August 1, 2011

A quick search of social networking sites Facebook, Linked In, Twitter and YouTube shows many busy anesthesia communities, and quite a few underutilized placeholders.  In case the term “social media” or the names of the major media noted above are unfamiliar to any readers, we will borrow ASA’s useful definition:  

"Social networking and media" is the term commonly given to various online and interactive technology tools that enable people to communicate easily via the internet to share information and resources, including social and professional networking sites, blogs, wikis, forums, virtual worlds, trade sites and Listserv^® lists. Social media can include the exchange of text, audio, video, images, podcasts and other multimedia communications that are user driven. As the name implies, social media involves the building of communities or networks, encouraging participation and engaging participants of all ages.

The Oxford Dictionary also now identifies “twitter,” “facebook” etc. as social media.

Two or three years ago, anesthesia organizations, vendors and some large practices had websites, and perhaps even a blog, but they had little presence on the formal social networking sites.  Today a search on the words “anesthesia” or “anesthesiology” turns up hundreds of web pages.  A sample listing appears at the end of this Alert. 

ASA correctly anticipated a coming explosion of communications through social media.  The organization created formal guidelines to ensure the integrity of ASA’s own Facebook and Twitter accounts, and also posted a valuable webinar in the members-only section of its website, Social Media 101 Webcast Training.

Should You Be Using Social Media?

Not surprisingly, there is a lot of noise out there.  Real value in using Facebook or Twitter requires careful thought.  If you are a novice or merely an interested party, there are several questions to ask yourself: 

1. How much time do you have available?

• If you don’t want to create and maintain an account of your own, you can always participate in discussions on other groups’ or organizations’ pages or forums. 

2. With whom do you want to communicate through social media?

• The public in general? Members of your group? Employees? Fellow anesthesiologists or other specialists? With family?  With patients?
• The answer(s) will suggest the medium or media to use.  Linked In is considered more of a business site, although you can also create a purely business profile on Facebook.  Twitter allows a short identity statement and is best for 140-character messages (headline-style “tweets”) to your “followers.”

3. What do you want to communicate?

• Provide basic information on your practice, e.g., address and map?
• Build your brand and advertise the nature/quality of the services you offer?
• Hold a discussion on clinical research developments?  On health policy or politics?
• Job openings?  (Don’t forget to take advantage of prospects’ own online profiles and postings.  Other employers screen candidates this way.)

4. Do you want to let others post comments or questions on your “wall?”

• Would patient feedback be helpful, in lieu of or as an adjunct to formal satisfaction surveys?

5. Do you have enough technical knowledge to ensure privacy?

• Confidentiality of intra-group communications, as appropriate
• HIPAA compliance: you may not reveal any “personal health information” (PHI) or data that would identify a patient. There are some exceptions:
  • The patient or his family member posts information revealing PHI, or
  • The patient gives you permission to make his PHI or photo public, e.g. for marketing.

Privacy Concerns

It costs nothing to launch a Facebook or Linked In page or a Twitter account – but using it clumsily can be very expensive.  Think of libel or even copyright claims, in addition to potential HIPAA violations and the less directly measurable costs to your reputation if there are indiscretions or a loss of content control on your public “wall.”  Several reports have highlighted the dangers to health care professionals who use social media carelessly, including Bloomberg News, which on July 7^th warned physicians against accepting Facebook “friend” requests from patients and stated:

Health professionals and medical students should also adopt strict privacy settings on the websites, where unchecked candor may damage patient confidentiality and hurt a doctor’s job prospects, the London-based [British Medical Association], which represents about 140,000 U.K. physicians and medical students, said in guidelines issued today. Online social networks can “blur the boundary” between a doctor’s professional and private lives, the group said.

“Writing something on a social networking site is anything but a confidential or private medium,” said Tony Calland, chairman of the medical group’s ethics committee, who uses the “most strict” privacy settings for his Facebook account, in an interview. “You just have to ensure that there’s a proper separation between professional life and social life.”

A group of doctors and nurses in 2009 took pictures of themselves lying facedown in places such as hospital trolleys, ward floors and an ambulance helipad as part of a game called planking. They were suspended after posting the photos on Facebook, according to reports in U.K. newspapers.

The manager of web development and social media for MassGeneral Hospital for Children, Dave Ekrem, gives the following advice on avoiding privacy difficulties:

1. Don’t discuss patients, even in general terms; it’s not that hard for John Doe’s friends to figure out that “Had a patient in the ER last night with alcohol-induced liver disease” might relate to John Doe.
2. Do talk about conditions, treatments, research and best practices without identifying patients.
3. Identify yourself.  “Anonymity breeds bad behavior.”
4. Don’t post online anything you would not say in the elevator.
5. Use separate accounts for your personal and professional lives.

Benefits of Using Social Media

The above tips were posted on an exemplary physician website, www.KevinMD.com, billed as “social media’s leading physician voice” and cited by ASA.  Kevin Pho, M.D., is also on Facebook, Twitter, and Linked In and his blog is distributed through various news readers.  Another blogger quoted on the Social Media page on KevinMD.com tells us that “If you don’t use Twitter, or even if you just ‘lurk,’ you will not become irrelevant to either your colleagues or patients” and that “Finally, no one knows where Twitter will go.  It may grow in its influence or it could just as easily flame out as something more effective comes along to fill the void.  Regardless, it’s got a pronounced footprint at the moment and is worthy of your consideration.”

The various social media are indeed worthy of your consideration.  Just “lurking” can keep you up to date on research developments.  In its official policy on Professionalism in the Use of Social Media, adopted at its annual meeting in June 2011, the AMA stated:  “Participating in social networking and other similar Internet opportunities can support physicians’ personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunity to widely disseminate public health messages and other health communication.”  

Some of the considerations in favor of using social media were reviewed in an article entitled “Making the Case for Social Media Marketing in Healthcare” that was posted on www.scrubsandsuits.com on May 9, 2011.  These considerations were: 

1. Your competitors are using social media.

• At least 367 hospitals currently have a social media presence.  Collectively they are responsible for more than 5,000 videos posted to YouTube and 267 Twitter accounts.  Of greater relevance to anesthesia groups, the large staffing companies such as NAPA and Teamhealth are developing their pages.
• Contributing to your hospital’s Facebook or Twitter postings may be another way to nurture your relationship.

2. Your patients are using social media.

• Patients are checking Facebook etc. for information on symptoms and diagnoses, and to find out what other people are saying about medication, treatment and providers.
• Comparison shopping has begun.  According to CNN Health, 16 state hospital associations operate websites that allow comparison shopping for such inpatient procedures as appendectomies, maternity stays (are labor epidurals far behind?) and knee or hip replacements: Georgia, Iowa, Montana, Nebraska, Nevada, New Hampshire, New Mexico, Oklahoma, Oregon, Rhode Island, South Dakota, Texas, Utah, Virginia, Washington, Wisconsin. Other states have their own systems. Minnesota health care providers collaborated on the HealthScores Web site, which allows price comparisons between 110 providers for 103 common medical procedures. The Web site tells what insurance companies pay, on average, for procedures ranging from Caesarean delivery to a colonoscopy.

3. Other doctors are plugged in.

• Almost 90 percent of physicians say that the internet is an essential part of their practice; they do 40 percent of their research on line, and overall 64 percent are using smartphones.
• The numbers are probably higher in anesthesiology.  Groups as well as hospitals can provide their doctors and CRNAs/AAs social media tools to share information and discuss best practices. 
• The Mayo Clinic has its own Center for Social Media and will hold a Social Media Summit in October, 2011, with scholarships for patient and caregiver participation.  The Mayo’s goal is to “lead the health care community in applying these revolutionary tools to spread knowledge and encourage collaboration among providers, improving health care quality everywhere.”

A Physician-Only Networking Site

Physicians have always learned from each other.  The most important function of social media – for now – is facilitating the exchange of expertise between physicians who might never meet face to face.  Doximity is a new private network for physicians, who submit to a 3-step verification process, that allows for:

1. “Curbside” consults with colleagues on clinical cases;
2. Keeping up with the latest treatment options in any of 87 specialties;
3. Exchange of HIPAA-secure email messages and faxes, private phone lists, back lines and pagers with colleagues whom you choose.

According to Scrubs & Suits,

The appeal of the site involves a free nationwide database of medical specialists, as well as the ability to reconnect with medical school classmates, direct phone numbers for hospitals, and even the ability to text message and receive picture mail using a secure network. Doximity is unlike similar sites because it doesn’t focus on user anonymity. The site creates a quicker method for treating patients throughout the US by reducing the amount of time it takes to contact colleagues and find information. This provides physicians more time to focus on patient care.

Doximity is a fast and effective way for physicians to get a hold of one another when needed on a professional level. This site reduces the need to fax information because all a physician needs to do is send a message through the use of smart phones, which is HIPAA compliant. What’s even better is the recipient of the message doesn’t even need to be a Doximity member, making this method more effective for everyone.

Twitter:
@ASALifeline (ASA meetings, job postings, workshops etc.)
@PatientLifeline (ASA news for patients)
@ASAGrassroots
@AnesthesiaLLC (Links to latest ABC Alerts)
@AAFighter (anesthesiologist assistants)
@aanawebupdates
@nurseanesthesia
@Anesthesia_Guy
@crnamaine
@seanesthesia
@GasWorkInfo
@crna
@ALNanesthesia (Anesthesiology online)
@Pg2Anesth (daily updates from Anesthesiology))
@kevinmd
@Duke_Anesthesia
@ArizonaPain (“We change lives by delivering the world-class pain management care that we would want for our own mom or day … providing hope and restoring life!”)

Facebook:
The American Society of Anesthesiologists
Anesthesiology (Journal news and link to blog)
ASA Vital Health
American Association of Nurse Anesthetists (Wikipedia entry only, not created by AANA)
Northside Anesthesiology Consultants (Mission statement, address and transportation; Wall posts include link to The School of Anaesthesia, thank-you from individual who shadowed a CRNA; recruiting; invitations to booth at meetings, smiling patient photos, etc.)
Chronic Pain Support Group (for patients)
MCW Anesthesiology (Medical College of Wisconsin.  Mission statement; faculty awards; resident retreat announcements, positions, etc.)

Linked In – Groups and Companies
American Society of Anesthesiologists (534 members)
Anesthesiologist Assistants
Anesthesia Professionals
North American Partners in Anesthesia
Pain Physician
American Society of Anesthesiologists
Anesthesia Business Consultants, LLC

It is always challenging to be in the maelstrom of technological change.  Anesthesia Business Consultants has Linked In, Facebook and Twitter accounts, and, like most of our readers, we are trying hard to realize the potential of these media.  Just as Twitter et al. can speed up the learning process for anesthesiologists in the clinical realm, the social sites themselves can help us determine what clients need from us, and what we can offer that you may not have thought of.  Let us begin the dialogue.

With best wishes,

Tony Mira
President and CEO