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Healthcare Notes for March 6, 2017

Debt and Geography

Geography of Medical Debt from The Atlantic Monthly examines the prevalence of unpaid medical bills across the US state by state. This was from from a study out of the Urban Institute.

Approximately 25% of American Adults under the age of 65 had medical debt with the southern US being hit the hardest. Lowest rate of medical debt was Hawaii at 6% of adults. The highest was Mississippi at 37%. Nationally African-Americans and those between 25 to 34 years of age were most likely to have past-due doctors’ bills.

There is a high correlation between past-due medical debt and a state’s uninsured rate.

Debt and the uninsured — Medical debt and uninsured rates among adults, by state

The study lays out various reasons for the geography of medical debt.

High deductibles
Co-Pays
Services not covered
Insufficient savings
Balance Billing

“This study highlights a common criticism of Obamacare—and the overall health-care system—from both the right and left: People might be able to afford an insurance card, but they might still end up slammed with bills they can’t pay or don’t understand”

This issue of medical debt is a lingering issue that has as much harm for the patient and family as the illness. The current ACA replacement ideas are not addressing this issue. Health-savings account the high-deductible plans are not going to fix this issue. And tax credits are not weighted by income. Rich or poor get the same tax credit.

In the end healthcare is complex and there are no one size fits all or fixes all. It is a matter of what do we pick and choose to fix and who gets hurt. Right now with those in power it is singling out the poor to benefit the rich in matters of health.

EMR and Patient Understanding

Journal of Medical Internet Research published the following “Readability Formulas and User Perceptions of Electronic Health Records Difficulty: A Corpus Study” Jiaping Zheng, MS from the University of Massachusetts identified the objective of the study

“The objective of our study was to explore the relationship between the aforementioned readability formulas and the laypeople’s perceived difficulty on 2 genres of text: general health information and EHR notes. We also validated the formulas’ appropriateness and generalizability on predicting difficulty levels of highly complex technical documents.”

Conclusions suggested that readability formulas’ were not ideal predictors of the reading difficulty of EHR by patients. The formulas correlated with each other yet they did not predict patient readability of EHR.

Two outcomes I see here. First, creating a new readability formula will likely not happen in the near future and if does happen I am not sure we can expect it to widely used for EHR and if the record needs to be fixed for readability will it be done. In a word no. Second, I see engaging patients with a HCP to give them a short 101 on how to read or what to read on and EHR specific to the patient and their medical needs. This later idea will help overcome that gap in understanding. But more important it will be another engagement tool between the patient and the physician. And that will yield better long term outcomes for patent health.

Millennials and Healthcare What’s not to love

The group we old folks love to hate have some interesting and telling views on healthcare. The Medical Futurist looked at a Gold Sachs research report about millennials and focused on the healthcare portion.

Millennials low hanging healthcare fruit, exercise more, eat smarter, smoke less. All good and they are app crazy for tracking training data (me too and I am old at the dirt on your floor). And millennials love to find food online. In the end they feel they are healthy scoring 3.5 out of 5 on the question How healthy do you consider yourself?

Here are some highlights

When asked if they think they care more about their health than their parents of grandparents.

43% Yes
22% No
36% Equally

The entire digital health apps and sensors was a bit of a surprise.

Do you use any health apps?

15.7% I use regularly
31.2% I have some on my phone/tablet but don’t use them regularly
45.7% I don’t use any
4.4% I don’t have a device

How would you feel about using sensors as well?

28.9% I don’t care that much to try one
17.4% I’d rather give a pass on it
25.6% Neutral
16.2% I’d rather give it a try
11.7% I’d definitely like to have one

The key take away here is that this segment of the population is much more socially motivated to drive others to a healthier lifestyle. It is not only talking with others it is urging them to use technologies to help.

When asked which can be more efficient in urging someone to a healthier lifestyle they responded:

17.6% New health technologies
69.6% Society’s impact
12.8% Other

Social motivation is the primary driver for healthcare in this population. They seem to single out education from companies who sell products to having incentives built into medical insurance.

All of the above is fairly standard. There is nothing earth shattering here except the difference between previous generations and this one. The educational pump on healthier lifestyle and by extension healthcare is primed. It makes sense that healthcare communications and not just about healthier lifestyle. This audience will be more attuned to evidence on diagnosis and treatment. The key communicator should be there physician. Beginning now with a baseline of evidence based messages and continuing forward will bode will for improved outcomes and smarter healthcare consumers.

Healthcare Notes March 1, 2017

Just to troll myself. This is a mediocre post on healthcare I’ve found that interested me. So why am I posting it? Because I need to get my groove back on finding and posting value based healthcare and other noteworthy pieces. It’s a one post at a time program.

A favorite healthcare blog Healthpopuli.com by Jane Sarasohn-Kahn had this: “Will Republican Healthcare Policy “Make America Sick Again? Two New Polls Show Growing Support for ACA”. If you are a healthcare junkie you know this. You’ve see clips from the town hall meeting were average citizens are not just protesting the repeal and replacement of the ACA but begging for help in staying healthy. Sarasohn-Kahn unwraps two recent surveys on how Americas view the ACA. They are from the Kaiser Family Foundation and Pew Research Center. The KFF survey charts Approve/Disapprove polls for the ACA since 2010 with 48% favorable and 42% unfavorable in February 2017. Republicans as a group are against the ACA. Nothing new here. What is new are independents shifted to favorable on the ACA.

The PEW poll asked do you approve or disapprove of the healthcare law passed by Obama and Congress in 2010. The difference was greater than KFF poll with 54% approving and 43% disapproving.

The biggest difference in approval and disapproval was with younger Americans compared to older Americans. Younger adults, 65%, approve of the ACA vs. 31% who disapprove. College graduates are more likely to support the ACA than those with no college.

Sarasohn-Kahn points to a fact $1 in $5 is the healthcare economy. It is the health economy stupid.

This is just one of many many articles, posts, Tweets, and videos on the coming replacement of the ACA. In my mind I see we are moving past the yelling and lawsuits to repeal the ACA with no evidence other than a smoldering hatred for Obama. Today people are beginning to look at the evidence to think about what healthcare means personally. Of course this comes back to the reason why people learn, to solve a problem they have. The problem we are facing is if we loose the ACA and healthcare insurance we head back to being uninsured, dropped into high risk pools for pre-existing conditions, and medical bankruptcy. The good old days. It is hard to put the genie back in the bottle once we know we can receive health CARE.

FiercePharma had the following “Pharma groups to FDA: Stop that new off-label rule in its tracks” Back in August of 2015 NY State judge ruled in favor of Amarin Pharma to allow them to promote Vascepa off-label. After this ruling by the court Pharma was expecting the FDA to step back. The FDA rolled out a new rule on the subject of off label. The rule defines ‘intended use’ for drugs and devices would include ‘totality of the evidence’ standard. Pharma is worried that totality of evidence will drive more whistleblowers because they can use circumstantial evidence. Here is something I didn’t consider about free speech and sales forecasts:

“The chilling effect of such a standard is difficult to overstate,” the petition said. “For example, if a company engages in scientific exchange about off-label use, forecasts on- and off-label sales, and scales production to meet the combined demand, a prosecutor could decide that this evidence reflects an off-label intended use.”

I believe freedom of speech is important. It is also important that clear concise evidence be offered so physicians can make decisions to treat patients that will benefit the patients and not Pharma.

Jumping the Shark in Healthcare Web Sites

Talk about jumping on the healthcare bandwagon and the shark. I present to you healthcare-sites. This is a place to go to have a healthcare website build for you. Oy

Take a look at the Psychiatrist site vs. Vet site. Your state of mental health and the fleas your dog has are indistinguishable. ‘Doctor my fleas are making me crazy’

Accelerating The Uptake of Healthcare Knowledge or How to Make a Jr. Mint a Wader

It seems everyone and every company is engaging in healthcare and healthcare technology. Twitter has 100s of healthcare chats each month. Microsoft, Verizon, GE, and many other companies are carving out a position in healthcare. Just consider all the healthcare blogs you visit and multiply that by 20. And we know that greater than 60% of adults who are online seek health information. Healthcare Professionals (HCP’s) are using social media and apps to share knowledge with colleagues. This is huge and is proving productive, positive, and important for healthcare (HC). It bodes well for bending the healthcare cost curve and improving patient care because greater numbers of people want to improve THEIR healthcare. This is a movement of HC self-awareness based on adult learning theory.

So we have this sea change occurring but who are the beneficiaries? Are the changes truly driving better patient care and outcomes? How can we accelerate knowledge acquisition by consumers and patients? How can we better engage HCP to step into the knowledge business with their patients? How do we lessen the lag time from ‘I need to learn about my health’ to ‘I’ve made changes that are giving me benefits’? Finally how do we get more people involved at a more productive level? I want to examine the latter two questions today and present an idea.

First, let’s identify and characterize those who are participating in healthcare knowledge seeking by their participation.

We have the Savvy’s who are the ones we see in chats, on blogs, participating on portals, tweeting, and posting like crazy. They are highly functional in the technology and healthcare knowledge. Most are healthcare professionals or damn close. This group is most active and the most focused on healthcare. They primarily speak to each other.

Next are the Waders. Those are the ones who are increasing their involvement. They may be lurkers on chats or readers of blogs. They are the ones printing reams of papers from WebMD or Medline and joining patient groups. They are positioned to move to Savvy’s but need a boost in confidence. Remember their reference point in all of this is watching the Savvy’s. The Savvy’s set the tone and embrace who enters Savvy Land. A hug from a Savvy is worth seven Like’s on Facebook.

The next group is what I call the Jr. Mints. They are newly minted seekers of HC knowledge and information. They are driven by problems they want to solve regarding their HC or HC of a loved one. They are spending hours searching and collecting HC information and trying to figure how to use it. I would say for the Jr. Mints it’s a hit and miss cycle of finding and capturing information. Much of what they gather early on is useless or just plain wrong. And to make matters worse they may not know it. Plus they may compromise their security online.

Finally there are the Befuddled who want to engage but are lost and not sure where to begin.

Let’s assume that this is a normal distribution with the majority of participants divided between the Waders and the Jr.Mints. The single most important outcome I would like to see is moving each group to the left, a Wader becomes a Savvy a Jr. Mint becomes a Wader and the Befuddled becomes a Jr. Mint.

Right now that is occurring slowly and painfully. I would present to you that we the Savvy’s can easily and simply change this distribution. Move more learners left on the curve and not surrender to natural selection, which is time consuming, and in some cases counterproductive.

In my humble opinion a group of Savvy’s should create a learning curriculum designed to help consumers/patients/caregivers navigate online resources better, find information specific to the healthcare problems they want to solve as well as specific to their educational need. My vision for this curriculum would be to first help the learner identify what their needs and goals are by having them self-identify those issues. And rate how confident they are in using online resources? And finally what are the goals they want to achieve with improved online skills?

The next part would be a review of how to do a search, what words to use, what the results mean, and how to improve and customize a search specific to healthcare. There are many secrets and tricks to performing a good search and those can be taught.

Helping learners identify trusted sites and what makes a site not trustworthy is a key part of this curriculum. It is critical that learners know how to critically appraise information based on the site and what they do. Part of this learning exercise should be a brief discussion of evidence-based knowledge and how that impacts healthcare.

Support groups, how to find them and how to function within one is another learning module. Critical in this part of the curriculum is identifying which groups are valid and which ones are not. It should also be discussed here how to be a good citizen of a support community, what are the generally accepted rules of the road and how to protect your personal information. Specific discussions should be made about Twitter, Facebook, Google+, etc. as well as how to leave comments and post questions on blogs and discussion groups.

Finally the course should be closed with a discussion of what do with your newfound knowledge. How can what you learn be added to your daily health routine? How to have a discussion with your HCP about what you’ve learned? How to track your progress and what are the markers that make the most sense when monitoring change.

Okay this is where this type of idea ends, it is laid it out roughly, provides some insight, and it sits there like latkes on a plate at the Carnegie Deli. Perhaps we take it step further. Make it an action item. What if a group of Savvy’s from say #hcsm, Patients Like Me or other sites and chats that attract leaders in social media and medicine decided to work together to create a curriculum. This group would work and develop a curriculum focused on the majority of online learners seeking to solve healthcare problems. The goal of the curriculum should be simple, easy to teach, with valuable information, and practical tips.

Once this curriculum is completed a very large group of from these sites should take the opportunity to email each and every community, city, community college, university library, and church to offer it for teaching. At the same time if there are any of members from these groups (#hcsm, Patients Like Me, etc.) who are local to these libraries they should offer to teach this course. Just imagine a monthly course taught at the local library “How to Use the Internet to Find Health Information’ Or something more snappy.

This is a grass roots educational process that can do so much more to drive the online trend in healthcare. And it will improve patient outcomes. Perhaps we not just use our knowledge to impress but use it to produce valuable and measurable outcomes.

What To Do With 5000 Hours

July 5 NEJM published an article titled ‘Automated Hovering in Health Care- Watching Over the 5000 Hours’.

The primary premise presented is that the US is ‘a reactive, visit-based model’ where patients are seen when they become ill, are hospitalized, and as outpatients. Besides being expensive and not driving proactive improvements in health it fails to address the 5000 hours per year that all of us spend outside of those healthcare encounters. It is during those 5000 hours where we engage in healthy or not behavior.

The importance of those 5000 hours is being addressed with various initiatives focused on employers and employee wellness programs, medication adherence, transitional care, and identifying the highest needs patients. These programs engage personal hovering, which make them expensive and difficult to scale up. A multi-center telemonitoring trial with heart failure patients showed no effect on outcomes of rehospitalization and death.

The authors presented three developments where automated hovering offered promise. The first is payments for outcomes as well as non-reimbursement for preventable readmissions. The second is the application of behavioral economics and the human desire to want better health and know what needs to be done to achieve it by applying motivation and financial incentives. And finally new technologies such as cell phones, wireless, and the Internet offer new ways to hover during those 5000 hours at a lower cost.

A study using a home-based pill dispenser connected to a lottery system offering a chance to win prize money reduced the rate of incorrect doses from 22% to about 3% in patients taking warfarin. Another study randomly assigned difficult to control patients with diabetes to receive standard care or mentorship from another patient who was successful in managing their glucose levels. After 6 months glycated hemoglobin levels were greater than a full percentage point lower then those in the control group.

The authors conclude by identifying targets fro automated hovering. Those include conditions whose management is dependent on individual patient’s behavior, medication adherence in hearth failure patients, management of diet, exercise or weight. Key to this success is how to make hovering heard over the din of social media, TV, and those things competing for out attention.

The ground work has been laid: behavioral economists, clinicians, educators, and patient groups will be gathered and studies initiated. These are complex studies. Any outcomes from these studies may not be anything that can be easily executed at the bedside or following an office visit. There may be one or two small things the HCP and the patient can do while waiting for these studies to be completed and initiatives to become part of our healthcare landscape.

Perhaps the HCP and the patient can establish something like shared decision making but in the realm of shared knowledge exchange where both the HCP and the patient agree to exchange information about health related topics specific to the patient. These can be as simple as short text messages regarding glucose monitoring or exercise or articles on a topic specific to the patient. This can all be established prior to the office visit via a tablet and confirmed during the visit. The principle is that at the visit the patient is more aware and interested in health and healthcare: leverage it. No point in loosing an opportunity to establish a conduit for communications, a way for both parties to open up those 5000 hours to each other in simple non annoying nanny state fashion. You can’t change behavior without having both parties sharing the need and desire to listen and learn. Engagement is a small simple step in communications between patient and HCP that begins perhaps a long term relationship.

The Aporia and Epiphany of Learning, Healthcare & Social Media

My one trick pony reprise: social media is just one shinny toy in a box of other equally shinny toys (i.e. tactics). You’re drinking the Kool-Aid if you believe SM in and of itself will solve the healthcare crisis, change outcomes, improve patient care, and save money. Throwing a Twitter hashtag at healthcare without a strategy, goals, and metics is like wearing flip flops in a blizzard.

In my view social media is a tactic best suited for education and learning. It offers those who apply it a robust tactic for learning about, learning to be, and learning to become active and engaged consumers and providers of healthcare.

I am reading and digesting ‘Learning for a World of Constant Change’ Homo Sapiens, Homo Faber & Homo Ludens’ by Douglas Thomas & John Seely Brown. You can read the PDF here and it is well worth it if for nothing else the rich tapestry of ideas about learning in todays complex ever changing world. (Just consider how many links to new information are tweeted on your timeline in an hour, a day a week)

The authors state, rightly so, that we cannot possible keep up or engage with the sheer volume and flux of [healthcare] knowledge occurring today.

In the 20^th century it was learning about. You accessed and learned skills and knowledge. Think slide lectures, didactic, reading, watching, etc.

Thomas and Brown further present that later in the 20th Century value was identified as learning to be where learning was put in the context of systems, identity and the transmission of knowledge. Think patient office visit, infusion lab, patient handouts, WebMD, support groups, etc.

Thomas and Brown further state that in the 21st Century learning is beaming a function of learning to become. We will all need to learn to become over and over. We will need to continuously reinvent ourselves to meet the constant change in information, knowledge, and data. Think changes in treatment, diagnosis, management of diseases and the aging population. Guidelines are changed almost bi-annually.

In this new world of ever expanding content and data where attention is measured in a fruit flies life span we must embrace the key principle in healthcare–life long learning. This is not solely the purview of the HCP but of the patient because it is abundantly clear that patients expect to be part of the care team. And, to become that member they to must engage in life long learning as well in order maximize the benefits of their healthcare professional and improve their own healthcare footprint. And fr the HCP to surrender that learning opportunity to others is a failure in seeing where the puck is going to be.

Over the course of the next couple of weeks post additional comments and thoughts from Thomas and Brown’s paper on learning and relating it to healthcare and social media.

Changing the Office Visit from Transaction to Value Experience

In my estimation a goal beyond the clinical exam of an office visit is to have both the HCP and the patient establish a foundation for better outcomes by managing knowledge and sharing problem solving. In a sense this is a form of shared decision making (SDM) where HCP and patients communicate thus moving the relationship from paternalism to partnership. SDM is labor intensive and best suited to chronic or terminal illnesses. How can the busy PCP change a HC transaction to a learning experience and gain the benefits of SDM?

All practices comprise patients at varying degrees of health status and age. Each segment will reside on a different part of the learning continuum. Say 10 is a highly active involved learner and 1 is a non-learner. The reality is that we can’t expect to move all patients to a 10. The goal is to move patients to be more active in their HC involvement. Say a 2 to a 4 or a 5 to a 6. These small changes can make a difference.

Over the course of six months each patient visit should be accompanied with a short questionnaire to determine where patients reside on the learning continuum.

1. Do you have a chronic illness or a healthcare problem that you are concerned about? Y/N

2. Are you actively learning about your illness or problem? Y/N

3. If you are active in learning what are your sources? (RankInternet

Social media and groups with similar concerns or illnesses
Friends and family
Medical and scientific journals
Support groups
Healthcare professionals

4. If you have a chronic illness or a healthcare problem but are not actively learning about your illness why?

My HCP is my decision maker
I know a lot about it and am managing it well with my HCP
I don’t have the time or desire to pursue this type of information
I never considered learning more

5. If your health is good and you have no HC problems are you interested in learning more about your health? Y/N

These five simple questions will first open an entry point for discussion. The HCP can identify what problems the patient is seeking to solve, are they active learners, where do they learn, etc. The key for moving the office visit from a drive by transaction to a learning experience is knowing where the learner resides and if they want to learn.

The data can be put into a database by disease, interest in learning, and other patient demographics. Once this is completed an educational strategy can be identified by segment or group. Outcomes can be as simple as did the patient at the next visit change his or her opinion about learning? Did they add some new knowledge to their knowledge base? Bottom line: the HCP should be the primary resource for patient learning or the most trusted. With a small effort the HCP can control and manage this knowledge channel

The Office Visit is Not a Drive By

In Digital Tonto’s post ‘4 New Marketing Paradigms’ Greg’s second paradigm is titled ‘From Campaigns to Platforms’. http://tiny.cc/srj2dw His premise is that marketers can no longer just run ads till they wear out; they need to build campaigns that integrate social media, e-commerce, and interaction with the reader/viewer. Marketers are now ‘tailoring the message to past behavior’. I am very found of his closing sentence ‘Brands need to become authors whose stories unfold over time.’ www.digitaltonto.com The brand becomes the connection to reader/viewer not just a feature or benefit.

How does this relate to healthcare? The physician is the brand. The patient is the consumer of that brand. The office visit for a check-up or care for an acute or chronic condition is the ad/commercial. It is where the consumer (patient) interacts with the brand (physician). And historically it is a flat moment where the patient is passive and the physician active. With all the changes occurring in healthcare etc. more patients are becoming active in their health and care. Many physicians are stepping up to meet that half way. But that is not enough and it misses key inflection points. Engagement between physician and patient is becoming the new black and it is up to the physician to lead the way. To in a sense create that learning narrative with the patient.

The physician as a brand should look at that visit not as a one time event in a string of events. It is a way to build a brand platform based on patient needs and goals. It is the moment where the physician can determine not just blood pressure but pressure points for knowledge uptake and begin that healthcare narrative. What are the problems/goals/needs the patient wants? How can the physician become the author of a patient narrative? Does the patient leave with an Rx? Or do they leave with a continuum of care based on integration into the brand platform? ‘My physician is a great doctor but he is also doing more then caring for me, he hears me.’

Yes, yes I know, not all patients want to be part of a platform or need to be. The 20 year old patient in excellent health who comes in for a check up is not looking to solve a healthcare problem. And frankly many older patients with chronic HTN are not interested either. What exists is the opportunity to for HCP to take the pulse of each patients’ needs and goals regarding their health and learning styles and to change the office visit from a drive by to an engagement for life. Why can’t patients move from grade school to graduate school in their relationship with their physician over time? Physicians need life long learning. So do patients. I’m getting all misty here http://tiny.cc/93j2dw

And yes dear readers (all three) you re correct, how does a busy HCP achieve this? Stick with me and it shall be shown.

Making The Office Visit a Value Exchange

Sunday night at 9pm EDT the #HCSM chat happens. It is one of the best online healthcare chats that I’ve participated in. It is fast, smart, well facilitated, and with some of the best and the brightest minds I have the pleasure of interacting with. The topics are well considered and examined in great detail. Each discussion drives me to think more and consider the changes occurring in healthcare. If you haven’t participated or lurked and you are interested in healthcare check it out, ” …as the dormouse said, ‘Feed your head’.”

I’m sure I am the most annoying participant with my continuous hocking about SM being a tactic and we need to identify strategies/goals and then overlay a tactic. Can’t help myself Donna and Alan beat me about the head for years to learn what a strategy is and how to use it. Sunday night #hcsm takes me back to sitting in the agency and having account people talk about tactics before they identify a strategy. Backing a tactic into a strategy is putting your shoes on and then your socks.

Sunday morning along with the NY Times I get my mailing from Digital Tonto (www.digitaltonto.com). One of his posts was 4 New Marketing Paradigms: here

Within that post were nuggets that clarified my thinking about those HCSM chats.

Greg the 4 new marketing paradigms:

From Making Contacts to Building Assets

From Campaigns to Platforms

From Awareness to Activation

From Transactions to Experiences

Yes, his post is about consumer media and marketing but let’s get real. We have to think in terms of marketing, communications, and strategies if we are going to meet the needs of patients in this evolving digital world.

It is the patient who is driving a need to know and learn because the www is allowing them in real time to seek solutions to problems they have, classic adult learning. To assume physicians who are struggling to keep up with an ever increasing work load and diminishing returns will jump into social media as a solution without first understanding what is happening is as likely as Mitt Romney is to have a cup of coffee.So we must look at strategies that engage both physician and patients and make that amazing unit of learning (patient & physician) work harder and produce better results. In a word use a strategy to show the physician what’s in it for them.

In the section: From Making Contacts to Building Assets Greg states ‘What’s emerging is the concept of value exchange in the form of owned media assets.’ This is not about using apps and content (tactics) to capture ‘eyeballs’ (think patient office visits). It’s about building assets and creating engagement.

The asset is the physicians knowledge and skill at delivering care. Creating engagement is helping patients replace or complement what they’ve learned at WebMD. Physicians should become MyMD to patients seeking knowledge. Make no mistake, patients trust their physician more then WebMD or they want to. Talk about a ready made gap to close, this is one that can be done.

Take away: The office visit is greater then the sum of its parts. It is a place to begin the ‘value exchange’.

I will examine how Greg’s other models relate to health communications and social media over the next few days. And I will show an example of how to begin that value exchange.

NYMC Seminar on Social Media and What I Learned

I attended the April 24th New York Medical College day of presentations on iMedicine- The Influence of Social Media on Medicine. This was an informative and forward thinking event on social media and healthcare. There were 10+ presenters including: Howard Luks, MD, Mark Ryan, MD, Brian McGowan, PhD, Ryan Madanick, MD, Lawrence Sherman, Kent Bottles, MD, and others:

The site is here: http://tiny.cc/wjbndw

Watching and listening I was struck by the depth of knowledge and experience each speaker had specific to SM and how well SM has served each one. As the day progressed I was filled with an overwhelming sense that SM in HC has the power to change, no improve, patient outcomes. Then Kent Bottles, MD spoke and shared the Gartner Hype Cycle. http://tiny.cc/mlbndw and http://www.shockoe.com/blog/trends-in-tech-truth-or-noise/ As he gently put it we may be drinking the Kool-Aid.

The consistent thread throughout all the presentations was the value social media has for physicians, patients, and outcomes. Each presentation spoke to social media not just an important new technology bringing physicians, patients, and healthcare together but showed executing it in new and more productive ways. Five presenters highlight key take away messages:

Mark Ryan, MD @richmonddoc spoke about the long history of personal one to one care delivered by the family physician and how social media can return us to that model and what it means for care.

Natash Burgert, MD www.kckidsdoc.com demonstrated how Tweeter, her web site, and other social media tools changed her practice and improved the care for her patients. She showed how a small investment in time produces durable and important outcomes with parents and patients. She is part of her local community and the community is part of her practice.

Ryan Madanick, MD @ryanmadanickmd presented was how his seeming late adoption of social media was not a barrier. In fact his coming into it as he did provided greater benefits for not just his patients but for his colleagues on both a national and global level.

Howard Luks, MD @hjluks presented the way he integrates a blog, Facebook Page, YouTube Channel, and personal site to educate and engage with patients.

Loring Day a patient spoke about how she was able to improve her care through social media and her physicians (Luks, MD) online presence.

I am highlighting these presenters among the many equally excellent and illustrative ones because they connect the dots in social media and healthcare. Social media in healthcare is about learning. It is shared decision making at a macro level. Patients are adult learners. They want to find solutions to problems they are having. Each of these HCP is offering their patients and colleagues not just places but knowledge. They are providing solution’s patients are seeking directly and indirectly. The physician and the patient is the smallest functional environment of learning and what was shown are ways to extend that beyond and back into the office visit, and ultimately to outcomes. These are communities of practice for the 21^st century built around technology and basic learning.

Kent Bottles, MD www.kentbottles.com is correct, in a way we are drinking the Kool-Aid believing social media is the answer to all out healthcare problems. We will see a period of dissolution with social media in healthcare and the plateau. We will NEVER reach 100% of patients.

My observations:

Social media in healthcare works. It extends what once was to what is and will be, care delivered not top down but together.

Are the audiences seen above a self-selecting small cohort? What can we do to move beyond self-selecting participants? Can we create a push pull?

Can we demonstrate outcomes? What are they?

Performing needs assessments to determine what problems patients are seeking solutions to and where on their continuum of knowledge/learning they reside? This will help to identify others outside the current users of social media. It will also give insight into learning needs that may differ between demographics with the same issue.

Social media is only a tactic, a mere toy. These presenters use social media as part of a strategy that educates, engages, and motivates. This is how a tactic work best, as part of an integrated strategy.

Whether each presenter deliberately identified a strategy or simple found where social media worked best is not up for debate. Social media works in healthcare. The question becomes how do we take these successes and extend it? How do we smooth out the Gartner Hype Cycle?

It is time to approach social media and healthcare in a deliberate fashion, as educators seeking to understand learner needs and problems. In every practice there are 20 year olds in perfect health who have no problems they are seeking solutions to. For them thier physicians social media is about as useful as breasts on a bull.

At the same time there are a slew of 50 something patients with problems who are seeking solutions. With a little planning and work we can improve the percent of 50 year olds who engage with HCP to solve their healthcare problems. It is not WebMD but MyMD. That is where the future of social media and healthcare will meet and improve outcomes.