There’s a great scene in the movie The Big Chill where the main characters are having a discussion on the topic of rationalizations. One individual comments that he doesn’t know anyone who could get through the day without two or three juicy rationalizations. That may be true. But when a rationalization involves taking things from the ofï¬ce or workplace, and that ofï¬ce just happens to be your medical practice, it becomes theft, no matter how you rationalize it. 

“It’s a prevalent issue,” says Jay Sattler, CPA with the ï¬ rm of Blum Shapiro (

), regarding the issue of fraud and theft in medical practices. “I would say it has become more prevalent over the last several years, and I would go so far as to say there’s a link between these types of matters and the state of the economy.” For some people, of course, this makes it easier to rationalize the disappearance of everything from ofï¬ ce supplies to medication samples. But it’s still theft. 

Timothy Dimoff, CPP, is the founder and president of SACS Consulting, Inc (

), a high-risk security consulting ï¬ rm. He agrees that the current state of the economy has produced an upswing in internal crime. The justiï¬ cations used by medical practice employees range from, “The doctor makes good money so she can afford it,” to, “I’m wearing two hats now that we’ve reduced staff, so if I take a few reams of paper, it’s no big deal.” 

But it is a big deal, says Dimoff. And it becomes an even bigger deal when pharmaceuticals become the target of choice. Employees see these medication samples left by pharmaceutical reps as “free,” so they justify it to themselves that they’re not really stealing. Everything from cold tablets on up is seen as fair game and brought home so staff don’t have to spend money to purchase these items. But this turns into an even bigger issue when staff pilfer potentially dangerous medications. 

“We have people working in [medical] ofï¬ ces who have addictions to drugs; addictions to painkillers and antidepressants,” Dimoff explains. “Why should they pay for the prescriptions when they can get samples for free? And some people who are hurting for money are stealing the pharmaceuticals and selling them.” 

So, how do you combat the problem? Dimoff suggests having a set, known process for every procedure at the practice. When pharmaceutical samples are dropped off, register them, and then any time a sample is removed and given to a patient, make certain it’s noted in a log. In other words, keep a tight inventory of all pharmaceutical products. “If there’s expected accountability, and you have a process in place, you decrease the opportunity for deviation tremendously,” Dimoff says. “But if it’s a free-for-all, people will look at the box in the corner ï¬ lled with samples as something they can have any time they want.” 

Sattler agrees, and suggests that a system of checks and balances should exist in all areas of a medical practice. For example, he says that the lack of segregation of duties is one of the biggest red ï¬‚ ag areas. When one worker has too much control, too much responsibility, there’s a greater probability that fraud and theft will take place. Mitigate that probability by cross-training employees. “When one person can spend some time during the year performing another person’s duties, you can avoid some of these issues,” says Sattler. 

Conducting thorough background checks prior to hiring staff is important, but that doesn’t mean you stop paying attention to your employees once they’re hired. Sattler explains that it’s important to watch for telltale signs, such as employees, or even physician colleagues, who may be experiencing ï¬ nancial difï¬ culties, living beyond their means, or exhibiting changes in lifestyle and behavior patterns. 

“It could be an ofï¬ ce manager who, for the last ï¬ ve years, has refused to take more than two vacation days in a row,” Sattler says. “That’s a huge red ï¬‚ ag. Theft or fraud is rarely ever done in conjunction with another person in the ofï¬ ce. So when you have someone who refuses to take something as simple as more than a couple of days of vacation in a row, that may be because that person needs to be in the ofï¬ ce to keep the theft or the transparency going so it isn’t detected.” 

Process, procedure, and accountability, says Dimoff, are critical to reducing the likelihood of fraud and theft. Fostering a culture where employees know what is expected of them will, in turn, prompt them to care about their work environment. 

Ed Rabinowitz is a veteran healthcare journalist based in Bangor, PA

Articles

Columns

There's a great scene in the movie The Big Chill where the main characters are having a discussion on the topic of rationalizations. One individual comments that he doesn't know anyone who could get through the day without two or three juicy rationalizations.

Financial Health Check Up: Corralling Theft in Medical Practices

, we will showcase a post by one of the HCPLive.com bloggers. This month, we have selected a post from the 

The Motorola Droid (http://tinyurl.com/ylj82kh) is the best smartphone option for Verizon Wireless customers. The Droid is the newest device from Motorola and the best effort from the Chicago-based company in years. The Droid runs Android 2.0 (also called “Eclair”), an advanced version of the Android operating system from Google. It is a major leap forward for the Android platform (http://tinyurl.com/ ylolpog) and truly is an enterprise-grade operating system that includes a bevy of new features: 

• Support for multiple Google and Exchange accounts 

• Third-party “sync adapters” that allow apps to tie in to the phone’s sync services 

• Quick contact menus for fast access to key information 

• Improved camera controls with white balance, macro, effects, and more 

• Improved keyboard layout, dictionary, and algorithm based on multi-touch support 

• Better graphics hardware acceleration 

A uniï¬ed inbox within Android will make managing multiple e-mail accounts less painful (http://tinyurl.com/ykryvpj). This is good news especially for those who use more than one Google or Exchange account. Now business users can load both their work and personal e-mail accounts onto the Motorola Droid and more easily interact with those accounts. 

Aside from the new platform, the device itself is extremely impressive. The Motorola Droid features EVDO Rev. A for super-fast 3G connectivity. GPS, Wi-Fi, Bluetooth 2.1+EDR, and USB 2.0 will help you stay connected. The whole thing is powered by a speedy 600MHz processor. 

The screen measures a generous 3.7 inches, with WVGA (480x854 pixels) resolution. If those ï¬ gures don’t mean much to you, let me say this: the display is absolutely beautiful; it’s one of the sharpest and most colorful displays on the market. The Droid packs a 5-megapixel camera with image stabilization, dual LED ï¬‚ash, and autofocus. It can capture DVD-quality video (720x480 pixels) at 24 frames per second. The phone comes with a 16GB microSD card. Support for the Android Market and its 10,000 apps is included, and it has a full QWERTY keyboard for typing messages. 

The combination of powerful software and good hardware makes the Motorola Droid one of the best smartphones available for physicians. 

Changing our focus now from hardware to software, if your practice uses smartphones that run on Microsoft software, I’d seriously recommend upgrading to the latest version of Windows Mobile 6.5. Your ï¬ngers will be glad you did. 

Did you ever notice how smartphones that run Windows Mobile 6.0 or 6.1 feel “old”? There’s a reason for that: Those versions of Microsoft’s mobile platform were born nearly a decade ago when the only way to interact with touch screens was via stylus. Now, new screen technology lets us poke at our phones with our ï¬ ngers. But Windows Mobile never really quite caught up to that trend and remained rooted in its old-school method of input—until now. 

Microsoft Windows Mobile 6.5 works with a slew of new devices from a number of different phone makers. The biggest improvement to the software is that it has been made much more ï¬ nger-friendly--interacting with the icons, menus, and applications on the screen is much easier and (almost) makes the stylus obsolete. More than ï¬ nger-friendliness, Windows Mobile 6.5 has also ï¬‚ attened out the folder architecture. This means it is easier to ï¬ nd what you’re looking for, as there are fewer layers to dig through to ï¬ nd applications, folders, settings, and ï¬ les. 

Another highlight is that Windows Mobile 6.5 supports the new Windows Marketplace for Mobile from Microsoft (

). What’s that, you ask? It is a new apps store that offers nearly 1,000 Windows Mobile applications for download, with more added every day. Some are free; some require payment. Available apps run the gamut from games and social media tools to business and productivity apps. 

The combination of new software and the growing Marketplace for Mobile makes Windows Mobile 6.5 a very enticing pick for physicians who want to use Microsoft smartphones in their practice. 

Eric Zeman is an editor and writer with more than 10 years’ experience in the publishing industry. He writes the MoBlog (Mobile Web Blog) at 

HCPLive.com Blog Spotlight - Is Motorola's Droid the  Best Bet for Docs?

The FDA public hearings on the use of the Internet and social media to promote FDA-regulated medical products drew hundreds of presenters and thousands of written comments. Although the FDA isn’t expected to issue formal rules or guidance until late next year at the earliest, the initial response among stakeholders has been positive. 

On November 12-13, the FDA held “a public hearing to provide an opportunity for broad public participation and comment on promotion of FDA-regulated medical products (including prescription drugs for humans and animals, prescription biologics, and medical devices) using the Internet and social media tools” (

). At this meeting, a variety of stakeholders—including consumers, patients, caregivers, healthcare professionals, patient groups, Internet vendors, advertising agencies, and pharma industry representatives&mdash;were allotted 10-15 minutes to offer comments and pose questions to help guide the FDA “in making policy decisions on the promotion of human and animal prescription drugs and biologics and medical devices using the Internet and social media tools.” Nearly 1,000 registrants had hoped to sit in on this meeting, but only 300 were granted access, leaving the rest of the world, 

 included, to follow along on Twitter. Among those who were able to speak at the FDA meetings were several names that should be familiar to 

 readers; each presenter is well known in the digital-marketing-meets-big-pharma-meets-social-media ï¬eld, and they all had great insights following the meeting in Washington, DC.

Fard Johnmar, founder of Envision Solutions 

What was the biggest surprise at the hearings? 

For anyone familiar with the pharmaceutical industry, getting key players to agree on anything is quite an accomplishment. Given this, perhaps the big- gest surprise of the hearing was that everyone—from agencies to consumer advocates&mdash;agreed on the importance of the Internet and social media for drug ï¬ rms, patients, and others. While they disagreed on how to address this issue, at least they were on the same page about the Internet’s importance. 

What were some of the best proposals regarding rules and regulations for pharma’s presence in the social media sector? 

I think there were many great suggestions, but the three that stood out for me were: 

• Google’s recommendation on how to incorporate fair balance informa- tion within sponsored text advertisements (

• Ogilvy’s “Three C’s” recommendation on how to address the issue of inï¬‚uence on online conversation (

• PhRMA’s recommendation on the development of an FDA seal of approval on online content. While I think this recommendation poses many, many problems—especially when it comes to veriï¬cation&mdash;a visual indication of quality online content backed by the FDA or another government agency would be tremendously helpful (

Where do you think the FDA will go from here? What do you think they should do? 

I think the FDA will take time to hear from a range of stakeholders about this issue. They will ultimately come up with guidelines—hopefully before the end of next year. However, people expecting comprehensive guidance from the FDA might be waiting in vain. The FDA may decide to bite off smaller parts of the regulatory pie in order to determine how advocates, policy makers, the industry, and others will respond to their evolving regulatory stance. I hope the FDA forms an outside advisory board that will provide them with diverse and informed perspectives on how the Internet is changing how people receive and consume health information. 

Director of Strategic Planning at Bridge Worldwide

Could you provide your initial feedback from these meetings, focusing on how the discussion and forthcoming regulations will impact physicians and their relationship with their patients? 

I’m not sure the meetings will immediately impact physicians. Certainly though, they should have heard loud and clear that people are turning to the Internet--in many cases before consulting with a physician--and are being inï¬‚ uenced by what they ï¬nd. Much of the information they ï¬nd is in the form of “social media,” with patients sharing their opinions with one another. But this isn’t new news. Physicians have seen this for years and regularly report that most patients arrive in their ofï¬ ces having done some sort of online research. Most welcome this, but it does make their job tougher, as they are required to spend more time explaining infor- mation that people ï¬ nd online. Eventually, should pharma companies increase their participation in social media, more people could come requesting speciï¬c medications or asking about symptoms they have that suggests a disease they heard about via a discussion that a pharma company was involved in. However, I don’t think that the overall volume will change much. As direct-to-consumer television ads are used less, perhaps the number of people coming in because of a commercial they saw will go down, but the number of people who see something online will go up. 

Physicians may need to take on a larger role as more companies begin to participate in social media, should new guidelines encourage it. I think a more proactive approach is important for physicians. Most people won’t make a ï¬ nal treatment decision without talking to their doctor. They’ll go 

Interested in ï¬nding more information on the FDA hearings? Go to 

 to ï¬nd all the presentations, Twitter discussions, and relevant articles and blog postings.

online and ï¬nd a mix of quality and questionable information. Some people sort this out for themselves, and others turn to their doctors to do this. In the end, it could save a lot of time and potentially dangerous situations if physicians proactively told their patients where to go online for more information. They know their patients are going to do it, so why not guide where they look and help point them toward highly credible sources? 

I’m not sure I’ve seen a ton of solutions to the lack of regulations at this point. One important thing to keep in mind is that a lack of regulations hasn’t stopped a huge number of healthcare companies from participating in social media already. I’ve been compiling a list for almost a year and have hundreds of examples (

). Remember that there isn’t a lack of guidelines altogether, there is a lack of social media guide- lines. The same promotional rules that the FDA has always had still apply. If these are followed, you can’t get into trouble. Keeping that in mind, you quickly realize that there is quite a bit that you can do in social media and still stay within current regulations. 

Wendy Blackburn, Executive Vice President of IntouchSolutions digital marketing 

With so many different outlets, it may be nearly impossible for the FDA to effectively regulate this space or rectify all of the misinformation. How can the FDA possibly monitor something as massive as social media? 

Tools and technologies exist today that would help monitor the social space to some degree. But it’s not realistic to expect the FDA (or pharma companies, for that matter) to be able to monitor every single social media channel and every conversation. I think the best anyone can expect is a “spot-check” approach, much like they do now for print, broadcast, Web, and other forms of advertising. They will catch some things, and others they won’t. 

What were the one or two key things that you learned from the public hearings? 

1) There are many passionate stakeholders in this debate, but unfortunately what we heard at the hearings was a rather one-sided view. We need to hear more from the consumer/patient perspective. 

2) The FDA is publicly recognizing the uniqueness and importance of the Internet as a whole, and of social media as an element of that. The hearing was a ï¬rst step. There will be many more discussions to come, and I hope it will be two-way conversation between the FDA and the industry. 

What do you believe might be the next steps the FDA will take, and how will their actions affect physicians? 

First, all stakeholders need to take the time to submit written comments to the FDA, and they have until the end of February to do so. The hearing was only two days of short presentations. The written comments have no space constraints and allow for detailed, data-driven testimonies. If physicians, patients, and companies have an opinion on these issues (and I expect most do), they need to be sure the FDA knows about it. The FDA will closely evaluate this information to form their recommendations. Do physicians want to continue to be able to talk freely with their peers about case studies, treatments, and care in social media settings, even if the information is off-label? Do they want to be able to have an open (documented) online dialogue with pharmaceutical companies? Do they a dialogue with patients, and within what parameters (eg, promotional, correction of misinformation, compliance help, customer service sup- port)? If they have an opinion, now is the time to speak up. 

Perhaps (and I hope they will) the FDA will form a committee that includes stakeholders to help work through the issues and formulate clear policies. Physicians need to be a part of this process. As for timing, I expect the FDA will issue guidance by end of 2010 or early 2011. 

Physicians need to be aware of how consumers search for and ï¬ nd information on the Internet. There is a lot of good information, but there is also a lot of misinformation out there. Physicians need to partner with their patients to ensure the “right” information is getting through, adverse events are being reported through the appropriate channels, and patients have access to all the information they need. 

How did you come up with the idea for the RxRISK logo, and what were some of the other proposed solutions?

 (See slides 21-29 of Blackburn’s presentation for more on RxRISK: 

My company, Intouch Solutions, has been doing online marketing for pharmaceutical companies for 11 years, so working within the constraints of this space is something we think a lot about. I was trying to come up with a solution that would potentially meet the needs of the four key enti- ties involved in pharma promotional marketing: 

1. The FDA needs to make sure consumers clearly understand the risks associated with any pharma product or medical device. Pharma products and medical devices are serious business, and companies need to be responsible in communicating risk information. 

2. Pharmaceutical companies need to be able to communicate both beneï¬ ts and risks, even in places where space is constrained (search ads, Twi ter, etc). They need to be able to get that information into the hands of patients who are looking for it. They need guidance from the FDA on a standard, consistent way to do that without getting a warning letter. 

3. Physicians need their patients to be informed, but they also need them to have all sides of the story. 

4. Patients need to be able to ï¬nd information about treatment and prod- ucts, when and where they are searching for that information. 

RxRISK seemed to meet these criteria with kind of an “in-your-face” approach to linking to risk information whenever a product is mentioned. And with the combination of the image and the link, I believe that it’s ï¬‚ exible enough to work for future Internet and social media platforms that haven’t yet been conceived. PhRMA proposed a similar solution using a logo that communicates that a product had been “FDA-approved.” The thinking behind that was to differentiate regulated, credible information with some of the more questionable information out there. Others proposed that FDA hire more social-media-savvy employees. And several people suggest FDA form a task force or committee to help develop and evaluate policies now and on an ongoing basis, which I think makes a lot of sense. 

Are there any additional resources you might point physicians toward?

Three are a couple of grassroots websites that are great resources for more in- formation on the FDA hearing and also serve as a gateway to related presenta- tions, blog posts, articles, and other resources. I’d recommend 

. If you’re on Twitter, you can follow the hashtag #fdasm for ongoing discussions. Finally, the FDA has a site (albeit static), featuring information and think it would be helpful or hurtful for pharmaceutical companies to have links on the topic at http://tinyurl.com/ yzobpqb, which includes instructions for submitting written comments.

Feature Articles

The FDA public hearings on the use of the Internet and social media to promote FDA-regulated medical products drew hundreds of presenters and thousands of written comments. Although the FDA isn't expected to issue formal rules or guidance until late next year at the earliest, the initial response among stakeholders has been positive.

Many Voices Are Speaking Up about Social  Media in Healthcare, but Is the FDA Listening?

On October 22, Microsoft released its new operating system, Windows 7. Coming off the debacle that was Vista, Microsoft has gone a long way toward correcting the errors of its ways to produce an operating system to replace its more popu- lar, but outdated Windows XP (released in 2001 when things like networking and security were not priorities). 

As Walt Mossberg, Technology Editor for the Wall Street Journal, describes, “Windows 7 is much more of an evolutionary than a revolutionary product” (

). Windows 7 gets rid of several of Vista’s fatal ï¬‚ aws (incompatibility, sluggishness, and annoying notiï¬ cations), while making signiï¬ cant improvements on XP in terms of ease of use and organization. In addition, there is clearly a WOW factor sufï¬ cient to make even your most Mac-centric colleagues somewhat jealous (though they probably still won’t admit it). For further details, please refer to the links included throughout this article. And now, the seven things you should know about Windows 7. 

Can I Upgrade My Current PC to Windows 7?

The hardware requirements (1GHz or faster 32- or 64-bit processor; 1GB RAM for 32-bit processor or 2GB for 64-bit; 16GB available hard disk space for 32-bit processor or 20GB for 64-bit; DirectX 9 graphics device with WDDM 1.0 or higher driver) are fairly trivial; most PCs purchased in the last ï¬ ve years will easily qualify. There are two important details to consider: 

If you have a 32-bit processor, you need to purchase the 32-bit version of Windows 7, whereas if you have a more powerful 64-bit processor, then you should purchase the 64-bit version. To ï¬ gure out the appropriate version, access the Control Panel on your computer, and under the System icon, you will ï¬ nd the desired information, as this screenshot of my ASUS eeePC netbook shows. I have been running a pre-release version of Windows 7 on a relatively underpowered netbook for about six months without any glitches. 

If you are currently running Vista, you can upgrade to the equivalent version of Windows 7 with a relatively uncomplicated “in place” update. This means all your ï¬ les, settings, and programs will be maintained without any painstaking backup and reinstall process. However, if your computer currently runs on Windows XP, you would require a “clean install,” which means that the hard drive has to be wiped completely clean before you install the new operating system. Fortunately, there is a program, PCmover Windows 7 Upgrade Advisor (

), which does all of the hard work for you and makes the process relatively painless. Refer to the WSJ article that reviews this process for further information (

). Check out the Microsoft site for more on compatability issues (

Cool Stuff You Can Do with Active Windows

With multiple open programs and open documents, the organization of your windows can be problematic. Windows 7 helps with the following features: 

Dragging a window to the right or left edge of the screen creates a half screen image of that window. This makes it easy to compare two documents side by side. 

Dragging the window up to the top of the screen activates “Snap,” which creates a full-screen version of that window. 

Shaking the title bar of a window makes all other active windows transparent so that you see only one window. Shaking again makes those windows visible again. 

Hovering the mouse over a small rectangle at the bottom right of the taskbar makes all windows trans- parent so that you see your desktop unencumbered. 

Keyboard shortcuts for these and other functions can be found at LifeHacker (

This is the strip along the bottom of the screen, which under XP and Vista shows small icons of active programs on the left and on the right shows icons of “applets” that get placed by third-party software companies. New features include: 

The ability to “pin” icons of programs to the Taskbar to launch those applications whenever desired. 

“Aero Peek” function: mousing over an icon will display a thumbnail of any open document from that program (including open pages from Internet Explorer) to help navigate to the desired document. Applets are well organized and manageable. 

Jump Lists Improve Upon the Task Bar Context Menu

These lists contain frequently used documents or common tasks performed with an application. 

These can be activated by either right-clicking on the icons in the taskbar or by left-clicking the icon and dragging upward. 

You can pin documents or websites to these jump lists to make their accessibility even easier. The Jump List for Internet Explorer includes the option for “InPrivate” browsing, which makes your surï¬ ng untraceable because no history of the websites that you visit is recorded. 

Libraries Are the New Paradigm for File and Document Storage

The system comes with four default “Libraries”: Music, Photos, Documents, and Videos. Right- clicking on any folder on the network allows you to send that folder to a Library. Therefore, similar ï¬ les on any device on a network (computer, external drive, server, etc) will all show up in the Library of any computer. New Libraries are easily created, making access to any document type anywhere on the network very simple (

Microsoft offers tons of free “eye candy,” putting the fun back into the computer (or something like that; 

While some familiar applications are not present (Outlook Express, photo organizing, and video editing), they may be downloaded for free. Several included applications have been noticeably improved: 

Calculator: including scientiï¬ c and statistics mode, as well as built-in templates for ï¬ guring out everyday math problems, such as mortgage payments. 

Word Pad now has the updated ribbon-style interface and can open Word 2007 documents. 

The backup and restore center has more robust features and options. 

The Windows 7 Media Center has the ability to play multimedia from networked computers. 

XP Mode can run any Windows 7 incompatible program in a virtualized mode (so people or businesses can conï¬ dently upgrade to Windows 7 knowing they can still run outdated programs; 

I would wholeheartedly agree with Walter Mossberg’s conclusion in the WSJ when he writes that “Bottom line: Windows 7 is a very good, versatile operating system that should help Microsoft bury the memory of Vista and make PC users happy” (

 Healthcare IT Advisory Board member, and Medical Information Ofï¬cer and the Chief of Neurology at Baton Rouge General Hospital in Baton Rouge, LA.

In the wake of the debacle that was Vista, all eyes have been on Microsoft and its eagerly awaited Windows 7. Does the new operating system correct Vista's fatal ï¬‚aws (incompatibility, sluggishness, and annoying notiï¬cations), while making signiï¬cant improvements on XP in terms of ease of use and organization? Read on to ï¬nd out.

Seven Things to Know  about Windows 7

2009 MAY VERY WELL BE LOOKED BACK ON as the year that social media ï¬ nally came into its own in healthcare. Compared to how things were a couple of years ago, the current level of penetration, acceptance, and utilization of social media tools of all stripes within healthcare is striking. Now, it seems that every physician not only has a blog, but also a Twitter account and a Facebook page. Forward-thinking innovators are constantly devising new social media tools, while power users conjure a steady stream of new, healthcare-speciï¬ c uses for existing platforms. The Health 2.0 Conference continues to attract recruits to the cause, growing in prestige and inï¬‚ uence every year (they’re even jetting off to Paris in 2010). The FDA convened a two-day public hearing on the use of social media in healthcare and pharmaceutical promotion that attracted hundreds of presenters and public comments. Even hospitals, not previously known as bastions of transparency, have jumped on the bandwagon, using blogs and Twitter accounts to open a dialogue with patients and the community. Here, we present summaries of some of the biggest stories and trends in healthcare social media from 2009. 

To Friend or Unfriend, that Is the Question 

“Friending,” “following,” or “connecting”--whatever you call it (and each social networking platform has its own jargon), it’s shorthand for a way for people to easily connect online, and it has clearly made its way into healthcare. For example, see this article on CNNhealth.com (

) that tells the story of a patient who ï¬ nds it easier to communicate with his physician via Facebook rather than by making repeated calls to the ofï¬ce. 

“Social media outlets, like Twitter and Facebook, allow doctors to strengthen relationships both with patients and their colleagues,” says Kevin Pho, MD, author of the HCPLive network blog KevinMD (

). “This is especially true now that a growing majority of patients consume health information on the Web.” However, “doctors need to be aware of certain potentially thorny issues, such as disseminating medical advice or violating patient privacy.” Further, doctors must also consider whether posting certain personal information on their Facebook account may conï¬‚ ict with their professional image. “If these pitfalls can be avoided, there is no reason why health professionals can’t embrace the potential advantages gained by engaging in social media,” adds Pho, who explains that keeping two separate accounts (one professional, one personal) may make sense for physicians. 

But that may not be enough, according to pediatrician blogger Bryan Vartabedian, MD (

), who says communication online with patients is fraught with potential risk. First, sharing privileged information requires written consent, and the laws are unclear on whether a patient-initiated conversation clearly implies consent. Plus, physicians are required to document all patient—physician communication, yet “the documentation on most social platforms isn’t detailed enough for other medical professionals or auditors to follow what’s gone on between you and your caregiver [and] let’s not forget that Twitter has a habit of disappearing after a couple of weeks,” wrote Vartabedian on his blog. He noted that privacy could be the biggest concern, as personal information shared via public sites like Twitter and Facebook could become indexed by search engines and thus become permanent ï¬ xtures online. 

“There’s tremendous potential for doctors to use Twitter and Facebook to interact with patients,” concluded Vartabedian, “by guiding patients to reputable sources of medical information, for instance. But social media isn’t mature enough for doctors to provide personal medical advice to patients.” 

Way back in January, the question/concern that was on everyone’s mind was, “Yeah Twitter seems great and all, but can you do anything useful with it in healthcare?” Phil Baumann, RN, provided an empathic answer when he posted on his blog a list of 140 healthcare uses for Twitter (

). Baumann wrote that “Twitter’s simplicity of functional design, speed of delivery and ability to connect two or more people around the world provides a powerful means of communication, idea-sharing and collaboration. There’s potency in the ability to burst out 140 characters, including a shortened URL. Could this power have any use in healthcare? After all, for example, doctors and nurses share medical information, often as short bursts of data (lab values, conditions, orders, etc).” Baumann conceded that Twitter has its constraints but said that they are far outweighed by its possibilities as a communications platform. 

We asked Baumann whether his thinking about Twitter had changed and whether he had observed any encouraging developments since writing the post. His excerpted comments appear below; check out the full interview at 

www.hcplive.com/ technology/articles/bauman_twitter

“2009 was a turning point for Twitter in healthcare. Hundreds of hospitals started tweeting. Barely any were tweeting at the end of 2008… Not all have kept up, but some have evolved their strategies and use Twitter as a staple in their day- to-day communications. I think 2009 represented a test-the-waters year for hospital adoption of Twitter. 2010 ought to be about maturing use of the service and broadening Web presence well beyond just Twitter. 

Since writing ‘140 Health Care Uses of Twitter,’ I’ve been very impressed with the spike in interest in using social technologies in healthcare. On Twitter alone, there’s a growing community of patients, doctors, nurses, healthcare marketers, and others who are passionate about bringing about changes in healthcare. In November, the FDA had its very ï¬ rst public hearing on social media (see page 24). I don’t have high expectations from this one hearing, but I would say the fact that they held it demonstrates that attention to social media in pharma and related industries is sorely needed. 

My prediction: 2010 is going to be a huge year in social media in general. We’ll start to get over the shiny-new-toy mentality and get into a more let’s- get-on-with-it approach. Healthcare will probably proceed much more cautiously than other industries, but I believe the continued and growing public discussions will help catalyze the revolution.” 

To Tweet or Not To Tweet: Why I Think Doctors Should Be on Twitter 

“Space... the Final Frontier. These are the voyages of the starship Enterprise. Its continuing mission: To explore strange new worlds, to seek out new life and new civilizations, to boldly go where no one has gone before.” 

If only Gene Roddenberry knew just how prophetic this opening Star Trek quote would become in our lives in the wake of the evolution of the Internet and social networking sites. Indeed, the drive to explore today’s social networking civilizations--even the ones we can’t quite yet grasp, such as Twitter--is powerful and a true mission for many people. Twitter’s growth has been mindboggling. It’s grown 1,382% in the past calendar year, boasting 14 million adult users, according to Nielson Online, and is projected to reach 18 million users by the end of 2010, according to eMarketer.com. Equally intriguing is that a true health communication niche has formed on the Twitter platform. The entire healthcare industry is represented on Twitter: physicians, nurses, therapists of every type, hospitals, large healthcare organizations, advocacy groups, and medical and health journalists, journals, papers, and magazines. 

As a physician, you can be involved on Twitter as either a follower or a participant. As a follower, Twitter will give you the latest health information quickly and efï¬ ciently. Major health news often breaks ï¬ rst on Twitter, so you’ll always be informed of key developments, via your computer or handheld. As a participant, you can keep the conversation ï¬‚ owing in the direction of facts and away from myths by tweeting the URLs of your blog posts and other useful resources or retweeting other’s tweets that you ï¬ nd interesting. 

Twitter is like a radio station where most people listen and occasionally call in. If nothing else, knowing the buzz will help you know what’s on your patients’ minds. So, tune in and consider participating. You’ll be helping not just your patients but the entire healthcare community. 

The deï¬nitive sign that the latest social media craze has reached critical mass and broken through into the public consciousness is when users are so infatuated with it that they organically form a supporting network of specialized search and organizational tools designed to enhance the user experience. True, Twitter itself has a search function (

) that works just ï¬ne, but there are so many other options available for the hardcore Tweeter. 

Want to search for trends and topics via #hashtag frequency? Go to 

. Want to search a real-time visualization of the Twitter thought stream? Then get thee to Twitscoop (

). You say timeliness isn’t your thing, and that you’re much more interested in search results organized by relevance? Then Tweeï¬ nd’s what you want (

). Use Topsy, “a search engine powered by tweets,” to ï¬ nd results based on how many times a post has been retweeted. Track trends in Twitter with Trendistic (

). Finally, if you want to search Twitter for links to sites that allow you to search Twitter, check out this page: 

The only social media tool that you hear more about than Twitter these days is probably Facebook. It’s like the way some people talk about baseball, but only focus on the Yankees and Red Sox—they forget that there are 30 other teams that warrant discussion (for the most part). Anyway, the point is that there are many social media applications that you should be using but probably aren’t even aware of because they’ve been obscured by all the hype over the big names. Here are a couple of MDNG faves that are well worth looking into: 

 — This is a nifty little program that only takes a few minutes to set up and will provide you with endless resources and entertainment. After installing the add-on (Firefox users, go to 

), you’ll notice a new toolbar in your browser window. Follow the steps to ï¬ ll in some info about your interests, and then you’ll be able to “like” or “dislike” any website you “stumble upon.” Your vote will help direct those with similar interests to the pages you like, or help others avoid resources you disliked. You can even add a short review about the page should you feel so inclined. In addition, you can click the “Stumble” button at any time to be directed to a random Web page that should align with your interests. It’s a great way to ï¬ nd educational, health-related resources and video clips. 

) keeps its users abreast of the most popular stories in a variety of categories. Users can download a toolbar version of Digg which will allow them to click a button any time they are visiting a website or reading a story that they want to “Digg.” So what’s the difference? Well, StumbleUpon will randomly take you to websites that have been recommended, whereas Digg works mostly through a voting system. The stories and websites with the most votes get the most exposure. Digg has a user-friendly interface with a slightly better toolbar than StumbleUpon’s (it offers streaming radio stations, RSS feeds, and other cool features). 

) is a service that is similar to StumbleUpon and Digg. It has something of a cult following, but its interface is not user-friendly and is not for the social media novice. Check out StumbleUpon and Digg ï¬ rst before delving into the world of Reddit. 

Why do they do it? What prompts a hospital CEO to start a blog? Ask 10 different bloggers and you’ll likely get 10 different answers; however, the best hospital blogs share several common traits: openness, honesty, curiosity, and a commitment to fostering communication between the hospital and the community of patients, physicians, and other stakeholders that it serves. Sure, hospital blogs will never be the place for revealing every little secret about what’s going on behind the scenes, but they can be remarkably effective vehicles for getting the word out about new programs and initiatives at the hospital, placing news and announcements into context, and establishing a “voice” for disseminating information to the public. 

Blogs also offer a way for patients who have been treated at the hospital to talk about their experiences. The Sharing Mayo Clinic blog (

) not only provides a “virtual place” for Mayo patients and physicians to share their stories, it also acts as a hub that links to Mayo Clinic’s pages on other social networking sites. Recent posts detail the experiences of a patient who had a mechanical aortic valve installed at Mayo, explain the concept of “purposeful rounding,” and offer a glimpse into the day of a Mayo ï¬‚ight nurse. Other hospitals use their blogs as patient education forums, offering information and commentary on key health topics. One of the best examples of this type of blog is Thrive (

), the Children’s Hospital Boston’s health and science blog. 

Some of our favorite hospital blogs include Beth Israel Deaconess Medical Center President and CEO Paul Levy’s Running a Hospital (

), which also features a list of other blogs run by hospital and health system CEOs; Nick Jacobs’ Healing Hospitals (

http://takingthehelloutofhealthcare.com/blog

On November 12-13, the FDA held a public hearing to discuss the role of pharmaceutical advertising and communication in the world of social media. Over the past decade, social networking has exploded and has become a vital means of communication for millions of people. Most of the people you know are using social media, and they are using it all the time to discuss everything from medical conditions to the latest episode of 

For all its beneï¬ cial uses, social media also has the potential for harm. False or misleading information can quickly spread in the social media world, and the stakes are highest when it comes to medical information. For a long time, the FDA refrained from issuing rules and guidance that would have clariï¬ ed for pharma companies which uses of social media were permissible. Many of these companies responded by ignoring social media for as long as possible but eventually came to the same conclusion: they needed to catch up to their customers when it came social networking. Healthcare professionals and patients alike were talking about their products online, so it only made sense for pharma companies to join the discussion. However, due to the lack of regulations, many companies were hesitant in their approach, wondering whether they could brand their Twitter account or post patient videos to their YouTube channels. 

The FDA’s silence on this issue, despite its own forays into several social media channels (

), frustrated many marketers and companies. But ï¬ nally, the pressure for action became too great for the FDA to ignore. The Social Media hearings in Washington, DC were only the ï¬ rst step. The ball is ofï¬ cially in the FDA’s court now, and you can bank on regulations being instated in 2010. 

 to let us know if we missed anything big, and tell us what you think will be the key issues in healthcare social media in 2010. 

Cover Story

2009 may very well be looked back on as the year that social media Ã¯Â¬ï¿½nally came into its own in healthcare. Compared to how things were a couple years ago, the current level of penetration, acceptance, and utilization of social media tools of all stripes within healthcare is striking. Here, we present summaries of some of the biggest stories 
and trends in healthcare social media from 2009.

December 2009

Financial Health Check Up: Corralling Theft in Medical Practices

HCPLive.com Blog Spotlight - Is Motorola's Droid the Best Bet for Docs?

Many Voices Are Speaking Up about Social Media in Healthcare, but Is the FDA Listening?

Seven Things to Know about Windows 7

How Tweet it Is - A Look Back at the Year in Healthcare Social Media

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