Where does social media fit into health care?
Social media has revolutionized how we interact with the world, and with each other. Facebook, Twitter, LinkedIn, YouTube, and the like, have become some of the world’s highest-valued companies, largely based on their vast adoption – on a scale that might have been inconceivable just a decade ago.
Clearly, modern society in the U.S. and around the world has found value in using platforms that allow us to share information about ourselves socially with circles of friends, or with the public at large. Some basic elements of successful social media make up a “social media paradigm” – elements that all the large platforms have in common: (1) they are free to use, (2) they run on any operating system, any browser, (3) they allow the asynchronous posting of messages to circles of contacts/friends, (4) it is easy to expand one’s circle by inviting other participants on the platform, (5) it has millions of users on the platform.
Businesses have used social media methods to promote themselves as well. Many businesses have Facebook pages where they update information about themselves, attract new customers by having as many as possible “like” them, and direct followers to their company web sites. Businesses also post Tweets and try to gather followers that way – often a successful method of promotion.
So what about health care?
Health care is a vast and varied ecosystem, with many facets. Much of it deals with personal health information (PHI) that is protected by HIPAA over-and-above the general privacy protection (personally identifiable information, or PII) that applies more generally to Internet commerce.
Unlike most other segments of commerce, health care transactions are generally not paid directly – they are paid by third parties (insurers), who want to have a say-so in the transactions of their enrollees. Imagine if that were the case in other areas of commerce: you go to the department store to buy clothes, but you don’t pay for the merchandise yourself. Instead, a third party pays some or all of your bill for you. Of course that third party is going to want to be involved in the clothes you choose, the amount you purchase, etc. Third-party intermediation in the customer-provider commerce relationship is a hallmark of health care, and makes for a whole dimension of complexity not found in other segments of the economy.
Health care is not practiced in silos, or by individuals – it is practiced by systems, formal or informal, that work together to deliver the services needed by individual patients. In other words, health information (PHI) needs to be shared among practitioners and between practitioners and patients. Traditionally, this has been done in paper, using faxes, and that has resulted in a lot of system chaos, duplication, and incomplete information being passed around.
The hope of the federal thrust to encourage the move to a healthcare electronic platform, with stimulus dollars being paid out to encourage the Meaningful Use of Electronic Health Record (EHR) technology, is that the sharing of clinical information will be more efficient, will be more accurate, will reduce inefficiencies and duplication of services, and will result in better measurable healthcare quality. This is a very ambitious task, given that, even though the “tipping point” of EHR adoption is being reached, and the use of EHRs by clinicians is becoming mainstream. By-and-large, the EHRs being used are often locally-installed enterprise systems that don’t talk to each other very well (especially in larger groups or hospital-centered networks) – though the adoption of web-based EHRs has become a significant segment of the EHR market in the past few years and changes the local-silo nature of health data distribution. Still, the sharing of clinical information back-and-forth across these disparate-system lines is a formidable challenge, which Stage 2 Meaningful Use is trying to address.
Can health care use social media?
It is tempting to think that a social-media approach to sharing information with appropriately-defined circles of contacts – assuming that the privacy firewalls needed for HIPAA can be built – is something that will be beneficial for health care. But is this approach the right tool for the job? It depends on what job we are talking about.
If the EHR platform is free, runs on any system, and easily signed-on, then a few of the elements of the “social media paradigm” seem to be met. This is not really true for enterprise installations (still the largest type of EHR usage currently in place), but it is arguably true for web-based systems. However, we must not over-simplify the nature of information-interchange (and therefore, commerce interchange) in health care. Information about patients between clinicians is business-to-business, not person-to-person. And the third party that is paying for the commercial transactions will want to be involved.
Even in its simplest form – a “curbside consult” by phone between physicians about a patient – there are intermediaries between the clinicians. When I want to speak to another doctor about a patient, I don’t simply pick up the phone and call. My staff does that. They call the recipient’s office, who then gets the physician, and our office staffs then put us each on the line. The most valuable resource for a clinician is his/her time. There is not the luxury of making a personal phone call; there is no time for that – it is facilitated by an office staff structure.
Furthermore, the “curbside consult” is not a significant workflow in ambulatory practice, largely because it is uncompensated by third-party payers. An actual, formal referral – which results in the patient being seen face-to-face by the recipient, and is therefore paid by insurance payers – involves my front desk, the recipient’s office staff, and often the health plan (via referral or authorizations numbers that might need to be gotten). If a “social media” tool does not integrate itself into this workflow, and allow for the three layers of intermediaries in the transaction (my staff/your staff/the health plan), then it will not be adopted. There is no time for it. This will be the failure of such attempts (though several companies are proceeding down that path).
If not there, then where?
So where can the “social media” approach to sharing information found in the consumer-based worlds of Facebook and the like be utilized in health care? There are a few scenarios that make sense.
First, there is the broadcasting advertisement of one’s clinic to the world. This is done via platforms like Facebook, where a clinician can create a Facebook page, and then encourage patients (and prospective patients) to “like” the page, using it as a resource for broadcast-appropriate information – “we have flu shots in stock now.” “Did you know we see children in our Family Medicine clinic too?” “Take a survey and let us know how we can serve you better.” The possibilities are endless, and this can be an effective way of promoting one’s practice to the public. Like with any other business.
Second, clinicians looking for employment opportunities, or clinics looking for clinicians to join them, can use LinkedIn. One can purchase job posting ads. I have had numerous conversations with clinicians who found their current employment (even involving geographic relocation) through LinkedIn.
Third, consumers themselves have created a whole segment of health-oriented information that they want to share socially with their friends – numerous Facebook apps like run trackers, activity monitors (e.g. FitBit), restaurant and eating choices, and so forth, already abound. Unlike the stand-alone Personal Health Records (PHRs) of the past, which have failed in their adoption and have been replaced by EHR-tethered PHRs, these new kinds of personal health data collection portals have been very popular largely because they can be shared socially. This consumer-based data is entirely outside the realm of HIPAA (until that information is shared with one’s physician, then the physician’s custody of that data is HIPAA-governed and can’t be shared elsewhere without the patient’s permission).
Gathering this consumer-collected data into a central place, where one can keep track of a “personal health and fitness dashboard”, while at the same time allowing the social sharing of selected pieces of that information where desired, is a new frontier of business and innovation. Feeding that data into a PHR (and therefore into the connected EHR) can be very powerful, and can give EHRs that are able to do this a real market advantage. It is the patient-based PHR tool that can be shared socially by the patient/consumer themselves, which gives it value.
A new generation of PHRs can be envisioned which are tethered, but can be signed up for directly, without having to have your doctor enroll you. Such new “direct PHRs”, if they can be made detachable (direct sign-on) and re-attachable to various different EHRs (through API interfaces, where they exist), and which have valuable features built-in (such as health education resources, two-way secure communication with one’s own physician, downloads of summary health information from the connected EHR like problem lists, medication lists, allergies, immunizations, lab reports, and upcoming appointments) are the next generation of health innovation. And tying such patient-centered portals into the socially-shared consumer-oriented Facebook apps (and others), allowing a one-stop place where an individual can manage the shareable information (Facebook shares of one’s running achievements, for instance), as well as the personal and protected information from one’s doctor’s EHR – that is the future of PHRs, and the future of how social media can play into health care.
Robert Rowley
Dr. Rowley is a practicing family physician and healthcare information technology consultant. From its inception through 2012, Dr. Rowley had been Practice Fusion’s Chief Medical Officer, having created the underlying technology in his own practice, and using that as the original foundation of the Practice Fusion web-based EHR. Dr. Rowley brings a depth of experience and expertise in health care as well as health IT, having been in clinical practice for 30 years, including experience as a Medical Director with Hill Physicians Medical Group and as a developer of the early EMR system Medical ChartWizard. His family practice in Hayward, CA has functioned without paper charts since 2002.
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Tags: PHR, social media