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January 2011

Chats on Change: Using New Media for Innovation in Health Care Delivery

Thank you for participating in the January 27th AHRQ's Health Care Innovations Exchange Chat on Change. The transcript from the live question and answer session with Ted Eytan, MD, MS, MPH from the Permanente Federation and Ellen Crown from AHRQ is available below. The Innovations Exchange also features several innovations and tools on telemedicine and mobile health.

Presenters:

Ted Eytan, MD, MS, MPH is the medical director for Delivery Systems Operations Improvement for the Permanente Federation, LLC, affiliated with Kaiser Permanente. He works with large medical groups, patients, and technologists to bring health care consumers useful information and decisionmaking tools so they can be active participants in their health care. He is a member of the Expert Panel of the Innovations Exchange.

Ellen Crown is a Health Communications Specialist with more than 12 years of government experience, ranging from military journalism to public health communications. Ellen joined AHRQ in 2007 as a member of the Office of Communications and Knowledge Transfer. Her work includes coordinating the audio-visual and New Media efforts and developing innovative ways to connect with audiences through the use of social media.

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View CoveritLive Session

Summary*

Audience Polls

How to Get Started with Social Media

New Media Target Audiences

Trends in New Media

Information Sources on New Media

New Media and Wellness

New Media and Risk

Connecting Patients with New Media

AHRQ and Social Media

Mobile Health

Conclusion

Audience Polls

The Chat included two audience polls:

Would you describe yourself as a:
- Physician – (7%)
- Nurse – (20%)
- Other Clinician – (3%)
- Researcher/Policy Maker – (30%)
- Health Administrator – (10%)

What kind of new media do you use in your health care-related work or research?
- Telemedicine – (13%)
- Facebook – (25%)
- Twitter – (20%)
- Linked In – (18%)
- YouTube – (10%)
- Other social media – (13%)

How to Get Started with Social Media

@ Sam G.: We are a federally qualified health center looking to use social media for communicating with our patient population and the community at-large. We have been struggling with the issues many health centers face: who can access Facebook, Twitter, etc.; how do you police the content; who will manage the traffic. Could you offer any insight or suggested policies and procedures to help us get started?

Ted Eytan: Ellen, this reminds me of the question “should I do social media, and why?” How did you approach it at AHRQ?

Ellen Crown: This is a great question. I expect resources are a consideration. It is smart to think about this carefully and weave it into your larger communications strategy. One important thing to do is to make sure you can respond to your audience. Who are your audiences? What are their needs? Will this channel suit them? What is your goal in the end.

Judi Consalvo: Please check out profiles on the Health Care Innovations Exchange (www.innovations.ahrq.gov) for some new ways to use new media — e.g. telemedicine, mobile phone apps — in health care delivery.

Andrea L.: I work for the Bangor Beacon Community — we are testing the use of social media for our project. We’ve just dipped our toe into Facebook, Twitter, YouTube, but want to know how to get more engaged. Can you suggest any tools to keep track of it all? Currently use TweetDeck.

Ellen Crown: Some traditional media tracking tools have now implemented social media tracking, so you might look into that. For example, they track not only traditional media story coverage but also Facebook posts and Twitter...

Ted Eytan: Ellen — why aren’t you naming specific products that people could use?

Ellen Crown: I want to be careful as a Federal employee not to name brands or companies, specifically.

Nancy Y.: What’s the best source to go to that tracks the use/adoption of the different types of social media by demographic and other population attributes...

Ellen Crown: @Nancy www.pewinternet.org

Audience Comments:

Wayne: Regarding social media policy: I would suggest that you approach it as a “Public Discourse” policy instead of a traditional social media or blogging policy. Oracle has a great example of this. They approach it as “how to conduct yourself in public”: http://www.sun.com/communities/guidelines_v1.jsp

New Media Target Audiences

Ed W.: Is social media for healthcare more specific to the commercial populations (access to computers, smartphones, Ipads etc)? is there a market for social media in the Medicare and Medicaid Populations?

Ted Eytan: I’m wondering what the differences might be between the populations in social media....is there less of a need? A lot of these technologies are accessible via mobile devices which makes them in some ways more usable by diverse populations.

Ellen Crown: New technologies are being created every day.

Ted Eytan: I tend to agree with Ellen — I wouldn’t underestimate the potential in any population.

Bennett: Is social media lending itself more readily to reaching English as a second-language populations? We know that radio does.

Ellen Crown: @Bennett, Your question is good. I would say using social media to complement a communications effort could help reach people who speak English as a second language because it formats the information in a variety of ways — making it easier for people to understand (comprehend).

Ted Eytan: I agree, and if we think social media is about reaching “people just like you,” there is great potential compared to traditional media.

Audience Comments:

Guest: To follow up from Ed’s comment — I think what he is saying is that the Medicaid and Medicare populations traditionally have less access to media — computers, cell phones, etc — than commercially covered people.

Ed W.: Correct I was trying to say that in some cases Medicare and Medicaid Populations may have less access to social media (online fees, subscription fees etc)

Craig L.: Look at the stats from the Pew Internet and American Life project. Differences do exist but are narrowing. Older age groups are the fastest growing segment of social network sites. http://www.pewinternet.org/Static-Pages/Data-Tools/Get-the-Latest-Statistics/Infographics.aspx

Brian A.: You can only choose one type of new media — most of us probably use many...

Lorri Z.: Twitter, Facebook, Ning, LinkedIn

Andrew: Here is a list of sample social media policies: http://govsocmed.pbworks.com/w/page/15060450/Web-2-0-Governance-Policies-and-Best-Practices

Trends in New Media

May: What are the latest trends in health care technology and dissemination of health messages?

Ted Eytan: Well I am kind of a fan of the Questions are the Answer campaign — do you want to mention that?

Ellen Crown: Oh yes! I love Questions are the Answer, which is available at http://www.ahrq.gov/questionsaretheanswer. The campaign focuses on getting people to engage their clinician more often during their appointments. Research shows that patients who are more involved in their health care have better health outcomes. Also. mapping is one new media tool that comes to mind. It is an interesting way to display geo-located data. There are many 3rd-party technologies available that for mapping, such as Socrata and ZeeMaps. I only mention these because HHS has signed Term of Services with them.

Ted Eytan: I’ve seen that about Term of Services — what does that mean?

Ellen Crown: Term of Service agreements or amendments relate to what you — the user — are agreeing to when you download and/or use the platform. It is important to read these carefully. I just wanted to throw this out there for more info on tools HHS has signed Term of Service agreements http://newmedia.hhs.gov/standards/tos.html.

Audience Comments:

Andrew: Terms of Service (TOS) is basically what someone agrees to when they sign up to use a service. Federal agencies have negotiated unique TOS that are acceptable for gov. See http://newmedia.hhs.gov/standards/tos.html.

Information Sources on New Media

Sue B: Pew Research Center has an online section devoted to social networking: http://www.pewinternet.org/topics/Social-Networking.aspx

Ted Eytan: Sue — agreed — I use Pew Internet and American Life Project data frequently. Highly recommend following them @Pew_Internet and @susannahfox.

Bonnie: When I see “other social media” — can you provide examples?

Ted Eytan: Bonnie, I think of location-based services, like Foursquare, and Instagram (a combo of picture sharing and location). And then there’s Flickr for photos....

Audience Comments:

Cheryl S.: The New York State DOH recently had a forum devoted to social media and HIV, STI, HCV. Take a look at nyconferences.org/socialmedia

New Media and Wellness

Regina S: Ted — I’m interested in how you use Foursquare. Can you say a little more about that, particularly in reference to promoting healthy behaviors and lifestyles (eg, tobacco prevention and control)?

Ted Eytan: Regina — like everything I’m just trying it all out, so for me, I’m just using it to show that I'm mobile and moving around.

Regina S.: Thanks Ted. Do you have any suggestions for what you have seen to be successful in healthy behavior work? For example, is Facebook good for this, Twitter, etc? Just trying to get a sense of what has worked for people when they have tried to innovate using social media with patients/clients.

Ted Eytan: Regina — that is such a good question, I would say work to discover which populations use which tools, that will help you.

Audience Comments:

Claudia P: I am wondering about apps to promote health and some incentives to stay healthy. Have you seen any movement towards the healthy incentives and focus?

Nancy Y: for apps and incentives to promote healthy behavior you may want to look at Ian Ayers stickks website.

New Media and Risk

Aaron Beth P.: We are having push back from our Information Technology department as far as the potential security problems of Facebook & Twitter so we haven’t implemented either. Did you have similar obstacles? If so, how did you overcome them?

Ellen Crown: @Aaron. I feel your pain. I have experienced that, as these tools become more popular, the risk level “perception” decreases...However, as you pointed out, that is not always true.

Aaron Beth P: That is a very common issue — one of the most common ways to deal with this is to get a computer that is off network to access social media sites (i.e. a laptop that uses an air card)

Stephanie: What do you think about the potential liability issues for the providers presented by these types of communications? I’m thinking about the professional liability risk. Social media seems like a wellness tool, but the risk in using these methods of communication in actual care seems pretty high.

Ted Eytan: Stephanie — like any communication, great care should be taken... I think health care providers manage risk all the time in their communication, they need to do it in this medium as well.

Ellen Crown: A communications team can help to discuss risk management and how social media /new media can complement an overall effort.

Ted Eytan: Deanna — well said, good to have experts like you at our side, engaged.

Audience Comments:

Christine K.: Great quote, Ted, re: HC providers managing risk: “I think health care providers manage risk all the time in their communication, they need to do it in this medium as well.”

Wayne: Regarding the comment about pushback from IT: We have all spent many years of late putting our more “risk averse” skills in charge of IT and privacy. Now we are challenging them to mix new totally open technologies in the same environment as PHI. Negotiating this starts with dispelling the myths about privacy and making sure you have the best skills on staff around security.

Deanna: Stephanie, I work in Risk Mgmt and I can see very high risks associated with the use of social media for PHI and to handle it very carefully. I also see the advantages and improvements that can be obtained from their use.

Connecting with Patients Using New Media

Ellen Crown: Ted, what tools do you use to connect with your patients? I know you’re a fan of Twitter.

Ted Eytan: All right, so, yes, Twitter I like a lot because it’s easy and quick, can do it from anywhere. I still maintain a blog (I hear such things are waning) because I like to have something that’s searchable and more ....hmmm..complete? I guess. Do a little location based stuff like Foursquare....

Jed: Can you speak to patient confidentiality and new media?

Ted Eytan: Jed — I suppose I would say that patient/member/consumer/citizen privacy needs to be protected regardless of media... And...colleagues at Center for Democracy and Technology are in the process of taking in HIPAA questions around Health 2.0 — http://cdt.org/blogs/cdt/submit-questions-health-20hipaa.

Craig L.: What are the challenges in having HCPs (health care providers) adopt social media in their practices?

Ellen Crown: @Craig, I am not sure I am equipped to answer the confidentiality question, though I am sure it is a concern. But I would like to say that a challenge would be finding the time. Once you open a channel (Build a Facebook page or start a Twitter account) you need to be accessible and RESPONSIVE to your patients. It is more harm than good to start something you cannot keep up with.

Bonnie: Can you also speak to physician orders — medications, treatments, etc. — being sent via text messaging.

Ted Eytan: Bonnie — I think several electronic health record vendors are working to create smartphone apps that allow this kind of interaction with their systems. As in our personal lives, I think we will also need to remember to “communicate with our ears,” “not just our eyes.”

Doreen: How can providers engage patients who are less inclined to use technology and might not be very involved with their health care? In social work, they’re known as “resistant clients.”

Ellen Crown: @Doreen, I think your question gets at the heart of communications and how using social media cannot, in itself, be a silver bullet. It has to complement a total communications plan that may include traditional tactics as well as new media tactics. ... Also, just thinking...you may want to check out some of the new stuff being done with mobile reminders...phone / text messages. That is a great way to engage pts and almost everyone has a phone.

Bev G: Ted I like your blog, I go back and look for things there.

Ted: Hey Bev! Everyone, know that Bev Green, MD is a national expert in innovating using telehealth to manage blood pressure...good to see you!

AHRQ Innovations Exchange: Here is Dr. Green’s profile on the Innovations Exchange: Web-Facilitated Home Monitoring in Hypertensive Patients

Bev G: I still have the question as how you use social media to get patient information such as blood pressures into the EHR. We are wanting to work with rural populations who may have cell phones but no computers (and they also are more likely to need these tools in Spanish). Would you have to use something intermediate to transfer these to an EHR?

Ted Eytan: Bev — good question, I presume you mean a person texting private information into their health care provider. I think this is an emerging area — as you know we have typically thought of an EHR as "read only” for the patient, and often “no read at all!”

Ted Eytan: Bev — and maybe to Ellen’s point, when leaders such as yourself establish the need and effectiveness of getting this data (blood pressure) in conveniently, the technology to support it will be built.

Chris S.: To Bev Green — we just successfully created an interface for a web assessment on childhood behavior, that integrates into our EMR Cerner. It is HIPAA compliant and directly inputs into the patient medical record. The next step will be to create an app for phones to do the same.

Debi: To Chris S: can you offer a website that provides more info on you web assessment tool?

Chris S.: The Cerner programmers told us it was not possible. So about 15 IT personnel and 8 months of work got it to succeed. Now they are believers. I look at it as the first success and am anxious to improve it. Sorry but do not have a link. I am just a physician trying to a better job.

Ted Eytan: Chris — impressive! I think your experience speaks to an important need for social media — to let people understand these innovations! And Chris, maybe you should put your innovation in the exchange :)

AHRQ Innovations Exchange: Submit your innovation at http://www.innovations.ahrq.gov/submit/submit.aspx.

Chris H.: @ Chris Stone, would love to know more about your work on childhood behavior

Chris S.: I will contact Ted to discuss how best to communicate our project.

Ted Eytan: Chris happy to help — I often see that innovations are not spread because people don’t know about them.....

Chris S.: I developed an ADHD specialty clinic and wanted to create the web based tools for better compliance and record keeping. But I plan to create phone apps to improve care in between visits, and to later include the two way tools.

Ted Eytan: Christine! The original innovator-convener-extraordinnaire.

Angie: Social media is especially useful as a means for bi-directional communication with patient populations, but this also creates challenges when trying to allow discussion without coming across as an be all and end-all authoritative figure. Do you have any recommendations for how to achieve a balance?

Ted Eytan: A good social media policy is useful — I highly recommend looking at Kaiser Permanente’s: http://xnet.kp.org/newscenter/media/downloads/socialmediapolicy_091609.pdf

Ellen Crown: @Angie, yeah...I am struggling with that RIGHT NOW! :) Seriously, it is very important to make sure that you refer the person to the right resource if it isn’t in “your lane.”

Bonnie: What about a physician texting medication orders utilizing texting abbreviations — cyberspace shorthand?

Ted Eytan: Bonnie — texting medication orders...to patients? or somewhere else? Can you give an example?

Bonnie: Physicians texting orders to nurses who are providing direct “bedside” care (rather than using a telephone to phone in orders)

Bonnie: Or physicians texting orders to hospitals, nursing homes, etc. as opposed to a phone call

Ed W.: Any movement to use social media in healthcare as part of the medical record: patient gets visit logs into phone takes back to have recorded?

Ted Eytan: Ed — I say at baseline that physicians and nurses could learn a lot from a patient’s lifestream. I recommend taking a look at ProjectHealthDesign, funded by Robert Wood Johnson Foundation — they are studying this.

Audience Comments:

Wayne: @Bev: This is likely a huge potential. Applications “apps” on smartphone can make the medication compliance or health status information as a self report during the patient’s day. game mechanics like Foursquare can help compliance with reporting

Brian A: I like getting text messages reminding me of medical appointments and tests — this is fairly easy to implement and I believe will provide some valuable benefits...

Wayne: about reminders: The Appointment reminder call companies are doing text messaging now as well. These can be used for those reminders.

Martin: To Claudia P. — Google Health has a page where patients can keep a medical history, and they also have the ability to view it from a mobile device.

AHRQ and Social Media

Ted Eytan: Ellen — what are the dominant tools you use at AHRQ?

Ellen Crown: Twitter, YouTube,

Ted Eytan: Ellen — do any AHRQ leaders use social media themselves? Blogs?

Ellen Crown: No blogging. But AHRQ leadership is very engaged. AHRQ Director Dr. Carolyn Clancy regularly creates audio podcasts for our Healthcare 411 consumer podcast series.

Mobile Health

Ted Eytan: Ed — here’s a list I created about impact of mobile health in Feb 2010 — #1 points to the impact of mobility in bringing diverse populations online....http://www.tedeytan.com/2010/02/18/4731

Cheryl S.: Ted I find that my Medicaid patients are highly engaged in social media on mobile devices AHRQ Innovations Exchange: we have mobile phone innovations on the Innovations Exchange.

Jed: @Ted how has your system implemented new media within the network?

Ted Eytan: Jed, do you mean health system? Kaiser Permanente? If so, I can point to several areas...

Ted Eytan: Twitter: @KPnewscenter and a very innovative use @KPCustomerService — check that one out, people interacting with Kaiser Permanente about service issues.

Ted Eytan: YouTube: youtube.com/kaiserpermanenteorg — great use of real patient stories about how technology and other innovative care helps them.

AHRQ Innovations Exchange: Check us out at http://www.innovations.ahrq.gov.

Audience Comments:

Susan C.: Someone mentioned sending reminders by mobile phone to patients. Does anyone have a link that shows how to do that?

Martin S.: To the person who asked about health apps, I think http://healthmonth.com looks promising. Check out this app that basically functions like a diary: http://healthmonth.tumblr.com/post/2629814543/check-in-with-your-spirit-animal

Conclusion

Judi Consalvo: We are nearing the end of this chat. We will put up a poll and would appreciate your feedback.

Did you find this chat helpful?

yes — (82%)
no — (8%)
not sure — (10%)

AHRQ Innovations Exchange: Visit the Innovations Exchange at http://www.innovations.ahrq.gov. Follow the Innovations Exchange on Twitter @AHRQIX . If you missed part of the chat, go to http://www.innovations.ahrq.gov/webevents/index.aspx?id=22 to read the chat.

External sources and links are provided as a resource and do not represent an endorsement by AHRQ or the Health Care Innovations Exchange. This summary includes text related to major discussion threads. Text was edited for brevity and clarity.

*External sources and links are provided as a resource and do not represent an endorsement by AHRQ or the Health Care Innovations Exchange.

Transcript*

Wednesday, 1/26/ 1:38pm AHRQ Innovations Exchange: The Chat Using New Media for Innovation in Health Care Delivery is now open for questions. Start submitting them now. We will answer the questions during the live session on 1/27 at 2pm EST.
Thursday, 1/27/2011 9:46am AHRQ Innovations Exchange: Use the box at the bottom of this screen to submit your questions. We will begin the chat at 2pm EST.
1:55pm AHRQ Innovations Exchange: We will begin in just a few minutes.
1:57 AHRQ Innovations Exchange: Innovations Website: Health Care Innovations Exchange.
1:59 Judi Consalvo: Good afternoon everyone - I’m Judi Consalvo and on behalf of the Agency for Healthcare Research and Quality I’d like to welcome you to AHRQ’s Health Care Innovations Exchange “Chats on Change”. We invite you to take a look at archived materials from some of our other Web events and to explore the Health Care Innovations Exchange Web site.
2:00 Judi Consalvo: Please answer the poll question.
Would you describe yourself as a:
Physician - ( 7% )
Nurse - ( 20% )
Other Clinician - ( 3% )
Researcher/Policy Maker - ( 30% )
Health Administrator - ( 10% )
Other - ( 30% )
2:01 Judi Consalvo: I'll now turn this over to Ted and Ellen!
2:01 Ellen Crown: Good afternoon.
2:01 Ellen Crown: I am so glad to be here, especially given the weather...
2:01 Ted Eytan: Hello Ellen! How was your trip into snowy Rockville?
2:02 [Comment From Jennifer H.: ] Good afternoon
2:02 Ellen Crown: It was fun. I am glad I am from Upstate NY and have experience driving in the snow. How about you?
2:02 Ted Eytan: Me not so good in terms of snow driving. Glad we are now in the same room and ready to chat!
2:03 Ellen Crown: Let's get right into then...We are taking a poll of what type of new media people use. Please respond.
What kind of new media do you use in your health care-related work or research?
Telemedicine - ( 13% )
Facebook - ( 25% )
Twitter - ( 20% )
Linked In - ( 18% )
YouTube - ( 10% )
Other social media - ( 13% )
2:03 Ted Eytan: (laugh) ok, should we take a question or two?
2:04 Ellen Crown: I think that is a great idea.
2:04 [Comment From Sam G.: ] We are a federally qualified health center looking to use social media for communicating with our patient population and the community at-large. We have been struggling with the issues many health centers face: who can access Facebook, Twitter, etc.; how do you police the content; who will manage the traffic. Could you offer any insight or suggested policies and procedures to help us get started?
2:04 Ted Eytan: Ellen, this reminds me of the question "should I do social media, and why?" How did you approach it at AHRQ?
2:05 [Comment From Brian A.: ] You can only choose one type of new media - most of us probably use many...
2:05 Ellen Crown: This is a great question. I expect resources are a consideration. It is smart to think about this carefully and weave it into your larger communications strategy.
2:05 [Comment From Lorri Z.: ] Twitter, Facebook, Ning, LinkedIn
2:06 Ted Eytan: Ellen, how did you decide social media fit in to AHRQ communications, and now how do you manage it?
2:06 [Comment From Andrew: ] Here is a list of sample social media policies http://govsocmed.pbworks.com/w/page/15060450/Web-2-0-Governance-Policies-and-Best-Practices
2:06 Ted Eytan: (Brian: Good point - we are using this communications platform for the first time - thanks for helping us co-innovate!)
2:07 Ellen Crown: One important thing to do is to make sure you can respond to your audience. Who are your audiences? What are their needs? Will this channel suit them? What is your goal in the end.
2:07 [Comment From Andrea L.: ] I work for the Bangor Beacon Community - we are testing the use of social media for our project. We've just dipped our toe into Facebook, Twitter, YouTube, but want to know how to get more engaged. Can you suggest any tools to keep track of it all? Currently use TweetDeck
2:09 Ellen Crown: Some traditional media tracking tools have now implemented social media tracking, so you might look into that. For example, they track not only traditional media story coverage but also Facebook posts and Twitter...
2:09 Ted Eytan: Ellen - why aren't you naming specific products that people could use?
2:10 Ellen Crown: I want to be careful as a Federal employee not to name brands or companies, specifically.
2:10 [Comment From Ed W.: ] Somewhat piggybacking on the previous question is social media for healthcare more specifc to the commercial populations (access to computers, smartphones, ipads etc) is there a market for social media in the Medicare and Medicaid Populations?
2:11 Ted Eytan: I'm wondering what the differences might be between the populations in social media....is there less of a need?
2:12 Ellen Crown: I would say yes. New technologies are being created every day.
2:13 Ted Eytan: I tend to agree with Ellen - I wouldn't underestimate the potential in any population.
2:14 [Comment From May: ] What are the latest trends in health care technology and dissemination of health messages?
2:14 Ted Eytan: Well I am kind of a fan of the Questions are the Answer campaign - do you want to mention that?
2:15 Ellen Crown: Mapping is one new media tool that comes to mind. It is an interesting way to display geo-located data. There are many 3rd-party technologies available that for mapping, such as Socrata and ZeeMaps. I only mention these because HHS has signed Term of Services with them.
2:16 Ted Eytan: I've seen that about Term of Services - what does that mean?
2:16 [Comment From Sue B: ] Pew Research Center has on online section devoted to social networking: http://www.pewinternet.org/topics/Social-Networking.aspx
2:17 [Comment From Craig L.: ] Look at the stats from the Pew Internet and American Life project. Differences do exist but are narrowing. Older age groups are the fastest growing segment of social network sites. http://www.pewinternet.org/Static-Pages/Data-Tools/Get-the-Latest-Statistics/Infographics.aspx
2:17 Ellen Crown: Oh yes! I love Questions are the Answer, which is available at http://www.ahrq.gov/questionsaretheanswer. The campaign focuses on getting people to engage their clinician more often during their appointments. Research shows that patients who are more involved in their health care have better health outcomes.
2:17 [Comment From Guest: ] To follow up from Ed's comment - I think what he is saying is that the Medicaid and Medicare populations traditionally have less access to media - computers, cell phones, etc - than commercially covered people.
2:17 Ted Eytan: Sue - agreed - I use Pew Internet and American Life Project data frequently. Highly recommend following them @PewInternet and @susannahfox.
2:17 [Comment From Bonnie: ] When I see "other social media" - can you provide examples?
2:18 [Comment From Cheryl S.: ] The New York State DOH recently had a forum devoted to social media and HIV, STI, HCV.
2:19 Ellen Crown: Term of Service agreements or amendments relate to what you -- the user -- are agreeing to when you download and/or use the platform. It is important to read these carefully.
2:19 Ted Eytan: While Ellen is typing about Term of Service - Bonnie, I think of location-based services, like Foursquare, and Instagram (a combo of picture sharing and location). And then there's Flickr for photos....
2:19 [Comment From Brian A.: ] CORRECTION: It is @Pew_Internet
2:19 [Comment From Claudia P.: ] I am wondering about app to promote health and some incentives to stay healthy. Have you seen any movement towards the healthy incentives and focus?
2:19 Ted Eytan: Thanks, Brian! It is @pew_internet:)
2:20 [Comment From Cheryl S.: ] take a look at nyconferences.org/socialmedia
2:20 Ellen Crown: I just wanted to throw this out there for more info on tools HHS has signed Term of Service agreements http://newmedia.hhs.gov/standards/tos.html.
2:20 [Comment From Andrew: ] Terms of Service (TOS) is basically what someone agrees to when they sign up to use a service. Federal agencies have negotiated unique TOS that are acceptable for gov. See http://newmedia.hhs.gov/standards/tos.html.
2:21 Ellen Crown: Ted, what tools do you use to connect with your patients? I know you're a fan of Twitter.
2:21 [Comment From Ed W.: ] Correct I was trying to say that in some cases Medicare and Medicaid Populations may have less access to social media (online fees, subscription fees etc)
2:21 Ted Eytan: Phew. lot of questions!
2:21 [Comment From Aaron Beth P.: ] We are having push back from our Information Technology department as far as the potential security problems of Facebook & Twitter so we haven't implemented either. Did you have similar obstacles? If so, how did you overcome them?
2:21 Judi Consalvo: Please check out profiles on the Health Care Innovations Exchange for some new ways to use new media - e.g. telemedicine, mobile phone apps - in health care delivery.
2:21 Ted Eytan: All right, so, yes, Twitter I like a lot because it's easy and quick, can do it from anywhere.
2:22 Ted Eytan: I still maintain a blog (I hear such things are waning) because I like to have something that's searchable and more ....hmmm..complete? I guess.
2:22 Ted Eytan: Do a little location based stuff like Foursquare....
2:22 Ted Eytan: Ellen - what are the dominant tools you use at AHRQ?
2:23 Ellen Crown: @Aaron. I feel your pain. I have experienced that, as these tools become more popular, the risk level "perception" decreases...However, as you pointed out, that is not always true.
2:23 [Comment From Guest: ] We are just getting started with Facebook and want to expand to other social media tools with a focus on using the tools to monitor and respond to customer's concerns (complaints). But we are struggling with allocating the resources that are needed to monitor.
2:24 Ted Eytan: Ed - yes and no? A lot of these technologies are accessible via mobile devices which makes them in some ways more usable by diverse populations.
2:24 Ted Eytan: Ed - let me find a piece 'o data to put in here for you....
2:24 Ellen Crown: Twitter, YouTube,
2:24 [Comment From Nancy Y: ] for apps and incentives to promote healthy behavior you may want to look at Ian Ayers stickks website
2:24 Ted Eytan: Ellen - do any AHRQ leaders use social media themselves? Blogs?
2:24 [Comment From Cheryl S.: ] Ted I find that my Medicaid patients are highly engaged in social media on mobile devices
2:25 [Comment From Andrew: ] @Aaron Beth P That is a very common issue - one of the most common ways to deal with this is to get a computer that is off network to access social media sites (i.e. a laptop that uses an air card)
2:25 [Comment From Guest: ] Ted I like your blog, I go back and look for things there. Bev Green
2:26 Ted Eytan: Ed - here's a list I created about impact of mobile health in Feb 2010 - #1 points to the impact of mobility in bringing diverse populations online....http://www.tedeytan.com/2010/02/18/4731
2:26 Ellen Crown: No blogging. But AHRQ leadership is very engaged. AHRQ Director Dr. Carolyn Clancy regularly creates audio podcasts for our Healthcare 411 consumer podcast series.
2:26 Ellen Crown: Ted, do you blog?
2:27 [Comment From Doreen: ] How can providers engage patients who are less inclined to use technology and might not be very involved with their health care? In social work, they're known as "resistant clients."
2:27 Ted Eytan: Hey Bev! Everyone, know that Bev Green, MD is a national expert in innovating using telehealth to manage blood pressure...good to see you!
2:27 Ted Eytan: Ellen, who? me? A little....
2:29 [Comment From Christina: ] I don't see my comments appearing on the screen. Am I doing something wrong?
2:29 [Comment From Jed: ] Can you speak to patient confidentiality and new media?
2:30 AHRQ Innovations Exchange: Here is Dr. Green's profile on the Innovations Exchange: Web-Facilitated Home Monitoring in Hypertensive Patients
2:30 Ellen Crown: @Doreen, I think your question gets at the heart of communications and how using social media cannot, in itself, be a silver bullet. It has to complement a total communications plan that may include traditional tactics as well as new media tactics. ... Also, just thinking...you may want to check out some of the new stuff being done with mobile reminders...phone / text messages. That is a great way to engage pts and almost everyone has a phone.
2:30 Ted Eytan: Jed - I suppose I would say that patient/member/consumer/citizen privacy needs to be protected regardless of media...
2:31 AHRQ Innovations Exchange: A reminder to readers - We're trying to answer as many questions as we can, but we won't be able to answer all questions or post all comments.
2:31 Ted Eytan: And...colleagues at Center for Democracy and Technology are in the process of taking in HIPAA questions around Health 2.0 - http://cdt.org/blogs/cdt/submit-questions-health-20hipaa.
2:32 Ellen Crown: Ted, I have been thinking more and more about where the future will take us with all of this new media. Where do you think we will be in 5 years? 10 years?
2:32 Ted Eytan: Ellen...hmmm....
2:33 Ted Eytan: I assume this (new media) will be seen as another tool....right? like e-mail is now becoming a part of clinical care?
2:33 Ellen Crown: Safer, higher quality health care?
2:33 [Comment From Regina S: ] Ted - I'm interested in how you use Foursquare. Can you say a little more about that, particularly in reference to promoting healthy behaviors and lifestyles (eg, tobacco prevention and control)?
2:33 [Comment From Martin S.: ] To the person who asked about health apps, I think http://healthmonth.com looks promising. Check out this app that basically functions like a diary: http://healthmonth.tumblr.com/post/2629814543/check-in-with-your-spirit-animal
2:33 Ted Eytan: Regina - like everything I'm just trying it all out, so for me, I'm just using it to show that I'm mobile and moving around.
2:34 Ted Eytan: (Ellen, this is moving fast, how are you doing?)
2:34 [Comment From Ed W.: ] Will we be able to review the dialogue from todays conversation online? If so could you please let us know the link? Thank You
2:34 Ellen Crown: Ted and I feel like we are working a help desk at (Insert popular name here) computer warehouse. WOW!
2:34 AHRQ Innovations Exchange: A transcript of this event will be available in about 1 week
2:35 [Comment From Jed: ] @Ted how has your system implemented new media within the network?
2:35 Ted Eytan: Yes , take a sip of water, let's get another question!
2:35 Ted Eytan: Jed, do you mean health system? Kaiser Permanente? If so, I can point to several areas...
2:35 [Comment From Bev G.: ] I still have the question as how you use social media to get patient information such as blood pressures into the EHR. We are wanting to work with rural populations who may have cell phones but no computers (and they also are more likely to need these tools in Spanish). Would you have to use something intermediate to transfer these to an EHR?
2:36 Ted Eytan: Twitter: @KPnewscenter and a very innovative use @KPCustomerService - check that one out, people interacting with Kaiser Permanente about service issues.
2:36 [Comment From Bonnie: ] Oh yes - alot of questions with all of the new technology. I'm question patient confidentiality on FB, Twitter, etc
2:36 Ted Eytan: YouTube: youtube.com/kaiserpermanenteorg - great use of real patient stories about how technology and other innovative care helps them.
2:36 [Comment From Craig L.: ] What are the challenges in having HCPs (health care providers) adopt social media in their practices?
2:37 Ted Eytan: Let me take Bev's question and Ellen you take Craig's...
2:38 [Comment From Wayne: ] Regarding the comment about pushback from IT: We have all spent many years of late putting our more "risk averse" skills in charge of IT and privacy. Now we are challenging them to mix new totally open technologies in the same environment as PHI. Negotiating this starts with dispelling the myths about privacy and making sure you have the best skills on staff around security.
2:38 Ellen Crown: @Craig, I am not sure I am equipped to answer the confidentiality question, though I am sure it is a concern. But I would like to say that a challenge would be finding the time. Once you open a channel (Build a Facebook page or start a Twitter account) you need to be accessible and RESPONSIVE to your patients. It is more harm than good to start something you cannot keep up with.
2:39 Ted Eytan: Bev- good question, I presume you mean a person texting private information into their health care provider. I think this is an emerging area - as you know we have typically thought of an EHR as "read only" for the patient, and often "no read at all!"
2:39 [Comment From Bennett: ] Is social media lending itself more readily to reaching English as a second-language populations? We know that radio does.
2:39 [Comment From Susan C.: ] Someone mentioned sending reminders by mobile phone to patients. Does anyone have a link that shows how to do that?
2:39 [Comment From Regina S.: ] Thanks Ted. Do you have any suggestions for what you have seen to be successful in healthy behavior work? For example, is Facebook good for this, Twitter, etc? Just trying to get a sense of what has worked for people when they have tried to innovate using social media with patients/clients.
2:40 Ted Eytan: Bev- and maybe to Ellen's point, when leaders such as yourself establish the need and effectiveness of getting this data (blood pressure) in conveniently, the technology to support it will be built.
2:40 [Comment From Wayne: ] @Bev: This is likely a huge potential. Applications "apps" on smartphone can make the medication compliance or health status information as a self report during the patient's day. game mechanics like Foursquare can help compliance with reporting
2:40 AHRQ Innovations Exchange: we have mobile phone innovations on the Innovations Exchange.
2:42 [Comment From Stephanie: ] What do you think about the potential liability issues for the providers presented by these types of communications?
2:43 Ted Eytan: Regina - that is such a good question, I would say work to discover which populations use which tools, that will help you.
2:43 Ellen Crown: @Bennett, Your question is good. I would say using social media to complement a communications effort could help reach people who speak English as a second language because it formats the information in a variety of ways -- making it easier for people to understand (comprehend).
2:44 Ted Eytan: I agree, and if we think social media is about reaching "people just like you," there is great potential compared to traditional media.
2:44 [Comment From Brian A: ] I like getting text messages reminding me of medical appointments and tests ~ this is fairly easy to implement and I believe will provide some valuable benefits...
2:44 Ted Eytan: Stephanie - like any communication, great care should be taken...
2:44 [Comment From Angie: ] Social media is especially useful as a means for bi-directional communication with patient populations, but this also creates challenges when trying to allow discussion without coming across as an be all and end-all authoritative figure. Do you have any recommendations for how to achieve a balance?
2:44 [Comment From Wayne: ] about reminders: The Appointment reminder call companies are doing text messaging now as well. These can be used for those reminders.
2:44 Ted Eytan: A good social media policy is useful - I highly recommend looking at Kaiser Permanente's:
2:45 [Comment From Bonnie: ] Can you also speak to physician orders - medications, treatments, etc. - being sent via text messaging.
2:45 Ted Eytan: http://xnet.kp.org/newscenter/media/downloads/socialmediapolicy_091609.pdf
2:46 [Comment From Chris S.: ] To Bev Green-we just successfully created an interface for a web assessment on childhood behavior, that integrates into our EMR Cerner. It is HIPAA compliant and directly inputs into the patient medical record. The next step will be to create an app for phones to do the same.
2:46 [Comment From Bonnie: ] What about a physician texting medication orders utilizing texting abbreviations - cyberspace shorthand?
2:46 Ted Eytan: Bonnie - texting medication orders...to patients? or somewhere else? Can you give an example?
2:47 [Comment From Claudia P.: ] Piggyback @ Wayne also an app for medication history. Do you know any app for medication history. Thank you the lead for staying healthy... I am wondering if there is an incentive for professional keep population healthy and if social media can help on that.
2:47 Ted Eytan: Chris - sounds interesting - how challenging was this for you? Feel free to send in a link if you have one to the work...perhaps your blog or twitterfeed:)
2:47 Ellen Crown: @Angie, yeah...I am struggling with that RIGHT NOW! :) Seriously, it is very important to make sure that you refer the person to the right resource if it isn't in 'your lane."
2:47 [Comment From Ed W.: ] Any movement to use social media in healthcare as part of the medical record: patient gets visit logs into phone takes back to have recorded?
2:48 [Comment From Chris JR : ] Is anyone is familiar with the use of social media in reaching population groups e.g. healthcare practitioners for such things as disseminating leading practices, resources, communications etc.
2:49 [Comment From Bonnie : ] Physicians texting orders to nurses who are providing direct 'bedside' care (rather than using a telephone to phone in orders)
2:49 Ted Eytan: Ed - I say at baseline that physicians and nurses could learn a lot from a patient's lifestream.
2:49 [Comment From Martin: ] To Claudia P. - Google Health has a page where patients can keep a medical history, and they also have the ability to view it from a mobile device.
2:49 Ted Eytan: Ed - I recommend taking a look at ProjectHealthDesign, funded by Robert Wood Johnson Foundation - they are studying this.
2:49 [Comment From Wayne : ] regarding social media policy: I would suggest that you approach it as a "Public Discourse" policy instead of a traditional social media or blogging policy. Oracle has a great example of this. They approach it as "how to conduct yourself in public"
2:50 Ted Eytan: Bonne - I think several electronic health record vendors are working to create smartphone apps that allow this kind of interaction with their systems. As in our personal lives, I think we will also need to remember to "communicate with our ears", "not just our eyes."
2:51 [Comment From Wayne : ] The link to the Oracle policy http://www.sun.com/communities/guidelines_v1.jsp
2:51 Ted Eytan: Wayne - do you have a link to that policy you'd like to share?
2:51 Ted Eytan: And there it is Wayne, thank you!
2:51 [Comment From Bonnie : ] Or physicians texting orders to hospitals, nursing homes, etc. as opposed to a phone call
2:51 [Comment From Stephanie: ] I'm thinking about the professional liability risk. Social media seems like a wellness tool, but the risk in using these methods of communication in actual care seems pretty high.
2:52 [Comment From Debi: ] To Chris Stone: can you offer a website that provides more info on you web assessment tool?
2:52 Ted Eytan: Stephanie - I think health care providers manage risk all the time in their communication, they need to do it in this medium as well.
2:52 [Comment From Chris S.: ] The Cerner programmers told us it was not possible. So about 15 IT personnel and 8 months of work got it to succeed. Now they are believers. I look at it as the first success and am anxious to improve it. Sorry but do not have a link. I am just a physician trying to a better job.
2:52 Ted Eytan: Ellen...thoughts?
2:52 [Comment From Ed W.: ] Will Do Thanks Ted
2:53 Ellen Crown: A communications team can help to discuss risk management and how social media /new media can complement an overall effort.
2:53 Ted Eytan: Chris - impressive! I think your experience speaks to an important need for social media - to let people understand these innovations!
2:53 [Comment From Nancy Y.: ] what's the best source to go to that tracks the use/adoption of the different types of social media by demographic and other population attributes.........
2:53 Ted Eytan: And Chris, maybe you should put your innovation in the exchange :) Here's the link....
2:54 [Comment From Chris H.: ] @ Chris Stone, would love to know more about your work on childhood behavior
2:54 [Comment From Chris S.: ] I will contact Ted to discuss how best to communicate our project.
2:54 Ellen Crown: @Nancy Pewinternet.org
2:54 AHRQ Innovations Exchange: Check us out at http://www.innovations.ahrq.gov.
2:54 [Comment From Cheryl S.: ] One of the best epi sources is PEW
2:55 Ted Eytan: Chris happy to help - I often see that innovations are not spread because people don't know about them.....
2:55 Ellen Crown: Ted, have you caught your breath yet? This crowd is lively and very smart!
2:55 Ted Eytan: I'm trying, Ellen, I'm trying!
2:55 Ted Eytan: :)
2:55 AHRQ Innovations Exchange: Submit your innovation at http://www.innovations.ahrq.gov/submit/submit.aspx.
2:55 Ellen Crown: I am really happy to hear how much people want to use this to connect in health care setting and innovate in their delivery.
2:55 [Comment From Christine K.: ] Great quote, Ted, re: HC providers managing risk: "I think health care providers manage risk all the time in their communication, they need to do it in this medium as well."
2:56 Ted Eytan: Absolutely. it feels like I shouldn't be answering the questions, I should be asking them!
2:56 Ellen Crown: Sure, there are risks and concerns to consider but most issues can be overcome with careful planning, no?
2:56 [Comment From Chris S.: ] I developed an ADHD specialty clinic and wanted to create the web based tools for better compliance and record keeping. But I plan to create phone apps to improve care in between visits, and to later include the two way tools.
2:56 Ted Eytan: Christine! The original innovator-convener-extraordinnaire.
2:56 [Comment From Deanna: ] Stephanie, I work in Risk Mgmt and I can see very high risks associated with the use of social media for PHI and to handle it very carefully. I also see the advantages and improvements that can be obtained from their use.
2:57 Ted Eytan: Deanna - well said, good to have experts like you at our side, engaged,
2:57 [Comment From Sam G: ] Great job. We appreciate all the work being coordinated through and by AHRQ.
2:57 Judi Consalvo: We are nearing the end of this chat. We will put up a poll and would appreciate your feedback.
Did you find this chat helpful?
yes - ( 82% )
no - ( 8% )
2:57 not sure - ( 10% )
2:57 Ellen Crown: Ted, I just wanted to say that I am really impressed with your willingness to connect with your patients. I think it is amazing.
2:57 Ted Eytan: moment of truth...oh boy!
2:58 Ellen Crown: Not bad...
2:58 [Comment From Ed W.: ] Deanna as with any new technology there will always be plusses and minuses
2:58 Judi Consalvo: We will leave the window for your suggestions on how to improve the chat.
2:58 [Comment From Regina S.: ] This was an interesting alternative to a webinar. Thanks!
2:58 Ted Eytan: This was very interesting. I need to refine a little..thanking everyone for their patience.
2:59 [Comment From Bonnie: ] thank you
2:59 Ellen Crown: Thank you to all who participated.
2:59 [Comment From Sue B.: ] I love the chat format - opportunity to practice what we preach
2:59 Ted Eytan: Absolutely. Thank you
2:59 Judi Consalvo: Thank you for attending and your lively chat! This was great!
2:59 [Comment From Claudia P.: ] It was great thanks!
2:59 Ted Eytan: Back in the snow....
2:59 [Comment From Ed W.: ] Thank You
3:00 [Comment From Janine: ] Thank you
3:00 AHRQ Innovations Exchange: Visit the Innovations Exchange at http://www.innovations.ahrq.gov. Follow the Innovations Exchange on Twitter @AHRQIX . External Web Site Policy

3:00 [Comment From Aimee V.: ] Very informative. Looking forward to the transcript!
3:01 AHRQ Innovations Exchange: If you missed part of the chat, go to http://www.innovations.ahrq.gov/webevents/index.aspx?id=22 to read the chat.
3:03 [Comment From Guest: ] Thank you...nice job. Almost left it the first few minutes (started slow). Glad I came back. It would be great if it were easier to get to and if it could go directly into Outlook calendar a week ahead of time. Look forward to getting information about patient (and staff and caregiver) experience with use of PHR and tethered portals: plusses and minuses of each.
3:03 [Comment From Chris JR: ] Great discussion and resources!
3:03 [Comment From Deanna: ] Great discussion. Thank you and I look forward to a continued conversation in the future.
*External sources and links are provided as a resource and do not represent an endorsement by AHRQ or the Health Care Innovations Exchange.

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