physicians’ standing as health care authorities, Pho emphasized that it is critical for doctors to use social media to counter myths perpetuated by inaccurate health information.
  3. Influence the health care debate.  Pho cited the results of a Gallup survey which concluded that patients trust physicians regarding health care policy. Participation in social media gives physicians a way to express their views and influence the formulation of policies that will shape how medicine is practiced.
  4. Connect with mainstream media.  Experience with social media can provide physicians with the skills they need to connect with mainstream media.  For example, Pho noted that writing his blog gave him the confidence to write op-eds for mainstream news publications. 
  5. Provide patient insights.  Social media gives patients a place to express their frustrations and concerns about health care.  By listening to patient feedback on his blog, Pho has changed the way he practices medicine.  He now offers same day appointments, doesn’t take his laptop into the exam room and makes sure patients receive their test results.
Rules of engagement

Prior to using social media, Pho suggested that physicians consult guidelines, such as those prepared by the American Medical Association or the Massachusetts Medical Society.    He emphasized that patient privacy always comes first.  He also offered these pointers:
  1. Tiptoe into social media.  Start small by establishing a presence in a single social media community.   Expand your presence as you get more comfortable.
  2. Stay professional.  Pho advised that rules for online and offline professional behavior are identical:  behavior on the web is no different from behavior in the exam room.
  3. Think twice before you hit enter.  Pho reminded attendees that what you post on the web is permanently indexed by search engines so post thoughtfully not impulsively. 
  4. Manage your online reputation.  According to Pho you can’t get delete a negative online review but you can downplay its significance by creating a healthy online presence.  He noted that any page you put in your own name such as websites, blogs or social profiles on Linkedin, Twitter or Facebook, will rank more highly in search results than reviews on third party rating sites.  Additionally, he suggested being proactive by asking patients to submit reviews. He noted that most reviews are positive.  He also encourages doctors to Google their name at least once a week to continually monitor and protect their reputations.
Pho closed by noting that the true value of social media for physicians may be its ability to strengthen and preserve relationships with patients. 

Monday, December 5, 2011

Limits of Health Care Social Communities

This post was originally published on HealthWorksCollective, an editorially independent, moderated community for thought leaders in health care.

Social networks such as Facebook and YouTube include many disease specific communities.  Members may find valuable emotional support and encouragement for managing their illnesses in these communities.  However, questions about the reliability of information in social communities have been raised in addition to concerns about patient privacy.  Until issues of credibility and privacy in social communities are addressed, social networks may fail to realize their full value to patients, physicians and health care marketers.
All health care social communities are not created equally
In evaluating healthcare social networks, researchers have found a wide range of variability when it comes to authenticity, privacy, clinical oversight and accuracy.  The highlights of some selected studies include the following findings:
  • A review of 100 YouTube videos on inflammatory bowel disease by researchers at the Cleveland Clinic Foundation rated the overall educational quality as poor.
  • Researchers at Brigham and Women’s Hospital, Harvard University and CVS Caremark surveyed the 15 largest social media sites dedicated to diabetes.   The results of the survey were published in Archives of Internal Medicine. (1)  Researchers found varying levels of oversight regarding the clinical information provided:
          10 sites (67%) required administrators to review posts
          5 sites (33%) had physicians available to answer questions 
          but only 7% of postings included a  physician response
          8 sites (53%) used diabetes educators to answer questions

          2 sites (13%) did not appear to monitor information posted; 

          one of these sites has over 300,000 members
          3 sites had no industry sponsorship; two of those without sponsorship 

          had neither a physician nor a diabetes educator available to answer 
  • Another review of Facebook sites for diabetics found that more than 25% of posts directed members to products not approved by the FDA.  The researchers also noted significant attempts to collect personal information from participants.
Is the Facebook exodus by pharma making things worse?
With its clinical expertise, the pharmaceutical industry can clearly help play a role in the credibility gap of disease specific social networks.  However, lack of guidance from the FDA, concerns about adverse event reporting and the elimination of the ability to moderate comments has  caused many pharma firms to leave sites like Facebook.  According to the Dose of Digital Pharma and Healthcare Social Media Wiki, 23 of 85 (27%) of industry sponsored Facebook pages have been removed.  Yet the exodus of pharma from Facebook may be exacerbating the credibility gap. 
In his blog, Eye on FDA, Mark Senak,  a lawyer at the international communications firm Fleishman-Hillard noted , “the lack of guidance from the FDA on social media doesn’t just affect the marketing and education by medical product manufacturers but rather, has the potential to cause harm when patients or caregivers rely on third party generated material such as a Wiki, that might be incorrect.  It’s not about marketing, it’s about public health.”
Privacy concerns persist
Even with clearer regulatory guidance and greater participation from pharma, concerns about patient privacy may limit the usefulness of social networks in health care.  In a national survey of patients, the Path of the Blue Eye Project found that 68% of Facebook users have not and would not share their personal health information on the site.  Additionally 39% of non-sharers indicated concerns about posting health information that could be found by others. 
Can curation, reputation and facilitation help?
In response to the issues of credibility and privacy, some firms and organizations are stepping in to vet existing social health communities or create more secure and reputable ones.  Some examples include:
Webicina:  Content curation is the process by which an organization or individual reviews and filters the online content to create an edited list of resources for a specific audience and purpose.  Founded by physician Bertalan Mesko, the goal of Webicina is to provide curated medical social media resources in over 80 medical topics and over 17 languages.   Webicina publishes curated social media collections on specific diseases such as Diabetes 2.0 or Neurology 2.0 , including blogs, community sites, podcasts or Youtube channels and others.  These curated resources, reviewed by members of Webicina’s advisory board, are targeted at both patients and physicians. 
Mayo Clinic Online Community: Since the Mayo Clinic has been a leader in the adoption of social media in health care it seems logical that it would capitalize on its social media expertise as well as its clinical reputation to build one of the first patient communities created by a medical provider.  The online community is open to anyone; however, participants must create a profile and login password.  Members have access to videos, discussion forums, news articles and blog posts.  They can also “friend” other community members with similar health interests.  One of the key features of the community is the ability of members to control the privacy of the information shared.   While search engines can scan topics posted in the discussion boards, the identity of individual members is not disclosed.
MerckEngage:  MerckEngage is a password-secured online site where patients can obtain information about certain disease conditions, set health goals and monitor progress.  Personal information is protected and not shared without a member's permission.  MerckEngage is not a true social community as members cannot interact with each other.  However, a unique feature of the site is that it allows patients to connect with their physicians through the site, thereby facilitating cooperation and communication between patients and their physicians.  This is especially important since most patients, acccording to a survey by the Pew Internet and American Life Project, still turn to their physicians for information, care or support.

Drs. Pamela Hartzbrand and Jerome Groopman noted in a 2010 New England Journal of Medicine article, that the Internet offers patients unlimited amounts of information.  However, they also cautioned that "falsehoods are easily and rapidly propagated" as well.  To make the best use of the wealth of information available, patients and physicians should work together rather than independently to identify reputable and secure social communities to manage patient health most effectively and safely.

Do you have examples of online health communities that have successfully addressed privacy and credibility issues? 
(1)    Shrank, William, et al. "Variations in Structure and Content of Online Social Networks for Patients with Diabetes." Archives of Internal Medicine 26 September 2011: 1589-1591.

Tuesday, November 22, 2011

Occupy with Grace

This year I'm pleased to participate in the Engage with Grace blog rally. This post was written by Alexandra Drane and the Engage With Grace team. The goal of blog rally is to get people talking about end of life issues with family members while they are still healthy, when it is easier to think through these issues more rationally and carefully.  

"Once again, this Thanksgiving we are grateful to all the people who keep this mission alive day after day:  to ensure that each and every one of us understands, communicates, and has honored their end of life wishes.  

Seems almost more fitting than usual this year – the year of making change happen.  2011 gave us the Arab Spring – people on the ground using social media to organize a real political revolution. And now – love it or hate it – it’s the Occupy Wall Street movement that’s got people talking.  
Smart people (like our good friend Susannah Fox have made the point that unlike those political and economic movements, our mission isn’t an issue we need  to raise our fists about…it’s an issue we have the luxury of being able to hold hands about.   
It’s a mission that’s driven by all the personal stories we’ve heard of people who’ve seen their loved ones suffer unnecessarily at the end of their lives. 
It’s driven by that ripping-off-the-band-aid feeling of relief you get when you’ve finally broached the subject of end of life wishes with your family, free from the burden of just not knowing what they’d want for themselves, and knowing you could advocate for these wishes if your loved one weren’t able to speak up for themselves. 
And it’s driven by knowing that this is a conversation that needs to happen early, and often.  One of the greatest gifts you can give the ones you love is making sure you’re all on the same page.  In the words of the amazing Atul Gawande – you only die once!  Die the way you want. Make sure your loved ones get that same gift.   And there is a way to engage in this topic with grace…
Here are the five questions – read them, consider them, answer them (you can securely save your answers the Engage with Grace site, www.engagewithgrace.org), share your answers with your loved ones. It doesn’t matter what your answers are, it just matters that you know them for yourself, and for your loved ones.  And they for you.    

We all know the power of a group that decides to assemble. In fact, we recently spent an amazing couple days with the members of the Coalition to Transform Advanced Care  -- or C-TAC – working together to channel so much of the extraordinary work that organizations are already doing to improve the quality of care for  our country’s sickest and most vulnerable.
Noted journalist Eleanor Clift gave an amazing talk – finding a way to weave humor and joy into her telling of the story she shared in this Health Affairs article.  She elegantly sums up (as only she can) the reason that we have this blog rally ever y year:   
For too many physicians, that conversation is hard to have, and families, too, are reluctant to initiate a discussion about what Mom or Dad might want until they’re in a crisis, which isn’t the best time to make these kinds of decisions. Ideally, that conversation should begin at the kitchen table with family members, rather than in a doctor’s office.”
It’s a conversation you need to have wherever and whenever you can – and the more people you can rope into it, the better!!   Make this conversation a part of your Thanksgiving weekend – there will be a right moment – you just might not realize how right it was until you begin the conversation. 
This is a time to be inspired, informed…to tackle our challenges in real, substantive, and scalable ways. Participating in this blog rally is just one small – yet huge – way that we can each keep that fire burning in our bellies, long after the turkey dinner is gone.
Wishing you and yours a happy and healthy holiday season.  Let’s Engage with Grace together." 
To learn more please go to www.engagewithgrace.org.

Monday, November 14, 2011

Maps 2.0: Interacting with Our Health Care World

Maps do more than characterize our physical world, they also help us visualize information contained within it.   Thematic mapping has been applied to many types of information, including health data.  One of the earliest and best known examples of health data mapping was done by Dr. John Snow in 1854.  Snow was able to identify the source of a deadly cholera outbreak by marking the location of victims on a London street map. (1)
Health maps enter the 2.0 era
Maps today are more than static depictions of information.  The integration of cartography with information technology has resulted in the creation of maps which are dynamic and interactive, allowing users to manipulate, analyze and manage geographically referenced data.  These advanced mapping systems are known as geographic information systems (GIS).
In health care, GIS-based maps are being used to better understand a variety of issues including:
  • Tracking the outbreak and distribution of disease
  • Characterizing environmental factors that can impact health
  • Visualizing the distribution and availability of health care resources

Visualizing problems, finding solutions

With over one million visits a year, HealthMap is one of the best known and most widely used health maps.  Created in 2006, HealthMap is produced by a team of researchers, epidemiologists and software developers at Children's Hospital Boston.   HealthMap collects information about disease outbreaks from various online sources including news aggregators, eyewitness reports, online discussions and public health reports.  The goal is to produce a comprehensive, real time map that allows early detection of global public health threats.   According to its website, HealthMap identified and tracked H1N1 cases well in advance of traditional reporting methods in the spring of 2009.  Currently HealthMap is tracking an average of 1000 events per day.

In May 2011, the Economic Research Service (ERS), a branch of the US Department of Agriculture (USDA), introduced the Food Desert Locator.  This interactive tool is designed to help policy makers and other public health professionals identify the location of food deserts so that they can effectively focus their efforts on expanding access to healthy foods. The ERS also produces the Food Environment Atlas, a mapping tool introduced in 2010, which provides geographic depictions of data on food choices, indicators of health and well being and community characteristics. 

The newly created Mobile Health Map depicts the 2000+ mobile health clinics operating across the US.  The goal of the project is to build support for such services by  demonstrating their cost-effectiveness in providing health services.   This map is being used as a data collection tool.  Mobile clinics are encouraged to enter information about their services and costs. 

More recently, social media has been incorporated into health mapping.  In October, 2011, Marcel Salathe, an assistant professor of biology at Penn State University, found evidence that sentiments about H1N1 vaccination among Twitter users were positively correlated with vaccination rates by geographic area.  Salathe concluded that negative sentiments may lead to geographic clusters of unprotected individuals, increasing the likelihood of disease outbreaks.  This information could potentially be used by public health officials to intensify educational campaigns in at risk geographic areas.  
Finally, health maps aren't just for public health professionals.  A new mapping service called Walk Score helps apartment hunters identify walkable neighborhoods as a means to promote better health.  
There’s an app for that
Using GIS enabled mapping doesn’t require a major investment in information technology.  Vertices  has developed a proprietary application called Mappler.com which enables community organizations to create interactive maps without specialized knowledge of GIS.  Examples of health related maps can be found on their website.
What health data would you like to see mapped?  

(1) Aschengrau, Ann and George R Seage III. Essentials of Epidemiology in Public Health. Sudbury: Jones and Bartlett, 2008.

Thursday, November 3, 2011

Is an Ounce of Prevention Worth a Pound of Cure?

True or false:   
Earlier disease diagnosis leads to more effective treatment and better outcomes.  
Most of us wouldn’t hesitate in responding true and yet maybe we should.  Early diagnosis can carry risks as well as benefits.   During the Bicknell Lectureship in Public Health at the BU School of Public Health, Dr. H.Gilbert Welch, a professor of medicine, practicing clinician and director of the Center for Medicine and Media at the Dartmouth Institute for Health Policy and Clinical Practice, was joined by a panel of health care professionals to discuss whether we need to reevaluate the value of diagnostic screening.
How early is too early?  
Today, Dr. Welch noted, patients are often diagnosed long before they become symptomatic.  Fueled by improvements in test sensitivity and the availability of new therapies, the diagnostic threshold for many diseases has been lowered, increasing the number of people who are classified as needing treatment. The problem with early diagnosis is that there may be a significant number of these “patients” who may not actually develop health problems. For this group significant harm can result from unnecessary treatment.  These patients, according to Dr. Welch, are overdiagnosed.  
The popularity paradox  
Many of us can probably point to a friend or family member whose life has been saved by early diagnosis and intervention. However, survivor stories, focusing only on benefits, can lead to a popularity paradox, making screening appear more valuable according to Dr. Welch.  He pointed out that it’s also important to look at screening value from a global perspective. Epidemiologists have suggested that even if a screening test correctly identifies people with preclinical disease, its effectiveness is measured by its ability to reduce disease related morbidity and mortality. (1) Yet, according to data presented by Dr. Welch, the increased incidence of many diseases, such as thyroid cancer, has been associated with stable death rates. We may be suffering from a diagnosis epidemic not a disease related one. 
In October 2011 the US Preventive Services Task Force (USPSTF) proposed new  recommendations on PSA screening,  advising against its use in healthy men.   Prostate cancer screening is often cited as a prime example of the problems associated with overdiagnosis.  Writing in the New England Journal of Medicine, Richard Ablin, developer of the prostate specific antigen test (PSA), noted that several studies have found prostate screening did not reduce the death rate in men over the long term.  Ablin urged the medical community to rethink the use of PSA screening to “rescue millions of men from unnecessary, debilitating treatments.”  Putting this in perspective, Dr. Welch presented data on prostate cancer that found for every life due to screening, 30 to 100 patients are overdiagnosed.   
It’s about better care, not denying care
Dr. Kenneth Lin, a practicing clinician, Assistant Professor of Clinical Family Medicine at Georgetown University School of Medicine and former medical officer for the USPSTF, echoed Dr. Welch. He emphasized that individual patients and emotional experience cannot be discounted in formulating screening recommendations; however, this must be countered with evidence that people can experience harm from overdiagnosis.  It’s about striking a balance, he said, between science and emotion.  
Dr. Deborah Bowen, Chair of the Department of Community Health Sciences at the Boston University School of Public Health, spoke about genetic screening tests.  She observed that patients may have difficulty understanding what genetic test results, such “at risk”, mean.   She cited numerous studies which have shown that patient misunderstanding can lead to anxiety, decreased quality of life, false assurance and poor choices.   In these cases, she concluded, screening can create more harm than good.  
Dr. John Fallon, Senior Vice President and Chief Physician Executive at Blue Cross Blue Shield of Massachusetts, explained that employers want to be fair in determining what screening tests to cover but they also want to see evidence that screening has value.   Furthermore, he emphasized that we need to have the courage to change course when scientific data suggests clinical practices are not helpful. 
Time to shift priorities?
Dr. Welch and the panelists agreed that more thoughtful consideration of the risks and benefits of screening is essential to providing better care for individual patients.  As Dr. Welch noted, it’s important to tell both sides of the story. He added that we may also need to rethink our health care priorities, focusing more on health promotion versus early diagnosis. Early diagnosis focuses on looking more closely for health problems, while health promotion focuses on good preventive maintenance:  eating healthier foods, exercising regularly, using alcohol in moderation and smoking cessation. 

In other words, "is an ounce of health promotion worth a pound of cure?"
You can read more about overdiagnosis in Dr. Welch's book, Overdiagnosed: Making People Sick in the Pursuit of Health.  Profits from the book are donated to charity. 
(1) Aschengrau, Ann and George R Seage III. Essentials of Epidemiology in Public Health. Sudbury: Jones and Bartlett, 2008.

Tuesday, September 27, 2011

Best Practices During Product Recalls Include Social Media

Product recalls represent one of the most challenging public relations issues faced by health care firms.  According to the FDA, Class I product recalls, the most serious level, can cause significant health problems or even death.  In 2011 there have been 37 drug recalls to date; most of these have been Class I recalls, requiring significant publicity.  While no firm can be completely prepared for such unexpected events, some firms have managed these communication challenges more skillfully than others.

In September 2011 the Marketing and Communications Committee of the Massachusetts Biotechnology Council convened a group of media and public relations professionals, along with industry representatives, to discuss best practices during a product recall.  The role of social media in crisis management was also explored.

The panel, moderated by Lisa Adler, VP Corporate Communications at Millennium included the following participants:

  • Arlene Weintraub, NYC Bureau Chief, Xconomy
  • Adam Feuerstein, Senior Columnist,  thestreet.com
  • Rob Weisman, Business and Technology Writer, The Boston Globe
  • Manisha Pai, Associate Director, Corporate Communications, Millennium
  • Todd Ringler, Managing Director Media Relations, Edelman Public Relations
  • David Albaugh, Senior Manager Public Relations, Millennium 

    Three simple rules
    Adler opened the discussion by offering  three simple rules that firms should follow during a product recall:
    • Communicate and update
    • Be transparent and accessible
    • Provide a method for customers to communicate and ask questions
    Todd Ringler added that high profile product recalls in health care have changed the way they are managed.  He observed that firms have become more willing to communicate proactively, motivated by both internal and external stakeholders. 

    Start by taking action
    According to Ringler, firms that successfully manage crises such as product recalls are very good at quickly understanding what went wrong and initiating corrective action before communicating to the outside.   He advised that explaining what happened and what's being done should be central to a firm's communications message. 

    David Albaugh recommended that a firm’s crisis management team include members that have responsibility for both internal and external audiences.  He emphasized that the team also needs to include people who can take action within the company, such as a manufacturing representative who has the authority to stop production if necessary.   This is critical in allowing firms to address the issue of what they’re doing to correct the situation.  Albaugh also advised that communication across audiences be consistent.   In addition to the media, he suggested that relevant audiences should include patient advocacy groups and FDA. 

    Rob Weisman observed that companies do best when they are open and transparent.  He recommended taking the time to educate reporters on the background of a case so they can put the problem in context.  He recounted his experience reporting contamination in a biologic manufacturing plant at Genzyme.  Genzyme helped him understand what they were doing by giving him a tour of the plant and explaining the manufacturing process in detail.   He found this especially helpful since he had limited knowledge about the challenges of manufacturing biologic products before the crisis.

    Using social media during a product recall
    During a product recall Lisa Adler noted that there is a need to communicate with many audiences utilizing a number of methods.  Social media is one of these methods.  Rob Weisman and Adam Feuerstein observed that tools like Twitter can be very useful as an alert mechanism.  Manisha Pai concurred, adding that social media can help companies quickly create a link to more detailed information.  David Albaugh pointed out that social media can help firms learn about potential problems more quickly by subscribing to FDA alerts (via Twitter or RSS).

    In addition to giving firms an opportunity to proactively communicate, Todd Ringler observed that social media is especially useful in providing ongoing information which doesn’t need to be formally communicated.  It’s also valuable when product recalls affect a small number of patients.  Finally, he noted that social media allows firms to monitor what the market is saying about them or how patient advocacy groups are reacting.

    Break the story before it breaks you

    Both Todd Ringler and Arlene Weintraub agreed that giving reporters a heads up prior to communicating with the public is tremendously helpful in building trust and credibility among the media.  This is especially critical during a product recall.  Ringler agreed, emphasizing that this strategy has always been effective for his clients.   

    In closing,  David Albaugh emphasized that putting the patient first is the best strategy for protecting the public's safety and preserving a firm’s reputation. 

    Tuesday, August 23, 2011

    Earthquake Underscores Value of Social Media During Emergencies

    Talk about timing! On August 22, 2011 the US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (ASPR), issued a press release about its contest for software developers to design Facebook applications which would help people communicate with friends and family after an emergency or disaster. If the $10,000 first prize didn’t grab the attention of the software community maybe the 5.8 magnitude earthquake, which struck in Virginia just one day later, will. The earthquake also underscores the value of social media in such situations.

    First, social media is an efficient broadcast mechanism, quickly alerting people to what is happening. Within minutes of the earthquake my Twitter stream was buzzing with reports of the quake from people located up and down the East Coast. Looking at my Facebook page I also saw numerous comments about the quake shortly after it occurred.
    Social media is also a more reliable communication channel. During disasters cell phone lines can easily become overwhelmed with traffic, rendering them useless. The August 23 earthquake was no exception. When I tried calling my son in New Jersey I was unable to get through to his cell phone. I was not alone. Several cell phone carriers reported disruptions in service due to heavy call volume.

    With the average American spending more time on social networks, it makes sense to use these channels to communicate in emergency situations. Nielsen reported that Americans spend nearly a quarter of their online time using social networks and blogs. And the Pew Internet and American Life Project reported that 52% of Facebook users and 33% of Twitter users engage with the platform daily.

    ASPR deserves praise for recognizing the value of social media in emergencies AND for making the development of a Facebook app a top priority. As the HHS press release notes, the first place winner will work with the government and Facebook to create an operational application within weeks of selection. I hope ASPR will expand its initiative to include other social media platforms such as Twitter too.  Unfortunately these apps won't be available by the time the next disaster strikes the East Coast:  the impending arrival of Hurricane Irene

    Monday, August 22, 2011

    Is Your Organization Making the Most of Twitter?

    Twitter can help organizations broaden their communications reach, share knowledge, develop relationships, grow their networks and gain visibility.  But realizing Twitter’s full potential involves more than just tweeting, retweeting and following.  Tools like tweet chats and twitterviews can be used by organizations of all sizes to maximize their impact on Twitter. 
    Fostering engagement, keeping the conversation alive
    At the CDC’s National Conference on Health Communication, Marketing and Media in August 2011, representatives from the Office of Disease Prevention and Health Promotion (ODPHP), Health Literacy Missouri (HLM) and the National Prevention Information Network (NPIN) discussed how they have used tweet chats to grow their following and increase audience engagement.  
    ODPHP:  A tweet chat held during Health Literacy Month, in October 2010, included one expert advisor and a panel of 11 key opinion leaders.  A total of 160 individuals participated in the chat which yielded 1000 tweets and 360 uses of the chat’s hashtag.  The chat also provided the impetus for ongoing discussion on the topic of health literacy.
    HLM: In October 2010, HLM hosted its first tweet chat which drew 100 participants and resulted in 500 tweets.  Since then HLM has hosted several successful tweet chats on a range of topics including Healthy People 2020, health reform, health literacy stories and how young people gather online health information.   Since it began hosting the chats HLM has increased its network by 1000.  According to the hashtag tool The Archivist there have been over 8,300 tweets which have used the #healthlit hashtag since October 2010.  
    NPIN:  For 2010 National HIV Testing Day NPIN held a tweet chat event that included representatives from 99 state and local health departments, community-based organizations and activists/influencers.  Over 1000 tweets, representing 145 Twitter accounts, were tracked using the event hashtag (#NHTD).  NPIN’s Twitter following increased by 10% during the week of the event.
    The four Ps of tweet chats:  plan, prepare, promote, publish
    The panelists  suggested the following tips to successfully host a tweet chat:
    • Participate in existing tweet chats to understand and get comfortable with the format.  Click here for a description and schedule of health care tweetchats compiled by the Fox Group.  A recent blog post by social media coach Jane Fouts offers helpful advice on how to participate in a tweet chat. 
    • Choosing a topic for your chat is crucial.  Find out what your audience is talking about by identifying, following and analyzing popular hashtags.  (Click here to view a list of health care hashtags, also compiled by the Fox Group.)  
    • Know your goals:  Determine what you are trying to accomplish, identify your target audience, understand what issues need to be a part of the conversation and why this topic is important to your audience, determine the main message you want people to remember.
    • Assemble a team to manage the chat and assign responsibilities.   The size of the team will depend on your organization’s resources and the expected attendance.
    Director:  oversees the overall operation of the chat; directs questions, watches the clock and makes decisions on how to respond to issues or questions that arise.

    Moderator: responsible for sending out pre-written tweets and keeping the conversation moving along. 
    Monitor: keeps track of questions asked by participants and directs them to appropriate respondent.  More than one monitor may be needed.
    Responder: answers participants’ questions.  Depending on the number of topics and participants, multiple responders may be needed.   Try to anticipate questions and prepare responses ahead of time. 
    • Use tools like TweetChat to help manage the actual event and monitor the conversation.
    • Make your event timely by choosing a topic that people are actively talking about or plan your chat to coincide with national events.
    • Start promoting well in advance of your chat date.
    • Identify a panel of influencers who are leading conversations about your topic (both online and offline) and invite them to participate.   Hashtag tools like Topsy, Hashtracking and The Archivist can help you identify top Twitter users for specific hashtags
    • Make it easy for influencers and other supporters to promote your chat via their networks by offering them sample tweets.
    • Promote the chat via your own Twitter account and other communication channels such as e-newsletters, your blog or other networks.
    • Invite relevant organizations as well as individuals.
    • Summarize and archive the key points that came out of the chat including relevant resources related to the chat.   Distribute the summary to your audiences.  
    The panelists acknowledged that planning and preparing for tweet chats requires a significant time commitment; however, the results they shared were impressive, even for a single chat.   If you haven’t hosted a tweet chat you may be missing an opportunity to make the most of your Twitter account.

    Please consider retweeting this post or following me @jamierauscher.

    Thursday, July 28, 2011

    Who will Drive Social Media Use in Health Care? Part 3

    This is the last of a three part series examining how various groups will drive social media use in health care.  Part one considered the impact of physicians and part two discussed the role of the pharmaceutical industry.  This week’s post examines the evolving and growing role of the federal government, particularly the Department of Health and Human Services (HHS).    
    HHS has become an active participant in social media with its role extending well beyond regulation.  As the HHS Center for New Media observed, social media tools enhance the government’s ability to share information with stakeholders, increase public engagement and participation and improve collaboration within and across departments and agencies.  
    HHS: social media champion
    HHS created its Center for New Media to actively promote and support social media adoption throughout the department.  The site contains extensive information for HHS agencies on why social media is important, how to get started, what tools are available and policies governing social media use.  Agencies within HHS have responded enthusiastically.  As of July 2011 there are 96 Twitter accounts, 64 Facebook accounts, 32 blogs, 24 YouTube channels, 9 Flickr accounts and 41 podcasts.  These social media channels represent a wide range of agencies within the department, including the Centers for Disease Control and Prevention (CDC), the Food & Drug Administration (FDA), the National Cancer Institute (NCI), the Agency for Health care Research and Quality (AHRQ), the National Institutes of Health (NIH) and others.     
    Some agencies within the department, such as the CDC, have developed considerable social media expertise.  An excellent example of this expertise is the CDC’s publication, The Health Communicator’s Social Media Toolkit.   The CDC recently demonstrated its mastery of social media with the wildly popular Zombie Apocalypse post on its Public Health Matters blog.  The post, written as a way to get the public interested in disaster preparedness, was so popular it ended up crashing the CDC website.  To date there have been 341 comments on the post.
    Promoting education, engagement and collaboration
    As an authoritative source of health information, HHS is using social media to educate and engage patients and clinicians on a wide range of health issues.  The flu.gov campaign is an outstanding example of how the federal government has used social media campaign to communicate with and engage the public about seasonal flu vaccination.  In addition to providing information about the flu, HHS is also using crowd sourcing to create educational campaigns. The CDC’s Flu App Challenge recently awarded $35,000 to nine developers who created mobile and web apps, games and other tools designed to raise awareness and educate consumers about the flu.  In 2009 HHS sponsored a  video PSA contest on flu prevention.
    Another interesting example of social media use by HHS is the AHRQ’s Effective Care Program.  This site is designed to help both patients and clinicians determine the best treatment options for a variety of diseases.  Additionally, the AHRQ allows visitors to suggest topics for upcoming treatment guides. The AHRQ also encourages sharing and promotion of its clinical information.   It has created widgets which allow clinicians and other professionals to embed links to AHRQ reports within their websites or blog.  
    HHS is also using social media to foster collaboration and encourage innovation among scientists and industry leaders in the public and private sectors.   Through its Health Data Initiative, HHS, in collaboration with the Institute of Medicine, is expanding public access to its abundant health data.  Its stated goal is to “harness the power of data, technology and innovation to improve the health and welfare of the nation.”   HHS has used social media tools, including a blog and Twitter account to promote awareness about the initiative.  In June 2011 it sponsored the 2nd Annual Health Data Initiative.  The event, attended by members of the scientific and business community, was streamed and tweeted live (#healthapps). 
    Promising signs
    Finally, HHS is using social media tools to communicate directly with external audiences.  On July 19, 2011 the FDA released  its proposed regulation of mobile medical apps.  That same day the FDA hosted a Twitter chat to answer questions related to the proposed regulation.  As noted on the Wego Health Blog, the use of a Twitter chat seems ironic given the FDA’s delay in issuing guidance on social media regulations for health care companies.  Still, it is encouraging to see the FDA actively participating in social media, a medium which it will be monitoring and regulating.  

    At a time when the US faces rising health care expenditures and numerous public health challenges, the widespread adoption of social media by HHS is an unexpected bright spot in the health care landscape.  

    Sunday, July 17, 2011

    Who will Drive Social Media Use in Health Care? Part 2

    This is the second of a three part series examining how various groups will drive social media use in health care.  Part one considered the impact of physicians.  This week, I examine the evolving role of the pharmaceutical industry.   Though pharmaceutical companies have been slow to embrace social media, their usage will accelerate as a result of increasing clarity in regulatory guidance, industry advocacy, the growing influence of online health information and changes in pharmaceutical marketing tactics.

    Lagging regulatory guidance, growing industry advocacy

    Pharma’s lag in the adoption of social media has been due largely to a lack of guidance from the FDA.   In November 2009 the FDA hosted a public hearing on social media use by pharma; however, it has delayed issuing final guidance several times.  Most notably, the FDA just dropped social media from its 2011 guidance agenda.  Despite the delays, Tom Abrams, director of FDA’s Division of Drug Marketing, Advertising & Communications (DDMAC), maintains that publishing guidelines is the highest priority. 

    In the absence of FDA guidance some firms are creating their own policies.  In August 2010 Roche disclosed its social media principles.  AstraZeneca followed in December 2010 with the publication of a white paper outlining its guidelines for social media use by the pharmaceutical industry.  More recently, in May 2011, medical blogger Dr. Bertalan Mesko launched the Open Access Social Media Guide for Pharma.  The goal of the project is to allow collaborative creation of guidelines that pharmaceutical companies can use to develop and refine their own policies.  Lack of FDA guidance may have slowed adoption of social media by pharmaceutical companies but it has not halted it. 

    Social communities as a source of health information

    According to the Pew Internet and American Life Project, patients are turning to online social communities for information on illnesses and therapy.  As noted in the blog eyeonfda,  if pharmaceutical companies do not participate in this space they will be allowing their brands to be shaped by outside forces.  The use of branded social communities, executed responsibly, can be a win-win situation:  social communities can provide patients with credible medical information about managing their health and pharmaceutical companies can build valuable relationships with patients; however, this potential has not been realized.  Many firms do not currently allow unmoderated patient comments in their social communities due to regulatory and liability concerns.

    In August 2011 pharmaceutical firms will be forced to address the issue of community moderation.  Effective August 15, Facebook will require that unmoderated comments be allowed on all company pages, including those maintained by pharmaceutical firms.   Some predict pharmaceutical firms will abandon Facebook; however, there are signs that others will stay. Janssen already allows patient comments without pre-screening on its Psoriasis 360 Facebook page.  In July 2011, at the Social Communications & Healthcare Conference in New York, Ray Kerins, VP, Worldwide Communications for Pfizer, commented that Pfizer is planning to maintain its Facebook presence and has developed a plan to deal with the new Facebook policies. While the August 2011 deadline only pertains to Facebook, it will certainly shape the industry's use of all social platforms. 

    Beyond patient engagement, the pharmaceutical industry may also turn to social media as a way to connect patients to clinical trials.  A recent white paper by Blue Chip Patient Recruitment addresses the use of social media in this area.  Recently, Pfizer announced it will use social media to engage patients during an upcoming clinical trial. 

    Changes in promotional tactics

    Pharmaceutical firms will expand their use of social media to communicate with physicians in response to marketing challenges.  Physicians are becoming more difficult to see and the number of pharmaceutical sales representatives has declined over the past decade.  Closed social communities offer pharmaceutical firms an alternative way to communicate with physicians.   Some firms have engaged with physicians indirectly, such as Pfizer’s collaboration with Sermo.  Other firms are establishing their own communities.  Consider iPractice by Sanofi-Aventis.  According to the site: “iPractice was created by Sanofi-Aventis U.S. exclusively for doctors.  It’s a hub of resources, tools and product support and information designed to help alleviate the burdens associated with running a practice.”   With this site Sanofi-Aventis has combined both product promotion and value added services in a secure physician community.  Of course, full access to the site requires physicians to register by providing information which will presumably be used by Sanofi-Aventis to target promotional activities. 

    Today’s modest use of social media by members of the pharmaceutical industry hints at its huge growth potential.  As clearer guidelines emerge we should see realization of this potential. 

    In part three of this series I’ll consider the role of the federal government in driving social media use in health care. 

    Thursday, June 30, 2011

    Who will Drive Social Media Use in Health Care? Part 1

    In his blog post titled Social Media in Health Care:  Barriers and Future Trends, author John Sharp notes that social media has invaded health care from at least three fronts:  startups, patient communities and medical centers. These three groups will continue to drive and expand the use of social media in health care over the next five years.  However, I believe other three other groups will also exert influence and expand use: physicians, pharmaceutical and medical device manufacturers, and the federal government. Over the next three weeks, I'll examine the impact of each of these groups on the future of health care social media.

    This week I consider the evolving influence of physicians.  Physicians have not been active in social media for several reasons:  lack of clarity on appropriate use of social media, slow adoption of information technology, and payment schedules that don't reimburse for patient conversations.   These factors are becoming less of a deterrent to the use of social media by physicians.

    Crystallizing professional guidance

    Major organizations such as the American Medical Association are issuing guidelines to help clarify the appropriate use of social media by physicians. Influential physicians who are active in social media, such as blogger Dr. Kevin Pho of KevinMD and Val Jones of Better Health, also provide useful guidance and lead by example. The newly established Mayo Center for Social Media also explores the appropriate use of social media by health care professionals in its blog series titled Friday Faux Pas and in its video project, The Doctor is Online: Physician Use, Responsibility, and Opportunity in the Time of Social Media.

    Impact of telehealth

    The American Telehealth Association (ATA) defines telehealth as "remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth."   According to a survey of 2000 US physicians, 7% use online video conferencing to communicate with patients.

    Use of telehealth technology is expected to grow because it provides a way to improve physician productivity and enhance the quality of care. A recent study by Kaiser Permanente found that among 35,423 patients with chronic health conditions, those that used email to communicate with their doctors saw a statistically significant improvement in health effectiveness measures.   Dr. Ron Dixon, Director of the Virtual Practice Project at Massachusetts General Hospital, also noted that information technology offers the ability to improve coordination of care among various providers.

    Expanded reimbursement

    A nationwide phone survey of 72 programs offering telehealth services by AMD Global Telemedicine, supplier of telemedicine technology found that more than half are currently receiving reimbursement from private payers. Private payers currently reimburse for telehealth programs in at least 25 states.   According to the survey over 100 private payers currently reimburse for telemedicine services. 

    A survey conducted by the Center for Telehealth & eHealth Law found that 39 states have some reimbursement for telehealth services, though the extent of coverage depends on many factors.  Similarly, the Centers for Medicare and Medicaid Services (CMS) also provides limited coverage for telehealth services. Recently, however,  the ATA sent a letter to CMS Administrator Dr. Donald M. Berwick, asking the U.S. Department of Health and Human Services, of which CMS is a part, to  waive restrictions for telehealth services under Medicare Parts A and B.

    Social media safe havens

    Additionally, the increasing popularity of secure “communities” where physicians can exchange clinical information will hasten adoption of information technology.  Since its launch in 2006, 20% of all US physicians have become members of Sermo, an online community where practicing physicians discuss clinical issues and practice management.  Doximity is another private network for physicians and other medical professionals.

    The rise of e-patients

    The emergence of e-patients, patients who are engaged, empowered and active online, will also encourage physicians to use social media.   The Pew Internet and American Life Project found:
    • 80% of internet users (or 59% of adults) have looked online for health information
    • 34% of internet users  (or 25% of adults) have read someone else’s comments about health or medical issues in an online news group, website, or blog.
    If physicians are to remain a relevant source of medical information for patients, they will need to establish their presence online as well as offline.  

    Next week I'll look consider the factors influencing increased social media use by pharmaceutical and medical device manufacturers.

    Wednesday, June 22, 2011

    Who's Responsible for Childhood Obesity?

    The San Francisco City Council recently banned toys in children’s fast food meals but the ban won’t fix the problem of childhood obesity because it doesn’t address its root causes. Childhood obesity, like adult obesity, is the result of numerous factors converging to create the perfect public health storm.

    Children are moving less

    Children spend more time engaging in sedentary activities such as playing video games or spending time online.  This is compounded by the fact that physical education programs and recess have been cut from many school programs.  Yet numerous studies have shown that physical activity has a positive impact on the academic performance of children. 

    Children are eating fewer home cooked meals

    Frequent family meals have been shown to increase fruit and vegetable consumption and reduce consumption of sugar sweetened beverages.  (1)  Yet away from home foods have been associated with foods that are less nutritious (higher in fat, lower in fiber) and have larger portion sizes.  (2)  Despite the unfavorable nutrition profile of away from home foods expenditures on these types of foods has been increasing.  Nearly half of families have reported consuming restaurant food at least once weekly.  (3)   Furthermore, the amount of time spent preparing food among US households has decreased for two reasons:  less time available for food preparation and lower time costs of food preparation.  The Economic Research Service report  Who has Time to Cook found that the amount of time spent preparing food decreased as the number of hours worked increased.

    What are the implications?

    Childhood obesity can be especially costly since it can lead to serious health conditions that have a lasting impact.  Children who are overweight and obese are at increased risk for hypercholesteremia, dyslipidemia, hypertension, insulin resistance, impaired glucose tolerance, Type 2 diabetes and depression.  The likelihood that these health conditions persist is quite high since the probability of childhood obesity continuing through adulthood increases from 20% at age 4 to 80% in adolescence.  (4)

    The solution to childhood obesity will require the efforts of multiple stakeholders:  schools need to serve better food and make physical activity a part of the daily curriculum, parents need to take the time to choose foods more carefully and make family meals a priority, even employers have a vested interest since the children of employees are covered by employer sponsored health plans.  Finally the government, at state, local and federal levels, needs to continue to educate the public through programs such as Let’s Move and create incentives that encourage schools to serve healthy foods. 

    Who’s responsible for addressing childhood obesity?   

    The answer is easy:  everyone.  The solution is not.

    (1) Fulkerson, Jayne et. al. “Family meals:  perceptions of benefits and challenges among parents of 8-10 year old children.” Journal of the American Dietetic Association (April 2008): 706-709. 
    (2) Greenwood, Jessica and Stanford, Joseph.  “Preventing or Improving Obesity by Addressing Specific Eating Patterns.”  Journal of American Board of Family Medicine ( March-April 2008): 135-140.
    (3) Ayala, Guadalupe et. al.  “Away from home food intake and risk for obesity:  examining the influence of  context.” Obesity (December 2008): 1002-1008. 
    (4) American Academy of Pediatrics, “Prevention of Pediatric Overweight and Obesity,” Pediatrics (August 2003):  424-430.