Talk delivered at Stoeckle Center Seminar, Massachusetts General Hospital

1. Medicine & Technology
Research Collaborative
www.themetrc.org
Approve, Deny, or Ignore:
Primary Care in the Age of Social Media
Bradley H Crotty, M.D.
Instructor in Medicine, Harvard Medical School
& Chief Resident, Beth Israel Deaconess Medical Center
Medicine & Technology
Research Collaborative
Stoeckle Center Seminar, October 28, 2011 www.themetrc.org

2. Conflict of Interest Disclosure
Bradley Crotty, M.D.
I have no financial relationships
with a commercial entity producing
healthcare-related products and/or
services.

3. This morning’s discussion…
• What are „Social Media‟ and who uses them?
• How does this relate to patients and clinicians today?
• How can clinicians use these tools professionally?
• How could (will?) we use social media in the future in
primary care?
Medicine & Technology
Research Collaborative
www.themetrc.org

4. Hawn, C., 2009. Health Affairs.
Medicine & Technology
Research Collaborative
www.themetrc.org

5. Some Definitions:
Web 2.0..
Not a new internet, but a new way of using the internet to
interact with others and share content.
Giustini, D., 2006. British Medical Journal.
Barsky, E., 2006. Journal of the Canadian Health Libraries
Medicine & Technology
Research Collaborative
www.themetrc.org

6. Some Definitions:
Web 2.0..
Not a new internet, but a new way of using the internet to
interact with others and share content.
Content Users
Giustini, D., 2006. British Medical Journal.
Barsky, E., 2006. Journal of the Canadian Health Libraries
Medicine & Technology
Research Collaborative
www.themetrc.org

7. Some Definitions:
Web 2.0..
Not a new internet, but a new way of using the internet to
interact with others and share content.
Content
Users
Giustini, D., 2006. British Medical Journal.
Barsky, E., 2006. Journal of the Canadian Health Libraries
Medicine & Technology
Research Collaborative
www.themetrc.org

8. Some Definitions:
Web 2.0..
Not a new internet, but a new way of using the internet to
interact with others and share content.
Giustini, D., 2006. British Medical Journal.
Barsky, E., 2006. Journal of the Canadian Health Libraries
Medicine & Technology
Research Collaborative
www.themetrc.org

9. Some Definitions:
Web 2.0..
Not a new internet, but a new way of using the internet to
interact with others and share content.
Giustini, D., 2006. British Medical Journal.
Barsky, E., 2006. Journal of the Canadian Health Libraries
Medicine & Technology
Research Collaborative
www.themetrc.org

10. Some Definitions:
Social Media
Websites and Internet-based tools that facilitate information
sharing among groups of people or the public at large.
Medicine & Technology
Research Collaborative
www.themetrc.org

11. Some Definitions:
Social Media
Websites and Internet-based tools that facilitate information
sharing among groups of people or the public at large.
Social Network
Sites
Blogs Wikis
Photo
Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

12. Some Definitions:
Social Media
Websites and Internet-based tools that facilitate information
sharing among groups of people or the public at large.
Websites such Social Network
as Facebook, Sites
PatientsLikeMe,
that facilitate
sharing Blogs Wikis
information
among a group Photo
Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

13. Some Definitions:
Social Media
Websites and Internet-based tools that facilitate information
sharing among groups of people or the public at large.
Web Social Network
+ Log Sites
Blog
Self- Blogs Wikis
Publication,
Interaction with Photo
followers Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

14. Some Definitions:
Social Media
Websites and Internet-based tools that facilitate information
sharing among groups of people or the public at large.
Web Social Network
+ Log Sites
Blog
Self- Blogs Wikis
Publication,
Interaction with Photo
followers Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

15. Some Definitions:
Social Media
Websites and Internet-based tools that facilitate information
sharing among groups of people or the public at large.
Websites Social Network
i.e. Flickr or Sites
YouTube
that allow
users to share Blogs Wikis
pictures and
video Photo
Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

16. Some Definitions:
Social Media
Websites and Internet-based tools that facilitate information
sharing among groups of people or the public at large.
Social Network
Topical Sites
websites
collectively
authored by a Blogs Wikis
user
community Photo
Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

17. Some Definitions:
Social Media
Websites and Internet-based tools that facilitate information
sharing among groups of people or the public at large.
Social Network
Topical Sites
websites
collectively
authored by a Blogs Wikis
user
community Photo
Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

18. WHO USES SOCIAL MEDIA?
Medicine & Technology
Research Collaborative
www.themetrc.org

19. All generations use the internet
… and many use to search for health info
Go Online E-Mail Use Search Health Info News Shopping
100
90
Percentage of Survey Respondents
80
70
60
50
40
30
20
10
0
18-34 35-46 47-56 57-65 66-74 75+
Generation
Fox S. Health Topics. A Report of Pew Internet & American Life Project. 2/11/2011
Fox S, Jones S. The Social Life of Health Information. Pew Internet & American Life Project. 6/11/2009.
Medicine & Technology
Research Collaborative
www.themetrc.org

20. All generations are using social
networking more
50% of Internet
Users age 50-64
use social
networking
Madden M and Zickhur K. Pew Internet & American Life Project. 8/26/2011
Medicine & Technology
Research Collaborative
www.themetrc.org

21. Social media use is prevalent across
race/ethnicity groups
(…of Internet Users)
100%
84%*
80%
73%*
63% 65%
61%
60% 56%
40%
20%
18%*
13%*
10%*
5% 3% 5%
0%
Social networking sites Online video Twitter Location services
White Black Latino
Smith A. Pew Internet & American Life Project. 9/17/2011
Medicine & Technology
Research Collaborative
www.themetrc.org

22. We have potential to reach patients
on mobile devices
100% (…of cell phone owners)
80%
60%
40%
25%*
19%
20% 15% 15%*
11%
7%
0%
Use phone to look up health info Have apps to track or manage health
White Black Latino
Smith A. Pew Internet & American Life Project. 9/17/2011
Medicine & Technology
Research Collaborative
www.themetrc.org

23. Your teenagers are not the
only ones using social media!
• Most adults „go online‟
• Many of these also use social media
• Health is a major driver of use
• Different socioeconomic groups may have
differential use

24. HOW ARE OUR PATIENTS USING
SOCIAL MEDIA?
Medicine & Technology
Research Collaborative
www.themetrc.org

25. Patients use Web 2.0 and Social
Networking for education and support
• Wikipedia for background learning
Medicine & Technology
Research Collaborative
www.themetrc.org

26. Patients use Web 2.0 and Social
Networking for education and support
• Wikipedia for background learning
• General social networks for ad hoc support
Medicine & Technology
Research Collaborative
www.themetrc.org

27. Social Networking Communities Can
Provide Support to Patients
Medicine & Technology
Research Collaborative
www.themetrc.org

28. Patients use Web 2.0 and Social
Networking for education and support
• Wikipedia for background learning
• General social networks for ad hoc support
• General social networks for disease specific
support and information sharing
Medicine & Technology
Research Collaborative
www.themetrc.org

29. Patients can use Social Networks
for ad hoc support
• Authors surveyed
participants from 5 online
psoriasis forums
• 260 respondents
• Most reported increased I have made friends through the online group
that I now communicate with outside of the
social support, some better support group, and with whom I feel
comfortable discussing personal situations
quality of life, psoriasis and health. This has allowed me to gain and
give more one-on-one support.
Idriss, S., Kvedar, J. & Watson, A., 2009. Archives of Dermatology.
Medicine & Technology
Research Collaborative
www.themetrc.org

30. What is the quality of this information?
Greene, J.A. et al., 2011. Journal of General Internal Medicine.
Medicine & Technology
Research Collaborative
www.themetrc.org

31. Video shared of a young
Man with diabetes and his
Experience with diagnosis
http://www.youtube.com/watch?v=FABfYl3Ay60

32. Social Media Also Supports Families

33. Patients use Web 2.0 and Social
Networking for education and support
• Wikipedia for background learning
• General social networks for ad hoc support
• General social networks for disease specific
support and information sharing
• Patient specific social networks for support
and information sharing
Medicine & Technology
Research Collaborative
www.themetrc.org

34. Social Networking Communities
Can Provide Support to Patients
PatientsLikeMe
• Social network
for healthcare
• Tracks
treatments,
patient
outcomes
• Research
Community
http://www.patientslikeme.com
Medicine & Technology
Research Collaborative
www.themetrc.org

35. Patients use Web 2.0 and Social
Networking for education and support
• Wikipedia for background learning
• General social networks for ad hoc support
• General social networks for disease specific
support and information sharing
• Patient specific social networks for support
and information sharing
• Social media for behavior change
Medicine & Technology
Research Collaborative
www.themetrc.org

36. Behavior Change… with social
media
http://www.stikk.com

37. Patients use Web 2.0 and Social
Networking for education and support
• Wikipedia for background learning
• General social networks for ad hoc support
• General social networks for disease specific
support and information sharing
• Patient specific social networks for support
and information sharing
• Social media for behavior change
• Social media for physician ratings
Medicine & Technology
Research Collaborative
www.themetrc.org

38. Bates, D.W. & Gawande, A.A., 2000. Health
Affairs

39. • 88% of physicians had a rating site listing;
• On average, 1.4 reviews for 300 physicians
• Physicians appeared to have added their
own reviews
Lagu T et al. 2010. JGIM

40. HOW CAN CLINICIANS WORK WITH
PATIENTS USING SOCIAL MEDIA?
Medicine & Technology
Research Collaborative
www.themetrc.org

41. Health teams are engaging with patients
• Share and/or spread reliable information
Medicine & Technology
Research Collaborative
www.themetrc.org

42. Medical Practices & Institutions
Adopt Twitter for Patient Education
http://www.twitter.com
Medicine & Technology
Research Collaborative
www.themetrc.org

43. Medicine & Technology
Research Collaborative
www.themetrc.org

44. Health teams are engaging with patients
• Share and/or spread reliable information
• Advertising
http://www.twitter.com
Medicine & Technology
Research Collaborative
www.themetrc.org

45. We also can ‘advertise’…
Medicine & Technology
Research Collaborative
www.themetrc.org

46. Health teams are engaging with patients
• Share and/or spread reliable information
• Advertising
• Learning from patients
Medicine & Technology
Research Collaborative
www.themetrc.org

47. Social Media for
Post-Marketing Drug Surveillance
Knezevic, M.Z. et al., 2011. Drug safety.
Medicine & Technology
Research Collaborative
www.themetrc.org

48. Learning with our Patients …tuanalyze
Weitzman, E.R. et al., 2011. PLoS ONE
Medicine & Technology
Research Collaborative
www.themetrc.org

49. If we can learn from large groups, can we
learn about individual patients?
Jent, J.F. et al., 2011. The Journal of Adolescent Health
Medicine & Technology
Research Collaborative
www.themetrc.org

50. of web users search the web about
doctors or other health proessionals
Fox S. Health Topics. A Report of Pew Internet & American Life Project.
2/11/2011
Fox S, Jones S. The Social Life of Health Information. Pew Internet & American
Life Project. 6/11/2009.

51. Number of MDs with Attributable Hits
Massachusetts
Number of Hits per MD
Internists
Type of Search Findings
Personal, Professional
Subgroup Analysis
250 physicians Differences between Physician Groups
Mostaghimi A, Crotty BJ, Landon BE. 2010. JGIM

52. Information found for 93.6% of physicians
• 92.8% had professional information
• 32.4% had personal information
• 11% had a public social networking page
• 86.4% had physician rating sites
(only 3 physicians had more than 5 reviews)
Mostaghimi A, Crotty BJ, Landon BE. 2010. JGIM

53. Jain, S. 2009. NEJM

54. Lagu T et al. 2010. JGIM

55. 271 Medical Blogs 1/06 - 12/06
57% of authors could be identified
Patients were described in 42% of blogs
(16% Positively, 18% Negatively)
3 blogs had patient pictures
Products promoted in 11% of blogs
Lagu T et al. 2010. JGIM

57. Creating a standard for conduct
by healthcare workers in a
connected world that maintains
confidentiality, honesty, and trust
in the medical profession.
Mostaghimi A and Crotty BH. 2011. Ann Int Med
Medicine & Technology
Research Collaborative
www.themetrc.org

58. Digital Domains
Medicine & Technology
Research Collaborative
www.themetrc.org

59. Public,M.D. Private,M.D.

60. Dual Citizenship

61. Recommendations
• Perform “electronic self-audits” to
monitor your online presence
• Maximize online privacy settings for
personal profiles and social networking
sites
• Develop “dual citizenship” online with
separate professional (public) and
personal (private) networking profiles
• Develop a professional biography for
patients and others to preferentially find
using search engines.

62. WHAT DOES THE FUTURE
HOLD FOR PATIENTS
AND PRIMARY CARE
Medicine & Technology
Research Collaborative
www.themetrc.org

63. Social Media &
the Future of Primary Care
• Health Promotion
• Chronic Disease Management
• Population Management
• Revolutionized Documentation
Medicine & Technology
Research Collaborative
www.themetrc.org

64. • Can notes be living documents?
• Who is the master of the note?
• Will this be useful, a distraction, or harmful?
• Will access to information benefit the
patient?
Delbanco et al. 2010. Ann Internal Med

65. Can Web 2.0 reinvent our practices?
Can we Social Network
redefine the Sites
team? Can we
connect
proactively? Blogs Wikis
Photo
Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

66. Can Web 2.0 reinvent our practices?
Can we Social Network
improve Sites
population
management
with a “Twitter” Blogs Wikis
like tool?
Photo
Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

67. Dashboard for Provider, M.D.
Frog,Hermit, 123-45-67 [Collapse]
- 8/2/10 0845 – Jane Frog (family) wrote:
“my father Hermit had a 5 lb weight gain over the weekend.”
- 8/2/10 1000 – Don Lane (clinical RN) wrote:
“have increased lasix, will follow-up in 2 days.
(OMR Note)
-8/2/10 1130 – Michael Daniels (Cardiology) wrote:
“ Thanks Don; if worse, schedule in HF center for IV lasix.”
Piggy, Miss 324-23-23 [Expand]
- 8/2/10 0934 – Don Lane (Clinical RN) wrote:
- “Patient will be coming into HF clinic today for palpitations.

68. Can Web 2.0 reinvent our practices?
Instead of a
separate note Social Network
each visit, can Sites
we just amend
the patient‟s
story/condition Blogs Wikis
s?
Photo
Sharing Sites
Medicine & Technology
Research Collaborative
www.themetrc.org

69. This morning’s discussion…
• Social media are easy to use internet tools and sites to
share information and content with others
• Many adults are already using social networking and
social media sites, and many for health information
• Clinicians should adopt „dual citizenship‟ to separate
personal from professional identities
• How could (will?) we use social media in the future in
primary care? … I leave that to you
Medicine & Technology
Research Collaborative
www.themetrc.org

70. Acknowledgements / My Social Network
Medicine & Technology Research -Bruce Landon
Collaborative
-Arash Mostaghimi Division of General Medicine &
-Yonas Tamrat Primary Care, BIDMC
- Tom Delbanco
Shapiro Center for Education - Russ Phillips
- Sigall Bell - Jan Walker
- David Roberts - Kaitlin Baratta
- Chris Smith - Nadine Farag
- Neha Trivedi
Dept of Health Care Policy, HMS
Medicine & Technology
Research Collaborative
www.themetrc.org