5/16/13 a) I do not participate in social media and/or dont know - - PDF document

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@Seth Bokser, MD, MPH Associate Clinical Professor, UCSF Medical School Medical Director for IT , UCSF Benioff Children’s Hospital

a) I do not participate in social media and/or don’t know what it is b) Yes I’ve signed up, but I don’t use it at all c) I use 1 Social Media Network d) I use 2-3 Social Media Networks e) I use 4 or more Social Media Networks

• Definitions
• Social Media
• Web 2.O
• Crowdsourcing
• Opportunities and Challenges facing providers in

using Social Media for healthcare

• Professionalism
• Patient Privacy
• Accuracy of health information
• Digital Health Innovations Using Social Media
• Questions, Comments, and Discussion

1985

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1991

Email

2007 2010 2013 2011

BBS

• “I don’t have the time”
• “Inauthentic”
• “Privacy is important”

Social media refers to the means of interactions among people in which they create, share, and exchange information and ideas in online communities and networks.

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Social networking platforms Blogs and Content Sharing

Today, I find that more people know me from my blog writings than from my 200 peer-reviewed articles and six books, and that I receive more direct feedback about my blog posts than about virtually any of my writings in more traditional

• media. -Bob Wachter, MD

Micro-blogging (Twitter)

≤ 140 character “tweets” (messages) commonly with links to other sites Hashtags = Keywords A method of categorization. So users can easily find tweets by topic of interest. Users include @ signs followed by usernames to mention or message to other users

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a) 10-30% b) 31-50% c) 51-70% d) 71-90%

Connect and Empathize Engage patients where they live Educate through the Wisdom of the Crowd Maintain professionalism and trust Respect patients’ privacy Minimize danger of inaccurate health information online

Opportunities Challenges/Constraints

*Gartner Research. Forecast: Social Media Revenue, Worldwide, 2011-2016 http://www.gartner.com/newsroom/id/2092217. Accessed March 25, 2013

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Strengthen Patient Relationships Connect and Empathize

Maintain professionalism and trust

Bosslet GT , et. al. The Patient–Doctor Relationship and Online Social Networks: Results of a National Survey. J Gen Intern Med. 2011 October; 26(10): 1168–1174

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Wolfson H. Social Media for Esophageal Cancer Survivors. American College of Gastroenterology's ACG) 76th Annual Scientific Meeting. Washington, DC 20011

Greysen RS, et al. Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical

• Boards. JAMA. 2012;307(11):1141-1142. doi:10.1001/jama.2012.330

0% 10% 20% 30% 40% 50% 60% Patient Privacy Violation Profanity Discriminantory Language Intoxication Sexually Suggestive

60% of US Medical Schools Reported Unprofessional Content Posted by Students using Social Media

Chretien KC, et al. Online Posting of Unprofessional Content by Medical Students

• JAMA. 2009;302(12):1309-1315.

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Child Psychiatrist: Maybe she’s hitting up the bar for her last drink? OB/GYN: So I have a patient who has chosen to either no- show or be late (sometimes hours) for all of her prenatal visits. . .. She is now 3 hours late for her

• induction. May I show up late to her delivery?

Here is the explanation why I have put up with it/ not cancelled induction: prior stillbirth “She should not be allowed to work with patients if she callously talks about them on her own facebook

• page. . . .As a woman who has had a full term still birth

if I found out my doctor was posting that information on her page and other doctors were joking about it, I would go straight to the top of hospital leadership to ensure this doctor was fired.”

Engage patients where they are (already communicating)

Respect patients’ privacy

1996 2009 2013

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• Separate personal and professional personas
• Consider establishing a professional online profile

so that it appear first in Google search

• Develop SM policies and educational programs to

prevent trainees from harming future careers

JM Farnan, et al. Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and the Federation of State Medical Boards. Annals of Internal Medicine. 2013 Apr;158(8):620-627.

• Set personal account privacy settings to High
• “Elevator Rule”
• Emotions change. The internet is forever.
• Do not discuss specific patients in public

social media forums

• Avoid: “I saw a 12 yo today with DKA”
• Okay: “DKA typically presents. ..”

Legal Disclaimer: I am not a lawyer

• Social Group prenatal care
• Empower women and partners to be active in own care
• Encourage Community
• Mindful Birthing and Parenting

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• Business Associate Agreement
• Dictates security and use of PHI
• No secondary use of data
• Data encrypted on device and in transit
• Providers use Chatter for professional only
• Patients know each other
• Use real names online

Educate through the Wisdom of the Crowd Minimize danger of inaccurate health information online

*Brabham, Daren (2008), "Crowdsourcing as a Model for Problem Solving: An Introduction and Cases", Convergence: The International Journal of Research into New Media Technologies 14 (1): 75–90

Scientific/Healthcare Context = Crowdsourcing is an online, distributed problem-solving and production model.*

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Chung M, et al. Safe Infant Sleep Recommendations on the Internet: Let's Google

• It. J Pediatr 2012;161:1080-4

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20th Century 21st Century

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Connect and Empathize Engage patients where they live Educate through the Wisdom of the Crowd Maintain professionalism and trust Respect patients’ privacy Minimize danger of inaccurate health information online

Opportunities Challenges/Constraints

*Gartner Research. Forecast: Social Media Revenue, Worldwide, 2011-2016 http://www.gartner.com/newsroom/id/2092217. Accessed March 25, 2013

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Seth.Bokser@ucsfmedctr.org

• 1. Choose one social media platform
• Talk to your patients/colleagues
• Consider some that I mentioned
• Understand the revenue model
• Understand privacy policy and privacy setting options
• 2. Create a profile just for professional use
• 3. Include a picture and your real name or practice name
• 4. Start by reading, following, and observing
• 5. Don’t talk about specific patients unless it’s already revealed in the public domain by

patient (e.g. Michael J Fox, Angelina Jolie)

• 6. Know when the conversation needs to be directed to a more appropriate venue like the

patient portal or an office visit.

• Patient privacy
• Exchanging data that directly affect treatment decisions—need to be in EHR.
• 7. Remember your manners.
• 8. Remember the Elevator Rule
• 9. Remember the Internet is forever.
• 10. Think about how to get your posts seen, but do not spam
• 11. Be authentic. You are not a brand. You are a person (or practice of people).
• 12. Dedicate some time to it. Connection is a reciprocal process. You need to be present.

At Twitter headquarters, a company spokesman said that yesterday’s incident, which briefly caused the Dow to plunge a hundred points and temporarily wiped off a hundred thirty-six billion dollars of value from the S.&P . 500, was “testament to the amazing growth of Twitter.”

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“In a few short years, Twitter has evolved from a mere waste of time into a force capable of massive havoc and destruction,” the Twitter spokesman said. “We’re excited to see what Twitter does next.”

Figure from: Marcio von Muhlen, Lucila Ohno-Machado Brief communication: Reviewing social media use by clinicians J Am Med Inform Assoc 2012;19:5 777-781 Published Online First: 3 July 2012doi:10.1136/amiajnl-2012-000990 *Doctors, Patients & Social Media," QuantiaMD, September , 2011. http://www.amednews.com/article/20110926/ business/309269969/2/#top

• Up to 90% of

physicians are using social media*

• 26% of physicians use

social media for professional purposes*

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0% 10% 20% 30% 40% 50% 60% Patient Privacy Violation Profanity Discriminantory Language Intoxication Sexually Suggestive

60% of US Medical Schools Reported Unprofessional Content Posted by Students using Social Media

Chretien KC, et al. Online Posting of Unprofessional Content by Medical Students

• JAMA. 2009;302(12):1309-1315.
• Covered Entities = All healthcare providers and employees
• Protected Health Information (PHI): 18 unique patient data

elements

• “All elements of dates”
• “Any unique identifying number, characteristic or code”
• Treatment, Payment, or Authorization.

1996 2009 2013 1996 2009 2013

• Business Associate (BA) = one who on behalf of a

covered entity, creates, receives, maintains or transmits PHI

• BAs are regulated directly under HIPAA and the BA

Agreement with the covered entity

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Recently, we suspended a user who registered as a patient in the Mood community. This user was not a patient, but rather a computer program that scrapes (i.e. reads and stores) forum

• information. . . .We have verified the account was linked to a

major media monitoring company, and we have since sent a cease and desist letter to its executives.

http://blog.patientslikeme.com/2010/05/20/bentransparencymessage/ 1991

Email

2007 2010 2013 2011

BBS FB FB2 Patient Blogs LinkedIn

Twitter Chatter Provider sites

* Garner J, O'Sullivan H. Facebook and the professional behaviours of undergraduate medical

• students. ClinTeach 2010;7:112–15

** Chritien KC, et al. Online posting of unprofessional content by medical students. JAMA. 2009;302(12):1309-1315. doi:10.1001/jama.2009.1387

• 52% medical students reported “embarrassing”

photos on Facebook*

• 60% (47/78) of U.S. medical schools reported

incidents of students posting unprofessional

• nline content**

Connect Engage patients where they live Crowdsource to empower, educate, and problem solve Maintain professionalism and trust Respect patients’ privacy Empower patients with valid health information

Opportunities Challenges

*Gartner Research. Forecast: Social Media Revenue, Worldwide, 2011-2016 http://www.gartner.com/newsroom/id/2092217. Accessed March 25, 2013

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Generate $16.9 Billion in revenue worldwide* Grow relationships Become more aware Realize business case for providers Vulnerability

• Cyberbullying
• Predators
• Authenticity

Become constantly distracted

Opportunities Challenges

*Gartner Research. Forecast: Social Media Revenue, Worldwide, 2011-2016 http://www.gartner.com/newsroom/id/2092217. Accessed March 25, 2013

Generate $16.9 Billion in revenue worldwide* Grow relationships Become more aware Realize business case for providers Health of SM relations

• Cyberbullying
• Predators
• Authenticity

Become constantly distracted

Opportunities Challenges

*Gartner Research. Forecast: Social Media Revenue, Worldwide, 2011-2016 http://www.gartner.com/newsroom/id/2092217. Accessed March 25, 2013

Generate $16.9 Billion in revenue worldwide* Grow relationships Become more aware Realize business case for providers Vulnerability

• Cyberbullying
• Predators

Become constantly distracted

Opportunities Challenges

*Gartner Research. Forecast: Social Media Revenue, Worldwide, 2011-2016 http://www.gartner.com/newsroom/id/2092217. Accessed March 25, 2013

Web 1.0 Web 2.0

• 72% of internet users say they looked
• nline for health information of one

kind or another within the past year.

• 35% of U.S. Adults “Online Diagnosers”

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I sort of look up to them and say ‘If they can do it, maybe I can do it’.

• Teenager in Ontario Hospital speaking of finding other

teenage hockey players with his diagnosis Hmm sometimes we do, like about doctors and stuff like he has a funny hairdo or like medication or stuff like that like we compare you know oh did you take like what happened when you did that. We kind of compare but apart from that we don't say like oh yeah I am going for surgery for nanana, it is not like professional, it is just for fun.

• Hospitalized teenager in Ontario Hospital speaking of how

pediatric inpatients interact on Facebook

Van der Velden M, El Emam K. “Not all my friends need to know”: a qualitative study of teenage patients, privacy, and social media. J Am Med Inform Assoc 2013;20:16-24 doi:10.1136/ amiajnl-2012-000949

http://www.aap.org/en-us/my-aap/Documents/SocialMedia_guidelines.pdf “Social media comes down to this Golden Rule: If it applies to traditional media or the Internet, it probably applies to most public social media platforms too” Professional Privacy Industry: We Technical Policy

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$1.6 Billion Dollar per Year Industry Revenue Model for Providers?

“This is non-reimbursed time that I don’t have.”

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Growing social connections Authenticity of relationships Danger Cyberbullying Your Patient or Patient’s Family

What to do when a patient “Friends?”

We are social beings

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http://www.forbes.com/sites/davidshaywitz/2013/04/14/four- reasons-doctors-worry-about-social-media-getoverit/2/