Category: Self – Management

  • Metric Matrix: How should we measure the impact of social media on clinical excellence?

    “What for? Can we achieve what we ought to achieve in healthcare without social media? We did that in the past, there’s no reason we can’t do that today!”

    After tooth combing available researches online, the above hypothesis seem logical.  There’s some evidence showing social media adding value to healthcare, but these are mostly qualitative studies. Qualitative studies  do not undergo rigid testing of hypothesis characteristic of a good scientific research.

    On the flip side, the absence of disputing evidence does not necessarily mean the hypothesis is valid.  It is just that we don’t have a metric yet to demonstrate the validity of that hypothesis. Such is the case for social media in healthcare.  To import metrics from other fields may also be too simplistic given our superficial understanding of social media behaviour of health stakeholders in relation to healthcare.

    Fortunately social media is considered a disruption in many fields, including healthcare. Desirable disruptions effectively short changes  accepted norms and processes usually in non conventional ways but achieve same or even better goals with uncanny efficiency. The true value of some disruption maybe demonstrable a later time when technology catches on.

    So let me state my alternative hypothesis. Social media might be a way to improve healthcare. The millions of social media users today couldn’t be just a technological spike. The use of social media in healthcare is self evident.

    Healthcare stakeholders engage each other on social media. Patients seek health information and find support groups on social media. Healthcare professionals have virtual communities to share knowledge and network with peers. Healthcare professionals seek social media in the hope of increasing scholarly activities such as research or to recruit population for larger studies. Healthcare organizations use social media for rapid information dissemination as well as engaging other healthcare stakeholders.

    The bottomline for engaging healthcare stakeholders are for me threefold- improve patient outcomes; achieve clinical excellence for healthcare professionals and humane, sustainable, fair provisions of quality healthcare for institutions. If somehow we have a way, a metric for demonstrating social media adding value to these three bottomline perhaps we have a way of sustaining or disputing my hypothesis.

    Let me focus on physicians clinical excellence for now and explore ways of showing impact or value of social media.

    A qualitative study by Kotwal et al showed the following determinants of clinical excellence in a hospital medicine: communicating effectively, appreciating partnerships and collaboration, having superior clinical judgment, being organized and efficient, connecting with patients, committing to continued growth and development, and being professional and humanistic “.

    Thus for social media to have an “impact” on physician clinical excellence, it has to demonstrate a significant significant improvement over time in any (or all) of the determinants from the baseline measure.

    There have been studies on social media as a communication, information dissemination tool in medicine. In the US for examples, Mishori et al looked at the adoption of twitter as an information dissemination platform of 3 big medical association networks. These 3 communities are growing but there’s  limited interaction within and across communities. Information dissemination is below its perceived potential. While the primary objective of the original goal seem to have been met, the study is critical on whether information dissemination alone constitute health “engagement” . Measuring how much engagement is attributed to social media in healthcare via this platform is another area ripe for research.

    • T1. What is healthcare engagement and how would social media add value to it?

    There is evidence showing healthcare professionals create virtual communities and share knowledge on social media. These same virtual communities exhibit what Rolls et al termed as clinicians’ tribal behaviours that may in fact limit the sharing of knowledge across communities. The impact of these virtual communities and the extent of collaboration and sharing of knowledge via social media should be another good area for research in healthcare social media.

    • T2. How would social media improve offline collaboration among healthcare professionals? How should we measure this?

    How does physician trust peers on social media? Panahi et al  found that the “majority of participants established trust on social media mainly through previous personal interaction, authenticity and relevancy of voice, professional standing, consistency of communication, peer recommendation, and non-anonymous and moderated sites.” Healthcare professional credentialing over social media

    • T3. Is social media a valid platform for credentialing healthcare professionals? How do you check peer’s credentials over social media?

    Standardized metrics for measuring the impact of social media to these determinants has yet to be developed. But the bottomline of all these- social media adding value to healthcare vis a vis clinical excellence, is that it adds up value in improving patient outcomes. Thats another area ripe for research.

    Join us this Metric Matrix Saturday March 11, 2017 9PM Manila time as #HealthXPh discusses how should we measure the impact of social media on clinical excellence among healthcare professionals?

    • T1. What is healthcare engagement and how would social media add value to it?
    • T2. How would social media improve offline collaboration among healthcare professionals? How should we measure this?
    • T3. Is social media a valid platform for credentialing healthcare professionals? How do you check peer’s credentials over social media?

    REFERENCES:

    1. Househ M. The use of social media in healthcare: organizational, clinical, and patient perspectives. Stud Health Technol Inform. 2013;183:244–248
    2. Kotwal S1, Peña I, Howell E, Wright S.J Defining Clinical Excellence in Hospital Medicine: A Qualitative Study.Contin Educ Health Prof. 2017 Winter;37(1):3-8. doi: 10.1097/CEH.0000000000000145.
    3. Rolls K, Hansen M, Jackson D, Elliott D. How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review. Eysenbach G, ed. Journal of Medical Internet Research. 2016;18(6):e166. doi:10.2196/jmir.5312.
    4. Panahi S, Watson J, Partridge H Fostering interpersonal trust on social media: physicians’ perspectives and experiences Postgraduate Medical Journal 2016;92:70-73.
    5. Mishori R, Singh LO, Levy B, Newport C. Mapping Physician Twitter Networks: Describing How They Work as a First Step in Understanding Connectivity, Information Flow, and Message Diffusion. Eysenbach G, ed. Journal of Medical Internet Research. 2014;16(4):e107. doi:10.2196/jmir.3006.
    6. Griffiths F, Dobermann T, Cave JAK, et al. The Impact of Online Social Networks on Health and Health Systems: A Scoping Review and Case Studies. Policy & Internet. 2015;7(4):473-496. doi:10.1002/poi3.97.
    7. Houry D, Swahn MH, Hankin A. Social Media, Public Scholarship, and Injury Prevention. Western Journal of Emergency Medicine. 2014;15(5):565-566. doi:10.5811/westjem.2014.5.22754.
    8. Thackeray R, Neiger BL, Smith AK, Van Wagenen SB. Adoption and use of social media among public health departments. BMC Public Health. 2012;12:242. doi:10.1186/1471-2458-12-242.
  • Ethical Considerations of using Social Media in Healthcare Research

    Social media has the potential of increasing public awareness and participation in healthcare research. It is a promising new area for exploring “how patients conceptualize and communicate specific health issues”. The heightened public awareness encourages more enrollment and participation in potentially beneficial clinical trials.

    Healthcare research on social media poses new ethical dilemmas however. Such research on a new public environment may require new ethical guidelines. Privacy issues remains on top of these ethical concerns. Without clear guidelines, investigators are at loss on how to meet their responsibilities to participants and the medical profession. Should they ask consent for investigating healthcare data that are on public space?

    Finally, interpreting data from social media healthcare research remains a challenge. To be valid, data mining, monitoring signals and validation of social media vocabularies often needs corroboration from other methods of obtaining healthcare information.

    Join #HealthXPh chat this Saturday January 21, 2017 9:00 PM Manila time as we discuss these ethical issues in conducting healthcare research on social media:

    • T1. Is informed consent needed when using data gathered from social media?
      T2. Should investigators make public their intentions of doing healthcare social media research? Why? or why not?
      T3.What are the limitations of healthcare research on social media??

    Just use the hashtag #HealthXPh when joining this twitter chat on Saturday.

    Header photo/poster courtesy of  Matthew S. Katz MD; Disease-specific hashtags for online communication about cancer care. 2015 ASCO Annual Meeting publication

    References:

    1. Sedrak MS, Cohen RB, Merchant RM, Schapira MM. Cancer Communication in the Social Media Age. JAMA Oncol. 2016;2(6):822-823. doi:10.1001/jamaoncol.2015.5475
    2. Matthew S. Katz et al. J Clin Oncol 33, 2015 (suppl; abstr 6520)
    3. Denecke K; Ethical aspects of using medical social media in healthcare applications.Stud Health Technol Inform. 2014;198:55-62.
    4. Holly A. Taylor, Ellen Kuwana, and Benjamin S. Wilfond; Ethical Implications of Social Media in Health Care Research; The American Journal Of Bioethics Vol. 14 , Iss. 10,2014
  • Should Physicians mind their “Webside Manners”?

    Approximately 87% of US adults are online. Of these, a huge 72% seek health information online. Trust for physicians remains high though as 70% of these adults would seek a healthcare professional’s help  for major medical conditions.

    Contrast this trend with how many of physicians are taking advantage of information technology to provide healthcare information online or even clinical care from a distance.  A measly 3% of physicians engages patients online. Even if one in three US physicians use or is planning to use telemedicine, the actual usage of telemedicine by patients is lower though at about 9-15%.

    What these statistics are saying is this: patients are going online for health information but our healthcare system is slow to adapt. The advantages of Telehealth and telemedicine especially for the archipelagic Philippines is pretty obvious but so are the staggering challenges.

    How about Social Media?

    Telemedicine is broadly defined as providing clinical care from a distance, using telecommunication and information technologies. Strictly speaking, social media isn’t part of telemedicine yet. Dr. Joseph Kim pointed out though that there’s a small (albeit increasing) percentage of doctors who use social media to provide health information and professional networking.

    Extending Bedside Manners

    The traditional physician-patient interaction in the clinical setting is governed by a set of attributes, behaviour or communication skills called “bedside manners”. Studies have shown that bedside manners ultimately affect delivery of care. The entry of information technology into actual patient-physician interaction clearly changes too the clinical setting. Perhaps this is an opportune moment for examining how effective a physician’s manners are in the light of information technology or maybe, we need to expand our concept of manners.

    Webside Manners

    The concept of webside manners came with the advent of telemedicine. While “bedside manners” pertains to how a healthcare professional interacts and communicates with a patient in a face to face encounter, webside manners probably refers to how the healthcare professional interacts or communicates with a patient over a medium (of information technology) to provide clinical care.

    So lets talk about “webside manners” this Saturday November 26, 2016 at 9PM Manila time and determine whether it should be (or it should be not) part of our bedside manners:

    • T1. Does Telemedicine have a role in clinical care? How about Social Media?Why or why not?
    • T2. Should our bedside manners need extending, to include webside manners with the advent of information technologies like telemedicine or social media?
    • T3. What webside manners do you think are most needed?

     

    Don’t forget to include hashtag #healthxph when joining the chat on Saturday at 9PM Manila time. See you!

    Image: https://commons.wikimedia.org/wiki/File:Telemedicine_Consult.jpg

    Resources:

    http://www.pewinternet.org/data-trend/internet-use/latest-stats/
    http://www.pewinternet.org/2013/01/15/health-online-2013/

    https://en.wikipedia.org/wiki/Telemedicine
    https://www.accessrx.com/blog/current-health-news/how-many-family-doctors-are-using-telemedicine/
    http://www.mobihealthnews.com/45682/survey-9-percent-of-consumers-have-used-a-telehealth-service

  • How should healthcare professionals respond to a medically related social media posting?

    If you were the medical professionals in these two examples, how would you respond to social media postings related to your actions?

    • Case # 1: A medical intern was captured on a cellphone video, was ate bedside of a patient, holding a phone on his left hand and a paper ( a referral letter? ) on the other hand. This video was posted on Facebook with a caption (in Filipino language) “Are all doctors like this?…My patient is near death and he still does this?”
    • Case # 2: A physician regularly conducting medical missions in one hinterland wrote several letters to local government authorities regarding the unusual prevalence of Hepatitis B in one tribe of local indigenous people. He asked for help to the same authorities for years. He related help never came from the government sector. As a last resort, he posted his difficulties on Facebook.  This Facebook postings did receive a ton of encouragement and support. What’s more scathing though is the few “negative comments”. The physician is clearly devastated.

    What’s common in these two examples?

    Trial by publicity spinoff

    First, the healthcare professional’s medical actions went public via a social media site. Second, while both healthcare professionals received encouragements and support, the negative comments hurt more in both cases.

    Negative publicity

    “Negative publicity” is one reason why healthcare professionals shy away from social media. Negative publicity take toll on personal and professional life. The reality is someone- somewhere and somehow, will post something about our medical actions online. It’s simply a question of “when”.

    Key components of a social media response

    A previous tweetchat about protecting online reputation summarises two key components of a social media response- a prompt but well thought out reply. A prompt, well thought out social media response could only come from a personal or institutional social network strategy.

    Social Media Response Strategy

    The recent spate of healthcare related negative comments online urges us to examine deeper these response strategies.  Vanderbuilt University Medical Center developed a Social Network Response Guide for healthcare professionals on how to respond to social media postings related to their profession. You can find that algorithm here.

    Dr. Iris Isip Tan adapted  this Social Network Response Guide for UPCM/ PGH in developing their own social media policy.

    vanderbuilt
    Vanderbuilt University Medical Center Social Network Response Guide as quoted and modified by Dr. Iris Isip-Tan for use of UPCM-PGH in developing their own social media policy ( Photo courtesy of Dr. Iris Isip- Tan)

    The end goal of this guide is for the healthcare professional to have a calibrated response using the strategy of transparency, timelines for thinking and responding, a more personal tone and credible sources.  How we implement this algorithm to our own specific case is one of the main goals of this tweetchat.

    Join us this Saturday July 9, 2016 9 PM Manila time as we discuss how should healthcare professionals respond to social media posting related to the profession
    Our aim for this upcoming chat is to provide template guides for healthcare professionals in responding to social media postings related to our profession.

    • T1: How should healthcare professionals respond if the social media post about him or her is “positive”
      T2: How should healthcare professionals respond if the social media post about him or her is “negative”
      T3: How should healthcare professionals act if you are not directly related to the social media post or posting is not within your area of expertise.

    Join the discussion via twitter, using the #HealthXPh in all your tweets, answering the above topic questions, from 9-10PM Manila time July 9, 2016.

  • Are digital devices depriving healthcare professionals of their much needed sleep?

    In its most recent tweet chat and hangout on air,  #HealthXPh discussed “Distracted Doctoring“- healthcare professionals and patients getting distracted by digital devices and social media while at work. Whatever the causal factor is, no patient wants a distracted healthcare professional. HCPs do not want a distracted patient either.  That was straightforward from last week’s discussions.

    But what if, the “distraction” happened outside of the hospital or clinics? What if  its effects extend into the healthcare professional’s work? Like lack of sleep?

    There are studies showing sleep deprived medical interns and residents committing more serious medical errors.  This has led to regulations reducing work hours for interns and residents in the US.

    So what about the other factors causing sleep deprivation in healthcare professionals?  I am talking about the use of electronic and digital devices that seem to preoccupy some HCPs at night.

    Are digital devices like smartphones or tablets depriving HCPs of  their much needed sleep?

    ipad-insomnia_02.grid-6x2

    A number of studies showed a correlation between use of digital device at night and sleep deprivation among children. The latter made headlines that led some to propose banning of digital devices at night for children. One went ballistic opposing the move, pointing out serious flaws in the article.

    I am tempted to telescope a conclusion by connecting the dots of these studies. I’m inclined to believe that use of digital devices at night may deprived human beings of their much needed sleep. I also tend to believe that sleep deprived healthcare professionals may commit medical errors in the clinics. Correlation and causality seem so close. Or are they?

    Are digital devices really depriving  HCPs of their much needed sleep?

    • T1: Confess. Are you spending time on digital devices at night before going to bed?
    • T2: Define. What is excessive time on digital devices for you?
    • T3: Choose. How would you minimize sleep deprivation from digital use at night?

    Join #HealthXPh as we tackle sleep deprivation on a timely change of schedule time slot-Saturday Night Live!  The tweet chat and Hangout on Air starts to unravel this Saturday May 24, 2014 9:00PM Manila time.

     

    References:

    Annual Sleep in America Poll Exploring Connections with Communications Technology Use and Sleep
    http://sleepfoundation.org/media-center/press-release/annual-sleep-america-poll-exploring-connections-communications-technology-use-

    The Phantom Menace of Sleep-Deprived Doctors

    10 Reasons Why Handheld Devices Should Be Banned for Children Under the Age of 12
    http://www.huffingtonpost.com/cris-rowan/10-reasons-why-handheld-devices-should-be-banned_b_4899218.html

    10 Points Where the Research Behind Banning Handheld Devices for Children Is Flawed
    http://www.huffingtonpost.com/lisa-nielsen/10-reasons-why-the-resear_b_5004413.html

    10 Reasons Why We Need Research Literacy, Not Scare Columns
    http://www.huffingtonpost.com/david-kleeman/10-reasons-why-we-need-re_b_4940987.html

    Social media main cause of sleep deprivation among students
    http://www.business-standard.com/article/news-ani/social-media-main-cause-of-sleep-deprivation-among-students-114031300395_1.html

    How Much Sleep Do We Really Need?
    http://sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need

    How artificial light is wrecking your sleep, and what to do about it

    How Artificial Light Is Wrecking Your Sleep, and What to Do About It

    The impact of light from computer monitors on melatonin levels in college students.
    http://www.ncbi.nlm.nih.gov/pubmed/21552190