1. Why add *another* task to a busy day? A @miller7 & @RichmondDoc production Social Media and Health Care

2.  Why should we pay attention to social media?  What is social media?  How can social media enhance patient engagement?  How could we use social media in medical education? Outline

7.  E-patient: not an abbreviation for “electronic patient”.  Equipped, enabled, empowered, engaged, equals, emancipated and experts.  E-patients use internet resources and social media to educate themselves and others and to enhance health care for patients (and for providers). Why this matters: e-patients

8.  Increasingly, patients and the public will look for physicians who are willing and able to interact with them via social media.  The Healthy People 2020 goals reflect this shift, and recognize the value of social media.Healthy People 2020  Pew Internet project shows some vulnerable communities with higher-than-average use of Twitter. Pew Internet project Why this matters: e-patients

9.  According to a recentNational Research Corp’s Ticker survey reported in Feb 2011:National Research Corp’s Ticker survey  1/5 Americans use social network sites to find health information—94% Facebook, 32% YouTube, 18% Twitter.  1/4 reported this info was “likely” or “very likely” to impact health care decisions.  1/3 reported “high” or “very high” level of trust; only 7.5% reported “very low” level of trust. Why this matters: e-patients

10.  Health 1.0: Health care providers (HCPs) control medical information, provide information to pts, and direct treatment.  Health 2.0: Pts become increasingly involved in care, asking questions of HCPs, collaborating in treatment. Why this matters: Health 2.0

11.  “A concise definition of Health 2.0 is the use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in health care including doctors, patients, and scientists, using principles of open source and generation of content by users, and the power of networks in order to personalize health care, collaborate, and promote health education.” Why this matters: Health 2.0

12.  In other words, in health 2.0 communication crosses in all directions between patients, patient advocates, HCPs, etc.  This communication includes user generated content in which individuals produce the material being distributed.  The goal is to enhance individuals’ health and health care.  Participatory health care. Why this matters: Health 2.0

13. Beware of the Blog

14.  Blogs  The most traditional of social media tools.  Online publications/diaries.  Content varies on the author’s interests.  Can include embedded pictures, videos, etc.  Dialogue/discussion via comments. Social Media Tools

15.  Life in Underserved Medicine Life in Underserved Medicine  Social Medial Healthcare: Community of Practice Social Medial Healthcare: Community of Practice  Collaborative Care blog Collaborative Care blog  Collaborative Care tumblr Collaborative Care tumblr Social Media Tools

16. More than 500 million active users 50% of active users log on to Facebook in any given day Average user has 130 friends People spend over 700 billion minutes per month on Facebook

17.  Facebook  Allows for private messages, public comments and discussion, and information sharing among a network of interested people.  For patient interaction, it is likely safest to have a professional Facebook page separate from your private Facebook page.  For professional pages, determine how much interaction you will allow. Social Media Tools

18.  Facebook  I recommend using tight privacy settings on private Facebook pages.  There is debate about whether to“friend”patients on Facebook. I choose not to. Social Media Tools

19.  Don Berwick fan page Don Berwick fan page  Una Vida Sana group page Una Vida Sana group page  National Physicians Alliance fan page National Physicians Alliance fan page Social Media Tools

21.  Twitter  Characterized by very short messages (140 characters).  Posts (tweets) are distributed among your “followers”.  Tweets are public unless you choose to protect them, in which case you must accept followers requests. Social Media Tools

22.  Some jargon:  All Twitter usernames (handles) start with the“@”  Retweet (RT): one user re-posts another’s post. This allows sharing of information and can help start conversations.  Replies start with another’s user name (@); this notifies the other user you are speaking to them.  Direct message (DM): only viewed by recipient, not the public. Social Media Tools

23.  Jargon (cont)  Hashtag (#): topics of interest can be tagged with a #. For example, any post focused on health care reform can be tagged “#HCR”. This allows you to search for any recent posts that incorporate that tag.  “What the Hashtag” is a website that defines as many #s as possible.  #s allow for Twitter-based conversations (#hcsm, #MDChat). Social Media Tools

24.  Mark’s Twitter profile Mark’s Twitter profile  Ben’s Twitter profile Ben’s Twitter profile Social Media Tools

25.  Best practices for Twitter:  Find resources worth following.  Interact with people.  Be a resource to the community.  Develop lists to filter out the stream.  Use tools (TweetDeck) to simplify use. Social Media tools

26.  YouTube and other video services  Users can record videos on any topic and upload them for viewing at any time.  These videos can be collected under a “channel” and could range from patient education information to medical education topics.  Blog Talk Radio and other podcast sites  Users can record radio shows and podcasts for listeners.  Allows for live, interactive discussions. Social Media tools

27.  Mayo Clinic YouTube channel Mayo Clinic YouTube channel  Mike Sevilla’s Family Medicine Rocks podcast Mike Sevilla’s Family Medicine Rocks podcast Social Media tools

28.  The goals of empowering patients, developing collaborative relationships between pts and HCPs align with the concept of the patient-centered medical home (PCMH):  “Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff.” Why this matters: Patient- centeredness and patient engagement

29.  Privacy (yours and the patient’s). Remember what is visible by the public.  Cannot practice medicine in this setting.  Not reimbursed.  No standards of use or official“best practices”. The AMA guidelines are not much help, and do not encourage use. AMA guidelines  Role is still developing: wider use within patient communities, variable interest for provider/patient communication. Cautions

30.  Envision how social media could change health care delivery:  Public health advisories: emergency responses, disease outbreak management and response.  Broadcast important public health information.  Answer general medical questions and be a resource to the community for general topics.  Advocacy. Potential

31.  Envision how social media could change health care delivery:  Send disease-specific reminders (Have you checked your blood sugar? Have you taken your medicine?); patients can choose to receive Tweets or Facebook updates as text messages.  Some evidence that text message reminders can improve adherence and patient satisfaction. Potential

32.  Envision how social media could change health care delivery:  Use Facebook or Twitter DMs to ask patients to contact the office.  If/when secure portals enter wider use, can refer patients directly into care via E-visits or other portal-based services.  Connecting social media into personal communication (SMS/text messages and portals) will maximize potential. Potential

33.  Help patients find necessary resources, including free clinic services, health fairs, and dental screenings.  Can have a personal Twitter account and a professional/practice Twitter account, and use them for different purposes.  Personal and professional benefits:  Professional collaborations on talks, projects, blogs  New information and information sources  New acquaintances Potential

34. Why This Matters: Medical Student and Resident Education  Medical student education  We must teach medical students about the potential risks of using social media. In 2009, JAMA reported that “60% of U.S. medical schools surveyed reported incidents of students posting unprofessional content online.”JAMA reported

35. Why This Matters: Medical Student and Resident Education  Family medicine resident education:  Twitter discussions (organized by hashtags) allow for concurrent discussions among multiple participants. Can be based in one residency, or shared among many (#VCUFMChat, perhaps?).  Multiple ways to get information to residents other than e-mail (Twitter and Facebook can be accessed via SMS messages on cell phones).

36. Why This Matters: Medical Student and Resident Education  Family medicine resident education: Core competencies:  Patient care: NO. (Not yet. Ever?)  Medical knowledge: Increased access to new sources of information; opportunities to discuss information with multiple contacts.  Practice-based learning and improvement: probably not yet.

37. Why This Matters: Medical Student and Resident Education  Family medicine resident education: Core competencies (cont):  Interpersonal and communication skills: as social media becomes more widely used, we need to teach residents these skills.  Professionalism: Enhanced accountability to society and the profession and sensitivity to diverse populations.  Systems-based practice: Interactions with diverse contacts enhances awareness of team-based care and the roles of other professionals and of patients.

38. Why This Matters: Role of Faculty  Family medicine faculty can facilitate student and resident learning via social media:  Identify valuable resources: blogs, Twitter accounts, Facebook, YouTube channels.  Moderate Twitter chats.  Use social media tools in productive and professional ways.  Record videos or podcasts to supplement teaching.

39.  We 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, but I think health care providers need to be engaged in the process because social media will become increasingly important.  There are many opportunities to enhance social media use for education. Conclusions

40.  Thank you for your attention.  mryan2@mcvh-vcu.edu mryan2@mcvh-vcu.edu  benjamin.miller@ucdenver.edu benjamin.miller@ucdenver.edu