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 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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How (Not) to Twitter Your Professional License to Death

Are you a nurse? A doctor? A lawyer? A CPA? Do you make a living protecting, defending and fighting for the confidence, dignity and honor of others? Do you Twitter? When Twitter asks “What are you doing” do you know what you’re doing? That is, do you know how to use Twitter to convey your professional experiences without betraying your sworn duties or breaking enforceable laws?

Online, there are millions of ways to breech confidentiality, compromise protected information, humiliate your fellow human beings, cast doubt on your profession, emit regrettable thoughts…jeopardize your license.

HEALTHCARE PROFESSIONALS HAVE IT THE ROUGHEST
For those of you in health care, there is of course HIPAA to follow. HIPAA, however, isn’t the be-all-end-all of patient protection. Doctors and nurses aught to realize that they can harm patients even without violating federal law. A bit of common sense and courtesy is probably enough to keep the risk of harm as low as possible:

  1. Don’t Twitter or use social media when you’re angry. Go get a milkshake.
  2. If your case is fascinating then reflect on it, find an eternal truth and then Twitter your revelation instead of the details. Write a short story.
  3. Assume that anonymity is an illusion. If you believe that you can achieve absolute anonymity online then go work for the NSA (apply here).
  4. Even if you don’t disclose identifiers, or if you conceal them behind fiction, be aware of triangulation. Temporal proximity and one detail might be just enough to cause embarrassment.
  5. Don’t dismiss patient dignity. You protect your patients from physical harm, so why not do the same for their dignity?
  6. Ask yourself: if I came accross a Tweet in TwitterSearch that sounded suspiciously familiar, how would I feel?
  7. Ask yourself another question: if I came across a Tweet from a patient about me (and it wasn’t nice), how would I feel?

Of course, these guidelines work for any profession, not just health care. Confidentiality and dignity are universal human needs. Entire economies depend on them. Without trust, what’s money worth?

IT’S NOT JUST YOUR PATIENTS OR CLIENTS
Beyond patients or clients, you also need to consider: your co-workers, your bosses, your facility’s administration and other professionals who you might feel tempted to discuss on Twitter.

Don’t assume that just because most of the health care industry is stuck in 1953 that you won’t be located. If anything, one of the first uses of social media by the industry will probably be to hunt down employees. (I hope I’m wrong but…I digress.)

IS IT WORTH THE COST?
We deal with stupid, annoying and dangerous people all the time among our work settings. You can talk about them online. But what does that accomplish? Is it free, or might that cost you something valuable? Just because you can, do you have to say what you want to say?

Think about how you use Twitter. There’s a lot you can reveal in 140 characters or a tiny url. Perhaps a more secure analog to Twitter will come around. Until then, be mindful of how Twitter might affect your licensure.

You worked hard to get through school, pass ridiculous exams, get through your first few years to get this far. If you got through critical care, endocrinology or the U.S. tax code, you’re smart enough to use Twitter without killing your license, aren’t you?

Twitter, HIPAA, Privacy and Freedom of Speech

Twitter will get you fired, fined or sued. Well, it will if you’re a health care professional who doesn’t follow the rules set down by the federal government and patient bills of rights. Here are some thoughts on how to Twitter safely in the clinical care setting.

WHAT HAPPENS ON TWITTER STAYS ON TWITTER…AND SUMMIZE AND…

Permission-based processes, whether you know it or not, have been a central dogma of medicine and nursing for many years. Acquiring informed consents or refusals has always been a right of patients, whether or not it was properly acknowledged by practitioners.

Twitter is a remarkable tool for broadcasting the latest advances in medicine or nursing. It’s also a way to establish an ambient intimacy within a community. Unfortunately, it has opened up a publicly viewable portal into the effluence of private patient information. What happens on Twitter, stays on Twitter…and Summize and FriendFeed and Disqus and ping.fm and Google’s cashes forever and ever and ever. Oh, and right on that PowerPoint slide which the plaintiff’s attorney ginormously projects onto a court room wide screen.

HIPPA IS DEFECTIVE LEGISLATION. BUT I FOLLOW ITS RULES.

Patients have a right to privacy when receiving care. That’s just common sense. Unfortunately, there have been legislative attempts to regulate how providers ensure patient privacy and information security. Those steps are honorable. Their execution, however, is matter for another blog post. Suffice it to say, HIPAA is not the optimal solution to the problem of patient information security.

HIPAA (Health Insurance Portability Accountability and Accountability Act of 1996) is one of those legislative examples of fighting the right war with the wrong means. Again, I won’t get into the merits of fighting HIPAA, but I’ll emphasize that until the act is properly amended, health care professionals are well advised to comply.

Why? Here are just two civil and crimianl penalties for non-compliance (Source):

  1. fines up to $25,000 for multiple violations of the same standard in a calendar year (ouch!)
  2. fines up to $250,000 and/or imprisonment up to 10 years for knowingly misusing individually identifiable health information (yikes!)

I’d hate to see any doctor or nurse lose their job, get fired or sued by a patient for violations that are easily avoided.

If you’re a health care provider and you plan on using Twitter or a similar tool to open up the world to what happens in the clinical setting (and I applaud you), here are two questions to ask yourself:

  • Would I want my care to be broadcasted to who-knows-whom?
  • Even if my name wasn’t mentioned, would I want my care to be on TwitterVision? If I do, did I sign a fully informed consent?

FREEDOM OF SPEECH

So, how could health care providers use Twitter to express their freedom of speech while protecting the information safety of patients? Here are some off-the-cuff suggestions:

  1. Be fictive with cases if your Twitter feed is on a public time-line
  2. Get permission, in writing, from patient’s or patient representatives
  3. Understand the ways in which protected health information privacy rights can be violated
  4. Remember that patient privacy is a part of patient safety
  5. Think about the purpose of a Tweet
  6. If you don’t have a real purpose to Tweet, don’t update
  7. Look at your license, recall that oath (I know corny, but it’s better than staring at a jail cell wall for 10 years)

I understand the excitement over using Twitter in a clinical setting (hey, I’m one of the advocates of Improvement through Health 2.0). But I don’t want that excitement to lose its luster in the wake of avoidable violations.

I’m not a big fan of HIPAA but I follow its rules. And so should you if you want to keep your license and practice the artful science of being a Jedi. Twitter’s awesome. But I’m not going to endanger my patient’s dignity and safety over it. All that, it ain’t.

Perhaps our first Tweets about the state of health care aught to be made about a wider discussion about how to simultaneously protect patient privacy and health professional sanity. HIPPA may be a stupidly constructed work of legislative ignorance, but it has the enforceable power to fine and jail you. Tweet Smart.

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