Healthcare’s Google-Facebook-Twitter Platform

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Can’t we just have one place on the web where all of us around the world can congregate to acquire reliable health care content, connect patients with each other, have conversations, trade experiences and otherwise partake in the vastness of health care?

That certainly is a dream – an idea which many patients and families and professionals ponder. After all, Google, Facebook and Twitter respectively demonstrate the power of Search, Social Media and Real-time Connection to accomplish a whole host of objectives. What if we had a health care version of such a triad, unified into one platform? Is it do-able? Or, perhaps more importantly, is it necessary?

A GINORMOUS WEB WITH NO CENTER

As tempting as it may be to have a mega health care social platform, I think such a hope is wrecked by the reality of the Web. The Web is an ever-expanding confluence of machines and people and protocols and media. Like a consciousness, it has no Center, no single brain cell that we can point to and say Here it is, the center of our mind! And yet, like a consciousness, it produces the seamless experiences of awareness and connection and action which we view through our browsers and mobile devices and wherever else the Web infiltrates.

Perhaps the very model for any Web platform for health care communities of content and people lies right in the artful sciences beneath health care itself: the evolutionary underpinnings of networks of the tiny cellular gadgets that supply our lives. Yes, our bodies do have central nervous systems, but life owes itself to the vastly distributed cascading of events which aren’t necessarily centrally-controlled. That is, after all, the wonder and power of our universe’s serendipity. The web of life may be metaphor for the web we started spinning years ago.

So I wonder if our primary challenge in weaving a Health Care Web is understanding the nature of evolutionary systems. That perhaps we need to overcome our linear and strict architectural ways of thinking and building, and seek organic views of the Web.

Historically, in our efforts to wage war against dangerous bacteria and viruses, we have taken a decidedly mechanical approach: discover a vulnerability and attack it. It works, for a time. But then subtle mutations succeed and replicate and the vulnerabilities of our tiny enemies become strengths and we start to lose the war again.

So just as we may need radically different approaches to infectious diseases – approaches which advance natural processes versus stemming them – so too may we need a radical re-think in how we work with the Web. Rather than hoping to overlay a single giant complex that dominates the landscape like a Big Mother, we aught to consider the power of local networks and communities, learn to harness de-centralization and discover how to cull order out of chaos.

In many regards, we already are doing these things. Those of us who use media like Twitter have learned to appreciate the value of curation and we’re always seeking out and playing with toys which help us streamline and enhance our consumption and production of information. Patients seeking health-related content or community similarly need ways of finding the right channels.

Perhaps, then, a key feature of health care online is providing media which improve the skills of patients in how to best derive order of out of chaos and separate verifiable fact from dangerous idiocy. How to accomplish such feats? One way is through individual, localized efforts on the part of patients, providers, technologists, librarians, entrepreneurs – charged with large boluses of initiative and courage.

ALL HEALTH CARE IS LOCAL

What we may need at the large scale isn’t a giant Google-Facebook-Twitter mashup for healthcare. Maybe what we need are media and tools which connect social graphs of people and databases and communities; which enable face-to-face communities which can be weaved back into the Web; which give permissions to patients and family members to port their data however they see fit; which enable providers to be bright facets at the critical nodes of key connections; which integrate emerging technologies and re-mash them into usable interfaces for expedient and curated information.

The fact about online health care communities is that they are, well, communities. Which is to say that their success depends on the particular dynamics and values of the communities. A service which offers forums for different health-related topics may house an amazing Diabetes group but fall short on Schizophrenia. Furthermore, patients and family members experience illnesses in their own unique ways: what may be a great community for someone with breast cancer may be ineffective (or even dangerous) for another.

We have many ways to go with the Health Care Web. We can’t necessarily busy ourselves with one silver bullet. So I offer one tip to the general public: advocate for change at the local level, using public social media to inspire passionate tribes of talented change agents. We can do that much now, without having to wait for the FDA or some other governmental agency to figure out how to hit the update button on Twitter, let alone how to piece together a Health Care Web.

If we can’t get our own family physician to connect with us on just one social medium, how can we connect the multitude of patients and providers globally?

What do you think? Is a Google-Facebook-Twitter Platform of Health Care achievable? Is it even necessary? Perhaps most importantly: is it something we should even desire, or fear?

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Power Dynamics & Virtual Health: Protecting Professional Boundaries in an Unbounded Web

Virtual Health – however that’s defined – has become a hot topic lately, especially in light of the rapidly evolving two-way real-time Web. Power dynamics – the interplays between patient and provider – must be protected in order to safeguard patient rights and protect their dignity, privacy and well-being. There’s more to virtualized practice than may be apparent on the surface.

Here are some thoughts, including an explanation of what I am (half-humorously) calling the “intimacy-boundary membrane”. [Link to video]

Power Dynamics & Virtual Health: Protecting Professional Boundaries in an Unbounded Web from Phil Baumann on Vimeo.

Patients are increasingly demanding online ways of interacting with their providers. As social media evolve, improve and proliferate, the ePatient movement will continue to expand and the healthcare industry will have to develop ways to meet the demand.

This movement, however, will have to ensure that it does not overlook the important behaviors all health care providers must express. It will also have to mature so that we aren’t left with a virtual health care landscape that is little more than a circus of amateurs. Experience matters more than content.

But social media is also rapidly shortening the spaces of intimacy and boundaries between people. This means that as health care professionals interactively enter the Web, the tension between intimacy and boundaries will increase.

We could say that there exists a safety zone between intimacy and professional boundary. These zones have traditionally been worked out for in-person clinical relationships. Online, however, we have a long way until we establish a collective understanding of how these technologies affect our virtual health care experience.

Since the space is shrinking to a thin wall, I’ve decided to call this problem the intimacy-boundary membrane. How do we go about protecting that membrane? Is this metaphor useful? You tell me.

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Healthcare Technology Isn’t Social…Yet

Healthcare professionals are technologists. Social media involves technology. But there’s a substantial gap between the general public’s use of social media and the Healthcare industry’s presence along the spectrum of social networking spaces. Why? Shouldn’t health care professionals be on the leading edge of online services and community-engagement?

Here’s a short video giving a partial explanation for the gap. (The second video is a bonus. for my  #hcmktg followers):

Patients deserve the best kind of healthcare in the world: the Web is part of our world – in fact it’s fast becoming the biggest part of our world. Amateur health care is a dangerous trend – therefore, it’s critical that healthcare professionals work extra hard to establish best practices for online transactions. And that can only be done by healthcare professionals extending their role from clinical technologists to social technologists.

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Components of Hospital Branding: A Rant

Along the lines of social capital, I’ve thought about hospital branding and why it’s an important part of any health care system. Marketing has a bad reputation (and deservedly so in part), but it’s a critical feature of delivering the values of any organization.

This morning, I saw some tweets about branding, and I was spirited with this.

Beyond the colorful jest, there are points to be made. What follows is my rant on hospital branding:

How do you feel about this. I’d like to hear from you professional marketers. Is this delusional? Or am I on to something important?

[Link to video if it’s not viewable here.]

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Health Care Privacy: Is It Worth Fighting For?

Is the right to Privacy the right war in the 21st Century or is it Dignity? It’s hard to abandon the ideas we grew up with. It’s harder still to deal with those ideas when they turn on you. You and I grew up in a culture that has highly valued privacy. It certainly is an important value. But the web is changing our ability to maintain privacy. In health care, it will become increasingly expensive to maintain patient privacy. Our policies on health care (eg. HIPAA) can actually hinder our right to privacy and undermine progressive efforts to improve health care.

So: is our right to health care worth fighting for? At what point do we decide that other rights may be more important to defend?

I’m not suggesting that we devalue our privacy. In light of the direction we are headed with exponential technological changes, we will need a re-think of which of our values are worth fighting for. I think the right to Dignity is a fight worth fighting for, perhaps even more important in this century than Privacy.

What do you think? Is our focus on privacy the wrong focus? Is it time that we challenged our assumptions and values about privacy? Exercise your right to speak.

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140 Health Care Uses for Twitter

twitter_logo_blueTwitter 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 [now defunct] 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.

* As of November, 2017, Twitter doubled its character limit to 280. If I have time, I suppose I could add another 140 items to this list 😉

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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Time Value of Health

Traditional Polish pączki
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Let’s introduce a simple term to an old problem in health care. As health problems increase, and their costs rise, we need to start thinking about ways to make it easier for the public to improve the lifestyle choices they make.

What you do today influences what happens tomorrow. Eat a deep fried donut today, have a heart attack later in life. Your health has a time value. Let me explain.

DO YOU KNOW THE TIME VALUE OF YOUR MONEY?

The concept is simple and it borrows from finance the concept of the time value of money:

A dollar today is worth more than a dollar tomorrow.

This is important because the opportunity cost of taking a dollar tomorrow is the investment that you could make with that dollar today. In terms of health, exercising today is an investment of effort that pays of in the future. Another way to look at it is the future value of a donut:

The future value of eating a donut today is a heart attack years later.

THE TIME VALUE OF YOUR HEALTH

It’s a simple concept. One of the reasons Americans are so unhealthy these days is because we don’t consider the consequences of our lifestyle choices in ecnomic costs. Invesment always involves effort, sacrifice and consideration of options. Long-term investors almost always enjoy prosperity over the course of their lives. The essence of (good) capitalism is discipline and self-restraint. So my definition of the Time Value of Health is this:

The time value of health is the interest you accrue from delaying the cost of an acute or chronic disease later in life.

If you don’t think that the time value of money is a matter of health, just look at the primary cause of our current economic health. Do you think that if all of the people involved in the biggest ponzi scheme in history exercised discipline, that we’d all be in better financial health?

Weight-management is harder for some people than others. So is daily exercise. Our culture isn’t helping: as we move more online, it’s easier to forego healthier choices that enhance our cardiovascular systems.

HOW CAN I USE THE TIME VALUE OF HEALTH IN MY LIFE?

The Time Value of Health doesn’t require complex calculations. It doesn’t need a number. It just requires a little imagination. Don’t make too much of this concept I’m offering you.The next time you’re tempted to go nuts on foods that you don’t need, ask yourself a simple question: is it worth the pleasure of eating this eclair to endure a stroke in 20 years?

Consumers If your a consumer, consider incorporating the idea into your lifestyle. Don’t be a nazi about it. Maybe just use it to save the goodies as a treat once in a while, or for your weekend. Create zones of healthy living. We all need indulgences (there’s health in feeling good about a nice dish). Investing some effort and discipline how you live earns a healthy return over time. What’s more, often the returns pay sooner: being fit and active produces a sharper, happier mind.

Providers If you’re a healthcare professional, consider ways of introducing the Time Value of Health into your practice. You probably don’t have much time anymore to give long speeches with tons of advice (too bad). A simple meme can often travel far. What’s to lose?

Readers Does this intuition pump help? Is it frivilous or does it offer a meaningful practical way to help improve the lives of good people who have a hard time with making healthy choices? The next time you grab those wings, or all that sugar in your coffee, could you imagine yourself on the floor panting in agony for breath in front of your children or granchildren?

What is the time value of your whole life?

(Sorry for tempting you with those donuts above. It’s OK, one won’t hurt you, will it?)

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