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

2009 MAY VERY WELL BE LOOKED BACK ON as the year that social media fi 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-specifi c uses for existing platforms. The Health 2.0 Conference continues to attract recruits to the cause, growing in prestige and infl 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 (http://tinyurl.com/loonjc) that tells the story of a patient who fi nds it easier to communicate with his physician via Facebook rather than by making repeated calls to the office.

“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 (www.kevinmd.com). “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 confl 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 (http://tinyurl.com/yfotcb6), 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 fi 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.”

Baumann’s Call to Arms

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 (http://tinyurl.com/8tzwvz). 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 fi 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

By Gwenn S. O’Keeffe, MD

“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 effi ciently. Major health news often breaks fi 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 fl 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 fi 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.

Where's Waldo, Twitter-style

The definitive 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 (http://search.twitter.com) that works just fine, but there are so many other options available for the hardcore Tweeter.

Want to search for trends and topics via #hashtag frequency? Go to http://hashtags.org/tags. Want to search a real-time visualization of the Twitter thought stream? Then get thee to Twitscoop (www.twitscoop.com). You say timeliness isn’t your thing, and that you’re much more interested in search results organized by relevance? Then Tweefi nd’s what you want (www.tweefind.com). Use Topsy, “a search engine powered by tweets,” to fi nd results based on how many times a post has been retweeted. Track trends in Twitter with Trendistic (http://trendistic.com). Finally, if you want to search Twitter for links to sites that allow you to search Twitter, check out this page: http://twitter.com/search_ tools_4u.

More than just Twitter

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:

StumbleUpon — 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 http://tinyurl.com/yuc799; IE users, go to http://tinyurl.com/k9vrw), you’ll notice a new toolbar in your browser window. Follow the steps to fi 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 fi nd educational, health-related resources and video clips.

Digg — Similar to StumbleUpon, Digg (www.digg.com) 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).

Reddit (www.reddit.com) 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 fi rst before delving into the world of Reddit.

Trendspotting: Hospital Blogs

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 (http://sharing.mayoclinic.org) 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 flight 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 (http://childrenshospitalblog.org), 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 (http://runningahospital.blogspot.com), which also features a list of other blogs run by hospital and health system CEOs; Nick Jacobs’ Healing Hospitals (http://takingthehelloutofhealthcare.com/blog); and McLeod health (http://blog.mcleodhealth.org).

The FDA Gets Social

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 Top Chef.

For all its benefi 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 clarifi 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 (http://tinyurl.com/cod8c7), frustrated many marketers and companies. But fi nally, the pressure for action became too great for the FDA to ignore. The Social Media hearings in Washington, DC were only the fi rst step. The ball is offi cially in the FDA’s court now, and you can bank on regulations being instated in 2010.

E-mail ccole@mdng.com 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.