Medicine & Technology                                                     Research Collaborative                          ...
Conflict of Interest Disclosure      Bradley Crotty, M.D.I have no financial relationshipswith a commercial entity produci...
This morning’s discussion…•   What are „Social Media‟ and who uses them?•   How does this relate to patients and clinician...
Hawn, C., 2009. Health Affairs.                                  Medicine & Technology                                  Re...
Some Definitions:                Web 2.0..                Not a new internet, but a new way of using the internet to      ...
Some Definitions:                Web 2.0..                Not a new internet, but a new way of using the internet to      ...
Some Definitions:                Web 2.0..                Not a new internet, but a new way of using the internet to      ...
Some Definitions:                Web 2.0..                Not a new internet, but a new way of using the internet to      ...
Some Definitions:                Web 2.0..                Not a new internet, but a new way of using the internet to      ...
Some Definitions:Social MediaWebsites and Internet-based tools that facilitate informationsharing among groups of people o...
Some Definitions:Social MediaWebsites and Internet-based tools that facilitate informationsharing among groups of people o...
Some Definitions:      Social Media      Websites and Internet-based tools that facilitate information      sharing among ...
Some Definitions:     Social Media     Websites and Internet-based tools that facilitate information     sharing among gro...
Some Definitions:     Social Media     Websites and Internet-based tools that facilitate information     sharing among gro...
Some Definitions:     Social Media     Websites and Internet-based tools that facilitate information     sharing among gro...
Some Definitions:    Social Media    Websites and Internet-based tools that facilitate information    sharing among groups...
Some Definitions:    Social Media    Websites and Internet-based tools that facilitate information    sharing among groups...
WHO USES SOCIAL MEDIA?                    Medicine & Technology                    Research Collaborative                 ...
All generations use the internet       … and many use to search for health info                                           ...
All generations are using social               networking more                                                            ...
Social media use is prevalent across          race/ethnicity groups                                                       ...
We have potential to reach patients                   on mobile devices            100%                                   ...
Your teenagers are not theonly ones using social media!• Most adults „go online‟• Many of these also use social media• Hea...
HOW ARE OUR PATIENTS USING      SOCIAL MEDIA?                      Medicine & Technology                      Research Col...
Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning                   ...
Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social n...
Social Networking Communities CanProvide Support to Patients                               Medicine & Technology          ...
Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social n...
Patients can use Social Networks         for ad hoc support       • Authors surveyed         participants from 5 online   ...
What is the quality of this information?Greene, J.A. et al., 2011. Journal of General Internal Medicine.                  ...
Video shared of a young                          Man with diabetes and his                          Experience with diagno...
Social Media Also Supports Families
Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social n...
Social Networking Communities            Can Provide Support to Patients                                  PatientsLikeMe  ...
Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social n...
Behavior Change… with social                    mediahttp://www.stikk.com
Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social n...
Bates, D.W. & Gawande, A.A., 2000. HealthAffairs
• 88% of physicians had a rating site listing;      • On average, 1.4 reviews for 300 physicians      • Physicians appeare...
HOW CAN CLINICIANS WORK WITHPATIENTS USING SOCIAL MEDIA?                       Medicine & Technology                      ...
Health teams are engaging with patients  • Share and/or spread reliable information                                       ...
Medical Practices & Institutions        Adopt Twitter for Patient Educationhttp://www.twitter.com                         ...
Medicine & TechnologyResearch Collaborativewww.themetrc.org
Health teams are engaging with patients              • Share and/or spread reliable information              • Advertising...
We also can ‘advertise’…                           Medicine & Technology                           Research Collaborative ...
Health teams are engaging with patients  • Share and/or spread reliable information  • Advertising  • Learning from patien...
Social Media for        Post-Marketing Drug SurveillanceKnezevic, M.Z. et al., 2011. Drug safety.                         ...
Learning with our Patients …tuanalyzeWeitzman, E.R. et al., 2011. PLoS ONE                                        Medicine...
If we can learn from large groups, can we         learn about individual patients?Jent, J.F. et al., 2011. The Journal of ...
of web users search the web about                     doctors or other health proessionalsFox S. Health Topics. A Report o...
Number of MDs with Attributable Hits  Massachusetts                            Number of Hits per MD    Internists        ...
Information found for 93.6% of physicians     •   92.8% had professional information     •   32.4% had personal informatio...
Jain, S. 2009. NEJM
Lagu T et al. 2010. JGIM
271 Medical Blogs 1/06 - 12/06                 57% of authors could be identified            Patients were described in 42...
Creating a standard for conduct               by healthcare workers in a             connected world that maintains       ...
Digital Domains                  Medicine & Technology                  Research Collaborative                  www.themet...
Public,M.D.   Private,M.D.
Dual Citizenship
Recommendations• Perform “electronic self-audits” to  monitor your online presence• Maximize online privacy settings for  ...
WHAT DOES THE FUTURE HOLD FOR PATIENTS AND PRIMARY CARE                  Medicine & Technology                  Research C...
Social Media & the Future of Primary Care• Health Promotion• Chronic Disease Management• Population Management• Revolution...
• Can notes be living documents?• Who is the master of the note?• Will this be useful, a distraction, or harmful?• Will ac...
Can Web 2.0 reinvent our practices?     Can we               Social Network   redefine the               Sites team? Can w...
Can Web 2.0 reinvent our practices?     Can we                 Social Network     improve                    Sites   popul...
Dashboard for Provider, M.D.  Frog,Hermit, 123-45-67                                       [Collapse]   - 8/2/10 0845 – Ja...
Can Web 2.0 reinvent our practices?  Instead of a separate note             Social Network each visit, can               S...
This morning’s discussion…• Social media are easy to use internet tools and sites to  share information and content with o...
Acknowledgements / My Social NetworkMedicine & Technology Research    -Bruce LandonCollaborative-Arash Mostaghimi         ...
Accept, Reject, or Ignore - Primary Care in the Age of Social Media
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Accept, Reject, or Ignore - Primary Care in the Age of Social Media

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  • Article appeared a few years back, two viewpoints. Really got me thinking… this will be a balance of this talk. Not simple. Think about this
  • Encyclopedia salesman is gone
  • The ‘crowd’ now edits the word…
  • Hidden Slide
  • Lesley story
  • Rate 13-25%
  • 15 groups, 15 wall posts
  • http://www.youtube.com/watch?v=FABfYl3Ay60
  • Video
  • Reputation
  • 300 physicians
  • 21 events, 1034 viewers
  • Google blurs
  • Identities can blurCarriemorgansteinsttory
  • Disparaging Patient StoriesInfluence Guidelines
  • Accept, Reject, or Ignore - Primary Care in the Age of Social Media

    1. 1. Medicine & Technology Research Collaborative www.themetrc.orgApprove, Deny, or Ignore:Primary Care in the Age of Social MediaBradley H Crotty, M.D.Instructor in Medicine, Harvard Medical School& Chief Resident, Beth Israel Deaconess Medical Center Medicine & Technology Research CollaborativeStoeckle Center Seminar, October 28, 2011 www.themetrc.org
    2. 2. Conflict of Interest Disclosure Bradley Crotty, M.D.I have no financial relationshipswith a commercial entity producinghealthcare-related products and/orservices.
    3. 3. This morning’s discussion…• What are „Social Media‟ and who uses them?• How does this relate to patients and clinicians today?• How can clinicians use these tools professionally?• How could (will?) we use social media in the future in primary care? Medicine & Technology Research Collaborative www.themetrc.org
    4. 4. Hawn, C., 2009. Health Affairs. Medicine & Technology Research Collaborative www.themetrc.org
    5. 5. Some Definitions: Web 2.0.. Not a new internet, but a new way of using the internet to interact with others and share content.Giustini, D., 2006. British Medical Journal.Barsky, E., 2006. Journal of the Canadian Health Libraries Medicine & Technology Research Collaborative www.themetrc.org
    6. 6. Some Definitions: Web 2.0.. Not a new internet, but a new way of using the internet to interact with others and share content. Content UsersGiustini, D., 2006. British Medical Journal.Barsky, E., 2006. Journal of the Canadian Health Libraries Medicine & Technology Research Collaborative www.themetrc.org
    7. 7. Some Definitions: Web 2.0.. Not a new internet, but a new way of using the internet to interact with others and share content. Content UsersGiustini, D., 2006. British Medical Journal.Barsky, E., 2006. Journal of the Canadian Health Libraries Medicine & Technology Research Collaborative www.themetrc.org
    8. 8. Some Definitions: Web 2.0.. Not a new internet, but a new way of using the internet to interact with others and share content.Giustini, D., 2006. British Medical Journal.Barsky, E., 2006. Journal of the Canadian Health Libraries Medicine & Technology Research Collaborative www.themetrc.org
    9. 9. Some Definitions: Web 2.0.. Not a new internet, but a new way of using the internet to interact with others and share content.Giustini, D., 2006. British Medical Journal.Barsky, E., 2006. Journal of the Canadian Health Libraries Medicine & Technology Research Collaborative www.themetrc.org
    10. 10. Some Definitions:Social MediaWebsites and Internet-based tools that facilitate informationsharing among groups of people or the public at large. Medicine & Technology Research Collaborative www.themetrc.org
    11. 11. Some Definitions:Social MediaWebsites and Internet-based tools that facilitate informationsharing among groups of people or the public at large. Social Network Sites Blogs Wikis Photo Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    12. 12. Some Definitions: Social Media Websites and Internet-based tools that facilitate information sharing among groups of people or the public at large.Websites such Social Network as Facebook, SitesPatientsLikeMe, that facilitate sharing Blogs Wikis informationamong a group Photo Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    13. 13. Some Definitions: Social Media Websites and Internet-based tools that facilitate information sharing among groups of people or the public at large. Web Social Network + Log Sites Blog Self- Blogs Wikis Publication,Interaction with Photo followers Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    14. 14. Some Definitions: Social Media Websites and Internet-based tools that facilitate information sharing among groups of people or the public at large. Web Social Network + Log Sites Blog Self- Blogs Wikis Publication,Interaction with Photo followers Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    15. 15. Some Definitions: Social Media Websites and Internet-based tools that facilitate information sharing among groups of people or the public at large. Websites Social Network i.e. Flickr or Sites YouTube that allowusers to share Blogs Wikis pictures and video Photo Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    16. 16. Some Definitions: Social Media Websites and Internet-based tools that facilitate information sharing among groups of people or the public at large. Social Network Topical Sites websites collectivelyauthored by a Blogs Wikis user community Photo Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    17. 17. Some Definitions: Social Media Websites and Internet-based tools that facilitate information sharing among groups of people or the public at large. Social Network Topical Sites websites collectivelyauthored by a Blogs Wikis user community Photo Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    18. 18. WHO USES SOCIAL MEDIA? Medicine & Technology Research Collaborative www.themetrc.org
    19. 19. All generations use the internet … and many use to search for health info Go Online E-Mail Use Search Health Info News Shopping 100 90 Percentage of Survey Respondents 80 70 60 50 40 30 20 10 0 18-34 35-46 47-56 57-65 66-74 75+ GenerationFox S. Health Topics. A Report of Pew Internet & American Life Project. 2/11/2011Fox S, Jones S. The Social Life of Health Information. Pew Internet & American Life Project. 6/11/2009. Medicine & Technology Research Collaborative www.themetrc.org
    20. 20. All generations are using social networking more 50% of Internet Users age 50-64 use social networkingMadden M and Zickhur K. Pew Internet & American Life Project. 8/26/2011 Medicine & Technology Research Collaborative www.themetrc.org
    21. 21. Social media use is prevalent across race/ethnicity groups (…of Internet Users) 100% 84%* 80% 73%* 63% 65% 61% 60% 56% 40% 20% 18%* 13%* 10%* 5% 3% 5% 0% Social networking sites Online video Twitter Location services White Black LatinoSmith A. Pew Internet & American Life Project. 9/17/2011 Medicine & Technology Research Collaborative www.themetrc.org
    22. 22. We have potential to reach patients on mobile devices 100% (…of cell phone owners) 80% 60% 40% 25%* 19% 20% 15% 15%* 11% 7% 0% Use phone to look up health info Have apps to track or manage health White Black LatinoSmith A. Pew Internet & American Life Project. 9/17/2011 Medicine & Technology Research Collaborative www.themetrc.org
    23. 23. Your teenagers are not theonly ones using social media!• Most adults „go online‟• Many of these also use social media• Health is a major driver of use• Different socioeconomic groups may have differential use
    24. 24. HOW ARE OUR PATIENTS USING SOCIAL MEDIA? Medicine & Technology Research Collaborative www.themetrc.org
    25. 25. Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning Medicine & Technology Research Collaborative www.themetrc.org
    26. 26. Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social networks for ad hoc support Medicine & Technology Research Collaborative www.themetrc.org
    27. 27. Social Networking Communities CanProvide Support to Patients Medicine & Technology Research Collaborative www.themetrc.org
    28. 28. Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social networks for ad hoc support • General social networks for disease specific support and information sharing Medicine & Technology Research Collaborative www.themetrc.org
    29. 29. Patients can use Social Networks for ad hoc support • Authors surveyed participants from 5 online psoriasis forums • 260 respondents • Most reported increased I have made friends through the online group that I now communicate with outside of the social support, some better support group, and with whom I feel comfortable discussing personal situations quality of life, psoriasis and health. This has allowed me to gain and give more one-on-one support.Idriss, S., Kvedar, J. & Watson, A., 2009. Archives of Dermatology. Medicine & Technology Research Collaborative www.themetrc.org
    30. 30. What is the quality of this information?Greene, J.A. et al., 2011. Journal of General Internal Medicine. Medicine & Technology Research Collaborative www.themetrc.org
    31. 31. Video shared of a young Man with diabetes and his Experience with diagnosishttp://www.youtube.com/watch?v=FABfYl3Ay60
    32. 32. Social Media Also Supports Families
    33. 33. Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social networks for ad hoc support • General social networks for disease specific support and information sharing • Patient specific social networks for support and information sharing Medicine & Technology Research Collaborative www.themetrc.org
    34. 34. Social Networking Communities Can Provide Support to Patients PatientsLikeMe • Social network for healthcare • Tracks treatments, patient outcomes • Research Communityhttp://www.patientslikeme.com Medicine & Technology Research Collaborative www.themetrc.org
    35. 35. Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social networks for ad hoc support • General social networks for disease specific support and information sharing • Patient specific social networks for support and information sharing • Social media for behavior change Medicine & Technology Research Collaborative www.themetrc.org
    36. 36. Behavior Change… with social mediahttp://www.stikk.com
    37. 37. Patients use Web 2.0 and SocialNetworking for education and support • Wikipedia for background learning • General social networks for ad hoc support • General social networks for disease specific support and information sharing • Patient specific social networks for support and information sharing • Social media for behavior change • Social media for physician ratings Medicine & Technology Research Collaborative www.themetrc.org
    38. 38. Bates, D.W. & Gawande, A.A., 2000. HealthAffairs
    39. 39. • 88% of physicians had a rating site listing; • On average, 1.4 reviews for 300 physicians • Physicians appeared to have added their own reviewsLagu T et al. 2010. JGIM
    40. 40. HOW CAN CLINICIANS WORK WITHPATIENTS USING SOCIAL MEDIA? Medicine & Technology Research Collaborative www.themetrc.org
    41. 41. Health teams are engaging with patients • Share and/or spread reliable information Medicine & Technology Research Collaborative www.themetrc.org
    42. 42. Medical Practices & Institutions Adopt Twitter for Patient Educationhttp://www.twitter.com Medicine & Technology Research Collaborative www.themetrc.org
    43. 43. Medicine & TechnologyResearch Collaborativewww.themetrc.org
    44. 44. Health teams are engaging with patients • Share and/or spread reliable information • Advertisinghttp://www.twitter.com Medicine & Technology Research Collaborative www.themetrc.org
    45. 45. We also can ‘advertise’… Medicine & Technology Research Collaborative www.themetrc.org
    46. 46. Health teams are engaging with patients • Share and/or spread reliable information • Advertising • Learning from patients Medicine & Technology Research Collaborative www.themetrc.org
    47. 47. Social Media for Post-Marketing Drug SurveillanceKnezevic, M.Z. et al., 2011. Drug safety. Medicine & Technology Research Collaborative www.themetrc.org
    48. 48. Learning with our Patients …tuanalyzeWeitzman, E.R. et al., 2011. PLoS ONE Medicine & Technology Research Collaborative www.themetrc.org
    49. 49. If we can learn from large groups, can we learn about individual patients?Jent, J.F. et al., 2011. The Journal of Adolescent Health Medicine & Technology Research Collaborative www.themetrc.org
    50. 50. of web users search the web about doctors or other health proessionalsFox S. Health Topics. A Report of Pew Internet & American Life Project.2/11/2011Fox S, Jones S. The Social Life of Health Information. Pew Internet & AmericanLife Project. 6/11/2009.
    51. 51. Number of MDs with Attributable Hits Massachusetts Number of Hits per MD Internists Type of Search Findings Personal, Professional Subgroup Analysis250 physicians Differences between Physician GroupsMostaghimi A, Crotty BJ, Landon BE. 2010. JGIM
    52. 52. Information found for 93.6% of physicians • 92.8% had professional information • 32.4% had personal information • 11% had a public social networking page • 86.4% had physician rating sites (only 3 physicians had more than 5 reviews)Mostaghimi A, Crotty BJ, Landon BE. 2010. JGIM
    53. 53. Jain, S. 2009. NEJM
    54. 54. Lagu T et al. 2010. JGIM
    55. 55. 271 Medical Blogs 1/06 - 12/06 57% of authors could be identified Patients were described in 42% of blogs (16% Positively, 18% Negatively) 3 blogs had patient pictures Products promoted in 11% of blogsLagu T et al. 2010. JGIM
    56. 56. Creating a standard for conduct by healthcare workers in a connected world that maintains confidentiality, honesty, and trust in the medical profession.Mostaghimi A and Crotty BH. 2011. Ann Int Med Medicine & Technology Research Collaborative www.themetrc.org
    57. 57. Digital Domains Medicine & Technology Research Collaborative www.themetrc.org
    58. 58. Public,M.D. Private,M.D.
    59. 59. Dual Citizenship
    60. 60. Recommendations• Perform “electronic self-audits” to monitor your online presence• Maximize online privacy settings for personal profiles and social networking sites• Develop “dual citizenship” online with separate professional (public) and personal (private) networking profiles• Develop a professional biography for patients and others to preferentially find using search engines.
    61. 61. WHAT DOES THE FUTURE HOLD FOR PATIENTS AND PRIMARY CARE Medicine & Technology Research Collaborative www.themetrc.org
    62. 62. Social Media & the Future of Primary Care• Health Promotion• Chronic Disease Management• Population Management• Revolutionized Documentation Medicine & Technology Research Collaborative www.themetrc.org
    63. 63. • Can notes be living documents?• Who is the master of the note?• Will this be useful, a distraction, or harmful?• Will access to information benefit the patient?Delbanco et al. 2010. Ann Internal Med
    64. 64. Can Web 2.0 reinvent our practices? Can we Social Network redefine the Sites team? Can we connect proactively? Blogs Wikis Photo Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    65. 65. Can Web 2.0 reinvent our practices? Can we Social Network improve Sites population management with a “Twitter” Blogs Wikis like tool? Photo Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    66. 66. Dashboard for Provider, M.D. Frog,Hermit, 123-45-67 [Collapse] - 8/2/10 0845 – Jane Frog (family) wrote: “my father Hermit had a 5 lb weight gain over the weekend.” - 8/2/10 1000 – Don Lane (clinical RN) wrote: “have increased lasix, will follow-up in 2 days. (OMR Note) -8/2/10 1130 – Michael Daniels (Cardiology) wrote: “ Thanks Don; if worse, schedule in HF center for IV lasix.” Piggy, Miss 324-23-23 [Expand] - 8/2/10 0934 – Don Lane (Clinical RN) wrote: - “Patient will be coming into HF clinic today for palpitations.
    67. 67. Can Web 2.0 reinvent our practices? Instead of a separate note Social Network each visit, can Sites we just amend the patient‟s story/condition Blogs Wikis s? Photo Sharing Sites Medicine & Technology Research Collaborative www.themetrc.org
    68. 68. This morning’s discussion…• Social media are easy to use internet tools and sites to share information and content with others• Many adults are already using social networking and social media sites, and many for health information• Clinicians should adopt „dual citizenship‟ to separate personal from professional identities• How could (will?) we use social media in the future in primary care? … I leave that to you Medicine & Technology Research Collaborative www.themetrc.org
    69. 69. Acknowledgements / My Social NetworkMedicine & Technology Research -Bruce LandonCollaborative-Arash Mostaghimi Division of General Medicine &-Yonas Tamrat Primary Care, BIDMC - Tom DelbancoShapiro Center for Education - Russ Phillips- Sigall Bell - Jan Walker- David Roberts - Kaitlin Baratta- Chris Smith - Nadine Farag - Neha TrivediDept of Health Care Policy, HMS Medicine & Technology Research Collaborative www.themetrc.org

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