What's trending in my head

Center to Advance Palliative Care: If you’re a healthcare professional or a patient CAPC is a knowledge rich site to access essential palliative care tools, education, and more http://www.capc.org/

Daring Fireball: John Gruber speaks to technology and truth, with great writing. He’s one dude who can throw a sentence down http://daringfireball.net/

Swiss-Miss: Sometimes you just need to take a moment to look at good design or ideas to know all is not lost http://www.swiss-miss.com/

Occupy Healthcare: My other love and passion is working to improve healthcare in America for both patients and healthcare professionals. Occupy Healthcare is a resource for all of us http://occupyhealthcare.net/



My goal is to share my reflections on healthcare, learning, marketing, communications. technology and anything else that catches my attention or interest. My hope is that you will first learn something new, see it differently, or engage. 


It's About Time? Mapping Physician Twitter Networks

Mishori, Singh, Levy, et. al. writing in JMIR offer the first I’ve see mapping physician Twitter networks. The article is titled "Mapping Physician Twitter Networks: Describing How They Work as a First Step in Understanding Connectivity, Information Flow, and Message Diffusion”

The objectives were to describe the characteristics of four medical networks, analyzes their theoretical dissemination potential, their actual dissemination, and the propagation and distribution of tweets.

The four networks were, The AMA, the AAPF, AAP, and ACP. Visualization was used to determine overlap between the groups, actual flow of tweets for each group was assessed and examined using a Twitter data aggregator Topsy. 

Results showed that overlap across groups is small limiting the community cohesion and cross-fertilization. AMA followers’ network is not as active as the others though the AMA posted the largest number of tweets while the AAP posted the fewest. Retweets were low showing sharing of information was well below potential. 

The authors make an important observation, dissemination of information has a huge potential in these networks. The more individuals within a group Tweet the larger the dissemination. The following is striking 

...the percentage of followers that have not sent any tweets is 6.92% for AAFP (522/7546), 8.17% (962/11,768) for AAP, 7.22% (430/5955) for ACP, and 18.43% (39,275/213,122) for AMA.

It shows that when those who have not sent any tweets are removed from the dissemination network the potential only decreases by 1%. Yet when all followers who have sent only 10 or fewer tweets are removed then the AMA group information dissemination potential falls by over 35%. The other professional groups impact remains at less than 1%. The AMA network is not as active as the others and the AMA has a larger portion of individuals who are not tweeting. 

Retweeting is key in the sharing and dissemination of information and the potential of networks to drive information. The authors examined tweets sorted by number of retweets. Since the authors only examined dissemination up to Level 2 followers and not beyond retweets may be disseminated to a great extent. 

The number of retweets and the number of individuals who received the tweet is less than 0.2% of the total potential. 

Conclusions: To increase the dissemination potential, medical groups should develop a more cohesive community of shared followers. Tweet content must be engaging to provide a hook for retweeting and reaching potential audience. Next steps call for content analysis, assessment of the behavior and actions of the messengers and the recipients, and a larger-scale study that considers other medical groups using Twitter.

This examination of physician networks and Twitter is fascinating and rich in information. It points to more study and hints that content is key. Why aren’t I surprised. I know for me on Twitter it takes time to get comfortable with it and what I retweet is driven by its value to me or to others who I think it will have value for. So that may be part and parcel of this study the need to look at content analysis and beyond. 

I see this study demonstrating how similar Tweeter is to Communities of Practice. CoP can be defined as 

Communities of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.

This fits with the goal of the authors to look at content analysis. You and I are only interested in what we are interested in. How can someone in the AMA network with an interest in say diabetes management in patients with CHF find others with the same interest in the AMA and across other networks? They seem not to look across networks and are not keying content to need. 

I think the goal is to create mini Twitter networks that mimic CoP? That in my mind is the real potential for Twitter and other social media as information and learning platforms. Thus CoP behavior may occur outside Twitter occuring within institutions and among colleagues. Twitter, FB, G+ etc. are perhaps where physicians and learners go to find information specific to the problems they want to solve and from there they join smaller networks or communities.Yet I think we are a long way from that. Either online or off line. When you talk to me about problems I want to solve I am interested.

And there is this study which was referenced in this article “The Role of Social Networks in Information Diffusion”  The PDF is available on the hyperlink. No paywall. 

Online social networking technologies enable individuals to  simultaneously share information with any number of peers. Quantifying the causal effect of these mediums on the dissemination of information requires not only identification of who influences whom, but also of whether individuals would still propagate information in the absence of social signals about that information.

This Facebook study demonstrated the following:

We show that, although stronger ties are individually more influential, it is the more abundant weak ties who are responsible for the propagation of novel information. This suggests that weak ties may play a more dominant role in the dissemination of information online than currently believed.

This has been said in may places and studied. It is worth noting strong ties are our echo chamber, weak ties are those on the edge who will introduce us to something we may not have considered or known. And since we are a weak tie in return information we share may not known therefore they share what is new and different. 


Physician Rating Websites Who Uses Them: A New Study

Terluter, Bidmon, Rottl, submitted an original paper in JMIR "Who Uses Physician-Rating Websites? Differences in Sociodemographic Variables, Psychographic Variables, and Health Status of Users and Nonusers of Physician-Rating Websites

Physician-rating Web sites (PRW) exist and are growing, yet use by patients falls short. The authors set out to examine different variables, including sociodemographic, psychographic and health status of users and non-users. 

29.3% of the sample knew of PRWs with 26.1% said they had used a PRW. Those patient users who were younger and more women participated. Also more highly educated and those with chronic diseases were higher in use. Interesting to note users were more positive about the Internet than non-users with a higher digital knowledge. Not surprising but nice to see it captured in a study. 

Adding psychographic variables and information-seeking behavior variables to the binary logistic regression analyses led to a satisfying fit of the model and revealed that higher education, poorer health status, higher digital literacy (at the 10% level of significance), lower importance of family and pharmacist for health-related information, higher trust in information on PRWs, and higher appraisal of usefulness of PRWs served as significant predictors for usage of PRWs.

In the end use of the Internet and PRW remain the domain of a younger demographic, women, and those chronically ill. It comes down to what we all know, design, usability, and accessibility makes a difference. And the authors note clearly we need speak to the innovators, females, better-eduated, and younger users. This will help you to identify out what strategy is needed for a PRW and how to include a social media to customize messaging. This is a great study filled with information we can use to improve patient physician engagement


Grief Mirrored in Language and Metaphor: Karen Russell

I’m a huge radio and podcast listener. It’s a primary means for learning, relaxation, and escape. Today listen to a Fresh Air interview with the author Karen Russell ''Sleep Donation': A Dark, Futuristic Lullaby For Insomniacs" I was struck by her language and metaphor. The narrator  of that novel is suffering grief from the loss of her sister. All italics are from Karen Russell and the interview. 

The longer I listened the more Russell’s language evoked new reflection on my grief and loss which I have written about here, here, and here. Yet hearing her words and seeing the images they evoked made me realize I may just be “water boarding the reader” with what I have shared. I thought I would revisit this old chestnut grief to see if I could better capture it. 

Early in the interview she reads from her book and reads 'to be evicted from your dreams'. That for those who have not suffered grief is exactly what it is in six simple words. We have been evicted from our dreams of the life we had, the life we were working toward, and life we wanted. Suddenly we are thrust into a 'Subaqueous state’. For me it has been that way since Donna died. I reside underwater unfocused and floating while struggling to find the surface. 

At the end of the podcast she is referring to another book ‘Swamplandia’ and said ‘Cue ball break of grief where everyone goes into their separate pocket’. How true and accurate, we all end up in our own places when we grieve. Everyone’s grief is different. And I will add for me it is not one place, it moves. My grief is organic. A HCP said to be “You have adapted well to your loss.” Wanting to be the good patient I drank that kool aid without measure. It was bullshit to a point said to clear the desk and chart notes. Yes there are days I feel adapted to my loss, yet that adaption is a moving target that requires us to keep careful aim in order to understand and learn. 

I will live with my grief as my partner and manage it like a tool to grow, learn, and motivate. I’ll not allow it to weaken me. Though I have been evicted from my dreams I will work to regain them each night. 


Empowered Patients: The New Black or Old Hat?

Pam Todd writing on HealthWorks Collective “From Patient Partner to Patient Leader” makes the case that empowered patients are an integral part of our healthcare landscape beginning with clinical trials through to patients and caregivers active participation in their care. I will not argue with that nor the fact tons of research show how much time people spend searching online for healthcare information and knowledge. 

Todd further identifies how the FDA is listening to patients, the WikiProject Medicine, and this quote:

“The patient is not the partner in medical care; the patient is the leader, the pilot, the decision-maker.Patients don’t need recommendations; they need information about the added benefit of one therapy versus another balanced against the added harm of the therapy. People are smart enough to make the trade-offs; they don’t need to be told what to do.”

What then is the role of the doctor? Here is their answer:

“Changing medicine from a ‘telling what to do’ profession to a ‘telling the patient the information’ profession will lead us to a better system of care, better in every way. The profession of medicine should have the goal to serve and inform, not recommend.”

This exists, it works, and it fits with adult learning, people what to find solutions to problems they are having. If my health is crap that’s a problem and I want to solve. This is demonstrated by the fact people with chronic illness and those caring for them seek health information at a very high level and if they have two illnesses it is even greater. You can find more information here, here, and here. Yet in my mind I see the physician being the weak link in this model. This is especially true for older physicians who came up through the time of parental medicine where the learned medicine man (woman too) knew all and lead not listened. This is changing over time with younger physicians who have been raised on FB, Twitter, Google Search, etc. having an easier time identifying with these empowered patients. 

How can first measure what impact patient driven knowledge and empowerment is having on their care from their own view, their HCP behavior, evidence based outcomes, and does a physician who supports and drives patient empowerment see different outcomes from those who do not? Finally dose the HCP have the time to respond to engaged patients effectively?

Finally my chant at times is not WebMD but MyMD. That is where physicians can make the biggest difference in managing and engaging patients by becoming a resource for knowledge or as said above "to serve and inform, not recommend.” This is about leveraging the current patient to improve outcomes of those who are engaged, helping those seeking to engage to be more productive, and getting those who may not want to engage to consider it part of their personal health portfolio. 


Early HIV Treatment: The Value in Life and Dollars

Bill Gardner writing on The Incidental Economist examines two studies in Health Affairs that look at “Treatment as Prevention: The Value of Early Treatment of HIV Infection” 

Compared to people who initiated cART late…, those who initiated treatment early (with a CD4 count of 350–500) could expect to live 6.1 years longer, and the earliest initiators (with a CD4 count of more than 500) could expect an extra 9.0 years of life.

cART is expensive, but it turns out that

[t]he total value of life expectancy gains to the early and earliest initiators of treatment was $80 billion, with each life-year valued at $150,000… The value of the survival gains was more than double the increase in drug manufacturers’ revenues from early cART initiation.

Clearly more studies similar to this are needed for other diseases. What are the benefits for life and what are the economic benefits.