Communication in the 21st Century: Connections, Collaboration, and Social Media

Communication in the 21 st Century Connections, Collaboration, and Social Media Daniel Z. Sands, MD, MPH, FACP, FACMI Cisco Internet Business Solutions Group, Beth Israel Deaconess Medical Center, and Harvard Medical School Vice president, Society for Participatory Medicine Boston, MA

Daniel Z. Sands, MD, MPH, FACP Has disclosed relationships with entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Disclosure of Financial Relationships Cisco Systems, Inc.: Employee and Shareholder

How Crucial is Communication in Healthcare? “… communication extends all the way from the intimate interaction between a clinician and a patient, to the most public dissemination of information.” Harvey Fineberg, MD, PhD President, Institute of Medicine

Many Reasons for Collaboration
Sharing and co-creating knowledge
Learning
Negotiating
Building consensus

Many Transitions Across Care Continuum … Home / Self-care Inpatient Care Emergency Care Ambulatory Care Post-acute Care

Collaborative Planning Improves Transitions in Care Each step requires collaboration Admission Planning Discharge or Transfer Planning Admission

Two Types of Connections Deliver the right information to the right person for the right patient at the right time Connect to the right person about the right patient at the right time

Human Connections are as Important as Data Connections in Healthcare Connected Life Sciences and Research Connected Hospital Connected Clinician Connected Health Information Exchanges Connected Health Authorities Connected Patient Connected Public Health Connected Funder or Payer

Many Tools for Communication…

Collaboration Through Video
Adds video to telephone calls
Enhances verbal communication with visual queues
Three different video technologies:
IP telephone or soft phone with webcam
Dedicated video phone
TelePresence

Web-based Collaboration
Adds desktop sharing to IP video telephony
Permits:
Sharing of images or documents
Collaborative document development

Cisco TelePresence— Transforming Communications, Transforming Business
A breakthrough technology for remote collaboration that allows local and remote participants feel as if they are “in person”
An immersive meeting experience created through a powerful combination of innovative technology and design
Integrates advanced audio, ultra-HD video, interactive collaboration tools and the underlying network as a platform
Cisco TelePresence can transform businesses

Increasing Effectiveness While Decreasing Complexity  Simplicity  Effectiveness  Simplicity ? Effectiveness  Simplicity  Effectiveness Unified Communications

Connecting with Patients: e-Communication
e-Communication includes encrypted e-mail or, more commonly, secure web messaging
e-Communication can provide an efficient means of communication because it is asynchronous
This is cost-effective and benefits both patients and physicians
Source: Delbanco T, Sands DZ, NEJM 2004.

Telemedicine as Collaboration with Patients
Many to many connection—routed based on network intelligence
“ Up close and personal” experience
Telemetric data transmission
Native system integration

Attributes of Technologies Technology Synchronous? Information Density Telephone   E-messaging   Text messaging/IM  /   Remote monitoring   Telemedicine  (usually)  Advanced Telemedicine   Office visit  

What Is Cisco HealthPresence?
HealthPresence combines state-of-the-art video, audio, and medical information from devices to create an environment similar to what most people experience when they visit their doctor or specialist

Optimizing Communication Tools Patient Self-care Counselor/ Educator Clinical Nurse NP/PA Physician Telephone E-messaging Text messaging/IM Remote monitoring Telemedicine Advanced Telemedicine Face-to-face visit

Jane Sarasohn-Kahn "Wisdom of Patients: Health Care Meets Online Social Media" California HealthCare Foundation 2008 What is Health 2.0? “ The use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health.” © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential Internet Business Solutions Group

Health 2.0 Technologies
E-messaging
Instant messaging
Text messaging
Patient portals
Communication
Information and records
Services
Other communities (e.g., ACOR, PatientsLikeMe)
Blogs
Twitter
Wikis
Social networking sites (e.g., Facebook, LinkedIn)
Others…

Physician Concerns Re: Health 2.0

http://www.patientsite.org

Mail :
Secure
Automated routing
Task assignment
Services :
Prescription refills
Appointment requests
Referrals
View bill
Records :
Secure
All CG records
Upcoming appointments
Meds/Problems/Results…
Personal records
Education :
Info prescriptions
Patient selected links
Predefined collections
Videos

Dave’s Assessment of PatientSite
“ This is too cool. It's almost SILLY that things can be this easy. I am having a very good patient/customer experience so far.”

Hi - there are several things I want to go over when we meet. I suspect several will require referrals, and given the time it takes to get a slot, I'm thinking of making those appointments now. (It's easy to cancel and create an opening for someone else.) I'm 56 and I generally don't have any complaints. Here are the symptoms I'm concerned about: […] What do you think? Copyright © 2008 D. Z. Sands and R. D. deBronkart. All rights reserved.

ACOR is great. I posted two messages tonight and got responses in 4 and 11 minutes. One responder also sent a private note mentioning Robin and Cathy. The other responder was Cathy. :) Through that list I've also found several other useful sites. Copyright © 2008 D. Z. Sands and R. D. deBronkart. All rights reserved.

Wikis: The Wisdom of the Crowd The wisdom of the crowd refers to the process of taking into account the collective opinion of a group of individuals rather than a single expert to answer a question. This process, while not new to the information age, has been pushed into the mainstream spotlight by social information sites such as Wikipedia and Yahoo! Answers, and other web resources that rely on human opinion.

http://medpedia.org

Twitter: “Microblogging”

Twitter’s Value to Me
Information/links/opinions from people I trust
News alerts
Concise
Can search, scan, drill down
Platform for me to share ideas
Build community of followers/build my brand
Determine zeitgeist of conferences I did not attend
Share key points of conferences (for others and for me)

“ We met online.”

What are Social Networks?
Illuminate our social and professional networks
Expand our communication options
Provide context and meaning to our communication
Validate who we are through our associations

Patient Network Plus:
SHARE
Patients’ sharing detailed health data is what makes our communities special. This information is the basis of the PatientsLikeMe network and validates each individual
LEARN The shared information creates a new knowledge about the real world treatment , symptoms , and reality of living with illness. Patients learn about their disease and themselves in context of the community FIND Patients’ find other patients like them. They discover what options are available for treatment and if their experience with their disease is normal. They can reach out to others like them for advice and insight.

Medical Professional Social Networks

“ Knowledge is power.” Sir Francis Bacon English author, courtier, & philosopher (1561 - 1626)

E-patients
85% of online adults
Rising over time
Each day, more people search for health information than see a physician!
More than half act on the information
Source: www.pewinternet.org

Changing Nature of Relationship Knowledge Asymmetry Knowledge Symmetry Paternalism Autonomy Patient-Physician Consumer-Provider

Shifting Paradigm?
Information asymmetry
Physician as oracle
Comfortable
A burden?
Information symmetry
Physician as partner
Threatening vs. liberating
Physician as healer
! ☺ ! !

Professional Care $ ¢ Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995.

Professional Care ¢ $ Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. Professionals as partners Professionals as authorities

http://participatorymedicine.org

Conclusions
Human connections as important as data connections
Collaborations are key!
Many newer tools for connecting and collaborating
Collaborations can improve care of patients
Considering patients as collaborators yields benefits
Health 2.0 tools useful to both patients and providers
Helps shift balance of power
Empowering to patients and physicians
Start using gradually and gain comfort

Questions and e-mail address Questions? [email_address] Twitter: @DrDannySands http://www.facebook.com/DrDannySands http://www.linkedin.com/in/DannySands

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Communication in the 21st Century: Connections, Collaboration, and Social Media

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