Social Media and MCR Readmissions


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Ben Miller and I presented some ideas on how social media could prevent/reduce Medicare readmissions.

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  • We live in a 24/7 society. At the touch of button, we can be immediately catching up with friends and family. All of those friends from back home are but a click away. We can access our bank account online, pay our bills and transfer funds all from the comfort of our own home, in our PJ ’s, with a drink, wearing a bandits mask. We can shop at our convenience for almost any single item anyone could ever imagine (and some). This too requires very little for us to do – a quick PC boot up, internet connection, we are set. We can read late breaking news as it happens, check the weather for the week at home or in Australia, and follow our favorite sports teams, possibly even catching the game live or watching highlights. These things are all possible. AND, this things often don ’t even require a computer. When 91% of the world has a cell phone, the information is often RIGHT IN OUR hands. They are in our pockets vibrating, alerting us to that one important email we have been waiting for all day. Go ahead, don ’t be shy, wave your phones, let’s see em. No shame in punching a few keys during a talk, we are all guilty of this. This is our connected society. We are in the age of constant connectivity. Very few of us are ever able to separate ourselves from our technology. We are connected and in the know. We can access whatever we want, when we want it. That is, until we start talking about healthcare.
  • I will argue today that part of being patient-centered has to do with how well we as providers and practices are up on our patient-centeredness. How willing are we to listen to info a patient read about online? How willing are we to accept conclusions the patient may have drawn from his or her facebook page? How do we even define patient-centered? A survey by the national research corporation indicated 1 in 5 use social media as a source of healthcare info – 94% have used facebook for info. Only 1/3 say they consider a high or very high level of trust in social media. So, let ’s do Social Media 101 and talk about each technologies application to the patient-centered medical home. First up, Facebook. From the Mayo Clinic to McDonalds, everybody has got one. How many of you have a Facebook page? Facebook is a social media outlet whereby individuals can connect freely to others. It is really quite simple to get started. Facebook will prompt you for certain events in your life – when you graduated high school, from where, college, etc. Businesses, universities, cartoon characters all have Facebook pages. Yes, you too can be their friend. You can learn more about people from their Facebook page often more than just talking to someone one on one. This has raised many a question especially when it comes to the relationship between a healthcare provider and his/her patients. There is a wonderful commentary in NEJM on “practicing medicine in the age of Facebook” I would highly encourage each of you to read this brief article on the pros and cons of “friending “ your patients. We have all heard the stories of the resident who was seen on his/her Facebook things engaging in questionable behavior and this page is viewed by a patient who complains to the practice manager who tells the preceptor who addresses this with the resident. It should be noted that Facebook is a reality we must face. Consider that 44.5% of medical students have a facebook page, and this is as of 2008 so the number is likely significantly higher today. And yes, unprofessional info does appear on the web, but very few policies are in place in medical schools when this happens. Most just caution students of their use of such technology. Does AF Williams, Rose or Swedish have a Facebook page? Many clinics do to keep their patients informed when weather turns sour or clinic hours change. What happens when you want to let everyone know that the latest special vaccination has arrived? You see where I am going with this. Just as there are reasons not to facebook, there are reasons to facebook.
  • Moving on to Twitter. Twitter is 140 characters. 140 characters. Think what you can say in 140 characters. You either say not much or you learn how to say it really, really efficiently. You follow people and they follow you. You build a network. You get connected to complete strangers who get whatever you get. Being the healthcare policy guy, I have found a tremendous group interested in talking about healthcare policy. To follow everyone who is on twitter talking about health care reform, I would put in a hashtag (really just a pound sign in front of my keyword) and hcr for health care reform. I can follow anyone and everyone who talks about healthcare, share resources, articles, and links. Twitter is a way for anyone and everyone to say whatever is on their mind, whenever it is on their mind. Literally anything and everything, whenever. 50 million tweets are sent a day. Impressive, huh? Tweets in 2009 grew some 1,400%. Traffic to grew around 1,100%, and total sent Tweets went up 1,400%. You can get info out fast, share your latest article, connect to others who have similar interests, and follow trends on specific topics. As a matter of fact, when I was preparing for this talk, I “tweeted” to find resources, articles. When I tweeted the title of my talk, what it was for, and when it was, I was asked if it would be streaming live, if the slides would be available, and how they could learn more about our Department. There are excellent tools out there to manage your twitter account. These applications can go on your iphone, computer, basically anything that does not have a heart beat. Tweetdeck, as you can see, allows you to keep a running stream of who you are following, you mentions you in a “retweet” who sends you a direct message, a personal message to only you that no one else can see, and any specific trends you are following. Now, talk about PCMH. Practice communication could be huge on Twitter! Similar to Facebook, Twitter could report upcoming events, highlight new providers, openings, or discuss general healthy tips or articles on health. Individual providers could build a following on an area of health they are interested. Take Dr. Kevin Po for example. With 21k individuals following him and his blog, Dr. Po gets a ton of medical information out there to the healthcare community. Any provider could do this on their specific medical interests. Patients have tracked down providers based on their twitter feed. This is twitter. This is social medical and networking. If twitter is a sprint, blogging is a marathon.
  • Social Media and MCR Readmissions

    1. 1. <ul><li>Preventing hospital readmissions through social media innovation </li></ul><ul><li>A @miller7 & @RichmondDoc production </li></ul>Social Media and Health Care
    2. 2. <ul><li>Evidence suggests many rehospitalizations are preventable— </li></ul><ul><ul><li>Many rehospitalized before seeing a physician. </li></ul></ul><ul><ul><li>Significant Inter-hospital and inter-state variation. </li></ul></ul><ul><li>What proportion of readmissions are truly &quot;avoidable&quot;? No one knows. </li></ul><ul><li>Probably hospitals, physicians, HHAs, nursing homes and pharmacists can prevent more readmissions working together than hospitals can by improving discharge process alone. </li></ul>Why we are here
    3. 3. <ul><li>Poor transfer of information to patient: </li></ul><ul><ul><li>Poor patient understanding of how to use medications after hospital discharge. </li></ul></ul><ul><ul><li>Patient doesn't understand warning signs that warrant an emergency call to their physician. </li></ul></ul>Information to Patient
    4. 4. <ul><ul><li>Hospital to nursing home staff. </li></ul></ul><ul><ul><li>Hospital to primary care physician. </li></ul></ul><ul><ul><li>Lack of clarity on end of life care preferences. </li></ul></ul>Information to Ambulatory Care
    5. 5. <ul><ul><li>Primary care physician unaware of hospitalization. </li></ul></ul><ul><ul><li>Patient has no transportation to primary care physician. </li></ul></ul><ul><ul><li>Patient has no primary care physician. </li></ul></ul>Timely Post Discharge Visit
    6. 6. The tools for innovation <ul><li>Enter social media </li></ul>
    7. 8. <ul><li>Increasingly, patients and the public will look for physicians who are willing and able to interact with them via social media. </li></ul><ul><li>The Healthy People 2020 goals reflect this shift, and recognize the value of social media. </li></ul><ul><li>Pew Internet project shows some vulnerable communities with higher-than-average use of Twitter. </li></ul>Why this matters: e-patients
    8. 9. <ul><li>According to a recent National Research Corp ’ s Ticker survey reported in Feb 2011: </li></ul><ul><ul><li>1/5 Americans use social network sites to find health information—94% Facebook, 32% YouTube, 18% Twitter. </li></ul></ul><ul><ul><li>1/4 reported this info was “likely” or “very likely” to impact health care decisions. </li></ul></ul><ul><ul><li>1/3 reported “high” or “very high” level of trust; only 7.5% reported “very low” level of trust. </li></ul></ul>Why this matters: e-patients
    9. 10. <ul><li>Health 1.0: Health care providers (HCPs) control medical information, provide information to pts, and direct treatment. </li></ul><ul><li>Health 2.0: Pts become increasingly involved in care, asking questions of HCPs, collaborating in treatment. </li></ul>Why this matters: Health 2.0
    10. 11. <ul><li>“ 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. ” </li></ul>Why this matters: Health 2.0
    11. 12. <ul><li>In other words, in health 2.0 communication crosses in all directions between patients, patient advocates, HCPs, etc. </li></ul><ul><li>This communication includes user generated content in which individuals produce the material being distributed. </li></ul><ul><li>The goal is to enhance individuals’ health and health care. </li></ul><ul><li>Participatory health care. </li></ul>Why this matters: Health 2.0
    12. 13. <ul><li>The goals of empowering patients, developing collaborative relationships between pts and HCPs align with the concept of the patient-centered medical home (PCMH): </li></ul><ul><li>“ 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 . ” </li></ul>Why this matters: Increased communication
    13. 14. <ul><li>More than 500 million active users </li></ul><ul><li>50% of active users log on to Facebook in any given day </li></ul><ul><li>Average user has 130 friends </li></ul><ul><li>People spend over 700 billion minutes per month on Facebook </li></ul>
    14. 15. <ul><li>Facebook </li></ul><ul><li>Allows for private messages, public comments and discussion, and information sharing among a network of interested people. </li></ul><ul><li>For patient interaction, it is likely safest to have a professional Facebook page separate from your private Facebook page. </li></ul><ul><li>For professional pages, determine how much interaction you will allow. </li></ul>Social Media Tools
    15. 16. <ul><li>Facebook </li></ul><ul><li>I recommend using tight privacy settings on private Facebook pages. </li></ul><ul><li>There is debate about whether to “ friend ” patients on Facebook. I choose not to. </li></ul>Social Media Tools
    16. 17. <ul><li>Don Berwick fan page </li></ul><ul><li>Una Vida Sana group page </li></ul><ul><li>National Physicians Alliance fan page </li></ul>Social Media Tools
    17. 19. <ul><li>Twitter </li></ul><ul><li>Characterized by very short messages (140 characters). </li></ul><ul><li>Posts (tweets) are distributed among your “followers”. </li></ul><ul><li>Tweets are public unless you choose to protect them, in which case you must accept followers requests. </li></ul>Social Media Tools
    18. 20. <ul><li>Some jargon: </li></ul><ul><ul><li>All Twitter usernames (handles) start with the “ @ ” </li></ul></ul><ul><ul><li>Retweet (RT): one user re-posts another’s post. This allows sharing of information and can help start conversations. </li></ul></ul><ul><ul><li>Replies start with another’s user name (@); this notifies the other user you are speaking to them. </li></ul></ul><ul><ul><li>Direct message (DM): only viewed by recipient, not the public. </li></ul></ul>Social Media Tools
    19. 21. <ul><li>Jargon (cont) </li></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>“ What the Hashtag” is a website that defines as many #s as possible. </li></ul></ul><ul><ul><li>#s allow for Twitter-based conversations (#hcsm, #MDChat). </li></ul></ul>Social Media Tools
    20. 22. <ul><li>Best practices for Twitter: </li></ul><ul><ul><li>Find resources worth following. </li></ul></ul><ul><ul><li>Interact with people. </li></ul></ul><ul><ul><li>Be a resource to the community. </li></ul></ul><ul><ul><li>Develop lists to filter out the stream. </li></ul></ul><ul><ul><li>Use tools (TweetDeck) to simplify use. </li></ul></ul>Social Media tools
    21. 23. <ul><li>Mark ’ s Twitter profile </li></ul><ul><li>Ben ’ s Twitter profile </li></ul>Social Media Tools
    22. 24. <ul><li>YouTube, Ustream, and other video services </li></ul><ul><ul><ul><li>Users can record videos on any topic and upload them for viewing at any time. </li></ul></ul></ul><ul><ul><ul><li>These videos can be collected under a “channel” and could range from patient education information to medical education topics. </li></ul></ul></ul><ul><ul><li>Blog Talk Radio, PodBean, and other podcast sites </li></ul></ul><ul><ul><ul><li>Users can record radio shows and podcasts for listeners. </li></ul></ul></ul><ul><ul><ul><li>Allows for live, interactive discussions. </li></ul></ul></ul>Social Media tools
    23. 25. <ul><li>Mayo Clinic YouTube channel </li></ul><ul><li>Mike Sevilla ’ s Family Medicine Rocks podcast </li></ul>Social Media tools
    24. 26. <ul><li>Privacy (yours and the patient’s). Remember what is visible by the public. </li></ul><ul><li>Cannot practice medicine in this setting. </li></ul><ul><li>Not reimbursed. </li></ul><ul><li>No standards of use or official “ best practices ” . The AMA guidelines are not much help, and do not encourage use. </li></ul><ul><li>Role is still developing: wider use within patient communities, variable interest for provider/patient communication. </li></ul>Cautions
    25. 27. <ul><li>How could social media reduce readmissions? </li></ul><ul><li>3 major causes of readmissions: </li></ul><ul><ul><ul><li>Poor transfer of information to patients. </li></ul></ul></ul><ul><ul><ul><li>Poor transfer of information to ambulatory caregivers. </li></ul></ul></ul><ul><ul><ul><li>Lack of timely post-discharge physician visits. </li></ul></ul></ul>Potential
    26. 28. <ul><li>Poor transfer of information to patients: </li></ul><ul><ul><li>Incorrect medication use: </li></ul></ul><ul><ul><ul><li>User-friendly links from Facebook or blog posts to patient-friendly medication information sites. </li></ul></ul></ul><ul><ul><ul><li>Patients/caregivers using social media (Facebook or Twitter)--including private messages--to request nurse calls (especially as messages can be received via SMS). </li></ul></ul></ul><ul><ul><ul><li>Live internet radio and podcasts discussing medication use. </li></ul></ul></ul>Potential
    27. 29. <ul><li>Poor transfer of information to patients: </li></ul><ul><ul><li>Lack of awareness of warning signs: </li></ul></ul><ul><ul><ul><li>YouTube or other video discussions and patient-friendly presentations highlighting warning signs for disease exacerbations, including early warning signs. </li></ul></ul></ul><ul><ul><ul><li>User-friendly links to patient-friendly chronic disease management resources. </li></ul></ul></ul><ul><ul><ul><li>Links to illness support groups. </li></ul></ul></ul><ul><ul><ul><li>Twitter and/or Facebook updates to remind patients about disease self-management suggestions (including SMS). </li></ul></ul></ul>Potential
    28. 30. <ul><li>Poor transfer of information to patients: </li></ul><ul><ul><li>Lack of awareness of warning signs (cont): </li></ul></ul><ul><ul><ul><li>Post-op care instructions (including video/pictures). </li></ul></ul></ul><ul><ul><ul><li>TweetChats used as “Ask a doctor/nurse” sessions where patients/caregivers could get general information about illnesses and necessary care. </li></ul></ul></ul><ul><ul><ul><li>Using Facebook groups to provide similar discussions with additional privacy. </li></ul></ul></ul>Potential
    29. 32. <ul><ul><ul><li>Poor transfer of information to ambulatory caregivers: </li></ul></ul></ul><ul><ul><ul><li>Hospital to nursing homes: </li></ul></ul></ul><ul><ul><ul><ul><li>Twitter/Facebook direct messages to inform nursing homes/skilled nursing facilities of impending discharges (including SMS). </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Video or other links on Facebook or blogs that help with the care of unusual or complicated illnesses. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Links to live, point-of-care medication and care resources for nurses and nursing assistants. </li></ul></ul></ul></ul>Potential
    30. 33. <ul><ul><ul><li>Poor transfer of information to ambulatory caregivers: </li></ul></ul></ul><ul><ul><ul><li>Hospital to ambulatory outpatient providers: </li></ul></ul></ul><ul><ul><ul><ul><li>Twitter/Facebook direct messages to inform outpatient physicians about an upcoming discharge (including SMS). </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Video or other links on Facebook or blogs that help with the care of unusual or complicated illnesses. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Using social media contacts to then link to secure portals to provide additional information. </li></ul></ul></ul></ul>Potential
    31. 34. <ul><ul><ul><li>Poor transfer of information to ambulatory caregivers: </li></ul></ul></ul><ul><ul><ul><li>Lack of clarity of end-of-life preferences: </li></ul></ul></ul><ul><ul><ul><ul><li>Links to end-of-life information and support groups. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Patient- and caregiver-friendly blogs or videos that discuss end-of-life choices and that provide additional information in different forms. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>TweetChats or other public discussions to provide general information about end-of-life options (such as the #HPM chat). </li></ul></ul></ul></ul>Potential
    32. 36. <ul><ul><ul><li>Lack of timely post-discharge physician visits: </li></ul></ul></ul><ul><ul><ul><li>Primary care physicians unaware of hospitalizations: </li></ul></ul></ul><ul><ul><ul><ul><li>Using Facebook or Twitter to supplement other communication to advise primary care physicians regarding upcoming discharges (including SMS). </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Linking to secure portals after social media communications to directly provide patient discharge information. </li></ul></ul></ul></ul>Potential
    33. 37. <ul><ul><ul><li>Lack of timely post-discharge physician visits: </li></ul></ul></ul><ul><ul><ul><li>Patients lack transportation to primary care physician: </li></ul></ul></ul><ul><ul><ul><ul><li>Use of social media to link patients/caregivers with community resources or medical transportation services. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Using social medial to encourage patient contact via secure portals (including video technology?) to provide care from home instead of face-to-face care. </li></ul></ul></ul></ul>Potential
    34. 38. <ul><ul><ul><li>Lack of timely post-discharge physician visits: </li></ul></ul></ul><ul><ul><ul><li>Patients has no primary care physician: </li></ul></ul></ul><ul><ul><ul><ul><li>Using social media to seek primary care physicians near patients’ residences, either on the part of the patient/caregiver or the discharging facility. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Using social media to link patients with free clinics or federally-qualified community health centers (as applicable) to provide follow-up care. </li></ul></ul></ul></ul>Potential
    35. 40. <ul><li>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. </li></ul><ul><li>There are many opportunities to enhance social media use to prevent readmissions, but it will take creativity and flexibility to find the best options. </li></ul>Conclusions
    36. 41. <ul><li>Thank you for your attention. </li></ul><ul><li>[email_address] </li></ul><ul><li>[email_address] </li></ul>