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How a few social networks tread the murky waters of encouraging doctors to interact directly with patients online.

In April, we wrote about the use of social networks for physician-physician communication and concluded that while there is much potential, the ultimate online physician network probably does not exist yet. In this article we turn our focus to social networks that enable physicians to communicate with patients.

Patient-doctor networks are a relatively recent and often controversial development. In addition to enabling most of the features on doctor-doctor networks, these networks may provide a way for physicians to prescribe educational resources to patients, acquire new patients, monitor patient health, behavior, and compliance, and perhaps even diagnose or treat patients. While some electronic health record platforms such as the DocPatient Network (www.docpatient.com/) and Practice Fusion (www.practicefusion.com) have been working on enhancing doctor-patient communication, these are not considered social networking platforms complete with personal profiles, newsfeeds, and connection browsing.

Soon after Facebook opened its doors to the general public – and thus could be used for physician-patient communication – questions emerged about professional etiquette, especially in cases where advice had been dispensed or patient information had been shared. As our ability to publicly share patient information, even through “private status updates” or “anonymized case reports,” has become easier, so too has it become easier to be in violation of HIPAA. A JAMA study that sampled physician behavior on Twitter found that three percent of doctors’ tweets could be considered unprofessional, a quarter of them because of potential patient privacy violations.

Currently only about 700 (1.6%) of the 20,000 US board-certified emergency physicians have Twitter accounts – compared to 13 percent of the general US population – but this number is expected to grow. With these growing numbers needs to be increased education as social media is increasingly being used as evidence for legal action. For example, emergency physicians may remember their Rhode Island colleague, Dr. Alexandra Thran, who last year was fined, reprimanded by the state medical board, and fired for posting identifiable information about a trauma patient on Facebook.

What about when a patient tries to initiate contact with their physician through a social networking platform? According to a 2011 study of over 4,000 clinicians on QuantiaMD, about 1 in 3 had received Facebook friend requests from patients. Of these, 3 out of 4 declined or ignored the invites (Doctors, Patients & Social Media. August 2011). When the physicians were asked to select up to three reasons not to interact with patients online, the top concerns included: “liability” (73%), “patient privacy” (71%), “no way to get paid for these activities” (41%), “lack of time” (38%), “feel such interactions are inappropriate” (20%), “just not that interested” (9%), and “the technology is new to me” (6%).

In response, patient-anonymized and HIPAA-compliant forums for patient-doctor exchange have emerged. In March, Jiff, Inc. announced that it was developing the “first HIPAA-compliant social network…[that] allows consumers and health care professionals to build personalized and private communities of care.” Though it is currently in private beta, one can get an idea of the social network’s interface from their demo video online.

altAnother network, called HealthTap, is a relatively new social network that enables physicians to build public profiles which are searchable by specialty and zip code, and earn reputation points and awards based on how many virtual patient questions they answer and how many colleagues agree with their answers. As with other gamified services this is perhaps their way of addressing the “no way to get paid for these activities” concern. (Full disclosure: this author first became acquainted with HealthTap as one of their “Medical Student Experts”).

For example, on June 7, 2012, HealthTap user “karthika” asked “I am a 53 year old male. I traveled from India to America a week ago. I am having severe headache and fever for the past 4 days. What medication can I have?” A “Level 12 Elite” Travel Medicine doctor from Pittsburgh, Dr. Sarah Kohl, answered with a response (limited to 400 characters) about malaria that she titled “Go to Emergency Room.” Two other doctors answered similarly, eight doctors agreed with her explanation (a la the Facebook “like” button) and one physician “ReTapped” it (a la Twitter), thus contributing to her reputation and perhaps helping an anonymous patient (though some patients use not-so-anonymous usernames).

For emergency physician Luke Hermann, a New York-based physician who won the “2011 HealthTappy Award for Top Emergency Medicine Specialist,” sites like HealthTap have the ability to save patients an unnecessary trip to the ED.

“Every day I see patients who have come to the emergency department not because they have a true medical emergency but because they have a health concern and no other way to access a physician to get an opinion or advice,” said Hermann. “Although it often may not be enough to get a “virtual” medical opinion, if I can help a few patients avoid an unnecessary trip to the ED, everybody wins.”

altPerhaps this, in addition to reputation-building and gamification, is why the social network has attracted over 11,000 U.S. physicians, though questions remain about whether HealthTap is crossing into the dangerous territory of uninformed telediagnosis. For this reason, HealthTap emphasizes in its Terms of Use that they “do support your health decisions and choices” but “do not provide medical advice and we are not a doctor.” It is unclear whether the network has done enough to address these liability issues and provide a valuable resource that keeps physicians and patients engaged. However, in an exclusive interview with EPMonthly, HealthTap’s founder Ron Gutman expressed his confidence that his patient-doctor network will change not only how physicians interact with each other and with patients, but also how we deliver healthcare:
“HealthTap is democratizing high-quality health information, and making relevant information readily available to everyone,” Gutman says. “We are changing the field of medicine by providing patients everywhere with access to the best medical knowledge and the best medical practitioners, in a way that’s scalable and that benefits both patients and physicians.”

As with the doctor-doctor social networks, only time will tell whether Gutman and other founders of physician-patient networks are correct. In their case, however, the price of being incorrect is much higher.

 

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