MDigitalLife: Understanding Physicians Online


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An abbreviated version of the presentation, as presented to the AMA's Austin Chapter on October 25, 2012. The full version can be found on WCG's channel:

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  • Discover needed servicesThrough social media, physicians can gain insight into what patients are willing to do to improve their health and what obstacles stand in their way, Kevin Abramson said in the PwC report. He is director of marketing planning for OptumHealth, a health management solutions company that is a subsidiary of UnitedHealth Group.Chris Keating, a physical therapist who manages social media activities for Strive Physical Therapy and Sports Rehabilitation in New Jersey, said Strive’s social media activities give him an outlet to find out what services and events interest people. When he posts photos of an event Strive held in the community, he’ll ask Facebook followers what events, such as screenings for certain medical conditions, they would like to see. It’s a way to get the information you want in a conversational way, he said.61% of patients say they trust information posted by physicians on social media.Jessica Logan, social media and online content specialist for the University of California, San Diego Health Sciences marketing and communications department, said she sees a lot of trends developing on Twitter that could indicate a need in the community. For example, she said she has seen a lot of discussion on ulcerative colitis. From a social media content perspective, she knows the community could benefit from her posting more information about that topic. From a business perspective, the conversations could help guide product or service development efforts.Although a small physician practice might not have the manpower to manage social media efforts, they are at an advantage when it comes to acting on information due to the smaller number of people making decisions. While it would be difficult for a large institution like UC San Diego to institute a program or specialized service immediately, a small practice has that flexibility.Jason Hwang, MD, an internist and executive director of health care at the Innosight Institute, a San Francisco-based research organization focusing on education and health care, said social media could provide a new way of tracking population health. Tracking health trends is becoming increasingly popular, as many practices move toward medical home and shared savings models. It also could identify “hot spots” for disease outbreaks.“A hospital or health system could engage social media to see what their patients are talking about and subsequently target those hot spots with certain therapies or interventions,” he said.Improve customer serviceHow a physician practice or hospital responds to negative comments and complaints can carry equal or more weight than positive consumer engagement, according to the PwC report. Unlike customer service issues brought to a practice’s attention in a survey, complaints made on social media can be addressed — and often remedied — immediately, because there is an outlet for a dialogue.Even though specific details should be kept offline, practices can respond in public with an apology and offer to correct the situation so that others can see action being taken. Logan said when other social media users see that a problem is being handled right away, they come to realize that customer service is taken seriously. It also gives the practice a chance to know about situations immediately so they are remedied and not exacerbated by an upset patient.Gather feedback on medicationsJared Rhoads, senior research analyst with CSC’s Global Institute for Emerging Healthcare Practices, said feedback on therapies is one of the most valuable uses for social media — and possibly one of the easiest to facilitate.“If 10,000 people start talking about a side effect of a drug, it won’t be that hard to find that out,” he said.Trends on Twitter sometimes indicate medical needs in the community.Monitoring Twitter buzz surrounding a certain drug, for example, would offer great insight into how patients are reacting to it. Not only is information on side effects useful, but information on therapies that are working well is valuable to physicians, he said. There may be insight about a therapy the physician hasn’t tried, or an alternative therapy he learns about through patient interactions on social media.Patient communities are a great source of information for physicians. HealthUnlocked in the United Kingdom, for example, has more than 100 disease-specific communities where patients share experiences and advice. With the users’ consent, the data are collected from their discussions and shared with physicians, researchers and pharmaceutical companies. (See correction)In the United States, companies such as Reading, Mass.-based InfoMedics use online communities to collect discrete data about topics patients might not always share with their physicians. They enter the online communities, and through questionnaires or surveys, ask questions that can be answered by patients in a quantifiable way.Gene Guselli, CEO of InfoMedics, said patients are often more comfortable talking about their health with a third party, even if they know their physicians is listening.Compare and improve quality
  • Chretian focused on professionalism while we’re looking more at behavior.
  • The male/female breakdown in the full MD population in the US is 65.% male and 34.2% female. In our dataset it is 73.7% male and 26.4% female. The actual variance represented in the data is 7.9%
  • 32% MDs link to a personal blog or website, 38% link to a practice website, 9% link to a business and 2% link to a medical resource.
  • After plastic surgeons, orthopedic surgeons were the second highest of any % at 78.5% of practice links, followed by Dermatology at 77% of practice links. The specialty with the highest % of personal blog/website links is pathology at 66.7%. The specialty with the highest % of business links was is Anesthesiology at 22.7%. The specialty with the highest % of Medical Resource links is also Pathology at 22.2%.
  • The all MD average (found by doing analysis on the individual level is 2.3x/day. The numbers per specialty are Pediatrics: 3.9/day, Opthalmology: 3.2/day, Radiology: 3.1/day, Otolaryngology: 3.0/day and Emergency Medicine: 2.7/day.
  • (Calculated at individual level) Median tweets/day is .5. 22% tweet between 1.5 and 2.5 times/day.
  • Percentages represent the percent of MDs within that category that have at least 20 MDs from database following them.What are the implications for different uses of twitter?  Engagement vs. Filtering vs. Newsgathering vs. Spamming
  • % of MDs followed by at least 20 other MDs by specialty: Pain Medicine 50%, Family Medicine 49%, Pediatrics 45%508 of 1397 36% were mentioned at least once by another physician in the data set
  • Top Linksnpr.org16medpagetoday.com15latimes.com9alvinblin.blogspot.com7annals.org7jwatch.org7medscape.com7usatoday.com7wsj.com7penispowerbook.com6aafp.org5ascopost.com5youtube.com5
  • This slide should be available in print out version but not in presentation.These are the classifications with more than 10 doctors.
  • This slide should be available in print out version but not in presentation. These are classifications with fewer than 10 doctors.
  • Should be available in printout version but not in presentation.
  • Should be available in printout version but not in presentation.
  • Should be available in printout version but not in presentation.
  • Should be available in printout version but not in presentation.
  • Should be available in printout version but not in presentation.
  • MDigitalLife: Understanding Physicians Online

    1. 1. Understanding Physicians OnlineGreg MatthewsOctober 25, 2012 Contents are proprietary and confidential.1 #AMAAHC | @chimoose
    2. 2. They’re here…#AMAAHC | @chimoose
    3. 3. But why are they here? • Discover Needed Services • Improve Customer Service • Gather feedback on medications • Compare and improve quality3 Contents are proprietary and confidential. #AMAAHC | @chimoose
    4. 4. With over 18,000 followers from medical communities, with the right strategy and communication, I can leverage the real power of my networks by using crowdsourcing very difficult questions and issues. Twitter is the fastest and most interactive social media channels in my work.” Dr. Bertalan Mesko Contents are proprietary and confidential.4 #AMAAHC | @chimoose
    5. 5. Connection promotes health, and twitter proves the model that simple digital tools can vastly increase connection. Aaron Stupple Resident, Beth Israel Deaconness Medical Center Contents are proprietary and confidential.5 #AMAAHC | @chimoose
    6. 6. I think using Twitter and other social media outlets has benefited me by letting me know where the patients are. I learn from their stories and I have a chance to truly hear them. In addition, I find social media beneficial as a learning source to interact with other physicians and med students I never would have met if I were confined by the walls of my own hospital. Danielle Jones, Medical Student Contents are proprietary and confidential.6 #AMAAHC | @chimoose
    7. 7. A benchmark In 2010, Dr. Katherine Chretien of the VA Medical Center in Washington led a team in producing the first known scholarly study of physicians’ use of twitter7 [ New, automated tools have enabled us to broaden the scope of our study Contents are proprietary and confidential. #AMAAHC | @chimoose [
    8. 8. Standing on the shoulders … The Chretien Study 260 5,156 Data Collected and tweets Analyzed between May 1st US Physicians and May 31st, 2010. from 260 physicans – the most recent 20 from each The power of automation Study 1,397 403,553 Data Collected and Analyzed US Physicians tweets between October 3 and validated against CMS’ National generated between October 15, 2012 Provider Identifier database May 1, 2012 and September 30, 20128 Contents are proprietary and confidential. #AMAAHC | @chimoose
    9. 9. Study Demographics9 Contents are proprietary and confidential. #AMAAHC | @chimoose
    10. 10. Reflecting the Population Plastic Surgery 3% … indexed within1,397 +/- 3 % of the total count US Physicians* 99.5 % Of Specialties… Residents -6 %10 Contents are proprietary and confidential. #AMAAHC | @chimoose
    11. 11. Reflecting geographic distribution 49 states indexed within +/- 4% of the total count overindexes underindexes11 Contents are proprietary and confidential. #AMAAHC | @chimoose
    12. 12. Reflecting gender distribution Overindex on twitter by 8% Underindex on twitter by 8%12 Contents are proprietary and confidential. #AMAAHC | @chimoose
    13. 13. Physician Profiles 78 % identify themselves clearly as such in their twitter bio 32 % link to a personal blog or website 80 % contain a URL in their bio13 Contents are proprietary and confidential. #AMAAHC | @chimoose
    14. 14. How are MDs using their accounts? Bio URL Distribution 6.90% 1.90% 93 % of all Plastic Surgery 37.70% URLs are links to their practice 31.90% Business Medical Resource Personal Blog/Website Practice14 Contents are proprietary and confidential. #AMAAHC | @chimoose
    15. 15. Twitter Activity – Time and Frequency15 Contents are proprietary and confidential. #AMAAHC | @chimoose
    16. 16. Tweets Over Time Trending steadily upward 4500 4000 3500 3000 2500 2000 1500 1000 500 0 1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 15116 Contents are proprietary and confidential. #AMAAHC | @chimoose
    17. 17. Tweets per day over Account Lifetime Pediatrics Ophthalmology Radiology Otolaryngology Emergency Medicine All MD Average17 Contents are proprietary and confidential. #AMAAHC | @chimoose
    18. 18. Tweets per day over 5 months May’12 Jun’12 Jul’12 Aug’12 Sep’12 42 are % increasing frequency 34 are % tweet at least 1 time per day 9 % maintaining frequency 50 are % decreasing in frequency18 Contents are proprietary and confidential. #AMAAHC | @chimoose
    19. 19. When can I find MDs on Twitter? Eastern time Morning Workday Work PM Evening Overnight (0500 – 0800) (0801 - 1200) (1201 - 1800) (1801-2300) (2301-0459) 18 % 22 % 32 % 12 % 17 % 32% 22% 18% 17% 12% Morning (0500 - 0800 Workday (0801 - 1200) Work PM (1201 - 1800) Evening (1801-2300) Overnight (2301-0459) 0500-0800 0801-1200 1201-1800 1801-2300 2301-045919 Contents are proprietary and confidential. #AMAAHC | @chimoose
    20. 20. Twitter and the MD Workflow Localized time Morning Workday Work PM Evening Overnight (0500 – 0800) (0801 - 1200) (1201 - 1800) (1801-2300) (2301-0459) 18 % 21 % 31 % 8% 22 % 31% 21% 22% 18% 8% 0500-0800 0801-1200 1201-1800 1801-2300 2301-045920 Contents are proprietary and confidential. #AMAAHC | @chimoose
    21. 21. The Connected Physician21 Contents are proprietary and confidential. #AMAAHC | @chimoose
    22. 22. MDs Most likely to be followed by peers* 25% 53% Personal Blog/Website 27% Business/ Organization All_Doctors No Bio URL practice 34% 40% *Percentages measure MDs followed by at least 20 others in the data set22 Contents are proprietary and confidential. #AMAAHC | @chimoose
    23. 23. How connected are online physicians? % 34 of all MDs are followed by at least 20 MDs Pediatrics Specialties who Emergency are followed by Medicine other MDs Family Medicine23 Contents are proprietary and confidential. #AMAAHC | @chimoose
    24. 24. Topics24 Contents are proprietary and confidential. #AMAAHC | @chimoose
    25. 25. Mining the Data A sample • Breast Cancer: (breast AND (cancer OR carcinoma)) OR (inflammatory AND breast) OR (inflammation AND breast) OR (breast AND (metastasis OR metastic)) OR (duct AND (carcinoma OR cancer)) OR (lobe AND (carcinoma OR cancer)) OR "DCIS" OR "LCIS" OR (estrogen AND receptor AND positive) OR "HER2" OR (breast AND MRI) OR (breast AND biopsy) OR (breast AND ultrasound) OR "mammogram" OR "mammography" OR "tamoxifen" OR (aromatase AND inhibitor) OR "exemestane" OR "trastuzumab" OR "Herceptin" OR "lumpectomy" OR "mastectomy" OR "komen" OR "BRCA1" OR "BRCA2” • Diabetes: "Diabetes" OR "Mellitus" OR "Insipidus" OR "Diabetic" OR "Gestational" OR "blood glucose" OR "Blood Sugar" OR "NIDDM" OR "IDDM" OR "LADA" OR ("Antiduretic Hormone" OR "ADH") OR ("Arginine Vasopressin" OR "AVP") OR "oral glucose tolerance" OR "fasting plasma glucose" OR "glycated hemoglobin OR HbA1c OR A1c" OR "insulin" OR "SMBG" OR "hyperglycemia OR hyperglycemic" OR "biguanides" OR "Sulfonylureas" OR "Meglitinides" OR "thiazolidinediones" OR "alpha glucosidase inhibitor" OR "GLP-1 agonist" OR "DPP-IV inhibitors" OR "DKA" OR "HHS" Contents are proprietary and confidential.25 #AMAAHC | @chimoose
    26. 26. Diabetes & Breast Cancer – Sample Search Contents are proprietary and confidential.26 #AMAAHC | @chimoose
    27. 27. The PSA Controversy 36 117 Doctors who state an opinion are more than 3:1 against the USPSTF’s ruling on PSA Tests 182 Negative Neutral Positive27 Contents are proprietary and confidential. #AMAAHC | @chimoose
    28. 28. Thank you #AMAAHC | @chimoose
    29. 29. AcknowledgementsPhysician Advisor – Bryan Vartabedian (@doctor_v)R&D Lead – Matthew Hager (@iSmashew)Research Analyst – Kayla Rodriguez (@Kaylarodrigue11)Visualizations – Ryan Ebanks (@ebanksre)Designer – Nidhi Raina (@NidhiRaina) #AMAAHC | @chimoose
    30. 30. #AMAAHC | @chimoose
    31. 31. Appendix #AMAAHC | @chimoose
    32. 32. Appendix – Classification Count Row Labels Count of classification Internal Medicine 314 Family Medicine 168 Pediatrics 116 Psychiatry & Neurology 100 Student in an Organized Health Care Education/Training Program 83 Obstetrics & Gynecology 76 Surgery 74 Orthopaedic Surgery 74 Dermatology 55 Emergency Medicine 53 Plastic Surgery 46 Otolaryngology 42 Anesthesiology 28 Radiology 27 Opthalmology 26 Urology 24 Allergy & Immunology 16 Pathology 14 Neurological Surgery 10 Preventive Medicine 10 #AMAAHC | @chimoose
    33. 33. Appendix – Classification Count Thoracic Surgery (Cardiothoracic Vascular Surgery) 9 Physical Medicine & Rehabilitation 9 General Practice 8 Pain Medicine 4 Colon & Rectal Surgery 3 Hospitalist 2 Nuclear Medicine 2 Neuromusculoskeletal Medicine & OMM 2 Medical Genetics 1 Phlebology 1 (blank) Grand Total 1397 #AMAAHC | @chimoose
    34. 34. Appendix – Specialty count Allergy & Immunology 16 Allergy 7 Allergy & Immunology 8 Clinical & Laboratory Immunology 1 Anesthesiology 28 Anesthesiology 21 Pain Medicine 6 Pediatric Anesthesiology 1 Colon & Rectal Surgery 3 Colon & Rectal Surgery 3 Dermatology 55 Clinical & Laboratory Dermatological Immunology 1 Dermatology 36 Dermatopathology 2 MOHS-Micrographic Surgery 5 Procedural Dermatology 11 Emergency Medicine 53 Emergency Medical Services 2 Emergency Medicine 51 Family Medicine 168 Addiction Medicine 3 Adolescent Medicine 1 Adult Medicine 5 Family Medicine 151 Geriatric Medicine 2 Sports Medicine 6 General Practice 8 General Practice 8 Hospitalist 2 Hospitalist 2 #AMAAHC | @chimoose
    35. 35. Appendix – Specialty Count Internal Medicine 314 Adolescent Medicine 1 Allergy & Immunology 2 Bariatric Medicine 1 Cardiovascular Disease 39 Clinical Cardiac Electrophysiology 5 Critical Care Medicine 2 Endocrinology, Diabetes & Metabolism 10 Gastroenterology 18 Geriatric Medicine 19 Hematology 2 Hematology & Oncology 17 Hospice and Palliative Medicine 5 Hospice Care & Palliative Medicine 2 Hospitalist 1 Infectious Disease 9 Internal Medicine 135 Interventional Cardiology 7 Medical Oncology 9 Nephrology 14 Nuclear Cardiology 1 Nutrition 1 Pulminary disease 1 Pulmonary Disease 3 Rheumatology 7 Sleep Medicine 3 Medical Genetics 1 Clinical Genetics (M.D.) 1 Neurological Surgery 10 Neurological Surgery 10 #AMAAHC | @chimoose
    36. 36. Appendix – Specialty Count Neuromusculoskeletal Medicine & OMM 2 Neuromusculoskeletal Medicine & OMM 2 Nuclear Medicine 2 Nuclear Cardiology 1 Nuclear Medicine 1 Obstetrics & Gynecology 76 Gynecologic Oncology 5 Gynecology 6 Maternal & Fetal Medicine 2 Obstetrics 1 Obstetrics & Gynecology 57 Reproductive Endocrinology 5 Opthalmology 26 Opthalmology 26 Orthopaedic Surgery 74 Foot and Ankle Surgery 5 Hand Surgery 6 Orthopaedic Surgery 48 Orthopaedic Surgery of the Spine 5 Orthopaedic Trauma 2 Orthopedic Surgery 1 Sports Medicine 7 Otolaryngology 42 Facial Plastic Surgery 9 Otolaryngology 23 Otolaryngology/Facial Plastic Surgery 6 Pediatric Otolaryngology 2 Plastic Surgery within the Head & Neck 1 Sleep Medicine 1 #AMAAHC | @chimoose
    37. 37. Appendix – Specialty count Pain Medicine 4 Interventional Pain Medicine 3 Pain Medicine 1 Pathology 14 Anatomic Pathology & Clinical Pathology 13 Blood Banking & Transfusion Medicine 1 Pediatrics 116 Adolescent Medicine 4 Developmental Behavioral Pediatrics 1 Neonatal-Perinatal Medicine 1 Pediatric Allergy/Immunology 3 Pediatric Cardiology 3 Pediatric Critical Care Medicine 1 Pediatric Emergency Medicine 2 Pediatric Endocrinology 4 Pediatric Gastroenterology 2 Pediatric Hematology-Oncology 3 Pediatric Infectious Diseases 3 Pediatrics 89 Phlebology 1 Phlebology 1 Physical Medicine & Rehabilitation 9 Pain Medicine 4 Physical Medicine & Rehabilitation 5 Plastic Surgery 46 Plastic Surgery 42 Plastic Surgery Within the Head and Neck 2 Surgery of the Hand 2 #AMAAHC | @chimoose
    38. 38. Appendix – Specialty Count Preventive Medicine 10 Occupational Medicine 2 Preventive Medicine/Occupational Environmental Medicine 3 Public Health & General Preventive Medicine 5 Psychiatry & Neurology 100 Addiction Psychiatry 1 Child & Adolescent Psychiatry 10 Clinical Neurophysiology 3 Forensic Psychiatry 2 Geriatric Psychiatry 1 Neurodevelopmental Disabilities 1 Neurology 25 Psychiatry 56 Psychosomatic Medicine 1 Radiology 27 Body Imaging 1 Diagnostic Radiology 17 Diagnostic Ultrasound 1 Radiation Oncology 6 Vascular & Interventional Radiology 2 Student in an Organized Health Care Education/Training Program 83 Resident 83 #AMAAHC | @chimoose
    39. 39. Appendix – Specialty Count Surgery 74 Pediatric Surgery 7 Plastic and Reconstructive Surgery 22 Surgery 32 Surgery of the Hand 1 Surgical Critical Care 2 Surgical Oncology 4 Trauma Surgery 4 Vascular Surgery 2 Thoracic Surgery (Cardiothoracic Vascular Surgery) 9 Cardiothoracic Vascular Surgery 8 Surgery 1 Urology 24 Urology 24 (blank) (blank) Grand Total 1397 #AMAAHC | @chimoose