Farris K. Timimi

Medicine, morality and health care social media

Social media includes many different forms of technology including online forums, blogs, microblogs (i.e. Twitter), wikipedias, video blogs, social networks and podcasting. The use of social media has grown exponentially and time spent on social media sites now represents one in five minutes spent online. Concomitant with this online growth, there has been an inverse trajectory in direct face-to-face patient-provider moments, which continue to become scarcer across the spectrum of health care. In contrast to standard forms of engagement and education, social media has advantages to include profound reach, immediate availability, an archived presence and broad accessibility. Our opportunity as health care providers to partner with our patients has never been greater, yet all too often we allow risk averse fears to limit our ability to truly leverage our good content effectively to the online community. This risk averse behavior truly limits our capacity to effectively engage our patients where they are -- online.

More Than Likes and Tweets: Creating Social Media Portfolios for Academic Promotion and Tenure

O ne of the foundations of modern medicine is academic output, which is part of the mission to advance biomedical science. This is accomplished through 3 different tracks: clinical practice, research, and education. Career advancement and tenure are structured around scholarly work in these 3 domains. Some have noted that research activities are considered the most influential for promotion, and the merits and drawbacks of research-focused versus education-focused career tracks have been discussed in the literature.

Health care social media: engagement and health care in the digital era.

Health care as an industry continues in reluctant participation with consumers through social networks. Factors behind health care’s laggard position range from providers’ concerns about patient privacy and lack of personal psychic bandwidth to organizational anxiety about employee time management and liability for online behavior. Despite these concerns, our patients are spending increasing amounts of their time online, often looking for information regarding their diagnosis, treatment, care providers, and hospitals, with much of that time spent in social networks. Our real opportunity for meaningful engagement in the future may depend on our capacity to meet our patients where they are, online, utilizing the tools that they use, that is, social media.

Use of Web 2.0 Social Media Platforms to Promote Community-Engaged Research Dialogs: A Preliminary Program Evaluation

Background Community-engaged research is defined by the Institute of Medicine as the process of working collaboratively with groups of people affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being. Traditional face-to-face community-engaged research is limited by geographic location, limited in resources, and/or uses one-way communications. Web 2.0 technologies including social media are novel communication channels for community-engaged research because these tools can reach a broader audience while promoting bidirectional dialogs. Objective This paper reports on a preliminary program evaluation of the use of social media platforms for promoting engagement of researchers and community representatives in dialogs about community-engaged research. Methods For this pilot program evaluation, the Clinical and Translational Science Office for Community Engagement in Research partnered with the Social Media Network at our institution to create a WordPress blog and Twitter account. Both social media platforms were facilitated by a social media manager. We used descriptive analytics for measuring engagement with WordPress and Twitter over an 18-month implementation period during 2014-2016. For the blog, we examined type of user (researcher, community representative, other) and used content analysis to generate the major themes from blog postings. For use of Twitter, we examined selected demographics and impressions among followers. Results There were 76 blog postings observed from researchers (48/76, 64%), community representatives (23/76, 32%) and funders (5/76, 8%). The predominant themes of the blog content were research awareness and dissemination of community-engaged research (35/76, 46%) and best practices (23/76, 30%). For Twitter, we obtained 411 followers at the end of the 18-month evaluation period, with an increase of 42% (from 280 to 411) over the final 6 months. Followers reported varied geographic location (321/411, 78%, resided in the United States); 99% (407/411) spoke English; and about half (218/411, 53%) were female. Followers produced 132,000 Twitter impressions. Conclusions Researchers and community stakeholders use social medial platforms for dialogs related to community-engaged research. This preliminary work is novel because we used Web 2.0 social media platforms to engage these stakeholders whereas prior work used face-to-face formats. Future research is needed to explore additional social media platforms; expanded reach to other diverse stakeholders including patients, providers, and payers; and additional outcomes related to engagement.

Perfecting patient-centered care: the needs of the patient come first.

The core principle that permeates the culture and guides the mission of Mayo Clinic can be simply stated as “the needs of the patient come first.” This conviction was articulated by Dr. William J. Mayo on June 15, 1910 during his commencement lecture at Rush Medical College: “The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.” [11] Four years later, in 1914, Minnesota’s first electrocardiogram was recorded at Mayo Clinic, marking the beginning of the Division of Cardiovascular Diseases and our singular focus to pursue and perfect patient-centered care based upon integrated practice, education, and research. Collaboration among Mayo cardiologists, cardiac surgeons, anesthesiologists, physiologists, and others resulted in the publication, in 1955, of the first series of open-heart operations with use of a heart–lung machine [10]. In 2008, approaching a century of patient care, the Mayo Cardiovascular Division has grown to become the largest academic cardiovascular practice in the world with 140 full-time physician staff committed to meeting the needs of the patient first. In this paper, we describe Mayo Cardiovascular Division’s pursuit of patient-centered care by adopting quality improvement strategies successfully used in other industries, focusing on coordination of care and disease-specific service lines, and developing patientcentered measures for quality of care.

The Strategic Imperative for the Use of Social Media in Health Care

Although health care lags behind many other industries in adopting social media as part of a business strategy, the Mayo Clinic recognized the importance of these applications more than a decade ago. In addition to typical media relations and marketing tactics, the Mayo Clinic has successfully used social media as part of an overall program to support the strategic imperatives of the institution.

Social Media: Boon or Boondoggle for Health Care Professionals?

The following 3 commentaries in this PM&R Ethics and Law column address an accompaying article published in this issue, “Ethical Considerations in using Facebook for Health are Support: A Case Study Using Concussion Management,” by Amed et al [1]. This is a ontemporary topic that, depending on one’s perspective, addresses either a burgeoning pportunity or a major pitfall in the physician-patient relationship. Social media is pervasive lobally and, as demonstrated by this article, has clearly been implemented as a medical nformatics tool. At the suggestion of the PM&R editor-in-chief, Stuart Weinstein, MD, I eartily agreed to build this ethics-law column around this article and its game-changing mplications. We believe that the following commentaries offer broad viewpoints that the linician should understand before fully immersing himor herself into the utilization of ocial media as a patient communication methodology. I asked several expert commentators o review this article and to consider the following questions.

Online Physician Reviews Do Not Reflect Patient Satisfaction Survey Responses

&NA; Online physician reviews have become increasingly prevalent and are a common means by which patients explore medical options online. Currently, there are no data comparing physicians with negative online reviews and those without negative reviews. We sought to compare industry‐vetted patient satisfaction surveys (PSSs), such as Press Ganey (PG) PSSs, between those physicians with negative online reviews and those without negative reviews. Overall, there were 113 unique individuals with negative online reviews from September 1, 2014, to December 31, 2014, with 8 being nonphysicians. We matched 113 physicians in similar departments/divisions. We obtained PG PSS scores of both groups and compared the mean scores of the 2 groups. Press Ganey PSS scores were available for 98 physicians with negative online reviews compared with 82 matched physicians without negative online reviews. The mean raw PG PSS scores were not different between the 2 groups (4.05; 95% CI, 3.99‐4.11 vs 4.04; 95% CI, 3.97‐4.11; P=.92). We also noted no difference in mean scores on questions related to physician‐patient communication and interaction skills between those with poor online reviews and those without (4.38; 95% CI, 4.32‐4.43 vs 4.41; 95% CI, 4.35‐4.47; P=.42). However, there was a significantly lower non–physician‐specific mean in those with negative online reviews (3.91; 95% CI, 3.84‐3.97) vs those without negative online reviews (4.01; 95% CI, 3.95‐4.09) (P=.02). Here, we provide data indicating that online physician reviews do not correlate to formal institutional PG PSS. Furthermore, physicians with negative online reviews have lower scores on non–physician‐specific variables included in the PG PSSs, emphasizing that these discrepancies can negatively affect overall patient experience, online physician reviews, and physician reputation. It is prudent that an improved mechanism for online ratings be implemented to better inform patients about a physicians online reputation.

Managing Physicians' Medical Brand

action in light of current limitations of the regulatory environment. This action includes conducting internal reviews of EHR-based drug indication modules to evaluate how they present off-label indications, particularly to populations at higher risk for off-label prescribing behavior (eg, patients with cancer, those with rare diseases, and pediatric populations). They should also only contract with data providers that have clear and transparent policies regarding off-label information inclusion criteria, that agree to external oversight and audit of their review committees/editorial boards, and that commit to working directly with their stakeholders (including hospital administrators, clinicians, and other prescribers) to ensure that off-label prescribing information is evidence based. At a minimum, hospital systems should demand that EHR service providers ensuredin a way that is clearly marketed and recognizable in EHR user interfacesdthe clear disaggregation of FDA-approved indications vs those that promote off-label uses. The FDA should also play an active role in addressing this new and emerging challenge in off-label promotion despite recent court decisions, given its potential impact on population health and patient safety. Facilitating regulatory certification of EHR drug prescribing modules while also developing open access data sources for drug indication information (such as publicly available data streams or application program interfaces that provide access and interaction with such data) could be crucial first steps. This process would shift the FDA from a reactive regulatory agency and allow it to become an unbiased and open source for evidencebased prescribing data that could be integrated directly into EHRs. Such actions would improve system interoperability and liberalize what is now fee-based licensed data.

Social Media Platforms and Heart Failure

With the pervasive use of the internet and social media, the potential applicability toward patients with heart failure (HF) remains understudied. Here, we outline the general use of social media and some early work with the use of social media as well as data from our own Mayo Clinic Center for Social Media experience. Both enterprise-wide social media data as well as those specific to HF-related pages and posts appear to support the preferential use of Facebook and Youtube for potential benefit in patients with HF. Large-scale prospective studies are needed to confirm these anecdotal results, and to ensure we can optimally, yet safely, engage our patients with HF to improve their care.