5/16/13 ¡ 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 @Seth Bokser, MD, MPH Associate Clinical Professor, UCSF Medical School e) I use 4 or more Social Media Networks Medical Director for IT , UCSF Benioff Children’s Hospital • Definitions - Social Media 1985 - 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 1 ¡
5/16/13 ¡ 1991 2007 2010 2011 2013 BBS Email • “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. 2 ¡
5/16/13 ¡ Social networking Blogs and Content platforms Sharing Micro-blogging (Twitter) ≤ 140 character “tweets” (messages) commonly with Today, I find that more people know me from my links to other sites blog writings than from my 200 peer-reviewed articles and six books, and that I receive more Hashtags = Keywords direct feedback about my blog posts than about A method of categorization. So users can easily find virtually any of my writings in more traditional tweets by topic of interest. media . -Bob Wachter, MD Users include @ signs followed by usernames to mention or message to other users 3 ¡
5/16/13 ¡ a) 10-30% b) 31-50% c) 51-70% d) 71-90% Opportunities Challenges/Constraints Connect and Empathize Maintain professionalism and trust Engage patients where Respect patients’ privacy they live Educate through the Minimize danger of Wisdom of the Crowd inaccurate health information online *Gartner Research. Forecast: Social Media Revenue, Worldwide, 2011-2016 http://www.gartner.com/newsroom/id/2092217. Accessed March 25, 2013 4 ¡
5/16/13 ¡ Strengthen Patient Relationships Maintain professionalism Connect and and trust Empathize 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 5 ¡
5/16/13 ¡ Wolfson H. Social Media for Esophageal Cancer Survivors. American College of Gastroenterology's ACG) 76th Annual Scientific Meeting . Washington, DC 20011 60% of US Medical Schools Reported Unprofessional Content Posted by Students using Social Media 60% 50% 40% 30% 20% 10% 0% Patient Privacy Violation Profanity Discriminantory Language Intoxication Sexually Suggestive Chretien KC, et al. Online Posting of Unprofessional Content by Medical Students Greysen RS, et al. Physician Violations of Online Professionalism and Disciplinary Actions: A National Survey of State Medical JAMA. 2009;302(12):1309-1315. Boards. JAMA. 2012;307(11):1141-1142. doi:10.1001/jama.2012.330 � 6 ¡
5/16/13 ¡ 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/ “She should not be allowed to work with patients if she not cancelled induction: prior stillbirth 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 Child Psychiatrist: would go straight to the top of hospital leadership to Maybe she’s hitting up the bar for her last drink? ensure this doctor was fired.” Engage patients Respect where they are patients’ 2013 1996 2009 (already privacy communicating) 7 ¡
5/16/13 ¡ • 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. Legal Disclaimer: I am not a lawyer • Set personal account privacy settings to High • “Elevator Rule” • Emotions change. The internet is forever. • Social Group prenatal care • Do not discuss specific patients in public • Empower women and partners to be active in own care social media forums • Encourage Community - Avoid: “I saw a 12 yo today with DKA” - Okay: “DKA typically presents. ..” • Mindful Birthing and Parenting 8 ¡
5/16/13 ¡ Educate Minimize danger of through the inaccurate health Wisdom of the information online Crowd • 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 Scientific/Healthcare Context = Crowdsourcing is an online, distributed problem-solving and production model.* *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 9 ¡
5/16/13 ¡ Chung M, et al. Safe Infant Sleep Recommendations on the Internet: Let's Google It. J Pediatr 2012;161:1080-4 10 ¡
5/16/13 ¡ 20 th Century 21 st Century 11 ¡
5/16/13 ¡ Opportunities Challenges/Constraints Connect and Empathize Maintain professionalism and trust Engage patients where Respect patients’ privacy they live Educate through the Minimize danger of Wisdom of the Crowd inaccurate health information online *Gartner Research. Forecast: Social Media Revenue, Worldwide, 2011-2016 http://www.gartner.com/newsroom/id/2092217. Accessed March 25, 2013 12 ¡
5/16/13 ¡ 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). Seth.Bokser@ucsfmedctr.org 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.” 13 ¡
5/16/13 ¡ “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.” • Up to 90% of physicians are using social media* • 26% of physicians use social media for professional purposes* 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 14 ¡
5/16/13 ¡ 60% of US Medical Schools Reported Unprofessional Content Posted by Students 2013 1996 2009 using Social Media 60% 50% 40% 30% 20% 10% • Covered Entities = All healthcare providers and employees 0% Patient Privacy Violation Profanity Discriminantory Language Intoxication Sexually Suggestive • Protected Health Information (PHI): 18 unique patient data elements - “All elements of dates” - “Any unique identifying number, characteristic or code” • Treatment, Payment, or Authorization. Chretien KC, et al. Online Posting of Unprofessional Content by Medical Students JAMA. 2009;302(12):1309-1315. 2013 1996 2009 • 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 15 ¡
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