Healthcare Uses of Social Media

Last week I presented at the Social Media Plus Summit and discussed the importance of understanding the nature of emerging media before just jumping into the latest craze.

Healthcare adoption of emerging technologies (not just new media) needs to be done with a robust understanding of them in accordance with strategic visions. Privacy isn’t the only consideration in healthcare: dignity, content, information and excellence in communication and community-building are just a few of the others.

I wanted to go beyond that typical social media hype and give a deep view of what’s needed in healthcare communications. Included are some slides on how Information and Content related with each other in order to provide true empowerment for patients.

You can view my presentation below or over here (there’s also another copy here).

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Too often, organizations and industries attempt to integrate new technologies without delving deeper into their ramifications, possibilities and limits. As a result, they often run into trouble and then back away, leaving internal champions frustrated. Understanding is the first step toward doing. Paradoxically, though, with emerging technologies you need to do a bit of both at the same time.

If you would like to see me speak to your organization or help conduct personalized workshops and bring some perspective and orientation on process design, email or call me: info@CareVocate.com – 484-372-0451.

The Danger of Science Denial

I came across this TED video of Michael Specter’s talk about the dangers confronting us as the war against science progresses.

Here’s TED’s description of the video:”TED Talks Vaccine-autism claims, “Frankenfood” bans, the herbal cure craze: All point to the public’s growing fear (and, often, outright denial) of science and reason, says Michael Specter. He warns the trend spells disaster for human progress.”

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more about “The Danger of Science Denial“, posted with vodpod

66 Ominous Predictions About Twitter in Healthcare

Is Twitter safe and effective?

Several years ago, as a second-career registered nurse practicing critical care – having a prior background in enterprise working with fairly sophisticated information technologies – it was all too easy for me get frustrated with paper medical records and laboratory reports laying in floors drenched in  Clostridium difficile.

How was it possible in the 21st Century that the informational flows in healthcare facilities could end up on contaminated floors? Surely, I thought, there must be technologies within our grasp that could spare us – our patients and the staff – such dangerous indignities.

I can’t remember where I was when I first heard of Twitter, but I was one of its early adopters. It occurred to me that Twitter’s essential feature – the power to share data instantly and briefly – was worthy of consideration in health care. But my early ideas about invoking Twitter into healthcare faced two hurdles: HIPAA always got in the way of my thinking and nobody else I knew at the time ever heard of “a Twitter”.

After Twitter deleted my first account, I gave up on the incompetent service. When I returned to Twitter sometime in early 2008, the use of Twitter (or any other social medium for that matter) in healthcare was still relatively unheard of.

Part of the reason I started blogging was to fill a relatively empty void in the healthcare social media space. Today, I believe we are seeing that space filling with more important voices. Since publishing 140 Healthcare Uses of Twitter in January, hundreds of hospitals have started up Twitter accounts. Every day we hear about Twitter’s role in health care, from disaster management to surgical live-tweeting.

So far, the word is largely positive concerning the experiences of a relatively small number of hospitals on Twitter. But has Twitter gone through the strainer, the one beyond the marketing and PR uses? I’m not so sure but I’m hopeful. Time and the further adoption of the service will tell us more about its safety and effectiveness.

BETWEEN EVANGELISM AND DEVIL’S ADVOCACY

A purpose of the list I published in January was to start a discussion about how micro-messaging technologies like Twitter could be used in health care. Twitter’s fame and hype continue to skyrocket and health care is one of the hottest topics of our time. I have no doubt now that micro-messaging and health care are important partners. My task then was to be an evangelist in a time of sparse awareness. The questions now are how far we will go with these technologies and what kinds of challenges and fears we are willing to face and overcome.

For as much as Twitter is now being examined by the healthcare and pharmaceutical industries (a welcomed step), we have yet to flesh out practical opportunities and dangers Twitter poses for them. I am encouraged that hospitals are tweeting. Some are doing remarkable work and learning as they proceed. But I also have concerns about the incorporation of Twitter in the healthcare setting. I know all too well about Twitter’s seductions. Twitter makes almost everything easy, including regret.

I have therefore assembled a collection of dark predictions about how Twitter may be misused or misappropriated. My task now is to be Devil’s advocate during a time of attention obesity.

I don’t know if I saved Follow Friday. I do hope that in the rush to embed Twitter into our daily lives that we strike the right chords between Twitter Evangelism and Devil’s Advocacy.

66 OMINOUS PREDICTIONS ABOUT TWITTER

  1. That physician you’re following on Twitter will turn out to be an impostor.
  2. Your Direct Message will FAIL. Horribly.
  3. Your organization/practice will violate HIPAA. Repeatedly.
  4. Patients who don’t fully understand Twitter’s viral powers will find themselves woefully embarrassed.
  5. Your surgeon will tweet the wrong body part.
  6. Disaster management will be a disaster thanks to spam.
  7. Pandemic alerting will be a mess thanks to spam, panicked retweets, amateur microbiology and the Baumann Uncertainty Principle.
  8. Twitter will never reserve hashtags for sole use by the CDC or FDA or any other public service to guard against spam and keep channels of authority clear.
  9. Big Pharma will pay out tens of billions of dollars in fines and civil lawsuits related to alleged misleading statements in the course of tweet-marketing.
  10. Pharmaceutical company Twitter accounts will be hacked and the exploits will tweet misleading drug information, malicious links, confidential legal settlements and other embarrassing material.
  11. Twitter’s curious effects on  Dopamine will lead to addictive behaviors interfering with activities of daily living.
  12. Some disappointed healthcare marketers will revert to the traditional broadcast model of marketing after realizing quarterly earnings aren’t immediately boosted by providing free value to the communities they serve.
  13. Twitter will accelerate the proliferation of self-diagnoses.
  14. Insurance companies will find and track patients by viewing the follow lists of public-timeline hospital Twitter accounts.
  15. Insurance companies will set up dashboards to monitor insureds and use the information profitably.
  16. Twitter chats about healthcare reform will be infiltrated by Townhall-like Hashtagging.
  17. Patient dignity will be violated by nurses and doctors who tweet about their shifts from hell.
  18. Big Pharma and medical device companies will pay out tens of billions of dollars in fines (again) years after the FDA decides what regulatory rules to impose on tweeting.
  19. Lawyers will set up dashboards to monitor the tweets of pharmaceutical companies, device manufacturers, doctors and healthcare organizations in search of opportunities.
  20. Big Pharma will find itself finally engaging with patients on Twitter, only to realize that having 1,550,000 followers on Twitter means having to employ armies of drug safety associates 24/7/365.
  21. Twitter chats around specific disease processes will be polluted not only with spam but also misinformation masquerading as evidenced-based medicine.
  22. Patient-provider boundaries will be broken at alarming rates.
  23. A patient with depression will enter an unstoppable cycle: depressing tweets which lead to being un-followed and ignored, leading in turn to more depressing tweets…
  24. During a live-tweeted procedure that goes wrong, staff will forget to personally attend and inform the family reading the tweets.
  25. Privacy settings in Twitter will be reset to public, either by a Twitter glitch or hack or user-error and patient data will be inadvertently published.
  26. Psychotherapists using Twitter to communicate with patients will misinterpret or miss a patient’s tweet, resulting in a suicide.
  27. Hospital staff will tweet out information related to an incident.
  28. The overuse of Twitter will increase hypomania in patients with bipolar affective disorder.
  29. Obesity will continue to proliferate as healthcare consumers spend more time on Twitter looking for diet and exercise tips.
  30. Tweeters expressing suicidal ideation will be trolled by malicious malcontents.
  31. The wrong kind of medical crowdsourcing will lead to the wrong diagnostic judgements.
  32. Nurses who are not accustomed to the safe use of clinical micro-messaging will be distracted from their bedside duties.
  33. Doctors in facilities that employ enterprise micro-blogs may issue the right order to the wrong patient.
  34. The wrong laboratory results will be mis-tweeted. Fortunately, a smart nurse will notice the discrepancy between the lab value and the patient’s signs. This time.
  35. Patient timelines in facilities using micro-sharing technologies will be confused, causing all sorts of mayhem during shifts.
  36. The tweets of doctors will be used in courts to contradict testimony regarding timeline claims.
  37. The content of doctors’ tweets will be compiled and analyzed to challenge their competencies.
  38. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end. Twitter chats about Obsessive-Compulsive Disorder will never end.
  39. Nurses will lose their jobs for posting TwitPics of patients in undignified positions.
  40. Family members will stick their unsolicited noses in each others’ health matters.
  41. CDC will inadvertently create panic during a major outbreak after a single malformed tweet is retweeted relentlessly. CNN and Fox News, confusing Twitter with sourcing, will re-broadcast the tweet, fueling more retweets and distortions of the original tweet.
  42. Small practices using Twitter for scheduling will tweet the wrong patient or time.
  43. Hospitals will monitor their staff’s Twitter streams for violations of confidentiality and other reasons for discipline or termination.
  44. Hospitals who don’t understand the subtle dynamics of Twitter-sociology will find themselves in front of public relations nightmares.
  45. Healthcare information consumers will be under-served by over-reliance on 140 characters, especially by organizations that don’t have a well-rounded social presence on the web.
  46. Hospital administrators will tweet annoying requests to staff busy with more important tasks.
  47. In a maternity ward, somewhere in the Midwest, the grandparents of twelve girls will read a tweet saying “It’s a boy!”, only to find out someone saw something that wasn’t there.
  48. A drug guide application accessible via Twitter’s API will tweet back the wrong dosage information.
  49. Shortly after retweeting the funniest thing she ever read, a newlywed will find out about her husband’s STD.
  50. Pharma will receive an unprecedented volume of Warning Letters for its uses of Twitter.
  51. A pharmaceutical company will inadvertently issue a drug safety alert about the wrong drug, resulting in billions of dollars in lost sales with a single tweet.
  52. A pharmaceutical company will not issue a drug safety alert, resulting in billions of dollars in lost sales with a single tweet.
  53. The FDA will issue a drug safety alert about the wrong drug, resulting in billions of dollars in lost sales with a single tweet.
  54. Practices using Twitter for patient care reminders will mix up patient Twitter accounts, causing confused home-care.
  55. A psychiatrist being sued for breech of confidentiality on Twitter will be relieved when she discovers that Twitter’s search engine no longer returns her troublesome tweet. Unfortunately for her, the lawyer suing her will find the tweet on FriendFeed’s search.
  56. Hospitals who should be blogging or otherwise investing in a larger social media landscape will over-invest in Twitter, since everybody has Dopamine receptors (see #11).
  57. Segments of the health care population who aren’t using Twitter will be overlooked or under-served.
  58. Allied care coordination, will be hampered by confusing tweets.
  59. Patients will increasingly realize that they can tweet adverse events on Twitter.  4Chan will catch on to this too. The big heart of a near-retirement CEO in Big Pharma will enter ventricular fibrillation. He will survive and will be prescribed the medication fictively referred to in #52.
  60. David will become internet famous during the next major infectious outbreak. The public, unaware of  @CDCemergency, will go to the most logical Twitter name for CDC:  @CDC. The confusion will lead to the conclusion that CDC is not on Twitter and will turn to bogus accounts and spammed hashtags for updates. This oversight by CDC and Twitter will go down as one of the biggest failures to capitalize on brand equity.
  61. The FDA will finally issue guidance allowing pharmaceutical companies to tweet links to products. Curiously, the FDA will encourage those tweets to be “non-retweetable”, stating that it will use its discretion in fining companies $10,000 for each retweet if, in the FDA’s opinion, the tweet appears “overtly re-tweetable”.
  62. The FDA will allow healthcare applications to be built on Twitter’s API. What’s more, the FDA, in its recognition of the importance of real-time technologies in our daily lives, will outline an efficient seven-year approval process for each application.
  63. Remarkable healthcare applications will be built on top of Twitter’s API, spurring wider acceptance of Twitter in serving the health care needs of the public. Unfortunately, Twitter will make unannounced changes in its API.  Jesse Stay, having helped to develop one of the most downloaded Diabetes iPhone apps, will suffer a brain aneurysm while discussing the changes with Twitter. He will survive and recover but will go on to delete his Twitter account and give up application development.
  64. The FDA, realizing Twitter’s role in public health, will require pharmaceutical companies and device manufacturers to publicly tweet Serious Adverse Events within 24 hours of receipt of notification. The hypothetical executive referred to in #59, in an extraordinary episode of psychosis, will go postal and use Twitter to live-tweet his rage. From that day onward, the phrase “going postal” will be replaced by “going Twitter”.
  65. HIPAA will be repealed and replaced with the Health Insurance Tweetability and Liability for Electronic Records Act of 2010. Among the provisions is the requirement that hospitals with public Twitter profiles not display their Following and Followers on their accounts. Twitter, of course, will offer no way to do this.
  66. Highlighting the power of Twitter’s monopolistic communications platform after a series of national health emergencies and a major terrorist attack coordinated in part via Twitter, the U.S. Congress will pass the Public Health And Safety Communications Act of 2012. Twitter Inc. is deemed a public utility holding company and enters an indefinite licensing agreement with the Department of Energy, whose charge is “to ensure the safe and uninterrupted use of Twitter and other micro-messaging services during times of national and international crises”. Twitter’s long-standing liquidity issues are finally resolved.

THE RESCUING ELEMENT

That last prediction may be the most dramatic, but given the tenuous state of our world’s psyche, it’s not far-fetched. Would it surprise you if it happened?

Am I being sarcastic or serious here? Does it matter? I mean: if we are to put safety and effectiveness above all else, shouldn’t we plumb the dangers posed by a real-time web?

Here’s another way to look at this list: as implied solutions to problems we may not have considered. Nothing is necessarily inevitable – awareness can prompt avoidance.

Twitter is telephony. Twitter is telepathy. Twitter is good. Twitter is bad. Twitter is useless. Twitter is useful. Twitter is whatever you make of it.

Twitter’s uses in Healthcare or Pharma or Politics or Marketing or any other field don’t so much depend on the technology as much as our willingness to be creatively courageous in the face of rapid change.

How we use Twitter in healthcare to streamline clinical operations, to provide richer experiences for consumers of healthcare information and to effectively propagate critical messages in times of crises depend on how willing we are to re-examine our traditions and re-envision what remarkable health care looks like given our new powers. We need leaders who aren’t afraid to break stupid rules and flush out deep prejudices.

In healthcare and other life sciences, following the rules is a vital part of the game. In fact, it usually is the game. Which is to say: leadership in healthcare is uniquely risky business.

For those of you who are currently using or planning to use real-time technologies in health care, think optimistically but responsibly about how you go about using them. Twitter and its yet-to-be-developed analogues bring forth into our world dangerous opportunities. When thinking about these dangers, here is a tweet-sized pearl of wisdom from Frederich Holderlin:

But where there is danger,

a rescuing element grows as well.

What do you think are the dangers of real-time social communities in healthcare? How would you propose we overcome those dangers? What are the rescuing elements among evolving – and sometimes unpredictable – threats from social technologies?

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140 Health Care Uses for Twitter

Twitter_bird_logo_2012Twitter may either be the greatest prank ever played on the internet community or it may be the best thing since sliced bread. It’s easy to make the first case if you read the public timeline for a few minutes. It’s a bit harder to make the second case, but I’ll do my best to make it. Specifically, I’d like to take a stab at offering 140 health care uses for Twitter.

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 URI. 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.).

[Update: Please note that this post was written in 2009. Obviously some things have changed, and yet Twitter’s essential feature remains unchanged. Since this post was written, Twitter has emerged not only as a mainstay for the real-time “pulse of the world”, it has also become a central platform for Healthcare professionals and patients to network and share ideas. Twitter is the metaphor for 21st Century human communication and machine interconnection. Even in 2009, many people thought Twitter was a passing fad. I suppose it remains a passing fad…a continually-recurring passing fad.]

CHALLENGES OF HEALTH CARE MICRO-SHARING

Unlike most other kinds of uses of Twitter (daily exchanges between friends, the kind of work @Comcastcares does, etc.), health care related matters pose unique challenges, including but not limited to:

  • Patient dignity and privacy
  • Professional oaths to do no harm
  • Litigation concerns
  • HIPAA

The possibilities that I believe Twitter offers currently far exceeds the constraints. I won’t offer work-around solutions to these constraints in this post. I want to focus on the possibilities because once we see the potential, we may have stonger motivations to deal intelligently with the constraints. So when reading this list, don’t get hung up on the details, the fears, the anxieties that may be provoked by the realities of health care as it is practiced today. It’s the 21st Century: let’s be imaginative, determined and innovative. 

In the health care industry there is often a fine line between caution and fear. It is the fear of change so common in health care that I hope we can overcome. Twitter may be a proving ground of how we overcome our fears, satisfy our cautions and extend the reach of our health care system with web-based technologies and communities.

What follows are uses than can be adopted right now and uses that remain to be developed. What do you think health care will look like in 2099? Will we still be using paper medical records or will we be using technologies that other industries use? Will we transcend our accustomed ways of thinking and re-socialize ourselves for how we interact with each other in an exponentially changing technoscape?

I hope this list sparks debate to help answer those questions. Here are the suggestions.

140 HEALTH CARE USES FOR TWITTER

  1. Tissue recruitment (for kidney and other organs, including blood)
  2. Epidemiological survey
  3. Disaster alerting and response
  4. Emergency response team management
  5. Supportive care for patients and family members
  6. Diabetes management (blood glucose tracking)
  7. Maintaining a personal health diary
  8. Adverse event reporting in the clinical setting and other pharmacovigilance functions
  9. Emitting critical laboratory values to nurses and physicians
  10. Alarming silent codes (psychiatric emergencies, security incidents)
  11. Drug safety alerts from the FDA
  12. Risk management communication
  13. Augmenting telemedicine
  14. Issuing Amber alerts
  15. Issuing alerts for missing nursing home residents
  16. Exercise management and encouragement
  17. Weight management and support
  18. Biomedical device data capture and reporting
  19. Nutritional diary and tracking
  20. Coordinating preoperative, perioperative and postoperative care (among pharmacy, nursing and surgical services)
  21. Medical service collaboration in the clinical setting
  22. Triage management in emergency rooms
  23. Census management/monitoring
  24. Arranging outpatient care
  25. Crowdsourcing for health care resources
  26. Shift-bidding for nurses and other health care professionals
  27. Mood tracking (for patients with bipolar and other mood disorders)
  28. Patient care reminders in the clinical setting
  29. Prescription management, including pharmacy refill reminders
  30. Daily health tips from authoritative sources
  31. Location awareness during crisis
  32. Occupational safety response
  33. Hazardous materials communication
  34. “Quick and dirty” diagnostic brainstorming between physicians (e.g. ’symptom clustering’)
  35. Clinical case education for (residents following attendings)
  36. Physician opinion-sharing
  37. Promoting Domestic Violence awareness
  38. Raising Child Abuse awareness
  39. USMLE preparation for medical licensing
  40. NCLEX for preparation for nursing licensing
  41. Recruitment of health care staff
  42. Alcohol and other substance abuse support
  43. Issuing doctor’s orders
  44. Environmental alerts: pollen counts, pollution levels, heat waves, severe weather alerts
  45. Remote wound care assistance
  46. Rural area health care communication
  47. Micro-sharing of pertinent patient information
  48. Micro-sharing of diagnostic results (blood tests, echocardiography, radiological images)
  49. Internal facility customer service (a hospital equivalent of @Comcastcares – c’mon hospitals!)
  50. Publishing health-related news
  51. Psychiatric “check-ins” for patients
  52. Nursing mentoring and collaboration
  53. Publishing disease-specific tips
  54. Childcare support
  55. Fund raising for hospitals and health-related causes
  56. Updating patient family members during procedures
  57. Live-tweeting surgical procedures for education
  58. Rare diseases tracking and and resource connection
  59. Reporting hospital staff injuries
  60. Tracking patient trends
  61. Tracking disease-specific trends
  62. Checking hospital ratings with other health care consumers
  63. Providing around-the-clock disease management
  64. Connecting genetic researchers with physicians
  65. Publishing the latest advances in biomedical devices
  66. Tracking antibiotic resistance
  67. Real-time satisfaction surveys with immediate follow-up for problem resolution
  68. Issuing asthma alerts
  69. Data collection for tracking facility patterns (process-performance, supply-chain and staffing problems)
  70. Live-tweeting medical conferences
  71. Keyword-tracking of health-related topics via Search.Twitter
  72. Posting quick nursing assessments that feed into electronic medical records (EMRs)
  73. Improving medical rounding systems
  74. Clinical trial awareness
  75. Hospital administration
  76. Sharing peer-to-peer reviews of articles of interest
  77. Connecting patients with similar disease processes
  78. Enhancing health-related support groups (e.g. buddy-systems for depression)
  79. Providing smoking cessation assistance
  80. Medical appliance support (e.g. at-home: colostomy care, infusion-pumps, wound-vacs)
  81. Reporting medical device malfunctions
  82. Tweeting updates to facility policies and procedures
  83. Arranging appointments with health care providers
  84. Product safety alerts
  85. Food safety alerts
  86. Information on women’s health
  87. Pain management
  88. Hospital reputation monitoring
  89. Publishing hospital-sponsored events in local communities
  90. Community health outreach
  91. Bioterrorism awareness and preparedness
  92. Issuing updates to hospital services to the public
  93. Insurance claim management
  94. Ethical, permission-based following of patients
  95. Micro-sharing consent for surgical and other procedures
  96. Patient-sharing of health-related experiences
  97. Posting ‘bread crumbs’ of facility experiences (”I had a bypass at this hospital and it went well but the food almost killed me.”)
  98. Patient searches for others confronting similar problems
  99. Stress management
  100. Mental health awareness
  101. Posting homeless shelter needs
  102. Food bank resource management
  103. Transmitting patient data to patients who are traveling abroad
  104. Generating streams of authoritative health care content online
  105. Exposing medical quakery
  106. Micro-sharing documentation for advanced medical directives
  107. Discussing public health care policy
  108. Developing stronger patient-provider relationships
  109. Tracking the safety and efficacy of pharmaceuticals
  110. Following health marketing
  111. Tracking influenza alerts from the CDC
  112. Exchanging/soliciting scientific validation of alternative health claims
  113. Following ad-hoc conferences on eHealth like HealthCampPhila
  114. Tracking toxic diseases
  115. Tracking HIV news
  116. Issuing/exchanging dietary tips
  117. Tweeting what you eat
  118. Comparing nursing home performance
  119. Coordinating clinical instruction
  120. Communicating with nursing supervisors
  121. Public safety announcements
  122. Tracking FDA guideline updates
  123. Tracking the progress of developing pharmaceuticals
  124. Broadcasting infant care tips to new parents
  125. Publishing vaccination/immunization services locations, hours and reminders
  126. Reporting adverse events to FDA (currently not available via Twitter: why not?)
  127. Obtaining information on Medicare and Medicaid
  128. Case management functions
  129. Clinical education coordination
  130. Facilitating patient-transfer processes
  131. Patient-information retrieval
  132. Reporting breeches of universal precautions in health care facilities
  133. Posting daily nursing tips
  134. Exchanging physician humor (we’re all human)
  135. Closing the digital divide with respect to health care information
  136. Coordinating allied health care services during patient admissions
  137. Coordinating patient discharges with all services
  138. Post-discharge patient consultations and follow-up care
  139. Helping device technicians to communicate directly with manufacturers
  140. Discussing HIPAA reform in the age of micro-sharing

There they are: 140 health care uses for micro-sharing platforms like Twitter. Implementing these uses can be enormously challenging (and even impossible) on Twitter given today’s constraints. For many of these uses, other more robust and secure micro-sharing platforms will be needed (e.g. Yammer). Certainly, Twitter offers a model of how micro-sharing can be used for a wide range of purposes. If social media marketers/gurus with little enterprise experience can figure out how to use Twitter, health care professionals can also figure out how to use micro-sharing.

HEALTH CARE SHOULD BE THE LEADER IN MICRO-SHARING

With 26 letters in the alphabet arranged within 140 characters, there are over 1.2 x 10^198 possible character combinations (thank you @symtym). Of course, the number of meaningful sentences is far less than that but a point stands out: there’s a virtually infinite number of short pulses of (meaningful) information that Twitter can facilitate.

With that kind of power, health care should be a leader in micro-sharing, not a lagger.

WHAT HAVE I MISSED? WHAT CAN YOU CONTRIBUTE?

I have probably missed some incredibly important healthcare uses for Twitter. I am also probably missing specific Twitter accounts that should be included as links in the list. Please contribute and I will continue to refine the list.

Visitors: please add to the list, make comments, ask questions, offer critique. It’s your health, it’s your century and it’s your right and responsibility to make this list as practical as possible. I’m doing my best to do my part. Your turn.

Download the eBook version of this post.

[NOTE: Major edits to this list based on feedback and the nature of the content will be disclosed. Also, Twitter’s logo was updated to conform to its requirements.]

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Healthcare Has No Shortage of Blogging Content!

personal health information - the wrkshop    

Image by Esthr via Flickr

There are many health care professionals who don’t blog. Some don’t blog because they’re cool people who just aren’t nerdy enough to blog. At least until they figure out that blogging isn’t what MSM makes it out to be.

Others, however, are concerned about the liability consequences of using social media and they believe that shuts out what’s most important (Beth’s blog is worth a drop into your reader.)

I understand that perspective but I don’t agree with it. The healthcare industry perhaps offers more interesting blogging content than any other topic.

There might be a nursing shortage but there’s no shortage of things to blog about the healthcare industry.

WHAT HEALTHCARE BLOGGING CAN BE

Healthcare blogging isn’t about compromising patient or coworker dignity and confidence. It’s just common sense not to blog personal and confidential information. There’s more to it than that. If you’re a stunad, you’re on your own.

Here are some off-the-cuff examples of what healthcare bloggers can cover:

  • The economics of healthcare (e.g. exploring the elasticity of demand and supply curves of various healthcare services)
  • The need for appropriate healthcare technologies
  • The success and failures of good and bad HIT systems
  • The growing shortage of willing nurses in the profession
  • The growing shortage of family physicians entering practice
  • Mentoring the next generation of healthcare workers
  • Discussing the day-to-day problems facing health care workers (generalizations will do fine)
  • Emphasizing the strengths of the healthcare system and highlighting its weaknesses
  • Covering political discussions about healthcare reform
  • Debating the proper roles of private enterprises and governments in healthcare provision
  • Providing high-quality, up-to-date content for practitioners
  • Providing a sharable platform for the progress of on-going research projects
  • Providing regular, clinically accurate and practical medical knowledge
  • Contributing proposals on how to improve healthcare
  • Healthcare fiction is an un-tapped blogging genre (no shortage of inspiration)
  • Hammering the need for HIPPA and liability reform
  • Educating the public on the need to protect their privacy AND the potential benefits releasing their stories to the public in a dignified context

The list can go on for miles. If you have topics to add, type in the comments below (and get a Disqus account if you haven’t already). Each step has liability implications, of course. Hurdles are meant to be jumped. It’s hard work. So is blogging. Get over it!

HEALTHCARE BLOGGING IS NECESSARY

Healthcare imposes more limitations on public discussion on certain matters. By no means, however, do those limitations preclude intelligent, creative, insightful dialogue. In fact, the blogging platform is a powerful way to raise public awareness.

Healthcare blogging is a specialized niche and requires extra skills that most other blogging niches need to succeed.

My advice for healthcare professionals who are discouraged from blogging because of liability matters is to forget about blogging the details of confidential experiences. Those details, interesting as they may be, are not at all the foundation of consciousness-expansion.

It’s more important to find the meanings of those experiences, connect those meanings to the public at large, and convey relevant opinions and information.

Public discussion certainly would benefit from the insight gained from colorful illustrations. Then again, the public had no idea about every gory detail involved in our visit to the moon. The public still supported the mission and we got there.

Time will tell if we accomplish for healthcare what we accomplished for inter-planetary travel. I sincerely hope that we get healthcare right. Blogging is a small part of getting right. But it’s a part.

HEALTHCARE WILL EVOLVE INTO ONE OF THE MOST IMPORTANT BLOG NICHES

In the meantime, if you want to become a healthcare blogger, use your brain, your imagination, your passion, your dreams. Work hard to say something meaningful to the public. Just because you can’t talk about that fecal impaction and the exploding colostomy bag, doesn’t mean you have nothing to say.

Don’t be discouraged by the limitations. In fact, use them to offer high-quality, interesting and socially-redeeming online content.

You who deeply care about using the web to improve healthcare: things aren’t going to change without your voice.

Blog on!

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Policy-Compliant Healthcare Fail

Just like any roadway, the healthcare system needs signals that work. Too many signals and the system arrests. Too little and everything crashes. It’s important to build a system of healthcare that anyone can use safely. It doesn’t need to be complicated. It just needs to work. So why might our system have so many jams and fails?

After seeing this video that Seth Godin shared on his blog, I started thinking about what might be wrong with how we provide healthcare. So many rules have to be followed that I think we end up breaking them right onto each other. When you watch this video, consider how our healthcare system builds policy-compliant accidents:

If you have ever worked in a corporate environmnet, you completely get this video. Painfully, it’s dead-on with the fundamental problems of complex organizational behaviors. Governmental organizations often operate with as much derrangement.

So my question about Healthcare Fail is this: if corporations and governments operate healthcare the same way as the geniuses designing the stop sign in the video do, just who or what is the right choice? It’s easy to say “the free market works”, as the political Right claim, or “healthcare should be free for everyone”, as the Left claim. Honestly, I don’t think either of those claims make any sense these days. I wish one of those claims were true. It would make our problem easier to solve. Simple-mindedness is not simplicity.

As the costs of healthcare increase inversely with the quality provided, our public discussion focuses more on Universal Healthcare initiatives. Unfortunately, I think that our emphasis on cost has largely gotten us into trouble. It’s as if Werner Heisenberg’s uncertainty principle is meliciously at work: the more we try to batten costs down, the higher they fly.

Rather than focusing on cost, we aught to focus on the value provided to patients and the community. Once the public understands what really goes into providing quality healthcare, then we might have a chance at a benefiting from a system that is neither the result of Capitalist Fail or Socialist Fail.

Our health is too important to hand over to corporations or governments. We need another kind of organization altogether, a totally novel way to provide quality care. I wish I had a name for it. For now let’s call it the Godinizaiton of Healthcare.

Godinize the Healthcare System

Part of the problem with the economics of healthcare is that we try to satisfy every conceivable end-point. It’s important that healthcare involves regulatory controls and well-conceived designs. If every intersection involves convoluted stop signs built to comply with everybody’s rules, we will have nothing but very reliable policy-compliant Healthcare Fail.

Policy-compliance is not a goal of healthcare: healthcare is the goal of healthcare.

A Model for Real-Time Medical Mircroblogging

Peviously, I expounded shortly on the utility of using a Twitter-like service for medical and other healthcare professionals. Right now, Twitter’s reliability, feature-limitations, spam susceptibility and other problems make the Twitter platform shaky for more professional use in healthcare.

But the basic concept is one that aught to inspire an easy-to-use system for the healthcare industry.

Enter Enterprise Social Messaging Experiement (ESME), tweeted by @dahowlett. ESME is a SAP-backed project supported by Siemens IT Solutions and Services (a division of Siemens) that was developed to help clients to communicate with other members of a professional team. ESME includes a service architecture that can allow business users to dynamically communicate, collaborate and solve collective problems. Furthermore it can allow for knowledge mining and microblogging.

The clip below illustrates how ESME can provide the tools to integrate real-time solutions to disparate problems:

IMPLICATIONS FOR HEALTHCARE

What if there were a similar service for the healthcare industry? How more effecitve could problem-sovling get with such a tool?

There are some features in ESME which would be desirable in a medical environment. Additionally, medical social messaging should include:

  • Security
  • HIPAA-compliance
  • Reliability
  • Scalability
  • Real-time networking
  • Dynamic integration
  • Searchable content
  • Role and group filtering
  • Tagging (including priority statuses)

A properly engineered medical social messaging system would naturally be a hefty investment; but the ROI could be worthy of the effort. Of course in its place we have IM, Twitter, Plurk, FriendFeed and countless other services which localized groups of physicians, nurses, and other healthcare providers could exploit rather effectively.

But the the openness of these current services pose problems which a customized enterprise solution could overcome. The public timeline feature is a blessing and a curse. A blessing because it opens users up to potentially millions of of helathcare professionals. A curse because that number could be overwhelming without the proper filters and logins, which if breeched, could harm a patient’s dignity and privacy.

ESME is being developed for use in manufacturing in the example provided in the video. But a similar thought experiement should be conducted for the medical industry.

A tag cloud with terms related to Web 2.Image via Wikipedia

A scalable system could be developed for use within a closed-off network or a within a global network.

Imagine the implications for clinical research, treatment advancement, learning, and the spreading of critically important memes. The list of applications is virtually limitless. An ESME like app could dig deeply into knowledge mines.

The tag cloud and group filtering features are ingenious user-friendly solutions to the problem of data over-abundance. They would go a long way toward intelligent and effective collaborative problem-solving.

There’s a lot of inspiration offered here with ESME. I plan on future posts to discuss the possibilities.

Learn a bit more (and find out what esme also means) here.

Youtube Link

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Bloggers Wanted: Why You Should Volunteer for a Hospital Blog

Of the billions of bloggers out there (albeit most with an average readership of 1), how many talented ones would be willing to volunteer their time to help out a community hospital with its blogging?

As I’ve discussed in the last post, hospital blogging can be a costly project. The opportunity costs of blogging can be huge (time spent on research or improving operations). But: the opportunity costs of not blogging can be even bigger (not showing off your knowledge base and expertise or establishing community trust and authority).

So to help the community of hospitals (large and small), one possible route is to solicit help from the community of bloggers. The blogosphere a disparate and often talented community. It includes soccer moms, engineers, web designers, doctors, politicians, forest rangers, comics, and a whole assortment of other resourceful individuals. Many of them also have other skills pertinent to business and process management.

I’m willing to bet that there are plenty of bloggers (some amateur, others experienced pros) who would be delighted to offer their services to community hospitals. There’s really no University of Blogging per se. And no one company that stands out to fill the role of uber-consultant. So hospitals interested in looking into blogging or other Web 2.0 projects could reap handsome rewards by reaching out to the blogging community.

Why would bloggers volunteer their time, even it would be for an hour per week? Here are some off-the-cuff benefits to volunteer hospital-blogging:

1. Boost traffic (slightly) to their own site (as appropriate)
2. Help enhance their reputation and authority
3. Develop another blogging “voice”
4. Build their brand (or resume if that’s what they want)
5. Expand their horizons
6. Offer a chance to become evangelists for healthcare technology on the web
7. Enhance their value to other bloggers
8. Network with other bloggers
9. Change the mix of their daily grind
10. Gain a sense of participating in a noble cause.

I hear people laugh and offer a lot of (understandable) sarcasm at the idea of bringing blogging and other social media to hospitals. That’s fine with me. As long as they have ideas for improving healthcare. And understand what it is that I’m driving at.

Cynicism is not skepticism.

Cynics put down the truth. Skeptics lift it up.

For you folks who find it a nutty proposition, please argue with any of the ten items I listed above. If you reject them all, would you just do me a favor and offer your own lists for improving healthcare. People are suffering. They could use your help. You’re brighter than me, so radiate your brilliance!

For those of you who believe in the values of hospital blogging let me know why you think volunteer blogging makes sense. Do you think it’s a realistic proposition?

Elements of Hospital Blogging…Some of the

Intensive care bed after a trauma intervention, showing the highly technical equipment of modern hospitals.

Image via Wikipedia

My post on Blog ROI generated some excellent questions about how to face the specific challenges of hospital blogging. There’s a lot of unchartered territory, and I doubt that any one person or group has all the answers. But I’ll pound out some on-the-fly thoughts.

A Little Internal Trackbacking
Before offering thoughts on how to address the specific problems of hospital blogging, it should be noted that whether or not a blog itself is ultimately worth burning the candle, there can be merit to the process of blogging.

There’s something about the discipline of blogging that confers benefits worth considering.

Just as the process of writing and reading can help you become a better communicator, thinker, problem-solver or just a more awakened animal, blogging can polish the lens through which you see things. The pliancy of the blogging process offers the ability to zoom-in on details you might otherwise miss or zoom-out to view the larger forest. It also connects you with other people and those people in turn connect you with new ideas or novel mutations of older ideas. And although it can be a solitary discipline, it opens you up to the world around you (if you’re paying attention). (Uh oh, I just caught myself meta-blogging. Shoot!)

Web 2.0 Shmeb 2.0…But: It’s Still Useful
For all the ridicule of Web 2.0’s hype, its tools permit a connection to the rest of the world that is unprecedented. That’s not a small thing. In fact it’s so big that it’s probably going to overwhelm us.

Still, the tools have utility in the right hands. For example, RSS feeds help you to stay on top of what an oncology nurse is thinking. And in conjunction with Twitter and Yahoo Pipes, RSS can help medical students Follow (spy on?) doctors. And I’m sure that there are ways to use FriendFeed similarly, if not even more powerfully.

(Incidentally, if you’re experiencing comment-fragmentation due to FriendFeed, here’s a WordPress plugin that’ll make your day.)

It’s usually blogging around that gets you hooked into these tools. So far, most of the social tools are being used to fuel untreated addictions. But that’s OK: boredom will eventually set in and the tools will evolve refinements that get us back to being more productive with them. For now, it’s a good time to adopt, play around, and figure out what works for you. Just don’t take all it too seriously.

That’s my argument for why hospitals might want to consider blogging. Not necessarily to throw a blog up (especially without seriously thrashing the project about up-front). But the benefits that the blogging process confers might justify its work-up. In the process, your employees might learn things they never knew were possible.

FACING THE CHALLENGES…SOME PROPOSALS

Basics…Start with Them
My primary suggestion for hospital blogging is to keep the focus pretty limited at first. I don’t think being comprehensive all at once is a safe approach. Rather a narrow focus on a topic that has a low risk of causing controversy and legal entanglements is a smart start.

Fear is not a strategy. It’s a paralytic.

Mindfulness is the Antidote.

For example, a CEO’s or CNO’s posts about her plans for her facility could be low risk with a better return than posts about controversial matters. Starting small also gives more wiggle room for the mistakes inevitably needed for learning.

Involving the right people is another important step. Scout for hospital employees who (responsibly) blog on their own time. There are some pretty web-savvy doctors and nurses out there who might just love the opportunity to contribute. Give them permission to be champions!

Ah, Them Lawyers and PR Wizards
Yeah, they blog…some of them do. And they’re smart and helpful…many of them are. Consulting with these resources is another important component of taking the first steps toward a hospital blog. Public relations may have a bad reputation (some of it earned, some of it not) but it’s an important tool in ensuring that the right kinds of messages are sent out.

“The right means in the wrong hands lead to the wrong results.”

That’s what good PR agents help you to avoid: costly and unnecessary wars. So consult with them and solicit their feedback.

In fact, PR and Legal might be able to spot bad operational decisions before they’re implemented since they may have a fresh perspective on a project that even the most capable operational managers can miss. So get them involved in the pre-launch thrashing. Don’t dismiss them. The up-front expenses of remarkable PR are probably lesser than their back-end replacements.

[[Link Update: Seth Godin indirectly invokes to the spirit of what I’m talking about with respect to PR and lawyers.]]

Involve IT, but Don’t Let ‘Em Bone You Out with “Can’t Do”
Strange as it is, the (important) IT component of blogging isn’t the biggest challenge. Blogs can be fairly straightforward, technologically. It depends on what you want. Find out how you might want to grow the blog. Consider the sorts of things should you build in at the beginning in case you want to expand your blog.

Establish strict security protocols. And make sure that the users of the blog can just blog and not have to worry too much about technical tweaks in a shaky system.

Custom-built bogs are one way to go. For smaller entities WordPress.org or Blogger might work. But WordPress, for all of it’s remarkable features, can be quirky and troubling. A simple and stable solution might be TypePad. Sure it’s not as sexy, but sex isn’t what you’re going for here I suspect.

Your Patients (aka Citizens)
Safety First. Always.

Don’t look for home runs or gushing bursts in your revenue streams. Instead, simply enable your community to interface with your facility’s human beings. Give time to sew the seeds and grow as it were. There’s no rush to assault Mount Remarkable. Don’t set high or unrealistic goals. Keep things simple.

Set strict privacy policies for your blogging. There shouldn’t be any reason for a hospital to mention the names of patients in a blog. And in fact, cases probably should not be discussed…at least until your blogging routine becomes well established. Start with fictive cases if that’s an interest.

Develop a Terms of Service policy. On one hand, you want to make it easy for participants to enter your blog; on the other, you need to establish their informed consent. And blog monitoring should ensure that participants do not reveal the names of other patients.

Complaints (legitimate) on a blog are perhaps the single most valuable commodity on a hospital blog. Why? Becuase they’re information. They’re (free) consulting data. Use what’s being given to you. Follow up immediately, whether or not it’s appropriate to do so on your blog. Give your citizens simple and easy choices on how to complain. Invite your complainers to a personal meeting. Ask them for more. And: thank them.

(You know what the Return in ROI really is? It’s “thank you”. Just a thought for all you John von Neumanns of financial ratio fetishes out there.)

ADDING IT UP

This is just a small outline of a larger plan for implementing a blogging strategy for a healthcare facility. These are just open-ended intuition pumps, to be taken more for early project-thrashing than as Gnostic Gospels with precise schematics to blindly follow.

It’s easy to get lost or burned blogging about your hospital activities. But it’s even easier to get burned providing the very services you provide daily. Examples of the risks/costs hospitals face/incur almost every day:

  • Medication Errors
  • Surgical blunders
  • Patient Identification FAIL
  • Protocol Breaches

These are the risks already inherently built into the fundamental operations of a hospital.

Blogging, for all its pitfalls and potentials for blunder, probably won’t harm people as much as the items above. Put things into perspective. If anything, the practice of blogging might:

  • Enable a more efficient dialogue about the risks listed above
  • Provide your facility with the opportunity to explain the challenges of running a hospital that you strive successfully to meet (people love the honesty of competent minds)
  • Offer an information-based incentive for your staff to provide the remarkable services for which you hired (and pay) them

Creatively capitalize on your investments. (And don’t stare at sunk costs. You’ll fall into a black (red?) hole.)

With a successful blog, you just might shine your sincere concern and commitment to safety and efficacy of care. That’s an assurance that’s good for patients. And your tush-line.

So, here are some of my off-the-cuff, very informal and un-researched suggestions for hospital blogging:

  1. Start small…but don’t be afraid to think big
  2. Keep the focus narrow, to one topic perhaps (e.g. fundraising events)
  3. Recruit passionate bloggers internally (or externally)
  4. Establish good blogging hygiene
  5. Monitor comments and vanguard privacy
  6. Promote locally first
  7. Don’t promote too heavily (at least in the beginning)
  8. Involve Legal and PR ahead of time (thrashing)
  9. Don’t get discouraged by setbacks
  10. Invite guest bloggers for consultation and/or posting
  11. Reach out to the community of “Social Media” folks…(but use your common sense and skepticism!)

Don’t blog until you really understand the hard work needed for easy use. The intangible costs of blogging are heavier than the tangible ones (yes, a paradox of physical laws, but that’s blogging). When in doubt bail out and get back in when you’re vision is clearer.

Blogging s an open affair, whose floorboards are set down on the fluid air. But so is life, which is what healthcare is all about serving. What I mean is: you have to acquire the talent and skill to be able to think and respond swiftly but responsibly even if the aren’t established templates or recipes for doing so.

The purpose of a blog (at least this one) is to spread ideas, have them filtered through other brains and watch them grow. My hope is that I encourage free (not hate) speech with critical commenting.

The process is the principle.

For more about integrating emerging technologies into your enterprise, check out Health Is Social here.

TWO MEDICAL BLOGS OF INTEREST I RECOMMEND:
The Efficient MD

CaseBlog

These aren’t “hospital blogs” but they do illustrate what some smart folks are doing with these tools.

Please…comment: it’s free and useful.