Social media Is there a role for community-based practicing cardiologists?

1. Social mediaIs there a role for community-based practicing cardiologists? Friday, June 6, 2014 Seth D Bilazarian, MD PMA DrSeth@pmaonline.com

2. Social media definition Social media (SoMe) include web-based and mobile technologies used to turn communication into interactive dialogue. "A group of internet-based applications that build on the ideological and technological foundations of Web 2.0 and that allow the creation and exchange of user-generated content." Wikipedia

3. Two questions SoMe raises for physicians in clinical practice • Is it worth it? • Is there time to spend on SoMe? • Will it be entertaining? • Will it be enriching personally? • Will it be enriching professionally? • Can I afford to ignore it? • Will there be consequences personally, professionally (individually and to my group) by "standard ostrich avoidance"?

4. Disconnect: Clinicians vs leaders, technophiles, and futurists • Many pundits characterize the slow adoption of all technology tools (EHR, SoMe) as a failure of entrenched clinicians to change and embrace these new realities. To technophiles, SoMe is a panacea. • Physicians are under enormous duress and financial constraints. Tools that provide efficiency and add to the efficacy of the physician-patient experience and ultimately health outcomes would be welcomed in a "do more with less" environment. To them, SoMe can't be integrated into practice. • What's the problem?

5. What leaders, technophiles, and futurists are saying • "Of all the professions represented on the planet, perhaps none are more resistant to change than physicians. If there were ever a group defined by lacking plasticity, it would first apply to doctors." p177 • "Too many doctors today are trying to fly a biplane in the jet age, the indicators all analog and completely out of whack. It's no wonder they seem to crash." p179 http://creativedestructionofmedicine.com

6. What clinicians might say • Where's the ROI on previous technology investments? • Healthcare really is different: Other industries derive benefit from internet traffic in reduced cost and increased sales • Malpractice risks? • HIPAA violation risks?

7. Disconnect: Clinicians vs leaders, technophiles, and futurists • What's the problem? • If physicians are profit motivated for their practices, wouldn't they be willing to adopt new strategies if they improved efficiency, quality, and safety and reduced cost?

8. The panacea of SoMe • In recent past, new solutions were touted for problems without admitting that these always present new unanticipated problems. Promoters naive or deceitful. • Examples • EHR/ EMR http://ht.ly/1hg9x9 • ACGME work-hour restrictions (http://goo.gl/N6Cmo and http://goo.gl/SvQ87 ) • Doctors to blame • Changing physician culture is hard, much harder than doing smart analytics. To succeed, we need a new cadre of IT-powered doctor-leaders. @ChasRoades) 2/12/12 11:07 AM • "Looking outside the system to digital media and communities for answers but are challenged with uncertainty over concepts of usefulness, practicality, bandwidth issues, 'ROI,' and privacy concerns." http://www.howardluksmd.com

9. Internet resources Facebook YouTube Twitter 79% of adults are on the internet Broadband is used in 60% of US homes 85% of adults in the US have a cell phone 26% of > 65-year-old people are on social networks No filter Dangerous? Any answer you want Online health-seekingdigital resources

10. Change in internet usage by age: 2000–2010 Teens (12–17 years old) 93% All adults (>18 years old) 79% Adults 18–29 95% Adults 30–49 87% Adults 50–64 78% Adults >65 42% Data from Pew Internet and American Life Project

11. Web 2.0="Gather and talk" Web applications that facilitate participatory information sharing, interoperability, user-centered design, and collaboration on the World Wide Web. A Web 2.0 site allows users to interact and collaborate with each other in a social-media dialogue as creators (prosumers) of user-generated content in a virtual community, in contrast to websites where users (consumers) are limited to passive viewing of content created for them. Examples of Web 2.0 include social networking sites, blogs, wikis, video-sharing sites. Wikipedia

12. Historical perspective:Medical resources on the internet: The future has arrived Advances in telecommunications technology have fostered the development of computer networks that allow access to vast amounts of information and services. The recent upsurge in interest in the Internet is due to several mutually reinforcing factors: • Increased ease and availability of access to the internet. • Lower access charges. • Faster communications. • More organizations offering services over the Internet. Of particular interest to the medical community is the large and increasing number of technical, scientific, and biomedical resources that can be accessed. Many medical organizations and some medical journals are advertising their services over the internet and can be contacted through electronic mail. As telecommunications cost decreases and speed increases, new forms of computer communication, such as long-distance, real-time audio, and video services will become available. Computer networks in general & the Internet in particular are likely to play more important roles in many aspects of medicine in the future. More now than in 1995 Ann Intern Med1995; 123:123-131

13. Problems–SecurityData breaches from unencrypted devices up 525% in 2011 • The increase in "bring-your-own-device" policies at various hospitals, in addition to the continued implementation of electronic health record systems, are too much for government alone to regulate. • The report digs into the latest major data breach figures–those breaches affecting 500 or more individuals–released by the US HHS's Office for Civil Rights. • With the addition of the 2011 Sutter Health breach, which affected 4.2 million patients, the number of major healthcare information breaches now sits at 385 since 2009. Fierce Health IT http://goo.gl/CI2MW

14. Problems–No filters • In Web 1.0–Trusted organizations filtered and presented data for consumption • In Web 2.0–No filters • In Web 2.0 –No barriers. February, 2012: Patients were asking questions directly to Steven Nissen at the Cleveland Clinic and Dr Harlan Krumholtz at Yale in separate webchats sponsored by their organizations

16. Patients asking questions regarding management: Should I get this test? What diet is best? Are these promotional strategies? Selling a book? Promoting the institution?

17. Heart 411: The Only Guide to Heart Health You'll Ever Need by Marc Gillinov, Steven Nissen 

18. Historical perspective:Weekend sign-out at PMA • Monday morning calls (left a note at hospital operator) • Home fax–thermal paper • Email, internet–print for hospital rounds the next day • Email to smart phone–(beeper gone)

19. My take on the tools afforded by Social Media • Useful for promotion, marketing of practices and healthcare businesses (Web 1.0) • Potentially great strategies for communicating with patients in a highly efficient and effective manner • Many unknowns and uncertainties: security, privacy, propriety • System impediments to adoption: malpractice risks, hospital system limitations are pervasive • Most physicians would enthusiastically adopt solutions that would improve efficiency and efficacy of patient interactions

20. More info and the future • @MayoClinicOct. 15–19, 2012 is social media week at Mayo Clinicmayocl.in/SMWeekatMayo • Blogging to be used for promotions/ tenure consideration?@RyanMadanickMD: My university recently announced that blogging can be used in promotion/tenure consideration  • Read especially persuasive and how-to SoMe essayhttp://www.howardluksmd.com/orthopedic-social-media/physician-social-media-presence-hjl20/

21. Social Media to be discussed on Practioner's corner • Email • Internet Searching: Google • Patient Portal • LinkedIn • Facebook • Twitter