Connectivity, Collaboration, and Disruption: Social Media and the Oncologist

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Health & Medicine

Published on February 6, 2014

Author: rsm2800



On 2/4/14, I presented a talk at Memorial Sloan-Kettering Cancer Center "Connectivity, Collaboration, and Disruption: Social Media and the Oncologist." I created a special hashtag - #msk_hcsm14 and used it to schedule a series of tweets to go out during the talk with some of my references.

#msk_hcsm14 Connectivity, Collaboration, and Disruption: Social Media and the Oncologist Solid Tumor Conference Memorial Sloan-Kettering Cancer Center February 4, 2014 Robert S. Miller, MD, FACP, FASCO Clinical Associate, Breast Cancer Program Johns Hopkins University School of Medicine Oncology Medical Information Officer Sidney Kimmel Comprehensive Cancer Center

#msk_hcsm14 Disclosures No relevant financial relationships to disclose Non-FDA approved uses of drugs or products discussed - None

#msk_hcsm14 Does social media matter in health care?


#msk_hcsm14 Wireless Sensors Genomics Creative Destruction New Medicine Mobile Technology and Bandwidth Internet SUPER CONVERGENCE Imaging Social Networking Computing Power + Data Universe Information systems Old Medicine

#msk_hcsm14 Social  media  is  user  generated  content  that  is  shared  over  the   internet  via  technologies  that  promote  engagement,  sharing  and  collabora8on.*   *  Defini(on  from  The  Social  Media  

Social  media  is  the  second  Internet  revolu8on.     #msk_hcsm14 Used  w/  permissions  GNU  License   h;p://   h;p://  

#msk_hcsm14 Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)

#msk_hcsm14 “Facebook hits milestone of 1 billion users”! --Washington Post 10/4/12 (CC) JD Lasica, Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0)





#msk_hcsm14 Social media categories & applications —  Blogging – WordPress, Blogger (Google) —  Microblogging – Twitter, Tumblr —  Social networking – Facebook, Google+, LinkedIn —  Collaborating – wiki’s, Google Docs —  Multimedia content sharing – YouTube, Flickr, podcasts, Instagram, Pinterest, Prezi, Slideshare —  Social bookmarking – Diigo, Delicious, CiteULike —  Rating/reviewing – Yelp, Epinions —  Location-based social networking – Foursquare

#msk_hcsm14 via @DouglasWRay

#msk_hcsm14 “Why would any physician bother with this stuff?” “Isn’t it risky and a total waste of time?” “I don’t get Twitter.”

#msk_hcsm14 Our patients are online, and they expect us to be there, too…

#msk_hcsm14 Patient engagement and empowerment - trends 1.  The rise of the e-patient --democratization of medical information 2.  Patient portals/online access to medical records = part of Meaningful Use 3.  Patients online and engaged in social media (long before physicians) 4.  Peer-to-peer healthcare


#msk_hcsm14 U.S.: Different sources for different information

#msk_hcsm14 Mobile health —  91% of U.S. adults own cell phones —  56% of U.S. adults own smartphones —  19% of smartphone owners use health apps — Self-tracking/“Quantified self ” — Exercise, fitness, pedometer, pulse monitoring, BP, diet, food/calories, blood sugar, mood, sleep

#msk_hcsm14 1.  295 unique apps 2.  Purpose: raise awareness (32%), educational info about cancer (29%), early detection (12%), fundraising (10%), support disease management (4%), prevention (2%) 3.  Few apps took advantage of smartphone capabilities (no mobile sensing, limited communication w/ medical team, other pts) 4.  0/594 articles w/evaluation of cancer app

#msk_hcsm14 Data ≠ Information ≠ Knowledge

#msk_hcsm14 Our institutions are online…

#msk_hcsm14 3  ways  physicians  might  use  social  media   1.  To  treat  –  engaging  directly  w/  pa8ents  about  care   2.  To  teach  –  providing  8mely  &  credible  educa8on   3.  To  learn  –  sharing  of  medical  informa8on/knowledge     Bucket  1   Bucket  2   Bucket  3  

#msk_hcsm14 Bucket  1   Bucket  2   Bucket  3   Care   Info   Info  

#msk_hcsm14 The  “Meaningful  Use”  of     Social  Media  by  Physicians   Brian  S.  McGowan,  Ph.D.     Senior  Director,  Oncology;     Medical  EducaDon  Group,  Pfizer  Inc   Chair,  Commi;ee  on  Emerging  Technologies  in  Educa8on   Alliance  for  Con8nuing  Medical  Educa8on   Consult  Columnist,  Social  Media  Connec(ons   Medical  Mee8ngs,  A  Mee8ngsNet  Magazine   Presented  at  “Medicine  2.0”  September,  2011,  Stanford,  CA  

#msk_hcsm14 Defining  ‘Sharing  Medical  Informa8on’   •  Sharing  medical  knowledge  is   defined  as  the  exchange  of   informa(on,  advice,  ideas,   reports  and  scien(fic   discoveries  with  other   physicians  in  the  medical   community.           Bucket  3  

#msk_hcsm14 Adopters  versus  Adamant  Non-­‐Adopters   %  of  Physicians   80   71   70   60   52   50   40   33   30   20   10   13   6   40   36   27   26   25   23   21   19   19   21   18   16   16   13   11   11   9   7   0   Will  Never  Use   Current  user   9   5   1  

#msk_hcsm14 •  24% use SM daily to explore/share medical information; 14% use SM daily to contribute •  60% say SM improves quality of pt care •  Oncologists more likely to use SM due to “personal innovativeness” •  PCP’s more likely to use SM to have access to peers

#msk_hcsm14 January 2010

January 2014 #msk_hcsm14

Academic oncologists on Twitter —  Sunil Patel (MDACC) —  Mark Lewis (MDACC) —  Julie Gralow (Univ of WA) —  Wafik El-Deiry (Penn State) —  Ray Dubois (ASU) —  Larry Norton (MSKCC) —  Anas Younes (MSKCC) —  David Johnson (UT-Southwestern) —  Naoto Ueno (MDACC) —  Michael Fisch (MDACC) —  Lee Ellis (MDACC) —  John Sweetenham (Huntsman) —  Charles Blanke (OHSU) —  Rich Schilsky (ASCO) —  Yousuf Zafar (Duke) —  Tom Beer (OHSU) —  Nathan Pennell (Cleveland Clinic) —  Don Dizon (MGH) —  Mark Robson (MSKCC) —  Miguel Perales (MSKCC) —  Robert Orlowski (MDACC) —  Antonio Wolff (Hopkins) —  Evan Lipson (Hopkins)

#msk_hcsm14 Why I like Twitter —  Low barrier to entry —  Platform agnostic —  Minimal requirements for content production (140- character tweets vs. 500-word blog posts) —  Emphasis on frequency, breadth not depth —  Asymmetric (“following” does not require reciprocation) —  Ability to embed shortened links —  #hashtags = metadata —  Instantaneous dissemination of information


#msk_hcsm14 Diagram of a Tweet “@” + username calls that user’s attention to message “shortened” link Actions you can take after posting Science at the heart of medicine # Hashtags = easier way to find groups of tweets | 39

#msk_hcsm14 #Tweetchats —  Virtual meetings usually held on a repeating basis organized around a specific topic and hashtag —  Healthcare Hashtag Project - —  #BCSM = Breast Cancer Social Media (Mon 9 pm ET) —  Moderated by 2 breast cancer advocates @jodyms & @stales and an LA breast surgeon @DrAttai


#msk_hcsm14 Je n’ai fait celle-ci plus longue que parce que je n’ai pas eu le loisir de la faire plus courte. --Blaise Pascal, Lettres Provinciales (1657) “I would have written a shorter letter, but I did not have the time.”

#msk_hcsm14 How I use Twitter - outbound

#msk_hcsm14 1/25/14 – 1/31/14: •  44 mentions/RTs •  8 favorites

#msk_hcsm14 How I use Twitter - inbound —  Twitter accounts I follow: §  Oncologists & other MD’s §  Thought leaders in organized medicine & IT §  Journalists, bloggers, patient advocates, public figures §  Professional societies, institutions §  Not necessarily everyone who follows me —  New insights – patient empowerment, patient-centered health IT, safety/quality —  New professional opportunities (but not academic advancement…yet)

#msk_hcsm14 How can there possibly be enough time to do this?

#msk_hcsm14 Consider the value: —  Unexpected connections & networking —  Crowdsourcing questions —  Establishing own digital footprint/reputation management —  Promote your science

PLoS Biol. 2013 April; 11(4): e1001535 “ In the age of the internet, social media tools offer a powerful way for scientists to boost their professional profile and act as a public voice for science.” “[I]n today’s technology-driven world, lack of an online presence can severely limit a researcher’s visibility, and runs the risk that undesirable search results appear before desirable ones…”

How and why to use social media as a scientist —  Online tools improve research efficiency §  Keeping up with new developments via Twitter §  Online communities for niche topics §  Blogs as medium for extended scientific conversations —  An active online presence may enhance credentials measured through traditional metrics —  Social media enhances professional networking —  Communicating science to the general public §  To patients/lay audience – teach, translate §  Combat pseudoscience (vaccine/autism example)

Use of Twitter at medical conferences

#msk_hcsm14 Twitter usage at ASCO Annual Meeting —  #ASCO10: 684 users, 4456 tweets (14 MD’s=979 tweets) #ASCO11: 1537 users, 8188 tweets (34 MD’s=1477 tweets) Chaudhry A, Glode LM, Gillman M, Miller RS (2012). Trends in Twitter use by physicians at the American Society of Clinical Oncology Annual Meeting, 2010 and 2011. J Oncol Pract 8:173-178.

San  Antonio  Breast  Cancer  Symposium   12/10/13-­‐12/14/13  

YouTube   PromoDng  clinical  trials  

PromoDng  ParDcipaDon  in  Clinical  Trials   Providing  links  to  1/20/14  

#msk_hcsm14 Social media & clinical trials —  Engage your institution’s media department and the sponsor before creating Facebook page/Twitter account —  Determine if IRB review required —  No proprietary information —  Avoid claims about efficacy or discussion about side effects —  No disclosure of trial results —  Monitor posts to avoid HIPAA violations —  No screening of subjects via social media —  Link only to sites for more info (e.g., —  No blogging about conduct of study (can be viewed as advertising) Adapted from Table 3 in Dizon DS et al J Oncol Pract Sep 1, 2012:e114-e124


#msk_hcsm14 Professionalism in the Use of Social Media (AMA Policy 11/8/10) —  Always maintain patient privacy/confidentiality. —  Monitor own Internet presence/use privacy settings on SM (know they are not absolute). —  Maintain boundaries when interacting with patients online. —  Consider separating personal & professional online accounts. —  Police colleagues’ online behavior. —  Online behavior can affect reputation & undermine trust in the medical profession.


#msk_hcsm14 Potential problem areas —  Establishing a patient-physician relationship via social media —  Communicating directly with existing patients via social media/online friendships and connections —  Writing about patients on social media —  Googling patients —  Product endorsements and advertisements Chretien K, Kind T. Social media and clinical care: Ethical, professional, and social implications. Circulation 2013; 127:1413-1421

#msk_hcsm14 Ten tips from ASCO (Tips 1-5) 1.  Get involved 2.  Engage often 3.  Always identify yourself 4.  Protect patient confidentiality and privacy 5.  Contextualize your activities

#msk_hcsm14 Ten Tips…. 6.  Avoid impropriety 7.  Give credit where credit is due 7.  Professionalism is critical 8.  Separate the personal from professional 9.  Be aware of your institutional guidelines

#msk_hcsm14 Mayo Clinic 12 Word Social Media Policy —  Don’t Lie, Don’t Pry —  Don’t Cheat, Can’t Delete —  Don’t Steal, Don’t Reveal --Farris Timimi, M.D., Medical Director, Mayo Clinic Center for Social Media

#msk_hcsm14 My version… —  Don’t be anonymous —  Don’t be stupid —  Remember everyone’s watching —  Developing trust in your online community takes time – maintain a healthy skepticism


#msk_hcsm14 How to get started —  Be a lurker first §  Read blogs, listen to podcasts, learn how to use RSS feeds for journals & news sites —  Join Twitter §  Pick a short, descriptive handle, use a real photo as an avatar §  “Who to follow” Twitter suggestions, follow people others follow §  Give it time to grow —  Share content – links to articles and stories that interest you —  Create content – blog —  Cultivate your network – RT’s, #FF, @replies

Public network skills every physician should have --Bryan Vartabedian, MD (33 charts blog) 1.  The ability to confidently shape and compose an idea 2.  3.  4.  5.  or opinion in under 500 words The ability to summarize and share an idea in a few hundred characters The ability to shape an idea and put it on a short video clip Understanding of the limitations of patient-specific dialog in public networks Understanding of how to manage input and consumption of information

New physician literacies in the digital age --Bryan Vartabedian, MD (33 charts blog) 1.  Network Awareness/Collaboration -Physicians no longer control information 2.  Input management -Too much to know (balancing information, attention, and filters) 3.  Creation/Translation -Moving online from observationàconversationàcurationàcontent creation 4.  Mindfulness -Balancing technology with attention to patients

#msk_hcsm14 Conclusions —  The Internet has democratized information and eliminated traditional filters constraining access to medical knowledge; social media (SM) is the communication channel resulting from this change in paradigm. —  SM provides an unparalleled opportunity for the authoritative voice of the physician to be heard in patient education & health messaging. —  Physicians can effectively use SM for connection and networking with other physicians and scientists both inside of and outside of traditional spheres of influence.

#msk_hcsm14 Conclusions (cont.) —  Concerns about patient privacy, liability, and time commitment do not negate the value of participation in SM. —  Physician professionalism and patient-centered focus trump all other considerations.

Track this talk on Twitter #msk_hcsm14 Follow me on Twitter: @rsm2800 Read my blog:

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