So­cial-ized medicine

Tweets, texts and apps help turn chat into ac­tion

Modern Healthcare - - PATIENT SAFETY -

Trans­lat­ing talk into ac­tion is al­ways a chal­lenge, and per­haps never more so than when the “talk” is so easy with a so­cial net­work such as Twit­ter. Some par­tic­i­pants in a weekly health­care so­cial me­dia chat on Twit­ter, hosted on Sun­day nights us­ing the hash­tag #hcsm, de­cided to take on that chal­lenge.

“Ev­ery­body likes to talk, but not ev­ery­body likes to act,” says April Fore­man, a clin­i­cal psy­chol­o­gist from Fron­tenac, Kan., who was one of those who wanted to act. “If we say we can do it, we should try to see if we can.”

One of Fore­man’s like-minded fel­low Twit­ter users noted that im­mu­niza­tions are the most suc­cess­ful pub­lic health in­ter­ven­tions ever recorded, and they fur­ther honed the idea to fo­cus on im­prov­ing the im­mu­niza­tion rate in the Kansas City, Mo., area, which has the low­est tod­dler im­mu­niza­tion rate in the coun­try, Fore­man says. The project got its own hash­tag, #hc­sm­vac, pro­nounced “hik-sem-vac.” The par­tic­i­pants col­lected in­for­ma­tion re­gard­ing where to get im­mu­niza­tions and flu vac­cines in the Kansas City area, and health­care blog­ger Chris Hall (hal­li­cious.com) pro­duced an online map that pa­tients can call up on their smart­phones via a QR code to find the clos­est site to them.

The #hc­sm­vac project is an ex­am­ple of the clin­i­cal use of so­cial me­dia that is gain­ing some trac­tion as clin­i­cians and pa­tients alike be­come more com­fort­able with so­cial me­dia tools. A re­lated, and of­ten in­ter­re­lated, idea is called mo­bile health, or con­nect­ing to pa­tients via text mes­sag­ing or smart­phone ap­pli­ca­tions, or apps.

Clin­i­cians be­com­ing re­cep­tive

Dave de­bronkart says he be­lieves that clin­i­cians are start­ing to come around to these ideas, although the gen­eral pub­lic is still largely un­aware of them. De­bronkart was di­ag­nosed with late-stage kid­ney can­cer in 2007, with a me­dian sur­vival time of only 24 weeks, but his par­tic­i­pa­tion in a clin­i­cal trial halted the dis­ease. De­bronkart be­came a full-time ad­vo­cate of epa­tients—the late Dr. Tom Ferguson’s def­i­ni­tion of pa­tients who are em­pow­ered, en­gaged, equipped and en­abled—and writes a blog at epa­tient­dave.com.

“The over­rid­ing prin­ci­ple that has emerged in the Twit­ter chats and con­fer­ence dis­cus­sions is you don’t prac­tice medicine on so­cial me­dia,” de­bronkart says. “You talk about it. You can spread in­for­ma­tion. You can ex­change in­for­ma­tion. But a clin­i­cian would not in­ter­act on the pa­tient’s so­cial me­dia space.”

Physi­cians make for pow­er­ful voices through so­cial me­dia, de­bronkart says. One ex­am­ple he cites is Dr. Wendy Sue Swanson, a pe­di­a­tri­cian and par­ent who writes the Seat­tle Mama Doc blog on the web­site of Seat­tle Chil­dren’s Hos­pi­tal, Re­search and Foun­da­tion and also main­tains a Twit­ter ac­count, @Seat­tle­ma­madoc. “She uses so­cial me­dia to help her pa­tients un­der­stand all the in­for­ma­tion on the In­ter­net, a lot of which is crap,” de­bronkart says. “It’s our job to coun­ter­act that.”

So­cial me­dia also can help pa­tients con­nect with each other, de­bronkart says. His pri­ma­rycare physi­cian sug­gested an online pa­tient com­mu­nity that de­bronkart says helped him greatly dur­ing his can­cer treat­ment. Physi­cians can as­sist these com­mu­ni­ties by lend­ing their ex­per­tise, and they can also stay up to date with the lat­est re­search shared in them, he says.

The #hc­sm­vac project founders used so­cial me­dia to dis­trib­ute in­for­ma­tion and con­nect pa­tients and clin­i­cians. “We didn’t want it to be generic ad­vo­cacy,” says Nate Osit, a health in­for­ma­tion tech­nol­ogy im­ple­men­ta­tion spe­cial­ist for a soft­ware com­pany. “We wanted it to be more spe­cific. We thought the way to do that is to make a Google map with all the vac­ci­na­tion lo­ca­tions in Kansas City and use so­cial me­dia to dis­trib­ute that mes­sage.”

Osit set up a web­site (about.me/hc­sm­vac) and an online folder that con­tained all the ma­te­ri­als the group pro­duced so oth­ers could use them, he says. The group pro­vided the vac­ci­na­tion map’s QR code to physi­cians, who could then have stick­ers printed up to give to pa­tients. Car­men Gon­za­lez, who works for a con­sult­ing firm that re­cruits pa­tients for clin­i­cal tri­als, pro­duced three short videos that de­picted the emo­tional case for im­mu­niza­tions—all the peo­ple in our lives who would not be there if they had not been im­mu­nized.

Mem­bers of the project also blogged and tweeted about these ef­forts and used so­cial me­dia to com­mu­ni­cate with par­ents who have con­cerns about im­mu­niz­ing their chil­dren, Gon­za­lez says. One fa­ther whose daugh­ter is autis­tic pro­vided his rea­sons for hav­ing her vac­ci­nated, pro­vid­ing a pow­er­ful peer story for par­ents, she says.

Gon­za­lez hopes the group will re­new the ef­fort next year, prob­a­bly in the Kansas City area again. Next time, she hopes that they can con­nect to lo­cal pub­lic health and char­i­ta­ble groups.

A tool to re­duce read­mis­sions?

Two clin­i­cians who con­nected through so­cial me­dia are look­ing at a clin­i­cal use of so­cial me­dia that should be of par­tic­u­lar in­ter­est to providers: Can so­cial me­dia help re­duce hos­pi­tal read­mis­sions? Dr. Mark Ryan, a fam­ily physi­cian with the Vir­ginia Com­mon­wealth Univer­sity School of Medicine, Rich­mond, and Ben Miller, a clin­i­cal psy­chol­o­gist and an as­sis­tant pro­fes­sor in the depart­ment of fam­ily medicine at the Univer­sity of Colorado at Den­ver’s School of Medicine, have col­lab­o­rated on pos­si­ble ways that clin­i­cians and hos­pi­tals might use so­cial me­dia to help pa­tients af­ter dis­charge to pre­vent read­mis­sions.

The fed­eral Agency for Health­care Re­search and Qual­ity has stud­ied why pre­ventable read­mis­sions oc­cur, and so­cial me­dia might be able to help with two of the prob­lems the agency iden­ti­fied, Miller says: poor trans­fer of in­for­ma­tion to pa­tients and the lack of a timely post­dis­charge visit.

Hos­pi­tals of­ten show pa­tients a video re­lated to their stay just be­fore dis­charge, but pa­tients and their care­givers of­ten have so much go­ing through their minds as they pre­pare to leave the hos­pi­tal that they don’t re­tain much of this in­for­ma­tion, Ryan says. Pro­duc­ing short videos on a se­ries of typ­i­cal post-dis­charge ques­tions— such as how to care for a new­born’s belly­but­ton or what a con­ges­tive heart fail­ure pa­tient should do af­ter dis­charge—and mak­ing those avail­able through so­cial me­dia would be an ef­fec­tive way to reach these care­givers and pa­tients, Ryan says.

Pa­tients also could agree to have their so­cial me­dia posts mon­i­tored for signs that they need a clin­i­cian visit, Ryan says. An ef­fort such as this could be fo­cused on a few pa­tients, usu­ally with chronic dis­eases, who make up a dis­pro­por­tion­ate share of treat­ment costs, Ryan says.

An­other ex­am­ple mar­ries so­cial me­dia to

A QR code links to an in­ter­ac­tive map di­rect­ing pa­tients to vac­ci­na­tion sites.

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