Published on February 6, 2014
#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 Guide.com weill.cornell.edu
Social media is the second Internet revolu8on. #msk_hcsm14 Used w/ permissions GNU License h;p://en.wikiversity.org/wiki/File:Web_2.0_elements.png h;p://en.wikiversity.org/wiki/File:Web_1.0_elements.png weill.cornell.edu
#msk_hcsm14 http://www.flickr.com/photos/interactegypt/6882960792 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, socialmedia.biz 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 http://instagr.am/p/nm695 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 http://www.pewinternet.org/Presentations/2013/Jul/Epatients-and-their-hunt-for-health-information.aspx
#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 http://www.jmir.org/2013/12/e287 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 http://www.jmir.org/2012/5/e117 • 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 - http://www.symplur.com/healthcare-hashtags #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) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635859
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. http://jop.ascopubs.org/content/8/3/173.full
San Antonio Breast Cancer Symposium 12/10/13-‐12/14/13
YouTube PromoDng clinical trials
PromoDng ParDcipaDon in Clinical Trials Providing links to Clinicaltrials.gov
#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., clinicaltrials.gov) 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. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medicalethics/opinion9124.page
#msk_hcsm14 http://jop.ascopubs.org/content/8/5/e114.long http://annals.org/article.aspx?articleid=1675927
#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 http://circ.ahajournals.org/content/127/13/1413
#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 http://www.asco.org/about-asco/social-media
#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 http://socialmedia.mayoclinic.org/2012/04/05/a-twelve-word-social-media-policy
#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 http://33charts.com/2013/09/public-network-skills-physicians.html
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 observationàconversationàcurationàcontent creation 4. Mindfulness -Balancing technology with attention to patients http://33charts.com/2012/09/new-physician-literacies.html
#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: rsm2800.blogspot.com
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