Social media and hospitals: Now more than just pretty pictures

Lakeridge Health report_cover

For leading hospitals, the use of social media tools and platforms has moved from giving in to the demands of the head of marketing to at least have a Facebook page, to a recognition that use of social media can add value throughout the enterprise.

This evolution beyond using social media to post nice pictures and videos of hospitals doing good things has occurred rapidly since the emergence of the first social media platforms a decade ago and holds great potential for health care institutions who want to communicate effectively with their patients.

This is my conclusion following an extensive review of the literature on social media use in North American hospitals and interviews with experts both in Canada and the U.S. who confirm this trend. This work was done on behalf of Lakeridge Health in Oshawa, Ontario as part of a review to improve patient experience at that institution.

While they acknowledge the huge potential for social media in the health care setting, leaders in health communications also recognize that social tools and channels represent just another series of communications options and should be used only as appropriate.

The only comprehensive survey of social media use by U.S. hospitals published by University of Pennsylvania researchers in 2014 showed 94.4% of the more than 3,300 hospitals polled had a Facebook account and just over half had a Twitter account. Anecdotal evidence suggests the same is true of Canadian hospitals.

“There are some really creative people out there who are finding ways to use these tools to engage patients and get their messages out,” said Christina Thielst, a Santa Barbara, California-based hospital administrator, consultant and author who has been following the use of social media by health care organizations for more than 30 years.

Ann Fuller, VP for volunteers, communications and information resources for the Children’s Hospital of Eastern Ontario, was quoted in 2013 as saying: “In Canada, in health care we’re at a point where most hospitals accept the role of social media for branding and communication, but only the lead adopters are using it for patient engagement and for clinical use.”

Since that time, she says “a lot of the perceived risks and threats of social media have lessened” yet, she adds, while “everyone agrees that social media can and should be used, and there are benefits to it, some of that stigma still exists.”

“It’s not about creating a community and trying to integrate those experts into it. It’s using social media to come up with a new platform for doing what they already do—such as engaging patients. It’s another way of bringing people together,” said Dave Bourne, a former communications director for Baycrest and the Scarborough Hospital and now director of communications for Sienna Senior Living.

But despite the most popular social media tools having been around for a decade or more, the optimal use of these tools in hospitals has yet to solidify.

“I don’t think anybody has nailed it to the point where there are best practices,” said Bourne.

Those looking for a leading Canadian hospital with regards to social media could do far worse than to study the experience of the Michael Garron Hospital in Toronto. That institution has taken an incremental approach and changed the hospital culture to slowly integrate social media into many of the hospital’s functions. Elements of that approach include

  • Publication of a policy or guidelines to assist hospital staff in the appropriate use of social media
  • Training of the senior management team as a group in how to use common social media tools such as Twitter.
  • Ongoing education and support from the communications team to assist any staff in using social media
  • Integrating social media tools into a new proactive approach to patient engagement which included aggressive timelines for dealing with patient concerns.
  • Integrating social media use into a new, more responsive approach to leadership

While social media remains an important and innovative set of tools for telling stories about the good things a hospital can do, it is clear that the most innovative institutions are also using those tools to facilitate both internal and external engagement with the communities they serve.

As Isabel Jordon, a BC-based patient advocate and chair of the Rare Disease Foundation, says: “the way I would like a hospital to use social media is to reach out to people to find out what we want from them; if there are going to be changes or something new coming down the pipe—to reach out and engage us before something is going to happen.”

(P.S. Anyone interested interested in publishing a more extensive analysis of this research please feel free to get in touch)




Social media transforms (@OntariosDoctors) dispute

Never has Canadian medical politics been so accessible, informative and, frankly, entertaining – all thanks to social media.

For good or bad, this is the new reality for a profession used to dealing with its financial negotiations in confidential discussions behind closed doors.

The current knock ‘em down drag ‘em out fight between those supporting and those opposing a new draft professional services agreement between the Ontario Medical Association (@OntariosDoctors) and the provincial government comes to a head this Sunday at a general meeting of the association to vote on the proposed deal.

The backstory behind this particular agreement to set fees for Ontario doctors is too long and complex to explain in this blog post. Suffice it do say that the leadership of the OMA is lobbying the membership hard to support the deal, while a well-organized opposition is urging its rejection and a return to the bargaining table to better halt government cuts and gain the right to binding arbitration.

All of this is being played out daily on social media and especially Twitter and blogs, as advocates for both sides post thoughtful essays on their views or engage in lively wars of words with their opponents. For its part the OMA has supplemented tweets and blog posts by leaders such as @GailYentaBeck, @ScottWooder and @VirginiaWalley with YouTube clips from well-known provincial physicians voicing support for the deal.

The profile of the whole situation has been raised by the involvement of André Picard (@picardonhealth), the nation’s leading health reporter and Steve Paikin (@spaikin), a leading provincial TV political affairs commentator, who together have more than 120,000 followers on Twitter. Picard especially has taken an active role in the debate challenging some views and chiding others for inappropriate comments.

Ontario doctors were among the first in Canada to recognize the potential for advocacy offered by social media platforms such as Twitter. It is sad that probably only a minority of the province’s physicians are observing Twitter and other channels to follow the discussions, debate, arguments, and bon mots.

Some leading Ontario physician bloggers and social media commentators were asked whether social media had inflamed or informed the current debate about the Ontario deal.

“I believe all communication does both,” said Dr. Shawn Whatley (@shawn_whatley). “Social media is no exception.”

“In my now nearly 40 years as an Ontario physician I have never witnessed such passionate engagement with OMA affairs or the political process,” said Dr. Alan Drummond (@alandrummond2). “That ‘movement’, if I can call it that, was directly fueled by the use of social media and the enhanced connectivity between different regions and specialties.”

“I was surprised by how many of my physician colleagues in Perth have expressed that their opinions were being formulated by arguments made on Twitter.  This was not necessarily all for the good.   Initially they were pleased with the nuanced concerns about the agreement; as things dragged on they were starting to get pissed off with all the negativity. Nevertheless, it is clear to me that social media has changed the game.”

Drummond noted the “vitriolic and misguided personal attacks” by some on social media and added “if we are going to put ourselves out there in public we have to remember that “the whole world is watching” and behave accordingly.”

Dr. Cathy Faulds (@fauldsca) said there are pros and cons to using social media for such discussions. On the plus side she references the ability to spread a diversity of views, prevent groupthink and “eliminate the paternalism that has plagued organizations and our medical culture.”

“The depth of learning and sharing is fantastic and reminds me of the surgeons’ lounge in my earlier days of practice. It is generally fun to be part of this (Twitter) crowd and the majority respect boundaries and are collegial),” she said.

The downside of debating on Twitter according to Faulds, include the 140 character limit, the “conversational swirl” that can make it difficult at times to follow discussion threads, and anonymity that can make it difficult to give context to some comments. She also noted the presence of “schoolyard bullies” and the fact cliques can easily develop that people block others they do not agree with.

Dr. Mario Elia (@supermarioelia) has a much broader condemnation of the social media element of the current debate.

“SM has allowed this (debate) process to spiral right out of control, allowing opposing positions to be distorted and for each side to attribute their worst fears to the opposing group. It has been horrific.”

Dr. Nadia Alam (@DocSchmadia), has possibly been the most active Ontario doctor in the social media debate and she describes that discussion as “eye-opening.”

“Normally mild-mannered docs now appear fierce, antagonistic even. Normally complex ideas are distilled into pivotal moments of wisdom.

“Social media decentralizes communication and is unparalleled in its reach across time and physical boundary. The price though is in the steep learning curve. I find it can be an unforgiving environment: adept users will judge and sometimes shame the clumsier novices.”

She describes the use of social media as a “two-edged sword” in that “it informs but it can also inadvertently ignite hostility. It can bring people together or tear them apart. It can be inclusive, but can also be used to ostracize people. It can help in the spread of information, but it can also feel like you’re lost amidst the noise.”

From these comments it appears that to many Ontario doctors, the social media platforms that most of their colleagues are reluctant to use for professional purposes has changed forever the nature of political discourse within the profession in this country.

(The author would like to thank all physicians who provided input into this post)



Patients with a voice but few MDs hear: Social media 2016


“Patients with serious illness don’t have time for incremental change. We need social media – transformational change with just one click.”

With those words at the recent Doctors 2.0 and You conference in Paris, Emily Kramer-Golinkoff (@emilykg1) encapsulated the promise and potential that social media channels and platforms bring for patient advocates and engaged patients everywhere.

It stood in stark contrast to my own presentation showing how few Canadian doctors have adopted social media in their professional lives and how U.S. data is probably only marginally better.

This divide between how patients are using social media in an attempt to enrich and transform their lives but lack a concomitant health care professional social media community to engage with is one of the more troublesome aspects of the current digital revolution in health.

Emily is a 31-year-old with advanced stage cystic fibrosis which does not respond to new medications on the market. She used her time at the podium in Paris to deliver a powerful address to describe her work in co-founding Emily’s Entourage which has had huge success through social media in raising more than $2.1 million to fast-track CF research.

She was preceded earlier in the morning by Kaat Swartebroeckx (@KSwartebroeckx), a 17-year-old Belgian student who described with evangelical fervor her work to help children with cancer, once again building on the reach of social media platforms such as Facebook.

Emily and Kaat were not the only patients with chronic illnesses or patient advocates at this year’s Doctors 2.0 meeting and all are utilizing social media in some form to make connections or gather and disseminate information.

Using social media in health is a given for these people: For the medical profession in 2016, not nearly so much.

In evaluating, professional social media use by physicians in Canada and the U.S. I had to stress that most practising physicians have little interest and even less experience in using social media for their work. Unfortunately, there is no evidence this is likely to change in the near future.

There are exceptions of course and some of these physicians were at Doctors 2.0 too: People such as Dr. Gia Sision (@giasison) from the Philippines and Hungarian medical futurist Dr. Bertalan Mesko (@Berci). But surveys demonstrate that these doctors are a definite minority.

For the busy practising physician in Canada or any other Western nation, professional use of social media is seen as a time-stealing luxury with few if any benefits and many potential pitfalls.

Given the degree to which the people they care for are seeking out health information, support, or solutions through social media, this is a problem.

To quote – as I often do these days – the head of Canada’s medical health insurance organization Dr. Hartley Stern: “While individual physicians are at different stages in their use of social media, it is a journey all physicians will eventually take.”

Although I believe this to be true, it is a journey for which most physicians have not yet bought a ticket.

#Ehealth2016 – inquiring minds want to know


ehealth_ambassadors_badge_300x300Canada’s premier conference on health information technology – #ehealth2016 – is now less than a month away.

That means it’s a good time to start to contemplate some of the big questions facing the health IT community in Canada and wondering whether this mega-meeting hosted in Vancouver.\, courtesy of COACH, Infoway and CIHI will provide any answers to these questions.

At its worst, this annual meeting can be an annoying combination of sometimes irrelevant keynote speakers and simultaneous sessions that do not live up to their titles/abstracts. But over the past decade e-health (however one chooses to write the name – hyphen, no hyphen, capital on ‘e’ or no capital on ‘e’ etc.) has become THE meeting for those interested in health IT to network, hear leaders in the field and gain insights into really interesting work going on at local/regional and provincial/territorial levels.

As an observer, I would suggest a few interesting questions this conference may help to provide answers for:

  • With the death or evolution of the big dinosaur programs for funding physician EMRs (POSP, PITO etc.) what is being done to continue to involve and engage physicians in improving how they use electronic records to improve care?
  • What is Infoway planning on doing with its new infusion of funding courtesy of the last federal budget?
  • Is patient engagement a thing in Canada in health IT and if so what does it mean?
  • Is the vendor space for EMRs and EHRs going to continue to consolidate ?
  • And that interoperability issue – is anything substantive happening to better connect physicians and hospitals.
  • Big data. (enough said).
  • Are hospitals and practitioners adapting to the mobile revolution in health?
  • Are these the correct questions to be asking? At HIMSS this year there was a big shift towards discussing digital connectivity beyond the electronic record and major discussions about data security in health. Should Canada be having those discussions too.

Inquiring minds want to know.


Texting medical trainees: “You don’t hear pagers going off any more.”


Texting is the most common means used to communicate with residents and trainees, a small study of surgeons at a major Canadian teaching institution has shown.

While almost all of these surgeons reported using texting for patient related communications, the majority were not using encrypted devices and many were not aware if their hospital has a policy on texting.

The study from the University of Toronto, Women’s College Hospital and the University Health Network (UHN) is one of the first to shed some light on how a dominant means of communications in the modern world is being used in a medical setting.

The results were described by first author Mohammed Firdouse, a medical student, in a poster presentation at the recent Canadian Conference on Medical Education held in Montreal.

In the study, 98 general surgeons at UHN were asked to complete a 39-question online survey about their use of texting for patient-related communications and their awareness of regulations concerning the practice.

Approximately one third of those polled (33) responded to the survey.

More than 90% said they used texting for patient related communications and 60.7% said it was the most common way used to communicate with residents and trainees. However, only 14.3% of these staff surgeons said the used texting to communicate patient-related information with other staff.

The respondents identified speed and convenience as their main reasons for using texting.

Responses with respect to privacy and confidentiality with texting were more problematic.

Almost two-thirds of respondents (62.1%) said they did not have encrypted phones or did not know if their phones were secure while texting and 48.3% said they did not know if their hospital had a policy on texting. Even more respondents (72.4%) said they did not know if texting patient information is addressed in the Personal Health Information and Privacy Act.

These findings do not come as a surprise to Dr. Chris Simpson, past-president of the Canadian Medical Association and chief of cardiology at Queen’s University and Kingston General Hospital.

“You don’t hear pagers going off anymore,” he noted in an online interview.

“My sense – anecdotally, is that electronic communications (especially text) are commonplace between attending doctors and residents; between residents themselves, and less so between doctors and other health professionals.”

“Texting is fast, easy and accurate,” he said.

“Privacy is important but the horse is already out of the barn on this issue.”

“It will always be the responsibility of health care providers to safeguard the privacy of patient information that they have in their possession – this is true. But I am not convinced that texting info poses any greater risk to privacy that currently endorsed communication practices like faxing.”

“The challenge is for us all to find ways to enhance our ability to use electronic technologies in as low risk a way as possible – to establish a best practices culture that minimizes risk of privacy breaches. The answer can’t be and shouldn’t be an outright ban on texting,” said Dr. Simpson

Dr. Matthew Bromwich is an Ottawa pediatric otolaryngology surgeon and founder of Clearwater Clinical Limited and he has a keen interest in the development of mobile apps and the implications for patient privacy.

In an interview, he said, texting now has “100% penetration” in the health care sector and is an invaluable tool due to its convenience.

However, he expressed concerns that hospitals are still paying for pagers for staff that they do not use rather than tackling the issue of making their networks secure for mobile phone use and texting.

Bromwich said while clinicians and trainees can protect patient confidentiality by taking some care in how they frame texts, it would be far better for hospitals to address the issue especially as texting is particularly prone to illegal access.


Mind the gap: social media and #meded


Two small but intriguing Canadian research studies have documented the wide gap between teachers and students and educator users and non-users in their perceived value of social media as learning tools in medical and health education.

The studies were presented at this year’s annual meeting of the Canadian Conference on Medical Association (#CCME16) and the research involved two leading physicians in the social media and digital health world in Canada, the University of Ottawa (uOttawa)’s Dr. Aliraza Jalali and the University of British Columbia (UBC)’s Dr. Kendall Ho.

The uOttawa study conducted by medical education researcher Dr. Safaa El Bialy with Jalali evaluated feedback from 72 medical professors and 63 second-year medical students on their use of popular social networking sites (Twitter, Facebook etc.).

The UBC study presented by second-year medical student Karan DSouza evaluated feedback from 270 health educators at 8 global institutions on their attitudes towards the use of social media in teaching.

The uOttawa study found the medical students were about three times more likely to use the social networking sites for medical education than the professors (67% vs. 23%).

While 94% of students said they felt the sites facilitated learning, only one third of the professors said they used such sites in their teaching practices.

Despite established social media platforms being more than a decade old, El Bialy and Jalali noted “some of the educators did not even know about social media use for educational purposes” and many expressed concerns that such sites were distractions and promoted time wasting.

Just as the uOttawa study documented the gap between medical students and professors, so the UBC study showed sharp differences in perspectives between educators who use social media in the classroom and those who do not, in a variety of countries.

That study documented that health educators globally have concerns about the lack of guidance and support for using social media for educational purposes and also the lack of evidence showing the value of such tools. Even among those using social media in teaching, only 11% said they had received training in using social media for teaching.

DSouza and Ho also echoed the uOttawa study in their introduction when they noted “students have already adopted social media informally to share information and supplement their lecture-based learning.”

They also documented that adoption of social media is not consistent within faculties, even at the same institution.

Both research teams provided suggestions on how the use of social media in the classroom could be encouraged and facilitated.

(Artwork by @Aga_ta_ta on display at CCME16)


To the EMR … and beyond


For a conference that was about health information technology, it was all about health IT.

Allow me to explain.

The annual meeting of the Canadian Agency for Drugs and Technology in Health (@CADTH_ACMTS) is a showcase for health technology assessment (HTA) and the mission of the organization is to provide credible, impartial advice and evidence-based information about the effectiveness and cost-effectiveness of drugs and other health technologies.

What was noteworthy about this year’s meeting in Ottawa –  the largest yet for the organization with about 750 attendees – was the number of times electronic records (either EMRs or EHRs) were referenced as an essential feature for both gathering and for disseminating credible information to support evidence-based medicine.

Physician speakers repeatedly noted the need to have easy, point-of-care access at the time of the patient encounter, and to all of them this meant embedding that information in the electronic record.

More than one family doctor talked about being overwhelmed with guidelines and best practices and the need to integrate this information into the physician workflow to be useful – and EMRs as the natural place to do this.

The Canadian Association of Radiologists creates world-class clinical practice guidelines, but as Dr. Martin Reed, a pediatric radiologist from Edmonton told the meeting, one of the problems with these guidelines is that it is very hard to get people to use them.

He said there is now a feeling in the medical imaging community that the best way to do this is to integrate the guidelines into CPOE (computerized physician order entry) systems.

Given that some Canadian physicians still do not use EMRs and some (many?) hospitals are not using CPOE this could raise concerns about the quality of care being delivered.

On this information gathering front, the new focus on real-world data has placed an increased emphasis on the value of EMRs or EHRs to gather useful information to evaluate the effectiveness of drugs and technologies, the meeting was told.

“The starting point is having an EHR covering all of the caregivers. At that point the world is your oyster,” said Dr. Murray Ross (@murrayrossphd), leader of the Kaiser Institute for Health Policy in Oakland, CA.

Dr. C. Bernie Good (@CBGood23) who holds numerous roles with the US Department of Veterans Affairs gave numerous examples of how the extensive database gathered on VA patients through EHRs has helped support evidence-based drug prescribing.

And it does not end there.

As Anil Arora, assistant deputy minister in the Health Products and Food Branch, of Health Canada told the meeting it is not just the information being gathered in patient records that will need to be taken into consideration in the future – but also the wealth of patient data now being collected through wearables and other devices as well as through social media.

Given that we have by no means maximized the value of EMRs to gather this information in Canada, the challenges of extending the information sources to other digital repositories of patient information is currently problematic to say the least.

(Picture – Anil Arora. Courtesy CADTH)