Good evening. I want to start by thanking Drs. Lys Fonger and Fiona Manning for inviting me here tonight. I am the IMP Librarian & before the IMP started in 2004 I was the family practice residency librarian at the chilliwack general hospital.I have no conflicts of interest to declare. Tonight I want to talk about the meaningful use of social media in medicine and how its powers can be harnessed. I’ll describe how social media differs from other media, I’ll introduce you to some of the toolsI’ll show how it’s currently being used in medicine/healthcare.
A 2012 paper about reviewing social media use by clinicians (primarily US clinicians) found that 86% of 18-29 year old students, those who might be entering medical school, use social media. (social media use by cliniciansby von Muhlen, Marcio and Ohno-Machado, Lucila Journal of the American Medical Informatics Association : JAMIA, ISSN 1067-5027, 09/2012, Volume 19, Issue 5, pp. 777 – 781) So what? Well, the World Health Organization in 2009 published a statement on what social media offers to health professionals & citizens. It states “Critically, health professionals need to use social media to engage in a conversation, not only to “pass down” information. The global social media community expects to be able to add value to the conversation, to help correct rumours or misinformation, provide feedback or offer personal experience.” Because our students use and value the use of social media in medicine, we need to be familiar with how to navigate the web’s communication and collaboration ecosystems. Because of the value social media is already providing via social media, , there’s an imperative to look further into the whole world of social media. One reason is because health information should be free to all. Already, evidence shows that health outcomes can be improved by using social media for patient education and care. As our society is increasingly global, social media gives us the unlimited ability to collaborate with colleagues locally and all over the world Social media is now the most powerful source for news updates We can influence health policy by participating in social media in healthcare
So to illustrate how social media differs from traditional information change have a look at this image. Traditionally, formal information exchange was essentially one way from an authority (journals or experts or government, etc.) to a consumer an often cost information (e.g. Journal subscriptions). Informal two-way information exchange takes place between colleagues discussing a difficult case in the doctors’ lounge, or at a CME event, etc. Social media is beyond two-way information exchange as every party in the network, no matter how big the network, can exchange information with each-other simultaneously. Social media is a great information equalizer.
This image about the social media effect is really about what’s called crowdsourcing. Social media provides open access information for everyone, and is participative and non-hierarchical. It’s the “Wisdom of the Crowds”. The general concept is to combine the efforts of crowds of individuals, where each one could contribute a small portion, which adds into a relatively large or significant result. Daren Brabham in 2008 defined crowdsourcing in the scientific literature as “an online, distributed problem-solving and production model.” Henk van Ess says that “crowdsourcing is channeling the experts’ desire to solve a problem and then freely share the answer with everyone.” It’s a democratic way of organizing the collective knowledge of the thousands, a way of collecting valuable, creative and cost-effective information and works as a interactive educational tool.What really matters is timely, accessible and credible health information to improve public health outcomes, help people take action during an outbreak, or to prevent illness.1,2Increased access to the Internet and mobile communication combined with strategic uses of social media can bring public health information to many more people, more quickly and directly than at any time in history.
I want to give you a sense of how powerful & fast information on social media travels. This 30 second visualization shows how twitter was used in just one-hour right before and after the Tohoku earthquake in Japan, March 2011. So now that we know about the social media effect of crowdsourcing let’s start exploring some popular social media tools.
A good example of a social media tool is a wiki, a web site developed collaboratively by a community of users, allowing any user to add and edit content.Wikipedia, a free, online, community-built encyclopedia was created in 2001 and It is based entirely on user-generated content, built by the many for the benefit of all. Wikipedia’s fundamental principles are that it’s to be an encyclopedia, not an advertising platform or vanity press; It has a neutral point of view, avoids advocacy, debates, opinions, interpretations and is has no plagiarized materials. All articles must strive for verifiable accuracy, citing reliable, authoritative sources, especially when the topic is controversial or a living person. A current example of how Wikipedia entries are created then changed by others, is that of the Wikipedia entry for Adrian Dix, B.C. NDP leader. On Apr. 9, it was reported that someone had been deleting negative information about Adrian Dix from his entry on Wikipedia. Today, it’s been reported that Wikipedia editors restored critical details and appear to be guarding against it being deleted again.Wikipedia’s entry on antibiotic resistance provides information on the causes of antibiotic resistance, its mechanisms, resistant pathogens, current research and more. It provides footnotes and has 106 scholarly references.
There are several good wikis such as Ask Dr. Wiki. Ask Dr. Wiki was set up by the Cleveland Clinic and is a good, free source of general medical information, imaging, etc.
Here are 2 more examples of a medical wikis, wikidoc.org & medpedia.The notion of a medical wikipedia—freely accessible and continually updated by doctors—is worthy of further exploration. Could wikis be used, forexample, as a low cost alternative to commercial point of care tools like UpToDate?
A blog is an easy-to-publish ,free-to-use website where bloggers post information and essays in sequential order and can be searched; readers can enter their comments below each blog post. The idea of a blog is to stimulate discussion and debate across a vast geographical expanse.
Here’s an example of a JAMA blog, news@JAMA
Here we see a blog put together Dr. VesDimov, an allergist/immunologist in Chicago. He is the founder of ClinicalCases.org, the most popular online case-based curriculum of clinical medicine, which has received more than 7.5 million page views since 2005. ClinicalCases.org was featured in 14 high-impact scientific journals and hyperlinked in the websites of 37 medical schools.Dr. Dimov is the Editor-in-Chief of AllergyCases.org, a case-based curriculum of Allergy and Immunology, endorsed by both the American Academy of Allergy Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI). AllergyCases.org has reached more than one million page views.
Twitter is probably my favorite social media tool. Twitter is a micro-blog, limited to 140 characters. The WHO in 2009 said that “Twitter provides an instant stream of information between people around the world. Users can follow health conferences, a developing health story, search for information or share web links instantly from their desks or mobile devices. Searching for any health topic on Twitter leads to new contacts, networks and information.” (Bull World Health Organ 2009; 87:566.) It’s a method of mass communication, it’s real time and you can blast your message/question/link/whatever to however many people “follow” you on twitter. Twitter makes it easy and quick to get feedback about your projects, and to seek collaborators or find content for presentations. At conferences attendees can blog or tweet about the latest keynotes and workshops so that those not attending in person can keep up to date with what’s going on. Let me show you what I mean by “following” someone on Twitter (link to it now – Buddha1516). Click on the link to my Twitter account and show how I tweet & retweet and search for information on various topics by searching for them using hashtags, for example: #hcsm, #meded, #mhealth etc. The World Health Organization used Twitter during the H1N1pandemic in 2009 and, at time of writing, had more than 11 700 “followers.” One account from the Centers for Disease Control in the United States of America has more than 420 000.
Phil Baumann’s list of 140 health care uses for twitter
In Facebook you can search for & follow friends/groups/journals, etc.
Images & videos can now be shared via social media almost instantly.
This is a video embedded in a ppt presentation. The video lets you see the heart beating as the surgery is performed. This is useful for residents learning the procedure, for example, or for showing a patient exactly how the surgery will be performed.The Nanaimo Family Practice Residency site has its own YouTube Channel, Pearls & Pitfalls for Preceptors, which covers many different topics.
FB for professionals, like an online CV
We’ve looked at some social media tools, now I’d like to show you some healthcare uses of social media. We saw how YouTube’s being used in medical education but let’s see how some hospitals are using social media.The Mayo Clinic Center for Social Media will accelerate adoption of social media for health-related purposes, starting at Mayo and then within health care more broadly through the Social Media Health Network. Through this work, Mayo Clinic looks to help improve health literacy, health care delivery and population health worldwide.Mayo Clinic’s Social Media Philosophy:Mayo Clinic believes individuals have the right and responsibility to advocate for their own health, and that it is our responsibility to help them use social media tools to get the best information, connect with providers and with each other, and inspire healthy choices. We intend to lead the health care community in applying these revolutionary tools to spread knowledge and encourage collaboration among providers, improving health care quality everywhere.Mission of the Center:Lead the social media revolution in health care, contributing to health and well being for people everywhere.Vision for the Center:Mayo Clinic will be the authentic voice for patients and health care professionals, building relationships through the revolutionary power of social media.
Here’s a Mayo Clinic youtube video about JeneeseEdroff and neurofibromatosis
Notice that this 2008 YouTube video has been viewed over 211,651 times
(Note: This is hyperlinked)
Can choose a community based on language, main topics (research or clinical cases), whether you can access images & videos, medical specialty, how closed the community is, etc.Doctors.net.uk is the largest and most active network of GMC authenticated doctors in the UK. It is a trusted channel for information, communication and education and is used by more than 40,000 doctors every day. Doctors.net.uk is a trusted source of medical education, research and communication and is used by around 40,000 doctors every day. CollaborationDoctors.net.uk is a centre for medical networking. Clinical and non-clinical forums allow doctors to seek advice from colleagues and discuss topical issues. Doctors.net.uk provides the opportunity for the wider healthcare sector to communicate directly with doctors using a variety of marketing communications and research channels. Almost 300 accredited education modules are available free to doctors through Doctors.net.uk. Education modules are authored by clinicians and peer reviewed. Doctors.net.uk has built strong partnerships and relationships with some of the country’s best professional bodies and colleges.Sermo (American) - With over 125,000 US MDs and DOs, Sermo is the largest online community, exclusive to physicians. Anonymity. (If you want it).Privacy is important in medicine. That's why Sermo is an anonymous community. Feel free to share as much or as little about yourself as you'd like. But rest-assured, your conversations on Sermo are confidential. So go on, speak your mind.
ScienceRoll has the biggest list of biomedical community sites
Another example of crowdsourcing is called “Citizen Science” or “Crowd Science.” Citizen science is scientific research conducted, in whole or in part, by amateur or nonprofessional scientists, often by crowdsourcing. The “crowd” helps capture, systematize, or analyze large amounts of data. A local example of crowdsourced science is the Neptune Canada Project at UVic. Neptune Canada is the world’s first regional-scale underwater ocean observatory network that plugs directly into the Internet. People everywhere can ‘surf the seafloor,’ while ocean scientists run deep-water experiments from labs and universities anywhere around the world. Those interested can join their community of scientists, students, policy makers and ocean enthusiasts to contribute to the program. In Jan. of this year a 14 year old boy, Kirill Dudko, from the Ukraine who had learned about NEPTUNE Canada on a Discovery Channel program, began watching live video streams from seafloor cameras, and gathering clips of interest to post on his YouTube Channel. On 12 January 2013, Kirill was watching the video feed in Barkley Canyon (depth: 894 m) and noticed a hagfish moving around on the sediment below the camera, when something unusual happened. "Suddenly, a huge creature grabbed the hagfish," he wrote, "You know, it was like a horror film! This creature wasn't like a fish, and I realized it was a mammal because of its nose and mustache." Kirill grabbed the clip and posted it on his YouTube channel, then sent us a message asking if we could help identify the creature that caught the hagfish. We put the word out to marine mammal experts in Canada and the US, who identified the mystery animal as a female northern elephant seal. This was the first sighting of an elephant seal in seafloor footage, recorded by a camera situated 894 m below the surface.
PatientsLikeMe is an example of the "e-Patient" movement, also referred to as "participatory medicine.“Social networking health sites such as PatientsLikeMe let people actively share and learn from each other’s medical information including histories of conditions, symptoms, side effects, and more (see www.patientslikeme.com). This gives people in similar situations a better understanding of possible treatments and outcomes. The idea is that when people are feeling ill they search online about medication or symptoms, thus enabling effective early disease detection and monitoring.ePatients are equipped, empowered, educated, engaged, and enabled to make their own decisions, talk with their medical team on an equal footing and take active participation in their medical care. ePatients want to learn more about their health, their condition and their treatment and share what they have learned with their peers.The true transformative power of social media is in the users and their communities. Patients become informed. Physicians share what they learn and create new knowledge both for patients, research and education. E-patients are: engaged, enabled, & empowered. Rather than disseminating medical advice, PatientsLikeMe serves as a platform for peers to interact with one another in a data-driven context. PatientsLikeMe now has more than 200,000 patients on the platform and is tracking 1,800 diseases. It is a free, Internet-based social networking & has No advertising. At the core of the tool is the patient's primary question: "Given my current situation, what is the best outcome I can expect to achieve and how do I get there?" PatientsLikeMe tries to get patients to quantify whatever they can about the diseases they have, scoring side effects like nausea and mood not usually captured as a number. It has designed 20 detailed questionnaires it circulates regularly to its members. Epileptics can enter their seizure information into a seizure monitor. It created a contrast sensitivity test with the Massachusetts Eye and Ear Hospital for people with Parkinson’s and the hallucinations that come with mood disorders. By collecting data in a systematic framework, aggregating them and then presenting compact visualizations of the course of a disease, PatientsLikeMe gives patients the tools to answer the question, "What is the best outcome I can expect to achieve?" Finally, the site answers the patient question "How do I get there?" in a variety of ways, whether it is symptom reports, treatment reports or interactions with other peers. Researchers are using the site is to study side effects or adverse events.
The best part of crowdsourcing is that it can be accessed anywhere, anytime, as long as there is Internet access. Doctors can pose a challenge or question to thousands of other doctors worldwide and get collaboration on a medical treatment issue. For example, the New York Times hosts a monthly Diagnosis column that outlines a complete patient situation, from the patient’s symptoms, in emerg and in the hospital.which can include a sequence of tests and images. The column then asks readers to answer questions or make a diagnosis. This patient has Lyme carditis.The American Academy of Pediatrics often put out an electronic call for knowledge and research on a given topic. To date, over 2,500 issues have been crowdsourced by the AAP and similar groups run by federal government and other bodies. Because of this crowdsourcing, many reports have been published discussing the findings.The NEJM has an “image challenge”
Webicina, is a social media resource for physicians and patients that I highly recommend you visit. Webicina collects and curates the most relevant medical social media resources, has a social media course, which I’ll show you later, organizes social media resources by specialty and more. It also has a “crowdsource a challenge” section. Let me show you some of Webicina (click on webicina slide)
Data has been collected using crowdsourcing on 23andMe to see which conditions are related to which other conditions. OPEN UP 23andme.com. For example, if we look at ‘Onion Intolerance’ (show them here that it’s connected to stomach pain, candidiasis yeast infection & fibromyalgia. * The data underlying the connections in this graph are relative risks between pairs of diseases and symptoms. Specifically, diseases are connected if CureTogether members reporting the selected disease had a significantly higher chance of also reporting the connected disease, compared with members who reported not having the selected disease. The CureTogether database consists 4.4 million total data points collected from it's nearly 39,000 members.
from the Oct. 18, 2011 discussion of patient-initiated research into spontaneous coronary artery dissection (SCAD) at the Social Media Summit in Rochester, Minn.
So, let’s acknowledge that most doctors already have a presence online. If doctors Google themselves, they likely will already have a profile from an online physician rating site. These profiles are often filled with advertisements or inaccurate content. The price of passivity is being defined online by someone else. Learn how to be in charge of your own digital footprint and use your footprint for good.So how can we learn more about using social media in a meaningful way while shaping our own digital footprint?
You can attend several conferencesa yearon social media in medicine such as Medicine 2.0, Health 2.0, etc.
Social networking, free publishing & collaboration tools for Canadian healthcare professionals – An introduction to Canadian Healthcare Education Commons (CHEC-CESC)Tuesday, April 23rd, 8:00am to 8:30am
UBC has a Master’s-level course in Social Media in Health and Medicine developed by the eHealth Strategy Office collaboratively with UBC biomedical librarians and social media experts, ran through the UBC School of Population and Public Health‘s Master of Public Health program. But I’m not sure if it’s being offered this year or not. This course welcomes Masters students, health professionals, educators, researchers, and others involved in health and medicine.
A colleague of Mine, Dean Giustini from the UBC Biomedical Branch Library has created a useful table of various social media, their pros and cons, how to get started tips and examples. If anyone would like a copy I have some here you can help yourself to after the talk.I have a one pager handout, also.
I found this infographic on a social media tool called Pinterest which also shows you which social media tools work best for which goals. (Show & enter infographic)Pinterest is a content sharing service that allows members to pin images, videos, and other objects to their pinboard.
This one’s from the CDC
I’ve shown you a few ways that social media are being used in medicine, including some powerful crowdsourcing ideas. If you’re interested in getting more familiar with using social media tools I recommend you take a look at relevant guidelines, for example, this one from the CPSBCThe guidelines emphasize the need to maintain patient confidentiality, provide accurate information, treat colleagues with respect, avoid anonymity online if writing in a professional capacity, be aware of how content is shared, review privacy settings and online presence, declare conflicts of interest, and maintain separate personal and professional profiles
To begin interacting with social media start small with one tool. Spend 10 minutes setting up a LinkedIn profile and get used to being online. Test it out. Share with colleagues. Set a goal. Focus on what purpose you want to use social media for. Is it to collaborate with colleagues, other thought leaders, researchers? Is it to help educate your patients with valuable and trustworthy health information? Is it to stay more up-to-date using social media tools?Be strategic and choose wisely. Identify what needs to be said and why, to whom and when. Focus efforts on the specific social media tools relevant to the audience and use them consistently. A string of abandoned or infrequently tended social media accounts hurts credibility. Twitter and other social media tools might not bring health to all, but they can help to bring accurate health information to more people than ever before. In fact, an emergency message about an outbreak, for example, can be spread through Twitter faster than any influenza virus. (Bull World Health Organ 2009;87:566) Privacy – you should know about guidelines, boundaries and separate your personal and professional online profilesDon’t talk about patients online, talk about casesReliability – to assess the quality of answers you receive, you have to build a relationship with these global colleagues based on trust, it takes time.
Dr. Kevin Pho says that “getting online & helping patients navigate through the trove of health information on the web is a new physician reponsibility for the 21st century, like it or not.”Social media is not a fad but is changing the way physicians and patients interact. The true transformative power of social media is in the users and their communities. Patients become informed. Physicians share what they learn and create new knowledge both for patients, research and education. Physicians become information curators, filtering only the best information for patients and leveraging their expertise to interpret what patients find on the web. As Dr. Michael Lara who blogs on social media for healthcare professionals says don’t just tinker with Twitter, for example, for a few weeks then write it off as a diversion. Why, because there’s a learning curve to learning social media properly. For example, start a YouTube channel for your patient education library. Think of the top 3 things you answer every day and make a 1-3 minutes video clip of your answer. Then upload these videos by creating a channel site on youtube. Then announce your video library of FAQs with printed info in your waiting room and on your FB page.
I want to thank you very much for your attention. Mention that I have copies of the excellent handout I mentioned earlier, Social Media at a Glance 2013, available for those who want a copy. I also have my business cards here for those who are interested in contacting me further.
Doctors 2.0 final
Doctors 2.0:Meaningful Use of Social MediaRebecca Raworth, MLISIsland Medical Program LibrarianApril 11, 2013
Background*http://www.pewinternet.org/Commentary/2011/November/Pew-Internet-Health.aspx (2011)**http://www.slideshare.net/prich/canadian-physicians-and-social-media-a-survey (2011)72% of internet users say they looked onlinefor health information within the pastyear.*(USA)A majority of CMA 2011 survey respondentsexpressed concerns about privacy and securityconsiderations, lack of knowledge about socialmedia and time constraints.**(Canada)81.8% of medical students agree that socialmedia are of value in day-to-day medicalpractice.**(Canada)
Medical WikisWiki Doc Medpediahttp://www.medpedia.com/http://wikidoc.org/index.php/Main_Page
What’s a Blog?Medical bloggers are highly educated and devoted blog writers, faithful totheir sources and readers. Sharing practical knowledge and skills, as well asinfluencing the way other people think, were major motivations for bloggingamong our medical bloggers. Medical blogs are frequently picked up bymainstream media; thus, blogs are an important vehicle to influence medicaland health policy.J Med Internet Res 2008;10(3):e28