by: Mark Ryan, MD

[Ed. This is the second of a two part series by guest writer Dr. Mark Ryan*, who is interested in how social media can be used to promote patient empowerment, health and wellness. You can find part one here.]

Social media, internet tools that allow the many varieties of one-to-one and one-to-many conversations, has forever changed the landscape of the world wide web.

However, the astonishing rise of Facebook and Twitter will likely also change medicine. In this second post, I will discuss the strengths and weaknesses of the various social media tools available today and offer ways to reach varying audiences and pass along different types of information:

Blogs

The most “traditional” of social media tools in that a blog’s content often resembles an essay…something many of us have written in our lives. Blogs allow longer content, and can include pictures, videos, multiple links and reader comments. The major limits to blogs are:
1) the need to be updated regularly, something that can take longer with blogs than other social media tools
2) the social nature of the medium is often restricted to comments under the post.
Thus, blogs may not be the most “social” of media but they often serve as a “home base” to allow writers to develop thoughts in greater depth.

Facebook

Facebook pages allow individuals and organizations to share updates, links, and photos with a group of online friends, though there is less room to write than blogs would offer. Facebook also adds two other forms of interaction that are especially useful for organizations or collaborative groups: fan pages which make it possible to provide news and updates to a large number of people at one time, and to have active and public discussion about those updates and groups, which can be made public or private, can be used to enhance dialogue and discussion, and can be used to set up online chats among group members. When using Facebook for personal reasons, I recommend tight security settings and declining to accept friend requests from patients. The privacy and interaction settings for Pages and Groups can be set according to need.

Twitter

Twitter allows for very short messages (under 140 characters), with the default setting of these messages being public. An account’s Twitter updates (tweets) are visible to anyone who follows that account, and those followers can share (retweet) those updates to their network of followers. This allows information to be shared widely, and quickly. Tweets can be directed to a general audience, targeted at one person, or sent more privately. Tweets can also be tagged with a hashtag—the # sign, followed by a short phrase. For example #HCSM is the hashtag for healthcare communications and social media, #HCR is the hashtag for health care reform. Hashtags can be used to search Twitter to see what is being discussed regarding a certain topic, and can be used to organize “Twitter chats” in which specific topics are the focus of conversation at a pre-determined time. Tools such as TweetChat allow for live discussions, without needing any specialized equipment. For many physicians, I would recommend that they have a personal and a professional/practice Twitter account and use them for different purposes.

BlogTalkRadio and PodBean

These allow users to live-stream and/or record and upload audio podcasts that can be accessed at any time.

YouTube and UStream

These allow users to record videos and upload them directly from their computer. Recordings can be as long or short as desired (though often shorter is better) and can include discussions and/or demonstrations. This material is available at any time.

I do recommend some cautions when using social media…although I do not think we need to be scared. I think it is wise to be careful. The primary caution is to be aware of privacy—both patients’ and your own. Nothing online is truly private, and even direct messages might not be as secure as we would like.

It is also necessary to avoid practicing medicine through social media channels, even if patients approach us for help. Social media use is not a reimbursable service. Eventually, patient-centered medical home models of care and accountable care organizations might provide a financial return on social media use if they can be shown to improve patient outcomes. Until then, however, if you use it you are doing so because of the added value you feel it provides.

Finally, there are no established “best practices” or agreed-upon guidelines for social media use and so anyone using these tools is doing so at something of a cutting edge…but is also helping define the tools’ uses in the future.

I think that social media communication tools will continue to impact how doctors and patients communicate with each other. We are early in the process of determining the best use. I believe health care providers need to be engaged in the process because social media will become increasingly important as patients are already looking to these channels to improve their health. At some point, asking “what is the ROI” will stop meaning what is the “Return on Investment”, and become what is the “Risk of Ignoring”?

* Dr. Mark Ryan works at the Department of Family Medicine, Virginia Commonwealth University Medical Center and is also a member of the Mayo Clinic Center for Social Media Advisory Board. He has spent his career working in rural and urban medically under-served communities in Virginia and on medical student teaching. He is an active participant in the #hcsm and #MDchat Twitter chats where you can follow him as @RichmondDoc, and is a contributor to the Social Media Healthcare blog. A slide presentation containing many of these ideas can be found here

by: Mark Ryan, MD*
[Editors note: First of a two part series by guest writer Dr. Mark Ryan, who is interested in how social media can be used to promote patient empowerment,
health and wellness.]

In these last few months, I have been lucky enough to discuss the use of social media with physicians in a number of settings. One of the major themes of these discussions is determining the value of social media that makes it worth adding to a physician’s day already filled with patient care, insurance, and other administrative work. I hope to make the point here that social media has a significant role to play in enhancing medical practice and that this role could increase in the future.

Today, we can instantly communicate with friends and access enormous amounts of information, often from a hand-held device. However, reliable health care information has not been as easily available.

Patients have responded to this absence by developing online communities such as Patients Like Me in order to advise each other regarding illnesses, treatments, and side effects. This development is sometimes labeled the e-patient movement: patients who are empowered, equipped, enabled, — equals with their physicians in making care decisions. These are patients who are activated and want to be partners in their care and are looking for resources to help them. Increasingly, they are looking online via social media tools.

Some of those resources are found via the concept of health 2.0. In more traditional styles of health care communication (health 1.0), information was held by an expert (the physician) and dispensed to patients as the physician saw fit. In health 2.0, communication can flow in any direction among physicians, patients, caregivers, patient advocates, allied health providers, and others. More and more of this information is disseminated via user-generated content such as blogs, videos, Twitter and Facebook updates which are created by patients and others. This user-generated content personalizes the health care experience and ensures that patients learn from one another how best to negotiate their health care. It allows patients to discuss worries and fears they might not be comfortable expressing elsewhere and that might be overlooked by more traditional sources of information.

The goal of health 2.0 is to empower patients to improve their health and their health care. Below are some potential uses of social media that have the potential to improve public and individuals’ health:

Public health:

• Broadcast important public health information
• Broadcast public health advisories: emergency responses, disease outbreak management and response
• Answer general medical questions and be a resource to the community for general topics
• Health care advocacy in the legal and political arenas
• Help patients find necessary resources, including free clinic services, healthfairs, and dental screenings

Individual health:

• Send disease-specific reminders, e.g.have you checked your blood sugar or haveyou taken your medicine?
• Patients can choose to receive tweets or Facebook updates as text messages if they follow a social media account
• Use Facebook or Twitter direct messages to ask patients to contact the office to schedule appointments, follow-up, etc.
• If/when secure portals enter wider use, we could refer patients directly intocare via E-visits or other portal-based services
• Record videos that can help patients improve their self-care (if patients) orhow to care for others (if caregivers)

Social media can also be used to enhance medical student and resident teaching by moderating virtual journal clubs, recording talks, & presentations for learners to view when it will be most valuable for them. For physicians, there are also personal and professional benefits such as the potential to collaborate on talks, projects and blogs. New medical information and information sources can be discovered as well new acquaintances and friends.

In part 2, I will discuss what I see as the pros and cons of various social media platforms as well as cautions for physicians entering the conversation stream.

Note about author:

Dr. Mark Ryan works at the Department of Family Medicine, Virginia Commonwealth University Medical Center and is also a member of the Mayo Clinic Center for Social Media Advisory Board. He has spent his career working in rural and urban medically under-served communities in Virginia and on medical student teaching. He is an active participant in the #hcsm and #MDchat Twitter chats where you can follow him as @RichmondDoc, and is a contributor to the Social Media Healthcare blog.

A slide presentation containing many of these ideas can be found here

A pilot study recently published in AIDS Research and Therapy looked into mobile learning for HIV/AIDS healthcare workers training in resource limited settings.

One of the pilot studies conclusions was that overall satisfaction of using mobile tools on the iPhone was greater than the Nokia N95.

Study participants cited screen/keyboard size, and image quality as problematic on the Nokia N95 when compared to the iPhone.

Overall, both mobile phones were found to be effective in delivering educational content to mobile health care workers. Of note, Facebook and Skype were used in conjunction with the learning modules. These social tools were used to put physicians in contact with experts or support staff knowledgeable about the particular learning module being used.

How the study worked:

Twenty physicians were given smart phones with portable solar chargers in Peru – half were given iPhones, and the other half Nokia N95s. Learning modules were placed onto the phones for a continuing medical education program lasting 3 months. Study participants had access to wireless internet via DSL or cable modems located at the HIV/AIDS clinics. At the end of each module learning outcomes were quantified using mobile quizzes.

Results:

The results showed overall satisfaction of using the mobile tools on the iPhone was greater than the Nokia N95. Using social media tools, such as Facebook and Skype, was easier on the iPhone than the Nokia N95. 66.7% of of iPhone users found it easy to access Skype, verse 22.2% of Nokia users. 88.9% of iPhone users found it easy to access Facebook, verse 44.4% of Nokia N95 users. Ability to access podcasts and post module learning quizzes was virtually even with both phones.

What can be taken away from this study:

The main take way from this pilot study is that with proper implementation, mobile learning in the field can be achieved by current smart phones available in the market.  Parsing through this study, one of the subtle take away points is how the use of current social tools can be used for mobile learning – such as Facebook and Skype. There is not necessarily a need to create new paradigms for mobile learning tools, rather, existing ones can be used but for medical education instead.

It should be noted this was a pilot study, and the authors themselves have stated the results are not necessarily generalizable – more participants and further analysis are needed.  So in order to conclusively say the iPhone is easier to use than the Nokia N95 for mobile learning, more data is needed.

Source: Mobile Learning for HIV/AIDS healthcare worker training in resource-limited settings (Authors: Zolfo M, Iglesias D, Kiyan C, et al.)

As international relief efforts ramp up in Haiti, we are reminded of how fragile society is in many parts of the world. With shanty towns scattered around Port-au-Prince, a health and public services infrastructure devastated by years of natural and human disasters, and a centralized leadership that was only recently beginning to establish legitimacy, the earthquake in Haiti has created a public health crisis of the worst kind. And as we as a global community respond to this tragedy, its worth considering what lessons we can take away from it so that when disaster strikes again, we will be even more prepared. And with that, maybe it’s time we consider how we can actively leverage platforms like Twitter and Facebook to save lives in disaster zones.

Before proceeding any further, I’d like to remind folks that money is the most valuable assistance that most of us can provide right now. While it may feel a bit impersonal, adequate funds allow groups that are on the ground like Doctors Without Borders and the Red Cross to purchase large volumes of essential supplies without worrying about the shipping costs associated with domestic material donations. Here at iMedicalApps, you can probably guess our favorite method of donating is via text message – for more information, check out this article from the New York Times. You can also donate directly to to the American Red Cross, Doctors without Borders, and Save the Children – these are just three large humanitarian organizations with extensive experience in Haiti with relief operations underway.

As the crisis continues to unfold, one thing that has become clear is that mobile technology, particularly via internet platforms like Facebook and Twitter, have again emerged as crucial forms of communication. As CNN describes, Twitter and Facebook have long been powerful ways to spread the word about a range of topics, even giving rise to the notion of “slacktivism” (think of all the Facebook groups dedicated to Darfur but with no discernible activity besides a few posts on the message board). In this current crisis, news outlets are reporting that in many cases Facebook, Twitter, and blog sites have been the sole method of communication for people seeking to share news or request help.

In a nation where the command and control infrastructure has been devastated, a management infrastructure will be critical to saving lives. Take Doctors Without Borders, who will be deploying a number of inflatable hospitals after all of their hospitals in Haiti were destroyed. Where should those hospitals go, how will resources be distributed once they are in place, what about all the make-shift triage centers that will function where the hospitals aren’t – this is an effort to build a public health system from scratch.

If we imagine Twitter as a communications tree, it’s not hard to imagine establishing follower relationships that line up with an organizational hierarchy and various workflows in such a system. For example, consider trying to manage a distribution network for antibiotics across multiple NGO’s throughout the country. Perhaps a Red Cross central supply manager would be followed by various regional rescuers from different organizations, who would then be notified as antibiotic supplies become available. Or in reverse, perhaps the central supply manager becomes a follower for field rescuers, civilians, and anyone else willing to share information on local needs. We could also imagine similar uses for Facebook. For example, initial rescuers in each town, village, or city district could use a Facebook page to post regular updates on needs, deaths, and other essential information. Then if Doctors without Borders was in one village but the Red Cross in another, they could more effectively share information and resources because these platforms can be easily accessed by both and in a sense are “standardized”.

Now, I know this is all grossly simplified.  I can hardly even begin to imagine what its like on the ground right now, but mobile technology is one of the main reasons why we’re even getting a glimpse of the current situation.  Having spent quite a bit of time in a very large hospital, I can tell you that effective management of any healthcare setting or system is critical – being able to put the right people with the right tools in the right place at the right time is something we take for granted because it happens so easily because of the strong infrastructure in place.  After a disaster of such high magnitude, strong leadership based on effective communications and information management will undoubtedly be the difference between life and death for many. Platforms like Facebook and Twitter have proven their resilience in times of civil upheaval, natural disaster, and intentional political censorship. So maybe its time we begin thinking about how we can integrate them into disaster management so the next time something terrible strikes, we’ll be just a little better prepared.