How Social Media Could Change the Public Face of Emergency Medicine
In this series, much space has been dedicated to explaining the changes coming to emergency medicine as hospitals try to qualify for federal stimulus dollars, by demonstrating meaningful use of electronic health records. But as these changes unfold, another tech revolution is taking place in health care – the way patients interact with each other, and with health organizations, using social media.
Most academic papers and conferences that touch upon physicians and social media emphasize the risks: Be careful about the comments you make online, be wary of “friending” a patient, be mindful of the many ways you can violate HIPAA or expose yourself to liability. The AMA published some guidelines. Hospitals have fired personnel and banned Facebook and Twitter from desktops. JAMA and the NEJM have published cautionary horror stories about the irresponsible use of social media by medical students and trainees.
Despite the dire warnings, however, use of social media among emergency physicians is unusually strong. Maybe it’s the nature of the patient interactions, or the hours, but emergency physicians have embraced the healthcare side of blogs, Facebook and Twitter in a way not seen among other specialists. In MedGadget.com’s Weblog awards this year, the top blogs were both written by emergency care personnel. (see the sidebar for more excellent EM blogs, twitter feeds, podcasts and more).
But browsing the web and reading medical posts, physician-to-physician, is just the beginning of social media’s impact on healthcare. Patients are asking for more, and it will behoove the medical establishment to pay attention. To a surprising extent, patients have begun sharing their stories and health data on forums and Facebook, and have posed questions about their diagnoses and lab reports. This will only increase as hospitals grant access to PHRs (personal health records, a patient portal into a hospital’s electronic system and a necessary component to achieving meaningful use of EHR).
This prompts the question of whether physicians should interact with patients in the social, public sphere – something we’ve so far been reluctant to do. Beyond the guidelines from the AMA and other organizations mentioned above, beyond the risks and liabilities, there’s the consideration that it’s a non-reimbursable interaction. Another significant barrier is the simple fact that most physicians have had unpleasant experiences online, seeing their names on websites like MDcompare, seeing arbitrary ratings and erroneous patient reviews that they have almost no recourse in correcting.
But this is precisely the reason that doctors and hospitals are going to have to create a social presence. The conversations are happening without us, right now, and we’re better off if we participate. If you head over to Twitter.com and search for tweets mentioning your hospital or ED, you’re likely to find some patients asking questions or voicing opinions. Maybe their comments are spot-on, or maybe they’ve got a complaint as nonsensical as the review about you on Vitals.com, from a patient you never even saw. But these online conversations are ultimately having an impact, and chances are, no one from your institution is engaging the patients and addressing their concerns.
A few healthcare organizations have been proactive in their use of social media – check out the Facebook pages for Cleveland Clinic, Mayo or Vanderbilt University Medical Center for examples. You’ll see a lot of fans, news updates about the hospitals, event listings, and some commentary between the page moderators and patients. Questions and comments are routed to the appropriate realms – often offline. Patients are being heard, and goodwill is generated between the hospital and the web community.
Occasionally, you’ll see a Facebook post about a metric, like central line infection rates or other quality indicators. These metrics are being reported publicly on sites like CMS’s HospitalCompare.org. As part of Meaningful Use, ED metrics like throughput time and time-to-doctor are going to be reported as well. As these metrics grow in importance to patients, hospitals (and individual EDs) will turn to social media to help patients put the numbers in context.
Furthermore, thanks to the metrics disclosed in the name of meaningful use, the ED could explain and elaborate on throughput and policies. You can imagine, as metric reporting goes from quarterly to monthly to weekly and faster, EDs could brag about whatever they happen to be doing well at the moment. At least one ED is already doing this, albeit in a limited fashion (http://twitter.com/FastJaxER).
We need to go back to the drawing board and ask what social media can do to really enhance the emergency department experience. Beyond simply answering patient concerns, Facebook and Twitter – and whatever application comes next – can be used to tell a positive story to the community.
Imagine that your ED published a newsletter for the community; what would go in it? Some straightforward items include flu shot opportunities, food drives for homeless shelters, tips for disasters (large and small), and re-postings from the CDC, FDA, and other health organizations. The department could crow about their renovation, or a new CT scanner. Patient praise would be welcomed, questions would be forwarded, and complaints would be heard (and taken off-line to be addressed). Social media makes this kind of sharing of information possible, story by story, in an unobtrusive way that patients can integrate into their online activities. It’s far less expensive, and likely with much higher impact, than those electronic billboards springing up advertising ED wait times. And, thanks to the many social media pioneers in emergency medicine, getting started has never been easier. So log on and join the fray.
Random Sampling of EM Social Media
- Academic Life in Emergency Medicine // academiclifeinem.blogspot.com
- Resuscitation Medicine Education // resusme.em.extrememember.com
- StoryTellERDoc // storytellerdoc.blogspot.com
- EMCrit Blog // emcrit.org
- SMART EM // smartem.org
- Life in the Fast Lane // lifeinthefastlane.com
- The Poison Review // www.thepoisonreview.com // twitter.com/poisonreview
- WhiteCoat’s Call Room // epmonthly.com/WhiteCoat
- The Society of Academic EM // twitter.com/SAEMonline // facebook.com/SAEMonline
- GruntDoc // GruntDoc.com
- Movin’ Meat // AllBleedingStops.blogspot.com
Dr. Genes is chair of SAEM’s social media committee and colleagues with the writers of EMCrit and Smart EM.