Thursday, March 3, 2016

Using Social Media for Patient Care and Population Health

I'm very interested in the ways we can use digital technologies to improve clinical care and population health. Over the years I've written a number posts on the topic (if you want to see them, the Facebook and Social Networking links will get you there). 

Digital technology in health care is a booming area - a form of the wild west, with some terrific innovations and a lot of hype and racing to make a quick buck. Next week the Harvard Pilgrim Health Care Ethics Advisory Group, which I have the privilege of chairing, is discussing the ethics of telemedicine. It's going to be a standing room only gathering with more than 40 participants.

I'm a big fan of Leslie Kernisan, a geriatrician in the Bay Area. I've only "met" Leslie via email, but I follow her terrific GeriTech blog. Last week she wrote a post on geriatricians and social media, in which she spoke in very practical terms about whether, why, and how geriatricians should make use of social media technologies. With Leslie's permission I'm republishing her post here:
Patricia Bach, a geriatric psychology colleague who is active in social media, recently emailed me a question: how to encourage more clinicians in geriatrics and long-term care to use social media?
In particular, she asked me “What do you feel is the ROI for geriatricians to use social media/networking in their professional roles?”
This is an interesting question to consider. After all, we have a limited number of geriatricians available for a growing older population. We also each have only so much time and energy in every day. 
So how should each of us be spending our time? How much should be on social media, and do we all need to be using it? 
I myself really like blogging — obviously — but was a reluctant adopter of shorter-form social media. To this day, I have a minimal personal social media presence. I only got going on Twitter because I started this blog in the fall of 2012. For me, Twitter was a good way to learn about digital health and connect with others interested in tech and aging. 
Then I started using Facebook in 2014, mainly because I was focusing more on my geriatrics content for the public, and at that time Facebook seemed to be a better platform for interacting with the general public, compared to LinkedIn or Twitter. (I would say this is still true. 
In adopting social media for these reasons, I was manifesting something that is very important to consider when it comes to physician behavior — or really any person’s behavior — with a respect to engaging in a certain activity:
  • What are the most important motivators and interests for the person? What are they most eager to accomplish? How does the activity address those?
  • What are the demotivators? What are the downsides to engaging in the activity?
  • How much friction or difficulty is involved in engaging in the activity?
You can also consider an activity in terms of “Return on Investment” (ROI), however, this term doesn’t usually take into account how soon the return is going to arrive. And we know that people are much more motivated by concrete returns that happen fast — and are related to something currently of great interest/appeal/fear to them — whereas they discount returns that are coming way off in the future. 
Social media is about communication and networking
Back to social media itself. It is fundamentally about communicating and networking. So to use it sensibly, I recommend individuals — or larger entities — consider the following:
  • Who do you want to communicate with?
  • What is your purpose in doing so?
  • What actions do you hope the audience/people you connect with will take?
  • What short-term and long-term results are you hoping for?
  • How will this communicating and networking help you advance your most important goals?
  • Which platforms are well-suited to your purposes?
  • What non-social media methods could you use to achieve your goals, and would that be a better fit given your time/resources/purposes?
It is also important to consider the learning curve of whatever platform and communication strategy one is embarking on, as well as any risks or downsides.
For instance, most social media platforms generate a torrent of information. So one downside is that doing social media takes time and energy, and if you aren’t careful or disciplined about your approach, it can swallow up a lot of time and energy. 
Should geriatricians use social media? 
To answer this question, we should consider it from the perspective and interests of various involved entities. At a minimum these would include:
  • The individual clinicians
  • The organizations that clinicians works for in some way, such an employer or even an association that a given clinician feels a duty to serve
  • Entities representing the welfare of the public, such as government agencies, large non-profits and foundations, and others who try to shape the healthcare environment so that the activity of clinicians benefits society.
Each entity has their own motives, interests, and particular priorities. Needless to say, there is often imperfect agreement between what the clinician is most interested in, the employer is most interested in, and other larger entities are most interested in. 
Whenever I hear someone — we’ll call them the “Suggester” — say “Doctors should do this!” or “Doctors should do more of this!” I certainly think about who is saying it, and what’s in it for them. 
And then I think about how to align that with what those individual doctors are interested in doing. Does this request fit in with the doctors’ interest and motivations? How feasible and easy to implement is it? Is the Suggester in a position to influence the doctors’ work environment or motivating factors? 
If you want people to do something, you need to understand how it fits in with what they are most interested in doing. And then you need to help make it possible and appealing for them to do it. 
An example from the published literature on healthcare social media: 
Here’s a quote from the abstract of a 2015 article titled “Social media is a necessary component of surgery practice.” 
“Each surgeon must embrace the power and potential of social media and serve as a guide or content expert for patients and other health care providers to facilitate and share responsible use of the various media available.” 
The abstract goes on to describe the potential power of social media to “improve consultation and collaboration, facilitate patient education, and expand research efforts…[and] to disseminate campaigns to increase disease awareness and communicate new research findings and best-practice guidelines.” 
I would not dispute the description of the potential power of social media. But it’s not at all clear to me that every surgeon must hence be on social media in a professional capacity. 
Instead, I would say that organizations that represent surgeons and surgical expertise should certainly have a social media presence. Certain individual surgeons may also find it serves their primary interests to be active on social media, either because they are doing it on behalf on an employer or professional association, or because the activity serves their personal projects and aspirations. 
Now, some will say that social media is important for maintaining your professional reputation. I’d say this really depends on what kind of work you are doing as a doctor. If you do research, then it can be good to have a social media presence that enables you to connect with colleagues and the media. If you are in private practice and are having trouble recruiting patients then yes, the right social media activity could help you raise your profile and find more work or patients. 
But most doctors I know are busy, and their biggest concerns relate to their working conditions and their ability to perform what they see as their core work. Usually, this is caring for patients and perhaps maintaining financial viability. For some physicians, it’s getting grants and other forms of academic success. 
Only rarely is it providing health information online to as many people as possible (that’s my project but I’m hardly representative of my colleagues) or even raising the visibility of the clinic or organization they work for, unless they are a designated social media ambassador (or trying to become one). 
Social media IS important to geriatrics and to the cause of improving the health and wellbeing of a growing older population 
To return to the question of whether there’s an ROI on geriatricians participating in social media: 
I absolutely believe that social media platforms can and should be used by geriatricians and related organizations, to help promote better health and healthcare for older adults
To begin with, in recent years social media endeavors — such as the Geripal blog — have played an important role in enabling geriatricians to connect with media influencers, which has helped the public become more aware of our field and expertise. The more often geriatric expertise is incorporated into the work of health journalists, the better. 
Then there is providing information more directly to the public. Digital platforms are now the primary way that most adults access information and certain forms of support. Older adults use digital media less than younger ones do, but their use of technology and digital communications is increasing rapidly, as noted by Pew. Pew has also found that family caregivers are often “wired for health.” 
As clinicians providing hands-on care, we should be familiar with the most commonly-used resources our patients and their families are using. These are increasingly digital, although the extent to which they are based on social media seems variable. (I find it depends on topic, niche, patient and caregiver population.) 
If an individual clinician is considering social media, I recommend considering the intended purpose and audience. Especially for those clinicians who mainly provide hands-on clinical work, social media may not be very useful to them. (You can network with colleagues at conferences and keep up with medical news via a few choice websites or journals.) 
However, most organizations should have a social media presence, which means some individuals will spend time maintaining that presence. Having a few clinicians participate in this can be nice, but they should be given time and resources to do it, and to keep up with the ever-evolving social media landscape. 
Social media for health and education 
I don’t have time to review the literature on this topic, so instead I’ll share my perspective as someone who has been creating geriatrics content online since 2008.
For educating and communicating out to the general public, I have found that writing longer content is far preferable to tweets, blog comments, or short Facebook posts. Create something that is more than a blip in a person’s attention, and that really tries to address a question or need. (I don’t personally produce videos but those can be great too. I am now going into audio and podcasting.) This content can be produced for one’s own website, or can be guest-posted to a bigger site with a larger audience. Interactive events like webinars with Q&A capability also have good potential. 
Otherwise, short-form social media (e.g. Twitter, Facebook) can and should be leveraged for dissemination. Such platforms allow clinicians and their audience to share longer content, or to share the notification of an upcoming event or opportunity. 
For learning from the audience — which essential to being truly helpful and to figuring out how to serve your audience — you need to spend a certain amount of time observing/listening, when it comes to what your audience says, does, and asks. Pay special attention to what they ask each other, and what they ask people who are not you, or not in your particular role. It’s also good to invite questions and participate in interactive events. 
Last suggestions for presenting to clinicians about social media 
Walk them through a process for thinking about their needs, their purpose, and how social media might fit in. 
Don’t conflate the needs/motives of the employer or society with the needs/motives of the individual clinicians. 
Provide education to make it easy for clinicians take the next step, if they’re interested.
Provide case studies and examples illustrating how different clinicians and organizations have used social media to achieve their goals. Tailor those case studies to overlap with what is likely to be the interests and goals of the clinicians you are presenting to. Some will be very interested in raising the brand and visibility of their clinic, but that may not be of interest to many geriatricians.

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