Kendall Ho

Social Media: A Review and Tutorial of Applications in Medicine and Health Care

Background Social media are dynamic and interactive computer-mediated communication tools that have high penetration rates in the general population in high-income and middle-income countries. However, in medicine and health care, a large number of stakeholders (eg, clinicians, administrators, professional colleges, academic institutions, ministries of health, among others) are unaware of social media’s relevance, potential applications in their day-to-day activities, as well as the inherent risks and how these may be attenuated and mitigated. Objective We conducted a narrative review with the aim to present case studies that illustrate how, where, and why social media are being used in the medical and health care sectors. Methods Using a critical-interpretivist framework, we used qualitative methods to synthesize the impact and illustrate, explain, and provide contextual knowledge of the applications and potential implementations of social media in medicine and health care. Both traditional (eg, peer-reviewed) and nontraditional (eg, policies, case studies, and social media content) sources were used, in addition to an environmental scan (using Google and Bing Web searches) of resources. Results We reviewed, evaluated, and synthesized 76 articles, 44 websites, and 11 policies/reports. Results and case studies are presented according to 10 different categories of social media: (1) blogs (eg, WordPress), (2) microblogs (eg, Twitter), (3) social networking sites (eg, Facebook), (4) professional networking sites (eg, LinkedIn, Sermo), (5) thematic networking sites (eg, 23andMe), (6) wikis (eg, Wikipedia), (7) mashups (eg, HealthMap), (8) collaborative filtering sites (eg, Digg), (9) media sharing sites (eg, YouTube, Slideshare), and others (eg, SecondLife). Four recommendations are provided and explained for stakeholders wishing to engage with social media while attenuating risk: (1) maintain professionalism at all times, (2) be authentic, have fun, and do not be afraid, (3) ask for help, and (4) focus, grab attention, and engage. Conclusions The role of social media in the medical and health care sectors is far reaching, and many questions in terms of governance, ethics, professionalism, privacy, confidentiality, and information quality remain unanswered. By following the guidelines presented, professionals have a starting point to engage with social media in a safe and ethical manner. Future research will be required to understand the synergies between social media and evidence-based practice, as well as develop institutional policies that benefit patients, clinicians, public health practitioners, and industry alike.

Making interprofessional education work: the strategic roles of the academy.

Faculties (i.e., schools) of medicine along with their sister health discipline faculties can be important organizational vehicles to promote, cultivate, and direct interprofessional education (IPE). The authors present information they gathered in 2007 about five Canadian IPE programs to identify key factors facilitating transformational change within institutional settings toward successful IPE, including (1) how successful programs start, (2) the ways successful programs influence academia to bias toward change, and (3) the ways academia supports and perpetuates the success of programs. Initially, they examine evidence regarding key factors that facilitate IPE implementation, which include (1) common vision, values, and goal sharing, (2) opportunities for collaborative work in practice and learning, (3) professional development of faculty members, (4) individuals who are champions of IPE in practice and in organizational leadership, and (5) attention to sustainability. Subsequently, they review literature-based insights regarding barriers and challenges in IPE that must be addressed for success, including barriers and challenges (1) between professional practices, (2) between academia and the professions, and (3) between individuals and faculty members; they also discuss the social context of the participants and institutions. The authors conclude by recommending what is needed for institutions to entrench IPE into core education at three levels: micro (what individuals in the faculty can do); meso (what a faculty can promote); and macro (how academic institutions can exert its influence in the health education and practice system).

Clinical Telehealth Across the Disciplines: Lessons Learned

Videoconferencing technologies can vastly expand the reach of healthcare practitioners by providing patients (particularly those in rural/remote areas) with unprecedented access to services. While this represents a fundamental shift in the way that healthcare professionals care for their patients, very little is known about the impact of these technologies on clinical workflow practices and interprofessional collaboration. In order to better understand this, we have conducted a focused literature review, with the aim of providing policymakers, administrators, and healthcare professionals with an evidence-based foundation for decision-making. A total of 397 articles focused on videoconferencing in clinical contexts were retrieved, with 225 used to produce this literature review. Literature in the fields of medicine (including general and family practitioners and specialists in neurology, dermatology, radiology, orthopedics, rheumatology, surgery, cardiology, pediatrics, pathology, renal care, genetics, and psychiatry), nursing (including hospital-based, community-based, nursing homes, and home-based care), pharmacy, the rehabilitation sciences (including occupational and physical therapy), social work, and speech pathology were included in the review. Full utilization of the capacity of videoconferencing tools in clinical contexts requires some basic necessary technical conditions to be in place (including basic technological infrastructure, site-to-site technological compatibility, and available technical support). The available literature also elucidates key strategies for organizational readiness and technology adoption (including the development of a change management and user training plan, understanding program cost and remuneration issues, development of organizational protocols for system use, and strategies to promote interprofessional collaboration).

A study of a rural community's readiness for telehealth

A qualitative approach was used to explore the readiness of a rural community for the implementation of telehealth services. There were four domains of interest: patient, practitioner, public and organization. Sixteen semistructured telephone interviews (three to five in each domain) were carried out with key informants and recorded on audio-tape. Two community awareness sessions were held, which were followed by five audio-taped focus groups (with five to eight people in each) in the practitioner, patient and public domains. In addition, two in-depth interviews were conducted with community physicians. Analysis of the data suggested that there were four types of community readiness: core, engagement, structural and non-readiness. The level of readiness varied across domains. There were six main themes: core readiness; structural readiness; projection of benefits; assessment of risk; awareness and education; and intra-group and inter-group dynamics. The results of the study can be used to investigate the readiness of rural and remote communities for telehealth, which should improve the chance of successful implementation.

Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis

Many studies examine the impact of interprofessional (IP) interventions on various health practice and education outcomes. One significant gap is the lack of research on the effects of IP interventions on health human resource (HHR) outcomes. This project synthesized the literature on the impact of IP interventions at the pre- and post-licensure levels on quality workplace, staff satisfaction, recruitment, retention, turnover, choice of employment and cost effectiveness. Forty-one peer-reviewed articles and five IECPCP project reports were included in the review. We found that IP interventions at the post-licensure level improved provider satisfaction and workplace quality. Including IP learning opportunities into practice education in rural communities or in less popular healthcare specialties attracted a higher number of students and therefore may increase employment rates. This area requires more high quality studies to firmly establish the effectiveness of IP interventions in recruiting and retaining future healthcare professionals. There is strong evidence that IP interventions at the post-licensure level reduced patient care costs. The knowledge synthesis has enhanced our understanding of the relationships between IP interventions, IP collaboration and HHR outcomes. Gaps remain in the knowledge of staff retention and determination of staffing costs associated with IP interventions vis-à-vis patient care costs. None of the studies reported long-term data on graduate employment choice, which is essential to fully establish the effectiveness of IP interventions as a HHR recruitment strategy.

Electronic communities of practice: guidelines from a project.

The timely incorporation of health research into the routine practice of individual health practitioners and interprofessional teams is a widely recognized and ongoing challenge. Health professional engagement and learning is an important cog in the wheel of knowledge translation; passive dissemination of evidence through journals and clinical practice guidelines is inadequate when used alone as an intervention to change the practices of the health professionals.An evolving body of research suggests that communities of practice can be effective in facilitating the uptake of best practices by individual health professionals and teams. Modern information technologies can extend the boundaries and reach of these communities, forming electronic communities of practice (eCoP) that can be used to promote intra- and interprofessional continuing professional development (CPD) and team-based, patient-centered care. However, examples of eCoPs and examination of their characteristics are lacking in the literature. In this paper, we discuss guidelines for developing eCoP. These guidelines will be helpful for others considering the use of the eCoP model in interprofessional learning and practice.

Online social networks for personal informatics to promote positive health behavior

Social network services are becoming increasingly popular, and people are using these networks to obtain and share information. The application of social network and social media to the collection, storage and review of personal information presents opportunities for improved personal health management. This paper presents a survey of the literature on the models for the use of online social networks and models for health behavior change. These are then combined to present a framework for health behavior change through social media. This framework is then used to develop a prototype for the system design.

User Satisfaction with Asynchronous Telemedicine: A Study of Users of Santa Catarina's System of Telemedicine and Telehealth

User satisfaction analyses in synchronous telemedicine and teleconsultation environments have been widely performed and generally show satisfied users. In the field of asynchronous telemedicine, however, satisfaction studies were performed only in one single location or with a restricted set of users. With the aim of offering an exemplar evaluation of the impact of the statewide use of a large-scale asynchronous telemedicine network on the satisfaction of the involved users, this study presents the results obtained from a survey of the perceived quality of the service by both patients and healthcare staff. For this purpose, a survey with satisfaction questionnaires was performed with 564 patients from seven upstate municipalities and 56 healthcare professionals from 46 municipalities, using a methodology from the process improvement field. The collected data were quantified and underwent statistical analysis, which showed a clear perception of the improvement in the quality of service by both patients and healthcare professionals. The present findings also showed that both patients and healthcare professionals felt that introducing these new technologies was a positive step, even in upstate areas and when they involved great changes in the usual processes of primary care.

Social accountability in action: University-community collaboration in the development of an interprofessional Aboriginal health elective

A survey of the health professional curriculum at the University of British Columbia revealed a need for improvements in education relating to Aboriginal health. At the same time, interprofessional education has been increasingly viewed as an essential aspect of sustainable health care reform. Interprofessional approaches to education and community practice have the potential to contribute to improvements in access to care, as well as health professional recruitment in underserved communities. While the benefits of interprofessional approaches have been identified, there are few published examples of the application of interprofessional learning and care in Aboriginal communities. This article describes the co-development by university and community partners of an accredited interprofessional, practice-based Aboriginal health course. Seed funding for this course was originally granted in November 2004 for a demonstration project led by the UBC Faculty of Medicine from a national Primary Health Care Renewal initiative focused on Social Accountability, namely “Issues of Quality and Continuing Professional Development: Maintenance of Competence” (referred to as CPDiQ project). This article presents findings from the development and implementation of this innovative course, run as a pilot during the summer of 2006 in two Aboriginal communities in British Columbia, Canada. Recommendations for integrating Aboriginal perspectives and foregrounding principles of social accountability in interprofessional health curricula are highlighted. In addition, successes and challenges are described related to garnering administrative and curricular support among the various health disciplines, interprofessional scheduling, and fostering cross-discipline understanding and communication.

Short message service (SMS) interventions for the prevention and treatment of sexually transmitted infections: a systematic review protocol

BackgroundGlobally, the incidence of sexually transmitted infections (STI) is rising, posing a challenge to its control and appropriate management. Text messaging has become the most common mode of communication among almost six billion mobile phone users worldwide. Text messaging can be used to remind patients about clinic appointments, to notify patients that it is time for STI re-testing, and to facilitate patient communication with their health professionals with any questions and concerns they may have about their sexual health. While there are a handful of systematic reviews published on short message service (SMS) interventions in a variety of health settings and issues, none are related to sexual health. We plan to conduct a systematic review to examine the impact text messaging might have on interventions for the prevention and care of patients with STIs.Methods/DesignEligible studies will include both quantitative and qualitative studies published after 1995 that discuss the efficacy and effectiveness of SMS interventions for STI prevention and management using text messaging. Data will be abstracted independently by two reviewers using a standardized pre-tested data abstraction form. Inter-rater reliability scores will be obtained to ensure consistency in the inclusion and data extraction of studies. Heterogeneity will be assessed using the I2 test and subgroup analyses. A nonhypothesis driven inductive reasoning approach as well as a coding framework will be applied to analyze qualitative studies. A meta-analysis may be conducted if sufficient quantitative studies are found using similar outcomes.DiscussionFor this protocol, we identified ten related systematic reviews. The reviews were limited to a particular disease or setting, were not exclusive to SMS interventions, or were out of date. This systematic review will be the first comprehensive examination of studies that discuss the effectiveness of SMS on multiple outcomes that relate to STI prevention and management, covering diverse settings and populations. Findings of the systematic review and any additional meta-analyses will be published and presented to our key knowledge users. This information will provide the evidence that is required to appropriately adopt text messaging into standard practice in STI care.