Twitter may either be the greatest prank ever played on the internet community or it may be the best thing since sliced bread. It’s easy to make the first case if you read the public timeline for a few minutes. It’s a bit harder to make the second case, but I’ll do my best to make it. Specifically, I’d like to take a stab at offering 140 health care uses for Twitter.

Twitter’s simplicity of functional design, speed of delivery and ability to connect two or more people around the world provides a powerful means of communication, idea-sharing and collaboration. There’s potency in the ability to burst out 140 characters, including a shortened URI. Could this power have any use in healthcare? After all, for example, doctors and nurses share medical information, often as short bursts of data (lab values, conditions, orders, etc.).

CHALLENGES OF HEALTH CARE MICRO-SHARING

Unlike most other kinds of uses of Twitter (daily exchanges between friends, the kind of work @Comcastcares does, etc.), health care related matters pose unique challenges, including but not limited to:

• Patient dignity and privacy
• Professional oaths to do no harm
• Litigation concerns
• HIPAA

The possibilities that I believe Twitter offers currently far exceeds the constraints. I won’t offer work-around solutions to these constraints in this post. I want to focus on the possibilities because once we see the potential, we may have stonger motivations to deal intelligently with the constraints. So when reading this list, don’t get hung up on the details, the fears, the anxieties that may be provoked by the realities of health care as it is practiced today. It’s the 21st Century: let’s be imaginative, determined and innovative. Let’s be remarkable.

In the health care industry there is often a fine line between caution and fear. It is the fear of change so common in health care that I hope we can overcome. Twitter may be a proving ground of how we overcome our fears, satisfy our cautions and extend the reach of our health care system with web-based technologies and communities.

What follows are uses than can be adopted right now and uses that remain to be developed. What do you think health care will look like in 2099? Will we still be using paper medical records or will we be using technologies that other industries use? Will we transcend our accustomed ways of thinking and re-socialize ourselves for how we interact with each other in an exponentially changing technoscape?

I hope this list sparks debate to help answer those questions. Here are the suggestions.

140 HEALTH CARE USES FOR TWITTER

1. Tissue recruitment (for kidney and other organs, including blood)
2. Epidemiological survey
3. Disaster alerting and response
4. Emergency response team management
5. Supportive care for patients and family members
6. Diabetes management (blood glucose tracking)
7. Maintaining a personal health diary
8. Adverse event reporting in the clinical setting and other pharmacovigilance functions
9. Emitting critical laboratory values to nurses and physicians
10. Alarming silent codes (psychiatric emergencies, security incidents)
11. Drug safety alerts from the FDA
12. Risk management communication
13. Augmenting telemedicine
14. Issuing Amber alerts
15. Issuing alerts for missing nursing home residents
16. Exercise management and encouragement
17. Weight management and support
18. Biomedical device data capture and reporting
19. Nutritional diary and tracking
20. Coordinating preoperative, perioperative and postoperative care (among pharmacy, nursing and surgical services)
21. Medical service collaboration in the clinical setting
22. Triage management in emergency rooms
23. Census management/monitoring
24. Arranging outpatient care
25. Crowdsourcing for health care resources
26. Shift-bidding for nurses and other health care professionals
27. Mood tracking (for patients with bipolar and other mood disorders)
28. Patient care reminders in the clinical setting
29. Prescription management, including pharmacy refill reminders
30. Daily health tips from authoritative sources
31. Location awareness during crisis
32. Occupational safety response
33. Hazardous materials communication
34. “Quick and dirty” diagnostic brainstorming between physicians (e.g. ’symptom clustering’)
35. Clinical case education for (residents following attendings)
36. Physician opinion-sharing
37. Promoting Domestic Violence awareness
38. Raising Child Abuse awareness
39. USMLE preparation for medical licensing
40. NCLEX for preparation for nursing licensing
41. Recruitment of health care staff
42. Alcohol and other substance abuse support
43. Issuing doctor’s orders
44. Environmental alerts: pollen counts, pollution levels, heat waves, severe weather alerts
45. Remote wound care assistance
46. Rural area health care communication
47. Micro-sharing of pertinent patient information
48. Micro-sharing of diagnostic results (blood tests, echocardiography, radiological images)
49. Internal facility customer service (a hospital equivalent of @Comcastcares – c’mon hospitals!)
50. Publishing health-related news
51. Psychiatric “check-ins” for patients
52. Nursing mentoring and collaboration
53. Publishing disease-specific tips
54. Childcare support
55. Fund raising for hospitals and health-related causes
56. Updating patient family members during procedures
57. Live-tweeting surgical procedures for education
58. Rare diseases tracking and and resource connection
59. Reporting hospital staff injuries
60. Tracking patient trends
61. Tracking disease-specific trends
62. Checking hospital ratings with other health care consumers
63. Providing around-the-clock disease management
64. Connecting genetic researchers with physicians
65. Publishing the latest advances in biomedical devices
66. Tracking antibiotic resistance
67. Real-time satisfaction surveys with immediate follow-up for problem resolution
68. Issuing asthma alerts
69. Data collection for tracking facility patterns (process-performance, supply-chain and staffing problems)
70. Live-tweeting medical conferences
71. Keyword-tracking of health-related topics via Search.Twitter
72. Posting quick nursing assessments that feed into electronic medical records (EMRs)
73. Improving medical rounding systems
74. Clinical trial awareness
75. Hospital administration
76. Sharing peer-to-peer reviews of articles of interest
77. Connecting patients with similar disease processes
78. Enhancing health-related support groups (e.g. buddy-systems for depression)
79. Providing smoking cessation assistance
80. Medical appliance support (e.g. at-home: colostomy care, infusion-pumps, wound-vacs)
81. Reporting medical device malfunctions
82. Tweeting updates to facility policies and procedures
83. Arranging appointments with health care providers
84. Product safety alerts
85. Food safety alerts
86. Information on women’s health
87. Pain management
88. Hospital reputation monitoring
89. Publishing hospital-sponsored events in local communities
90. Community health outreach
91. Bioterrorism awareness and preparedness
92. Issuing updates to hospital services to the public
93. Insurance claim management
94. Ethical, permission-based following of patients
95. Micro-sharing consent for surgical and other procedures
96. Patient-sharing of health-related experiences
97. Posting ‘bread crumbs’ of facility experiences (”I had a bypass at this hospital and it went well but the food almost killed me.”)
98. Patient searches for others confronting similar problems
99. Stress management
100. Mental health awareness
101. Posting homeless shelter needs
102. Food bank resource management
103. Transmitting patient data to patients who are traveling abroad
104. Generating streams of authoritative health care content online
105. Exposing medical quakery
106. Micro-sharing documentation for advanced medical directives
107. Discussing public health care policy
108. Developing stronger patient-provider relationships
109. Tracking the safety and efficacy of pharmaceuticals
110. Following health marketing
111. Tracking influenza alerts from the CDC
112. Exchanging/soliciting scientific validation of alternative health claims
113. Following ad-hoc conferences on eHealth like HealthCampPhila
114. Tracking toxic diseases
115. Tracking HIV news
116. Issuing/exchanging dietary tips
117. Tweeting what you eat
118. Comparing nursing home performance
119. Coordinating clinical instruction
120. Communicating with nursing supervisors
121. Public safety announcements
122. Tracking FDA guideline updates
123. Tracking the progress of developing pharmaceuticals
124. Broadcasting infant care tips to new parents
125. Publishing vaccination/immunization services locations, hours and reminders
126. Reporting adverse events to FDA (currently not available via Twitter: why not?)
127. Obtaining information on Medicare and Medicaid
128. Case management functions
129. Clinical education coordination
130. Facilitating patient-transfer processes
131. Patient-information retrieval
132. Reporting breeches of universal precautions in health care facilities
133. Posting daily nursing tips
134. Exchanging physician humor (we’re all human)
135. Closing the digital divide with respect to health care information
136. Coordinating allied health care services during patient admissions
137. Coordinating patient discharges with all services
138. Post-discharge patient consultations and follow-up care
139. Helping device technicians to communicate directly with manufacturers
140. Discussing HIPAA reform in the age of micro-sharing

There they are: 140 health care uses for micro-sharing platforms like Twitter. Implementing these uses can be enormously challenging (and even impossible) on Twitter given today’s constraints. For many of these uses, other more robust and secure micro-sharing platforms will be needed (e.g. Yammer or ESME). Certainly, Twitter offers a model of how micro-sharing can be used for a wide range of purposes. If social media marketers can figure out how to use Twitter, health care professionals can also figure out how to use micro-sharing.

HEALTH CARE SHOULD BE THE LEADER IN MICRO-SHARING

With 26 letters in the alphabet arranged within 140 characters, there are over 1.2 x 10^198 possible character combinations (thank you @symtym). Of course, the number of meaningful sentences is far less than that but a point stands out: there’s a virtually infinite number of short pulses of (meaningful) information that Twitter can facilitate.

With that kind of power, health care should be a leader in micro-sharing, not a lagger.

WHAT HAVE I MISSED? WHAT CAN YOU CONTRIBUTE?

I have probably missed some incredibly important healthcare uses for Twitter. I am also probably missing specific Twitter accounts that should be included as links in the list. Please contribute and I will continue to refine the list.

Visitors: please add to the list, make comments, ask questions, offer critique. It’s your health, it’s your century and it’s your right and responsibility to make this list as practical as possible. I’m doing my best to do my part. Your turn.

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[NOTE: Major edits to this list based on feedback and the nature of the content will be disclosed.]

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