Engaging e-Patients in a Digital World:     How e-Messaging, Social Media, and Patient Activation Can    Transform Your P...
Objectives                          1.      How are some advanced physician-patient communication                         ...
Disclosure of Financial RelationshipsDaniel Z. Sands has disclosed relationships with entitiesproducing, marketing, re-sel...
   Connecting and Agenda-Setting© Copyright 2013 D. Z. Sands, All Rights Reserved
http://www.patientsite.org© Copyright 2013 D. Z. Sands, All Rights Reserved
Mail:                           Secure                      Services:                           Automated routing       ...
Dave (Pre-diagnosis)        This is too cool. Its almost SILLY        that things can be this easy. I am        having a v...
Affective Impact: 61M Minister with DM and Chronic Pain       I have a lot of medical issues. This       email system has ...
Connecting with Patients: e-Communication    e-Communication includes encrypted           e-mail or, more commonly, secur...
Question Using e-mail with patients…       a. Increases liability and is a HIPAA violation       b. Increases liability b...
Hi - there are several things I want to go over    when we meet. I suspect several will require    referrals, and given th...
   The Visit© Copyright 2013 D. Z. Sands, All Rights Reserved
The Incidental Finding© Copyright 2013 D. Z. Sands, All Rights Reserved
The Incidental Finding                            INDICATION: Right shoulder pain.                            COMPARISONS:...
   Diagnosis, Information, and Support© Copyright 2013 D. Z. Sands, All Rights Reserved
Lesion 1 – Left Upper Lobe 39x43mm© Copyright 2013 D. Z. Sands, All Rights Reserved
Primary Tumor Found© Copyright 2013 D. Z. Sands, All Rights Reserved
Question                           Most of the health information on the internet is                                  bad...
© Copyright 2013 D. Z. Sands, All Rights Reserved
© Copyright 2013 D. Z. Sands, All Rights Reserved
ACOR is great. I posted two messages     tonight and got responses in 4 and 11     minutes. One responder also sent a priv...
My doctor prescribed                              ACOR and it saved my                              life.© Copyright 2013 ...
© Copyright 2013 D. Z. Sands, All Rights Reserved
© Copyright 2013 D. Z. Sands, All Rights Reserved
Successful Treatment© Copyright 2013 D. Z. Sands, All Rights Reserved                 Baseline: 39x43 mm                  ...
Knowledge is power.                                                               Sir Francis Bacon    English author, co...
Online Population Rising…© Copyright 2013 D. Z. Sands, All Rights Reserved
…And Health Info Seeking Popular…© Copyright 2013 D. Z. Sands, All Rights Reserved
Online Health Habits of US Adults               80% of online adults have looked for health info                      Ri...
e-Patients Want To Be Engaged…                                                    Communication                           ...
But Are All Patients Ready for Engagement?            Source: Adapted from DiClemente and Prochaska, 1998 by http://www.ad...
…But We Make it Difficult:        Mismatch Between Desires and Service Offering                "Thinking now of new techno...
Meaningful Use© Copyright 2013 D. Z. Sands, All Rights Reserved
Meaningful Use and Patients© Copyright 2013 D. Z. Sands, All Rights Reserved
http://www.nationalehealth.org/patient-engagement-framework© Copyright 2013 D. Z. Sands, All Rights Reserved
© Copyright 2013 D. Z. Sands, All Rights Reserved   Source: KP.org screenshots and data courtesy of Kate Christensen, MD
KP.org: Efficiencies          Electronic health record use leads           to fewer office visits (Health           Affai...
KP.org: Health Outcomes   Improved quality scores   associated with secure   messaging, including 2   percent to 6.5 perce...
KP.org: Health Outcomes          Digital Coaching results in           positive health outcomes          Recent data sho...
www.myopennotes.org© Copyright 2013 D. Z. Sands, All Rights Reserved
OpenNotes: Results   Patients:                                                 Physicians:          47-92% viewed       ...
[Health 2.0 is] the use of social software           and light-weight tools to promote           collaboration between pat...
Wikis: The Wisdom of the Crowd  The wisdom of the crowd refers to the process of taking into account the  collective opini...
“We met online.”
What are Social Networks?             Illuminate our social               and professional               networks        ...
Question The elderly are not significant users of social media.       a.   True       b.   False
Source: http://www.shapeup.com
Patient Network Plus:        SHARE                                FIND                               LEARN Patients’ shari...
“On the Internet, nobody knows you’re a dog”
Medical Professional Social Networks
© Copyright 2013 D. Z. Sands, All Rights Reserved   Source: http://twitter.com
Question Twitter has no use in healthcare.       a.   True       b.   False
Source: http://philbaumann.com/140-health-care-uses-for-twitter/
Twitter’s Value to Me Information/links/opinions from people I trust News alerts Concise Can search, scan, drill down...
Ethics and SM Cases Surgical resident taking picture of patients tattooed   penis with phone during gallbladder surgery ...
Ethics and SM Cases Participating in inappropriate Facebook groups Posts promoting inappropriate behavior   (sex, drugs,...
“The AMAs Code of Medical Ethics already                contains an abundance of guidance for physicians                re...
“Physicians must recognize that actions online and                content posted may negatively affect their              ...
Ethics and SM Guidelines
Source: http://itunes.apple.com and http://mobihealthnews.com/13368/report-13k-© Copyright 2013 D. Z. Sands, All Rights Re...
Shifting Paradigm?                  Information asymmetry                      Physician as oracle                      ...
The Power of “I Don’t Know”© Copyright 2013 D. Z. Sands, All Rights Reserved
[T]he education of health professionals in the 21st                   century must focus less on memorising and           ...
Tacit      Honest        Asking                                                    Approval   Disclosures© Copyright 2013 ...
It’s About Engagement                                                          Engaged                                    ...
Encouraged    $                                      Tertiary                                                             ...
Encouraged    ¢                                  Individual self-care                                                    F...
http://participatorymedicine.org     Participatory Medicine is a cooperative model of health care  that encourages and exp...
But What About Physician Concerns?         Time                                       Helping patients but not me       ...
Top 10 Reasons e-Messaging Pays Off                          1.      Attain Meaningful Use 2 and 3 goals                  ...
Do We Need Most F2F Visits?                    Technology                      Synchronous?   Information Density         ...
Patients and Physicians Each Have Expertise© Copyright 2013 D. Z. Sands, All Rights Reserved
Patients Can (and Must) Help© Copyright 2013 D. Z. Sands, All Rights Reserved
It can be argued that the                   largest yet most neglected                   health care                   res...
Question What technology has had the greatest impact on   patient empowerment?      a.   Facebook      b.   Mobile phone ...
Because of the Web, Patients Can Connect to Information                          and Each Other (and to Doctors)© Copyrigh...
[P]hysicians are reluctant to encourage                   patient participation because either they                   refu...
© Copyright 2013 D. Z. Sands, All Rights Reserved
Changing Nature of Relationship Information Asymmetry                              Information Symmetry       Passive Reci...
Conclusions         Physician and patient engagement are critical         Participatory Medicine and Health 2.0: an impo...
© Copyright 2013 D. Z. Sands, All Rights Reserved
Questions?                                                    Danny@DrDannySands.com                                      ...
Recent Books© Copyright 2013 D. Z. Sands, All Rights Reserved
Engaging e-Patients in a Digital World (ACP 2013)
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  • e
  • b
  • This is our patient portal. Patient portals come in all types – What makes ours work for patients:
  • b
  • b
  • Patty Brennan at the University of Wisconsin calls care away from healthcare professionals “The care between the care.”
  • VERSION 2: WITH ANIMATIONSFour Pillars of the SPM: (CARE)Community: Stimulate awareness and foster collaboration among all stakeholders to advance participatory medicineAdvocacy/Policy: Advocate for policies that support the core premises of participatory medicineResearch:Cultivate forums for exchange of research, data, and ideas regarding the adoption of participatory medicineEducation: Develop and disseminate resources,tools, and curricula that encourage adoption of participatory medicine practices
  • c
  • This is our patient portal. Patient portals come in all types – What makes ours work for patients:
  • We have approximately 208,000 MyGeisinger users out of an active patient base in the 500,000 - 600,000 range.  We average 9,000 hits a day and 57,000 unique user visits a month.  The portal has been in place since 2001. There is a demo available on the MyGeisinger.org website that will give you an orientation to the various features available to patients on the site.  Patients have access to clinical information on both an outpatient and inpatient basis (problem list, visit summaries, meds, allergies, labs/diagnostic tests, discharge instructions, discharge summaries), can request prescrption refills, schedule primary care and Women's Health appointments, access educational resources and can message their provider.  We have disease-specific centers for asthma, diabetes, CHF and hypertension and are planning additional centers.  These centers are focused areas for the patient's medical results (labs, meds, preventive care) specific to that condition and display any treatment plans in place between the patient and provider and offer educational resources.  We receintly completed a joint research study called OpenNotes on displaying provider notes in a patient portal.  The most recent artcile on the outcomes is at http://annals.org/article.aspx?articleid=1363511 and the main site is www.myopennotes.org.  Both patients and providers felt the notes offered opportunities to deliver better care. Over the last two years, we have had a major push to use MyGeisinger for patient-reported data.  We have the ability for patients to track their glucose, blood pressure and weight in MyGeisinger, with seizures to be added soon, and these measures are sent to the provider.  Any measures that are out of the provider specified ranges, are immediately sent to the provider's EMR inbasket.  Normal readings are sent once a month.  I do not have any official statistics on these readings, but Women's Health has felt the glucose monitoring has helped them better monitor women with gestational diabetes and keep insulin usage at a minimum.  We have a provider in primary care who is using the glucose readings to do rapid cycle insulin changes with patients where he is trying to find the right level for the patient. We have questionnaires that we deliver through MyGeisinger for asthma, med rec, GI-Nutrition and are planning significantly more.  For asthma, it is the Asthma Control Test (ACT) which is recommended to be delivered every 90 days for persistent asthmatics.  This is a check-in to try and catch any issues before a patient ends up in the emergency room.  As of June, 2012, we had received 295 ACT responses from patients.  15 patients scored poorly and all received nurse calls as follow-up.  It was determined that 3 patients needed to come in.  2 kept the appointment and one went to an urgent care as he was not able to come in to the clinic during the hours provided. Med rec is done using MyGeisinger approximately 2 weeks before an office visit.  This is currently operational in a handful of clinics and focused on patients with chronic conditions and multiple meds.  As of June, 2012, we have 518 patients return the questionnaire.  The information is sent to a pharmacist who follows-up with the patient as needed and updates the medical record.  The provider is also informed  Through this process, we have reconciled 6,095 meds, identified 946 meds in our records that a patient is no longer taken, and identified 166 prescribed meds, 29 inhalers and 390 over-the-counter drugs that we were not aware of.  The information on this effort will be published by NORC as part of an ONC grant.
  • We have approximately 208,000 MyGeisinger users out of an active patient base in the 500,000 - 600,000 range.  We average 9,000 hits a day and 57,000 unique user visits a month.  The portal has been in place since 2001. There is a demo available on the MyGeisinger.org website that will give you an orientation to the various features available to patients on the site.  Patients have access to clinical information on both an outpatient and inpatient basis (problem list, visit summaries, meds, allergies, labs/diagnostic tests, discharge instructions, discharge summaries), can request prescrption refills, schedule primary care and Women's Health appointments, access educational resources and can message their provider.  We have disease-specific centers for asthma, diabetes, CHF and hypertension and are planning additional centers.  These centers are focused areas for the patient's medical results (labs, meds, preventive care) specific to that condition and display any treatment plans in place between the patient and provider and offer educational resources.  We receintly completed a joint research study called OpenNotes on displaying provider notes in a patient portal.  The most recent artcile on the outcomes is at http://annals.org/article.aspx?articleid=1363511 and the main site is www.myopennotes.org.  Both patients and providers felt the notes offered opportunities to deliver better care. Over the last two years, we have had a major push to use MyGeisinger for patient-reported data.  We have the ability for patients to track their glucose, blood pressure and weight in MyGeisinger, with seizures to be added soon, and these measures are sent to the provider.  Any measures that are out of the provider specified ranges, are immediately sent to the provider's EMR inbasket.  Normal readings are sent once a month.  I do not have any official statistics on these readings, but Women's Health has felt the glucose monitoring has helped them better monitor women with gestational diabetes and keep insulin usage at a minimum.  We have a provider in primary care who is using the glucose readings to do rapid cycle insulin changes with patients where he is trying to find the right level for the patient. We have questionnaires that we deliver through MyGeisinger for asthma, med rec, GI-Nutrition and are planning significantly more.  For asthma, it is the Asthma Control Test (ACT) which is recommended to be delivered every 90 days for persistent asthmatics.  This is a check-in to try and catch any issues before a patient ends up in the emergency room.  As of June, 2012, we had received 295 ACT responses from patients.  15 patients scored poorly and all received nurse calls as follow-up.  It was determined that 3 patients needed to come in.  2 kept the appointment and one went to an urgent care as he was not able to come in to the clinic during the hours provided. Med rec is done using MyGeisinger approximately 2 weeks before an office visit.  This is currently operational in a handful of clinics and focused on patients with chronic conditions and multiple meds.  As of June, 2012, we have 518 patients return the questionnaire.  The information is sent to a pharmacist who follows-up with the patient as needed and updates the medical record.  The provider is also informed  Through this process, we have reconciled 6,095 meds, identified 946 meds in our records that a patient is no longer taken, and identified 166 prescribed meds, 29 inhalers and 390 over-the-counter drugs that we were not aware of.  The information on this effort will be published by NORC as part of an ONC grant.
  • Engaging e-Patients in a Digital World (ACP 2013)

    1. 1. Engaging e-Patients in a Digital World:  How e-Messaging, Social Media, and Patient Activation Can Transform Your Practice Daniel Z. Sands, MD, MPH Society for Participatory Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA Slides at http://goo.gl/CtjgN© Copyright 2013 D. Z. Sands, All Rights Reserved
    2. 2. Objectives 1. How are some advanced physician-patient communication and collaboration technologies being used in medical care? 2. What are some challenges in the use of social networking (e.g., Facebook, Twitter) in patient care and how can I overcome them? 3. How can care and collaboration be enabled by using advanced technologies, such as videoconferencing, Web-based collaboration, social networking, patient health records, and patient portals? 4. How can social networking benefit patients without involving physicians? 5. What “killer” apps (smartphone and tablet) are available to engage patients and facilitate self-care?© Copyright 2013 D. Z. Sands, All Rights Reserved
    3. 3. Disclosure of Financial RelationshipsDaniel Z. Sands has disclosed relationships with entitiesproducing, marketing, re-selling, or distributing health caregoods or services consumed by, or used on, patients.  SeniorLink, Inc. – Consultant  BestDoctors, Inc. – Consultant  Kinergy Health – Consultant  PostWire – Consultant
    4. 4.  Connecting and Agenda-Setting© Copyright 2013 D. Z. Sands, All Rights Reserved
    5. 5. http://www.patientsite.org© Copyright 2013 D. Z. Sands, All Rights Reserved
    6. 6. Mail: Secure Services: Automated routing Prescription refills Task assignment Appointment requests Referrals View bill Records: Secure All system records Upcoming appointments Meds/Problems/Results… Personal records Education: Info prescriptions Patient selected links Predefined collections Videos© Copyright 2013 D. Z. Sands, All Rights Reserved
    7. 7. Dave (Pre-diagnosis) This is too cool. Its almost SILLY that things can be this easy. I am having a very good patient/customer experience so far.© Copyright 2013 D. Z. Sands, All Rights Reserved
    8. 8. Affective Impact: 61M Minister with DM and Chronic Pain I have a lot of medical issues. This email system has left me feeling comfortable and in good hands! Otherwise, I would feel as cold, depleted, and alone, as the lifeless tree in my front yard in the deepest of winter!© Copyright 2013 D. Z. Sands, All Rights Reserved
    9. 9. 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 Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.© Copyright 2013 D. Z. Sands, All Rights Reserved
    10. 10. Question Using e-mail with patients… a. Increases liability and is a HIPAA violation b. Increases liability but is not a HIPAA violation c. Does not affect liability but is a HIPAA violation d. Does not affect liability and is not a HIPAA violation e. None of the above
    11. 11. 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, Im thinking of making those appointments now. (Its easy to cancel and create an opening for someone else.) Im 56 and I generally dont have any complaints. Here are the symptoms Im concerned about: […] What do you think?© Copyright 2013 D. Z. Sands, All Rights Reserved
    12. 12.  The Visit© Copyright 2013 D. Z. Sands, All Rights Reserved
    13. 13. The Incidental Finding© Copyright 2013 D. Z. Sands, All Rights Reserved
    14. 14. The Incidental Finding INDICATION: Right shoulder pain. COMPARISONS: Comparison is made to a chest radiograph from December 23, 2003. TECHNIQUE: Right shoulder, three views. IMPRESSION: 1. Degenerative changes of the acromioclavicular joint. Normal radiographic appearance of the glenohumeral joint. 2. 3.3 cm right upper lobe lung mass needs further evaluation with a chest CT to exclude malignancy.© Copyright 2013 D. Z. Sands, All Rights Reserved
    15. 15.  Diagnosis, Information, and Support© Copyright 2013 D. Z. Sands, All Rights Reserved
    16. 16. Lesion 1 – Left Upper Lobe 39x43mm© Copyright 2013 D. Z. Sands, All Rights Reserved
    17. 17. Primary Tumor Found© Copyright 2013 D. Z. Sands, All Rights Reserved
    18. 18. Question  Most of the health information on the internet is bad and patients can’t differentiate the good from the bad. a. True b. False© Copyright 2013 D. Z. Sands, All Rights Reserved
    19. 19. © Copyright 2013 D. Z. Sands, All Rights Reserved
    20. 20. © Copyright 2013 D. Z. Sands, All Rights Reserved
    21. 21. 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 Ive also found several other useful sites.© Copyright 2013 D. Z. Sands, All Rights Reserved Copyright © 2012 D. Z. Sands and R. D. deBronkart. All rights reserved.
    22. 22. My doctor prescribed ACOR and it saved my life.© Copyright 2013 D. Z. Sands, All Rights Reserved Copyright © 2012 D. Z. Sands and R. D. deBronkart. All rights reserved.
    23. 23. © Copyright 2013 D. Z. Sands, All Rights Reserved
    24. 24. © Copyright 2013 D. Z. Sands, All Rights Reserved
    25. 25. Successful Treatment© Copyright 2013 D. Z. Sands, All Rights Reserved Baseline: 39x43 mm 50 weeks: 20x12 mm
    26. 26. Knowledge is power.  Sir Francis Bacon English author, courtier, & philosopher (1561 - 1626)© Copyright 2013 D. Z. Sands, All Rights Reserved
    27. 27. Online Population Rising…© Copyright 2013 D. Z. Sands, All Rights Reserved
    28. 28. …And Health Info Seeking Popular…© Copyright 2013 D. Z. Sands, All Rights Reserved
    29. 29. Online Health Habits of US Adults  80% of online adults have looked for health info  Rising over time  Each day, more people search for health information than see a physician!  More than half act on the information  1/3 have read about others’ health experiences  1/4 have tracked their health information online  1/3 use social media for health Sources: www.pewinternet.org; PwC HRI Social Media Consumer Survey, 2012© Copyright 2013 D. Z. Sands, All Rights Reserved
    30. 30. e-Patients Want To Be Engaged… Communication Involvement in Care Information Convenience© Copyright 2013 D. Z. Sands, All Rights Reserved
    31. 31. But Are All Patients Ready for Engagement? Source: Adapted from DiClemente and Prochaska, 1998 by http://www.adultmeducation.com/FacilitatingBehaviorChange.html© Copyright 2013 D. Z. Sands, All Rights Reserved
    32. 32. …But We Make it Difficult: Mismatch Between Desires and Service Offering "Thinking now of new technologies your health care provider could implement, how important would each of the following be to you?” (of patients who saw physician in past year) 0% 10% 20% 30% 40% 50% 60% 70% Online Appts Online Billing/Pmts Online Costs E-mail Viewing Record Available Desired (Important/Very Impt) Source: Harris Interactive 9/10/12 at http://goo.gl/VzfmT© Copyright 2013 D. Z. Sands, All Rights Reserved
    33. 33. Meaningful Use© Copyright 2013 D. Z. Sands, All Rights Reserved
    34. 34. Meaningful Use and Patients© Copyright 2013 D. Z. Sands, All Rights Reserved
    35. 35. http://www.nationalehealth.org/patient-engagement-framework© Copyright 2013 D. Z. Sands, All Rights Reserved
    36. 36. © Copyright 2013 D. Z. Sands, All Rights Reserved Source: KP.org screenshots and data courtesy of Kate Christensen, MD
    37. 37. KP.org: Efficiencies  Electronic health record use leads to fewer office visits (Health Affairs, Vol. 28, 2009)  Online behavior change program use leads to increased productivity at work (HealthMedia, 2008)  Patients booking online appointments are more likely to keep them (KP study, 2008)  Access to forms and health plan insurance documents saves printing and postage costs© Copyright 2013 D. Z. Sands, All Rights Reserved Source: KP.org screenshots and data courtesy of Kate Christensen, MD
    38. 38. KP.org: Health Outcomes Improved quality scores associated with secure messaging, including 2 percent to 6.5 percent improvements in glycemic, cholesterol and blood pressure screening and control. Health Affairs 29, NO. 7, 2010© Copyright 2013 D. Z. Sands, All Rights Reserved Source: KP.org screenshots and data courtesy of Kate Christensen, MD
    39. 39. KP.org: Health Outcomes  Digital Coaching results in positive health outcomes  Recent data show that over half of participants:  Lose weight  Reduce stress  Quit smoking  Improve diet© Copyright 2013 D. Z. Sands, All Rights Reserved Source: KP.org screenshots and data courtesy of Kate Christensen, MD
    40. 40. www.myopennotes.org© Copyright 2013 D. Z. Sands, All Rights Reserved
    41. 41. OpenNotes: Results Patients: Physicians:  47-92% viewed  70-72% took  0-5% felt visits longer at least one better care of note themselves  0-8% took more time in visits  20-42% shared  60-78% the note described  0-21% took more time writing better notes  77-85% medication reported better adherence  No change e-mail volume understanding of conditions  92-99% did not feel  3-36% changed their note content overwhelmed  77-87% felt more in control  Many described strengthened relationship with patients www.myopennotes.org© Copyright 2013 D. Z. Sands, All Rights Reserved
    42. 42. [Health 2.0 is] the use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health. Jane Sarasohn-KahnWisdom of Patients: Health Care Meets Online Social Media, California HealthCare Foundation 2008 50
    43. 43. 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, hasbeen pushed into the mainstream spotlight by social information sites such as Wikipedia and Yahoo! Answers, and other web resources that rely on human opinion. Source: http://en.wikipedia.org/wiki/Wisdom_of_the_crowd
    44. 44. “We met online.”
    45. 45. 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
    46. 46. Question The elderly are not significant users of social media. a. True b. False
    47. 47. Source: http://www.shapeup.com
    48. 48. Patient Network Plus: SHARE FIND LEARN Patients’ sharing detailed Patients’ find other patients like The shared information createshealth data is what makes them. They discover what a new knowledge about the our communities special. options are available for real world treatment,This information is the basis treatment and if their experience symptoms, and reality of living of the PatientsLikeMe with their disease is normal. They with illness. Patients learn aboutnetwork and validates each can reach out to others like them their disease and themselves in individual for advice and insight. context of the community Source: http://patientslikeme.com
    49. 49. “On the Internet, nobody knows you’re a dog”
    50. 50. Medical Professional Social Networks
    51. 51. © Copyright 2013 D. Z. Sands, All Rights Reserved Source: http://twitter.com
    52. 52. Question Twitter has no use in healthcare. a. True b. False
    53. 53. Source: http://philbaumann.com/140-health-care-uses-for-twitter/
    54. 54. 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)
    55. 55. Ethics and SM Cases Surgical resident taking picture of patients tattooed penis with phone during gallbladder surgery Physician posting pictures of injured nursing home patient on Facebook Physician making fun of patients on his blog Posting video of end-of-year party performance in which patients were objects of derision
    56. 56. Ethics and SM Cases Participating in inappropriate Facebook groups Posts promoting inappropriate behavior (sex, drugs, alcohol...) Posting patient information Providing medical advice online Friending patients
    57. 57. “The AMAs Code of Medical Ethics already contains an abundance of guidance for physicians regarding professional interaction with their patients that applies to communication in all settings, including online.” Shore R, Halsey J, Shah K, Crigger B, Douglas SP.Report of the AMA Council on Ethical and Judicial Affairs: Professionalism in the Use of Social Media. J Clinical Ethics 2011. 22:2; 165-72.
    58. 58. “Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their careers ..., and can undermine public trust in the medical profession.” Shore R, Halsey J, Shah K, Crigger B, Douglas SP.Report of the AMA Council on Ethical and Judicial Affairs: Professionalism in the Use of Social Media. J Clinical Ethics 2011. 22:2; 165-72.
    59. 59. Ethics and SM Guidelines
    60. 60. Source: http://itunes.apple.com and http://mobihealthnews.com/13368/report-13k-© Copyright 2013 D. Z. Sands, All Rights Reserved iphone-consumer-health-apps-in-2012/
    61. 61. Shifting Paradigm?  Information asymmetry Physician as oracle Comfortable A burden?  Information symmetry Physician as partner Threatening vs. liberating Physician as healer© Copyright 2013 D. Z. Sands, All Rights Reserved
    62. 62. The Power of “I Don’t Know”© Copyright 2013 D. Z. Sands, All Rights Reserved
    63. 63. [T]he education of health professionals in the 21st century must focus less on memorising and transmitting facts and more on promotion of the reasoning and communication skills that will enable the professional to be an effective partner, facilitator, adviser, and advocate.  Health Professionals for a New Century Commission on Education of Health Professionals for the 21st Century. Lancet 2010.© Copyright 2013 D. Z. Sands, All Rights Reserved
    64. 64. Tacit Honest Asking Approval Disclosures© Copyright 2013 D. Z. Sands, All Rights Reserved
    65. 65. It’s About Engagement Engaged Equipped Empowered Educated Enlightened Etc.© Copyright 2013 D. Z. Sands, All Rights Reserved
    66. 66. Encouraged $ Tertiary Professional Secondary Care Primary Self-Care Discouraged (off the Map) ¢Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995.© Copyright 2013 D. Z. Sands, All Rights Reserved
    67. 67. Encouraged ¢ Individual self-care Friends and families Self-health networks Professionals as facilitators Discouraged Professionals Professional as Care partners Professionals $ as authoritiesSource: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995.© Copyright 2013 D. Z. Sands, All Rights Reserved
    68. 68. http://participatorymedicine.org Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.)as integral to the full continuum of care. The “participatory” concept may also be applied to fitness, nutrition, mental health, end-of-life care, and all issues broadly related to an individual’s health. Society for Participatory MedicineCommunity Advocacy Research Education
    69. 69. But What About Physician Concerns?  Time  Helping patients but not me or my practice  Money  Don’t know how to get  Liability started  Privacy© Copyright 2013 D. Z. Sands, All Rights Reserved
    70. 70. Top 10 Reasons e-Messaging Pays Off 1. Attain Meaningful Use 2 and 3 goals 2. Time shifting 3. Take care of patients in your pajamas (or running clothes) 4. Increase your satisfaction 5. Increase patient satisfaction 6. See only your patients who really need F2F care (RVU or capacity) 7. Keep your patients healthier / improve outcomes 8. Reduce malpractice liability 9. Have automatic documentation of patient communications 10. Offset phone call volume© Copyright 2013 D. Z. Sands, All Rights Reserved
    71. 71. Do We Need Most F2F Visits? Technology Synchronous? Information Density Telephone   E-messaging   Text messaging/IM /   Remote monitoring   Telemedicine  (usually)  Advanced Telemedicine   Office visit  © Copyright 2013 D. Z. Sands, All Rights Reserved
    72. 72. Patients and Physicians Each Have Expertise© Copyright 2013 D. Z. Sands, All Rights Reserved
    73. 73. Patients Can (and Must) Help© Copyright 2013 D. Z. Sands, All Rights Reserved
    74. 74. It can be argued that the largest yet most neglected health care resource, worldwide, is the patient… Slack WV. CyberMedicine: How Computing Empowers Doctors  and Patients for better Health Care. Jossey-Bass 2001.© Copyright 2013 D. Z. Sands, All Rights Reserved
    75. 75. Question What technology has had the greatest impact on patient empowerment? a. Facebook b. Mobile phone c. The Web d. Twitter e. None of the above
    76. 76. Because of the Web, Patients Can Connect to Information and Each Other (and to Doctors)© Copyright 2013 D. Z. Sands, All Rights Reserved
    77. 77. [P]hysicians are reluctant to encourage patient participation because either they refuse to delegate power or control or they are afraid to lose their identity. Longtin Y et al. Patient participation: current knowledge and applicability  to patient safety. Mayo Clin Proc 2010;85(1):53-62.© Copyright 2013 D. Z. Sands, All Rights Reserved
    78. 78. © Copyright 2013 D. Z. Sands, All Rights Reserved
    79. 79. Changing Nature of Relationship Information Asymmetry Information Symmetry Passive Recipient Active Partner Paternalism Participation Patient-Physician Consumer-Provider© Copyright 2013 D. Z. Sands, All Rights Reserved
    80. 80. Conclusions  Physician and patient engagement are critical  Participatory Medicine and Health 2.0: an important paradigm shift  A new dance that both partners need to learn  Transforms patient and clinician experience  Helps shift balance of power  Promises to improve quality and reduce costs  Connected technology, including secure e- messaging, PHRs, and online resources lowers barriers to engagement, empowering and enabling all stakeholders© Copyright 2013 D. Z. Sands, All Rights Reserved
    81. 81. © Copyright 2013 D. Z. Sands, All Rights Reserved
    82. 82. Questions? Danny@DrDannySands.com http://www.DrDannySands.com© Copyright 2013 D. Z. Sands, All Rights Reserved @DrDannySands
    83. 83. Recent Books© Copyright 2013 D. Z. Sands, All Rights Reserved

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