Mind if I sit in?

ImageAs I write this, three major clinical conferences are underway in the U.S. – the annual meetings of the American Academy of Pediatrics (#AAP13), American College of Rheumatology (#ACR13) and CHEST (#CHEST2013), the primary meeting of U.S. respirologists.

I am following all of these meetings on Twitter to gain insights on new research in each of these fields and retweet items I feel will be of particular interest to Canadian clinicians and others. On certain occasions I even make my own contributions.

It being the season for conferences in the medical world, this is at least the third consecutive week when a number of interesting meetings with associated hashtags have been occurring simultaneously around the world.

For those of us spending a large amount of time on Twitter it is a golden period when this social media tools truly meets a dual mandate of providing valuable information while also allowing engagement and networking with like-minded individuals.

It’s a far cry from the pre-Twitter period when one had to pick and choose about which conference to attend and wait for media or individual reports from afar on other meetings in which you may have had an interest.

It also permits people such as myself  to attend one meeting and monitor others – such as was the case two weeks ago when I attended the major joint Canadian #Vascular2013 conference while at the same time listening via Twitter on a large gathering of medical students in Toronto.

I sometimes wonder whether delegates at a conference, especially a smaller one, resent my intrusion into their gathering through Twitter. But then I remember, the meeting has created a hashtag specifically to encourage remote followers.  Also, it used to be that as a medical writer it would have been hugely inappropriate for me to go to a microphone and question a physician speaker about something he or she had said. After all, I was supposed to be a “fly on the wall” and not an active participant.Social media has changed all of that.  Valid comments from anybody are seen as being both acceptable and encouraged in the hashtag era. This means that not only can physicians not at the meeting make valid contributions but members of the public or epatients such as @AureliaCotta can add their unique insights.

For those of us in the medical information business, it is truly the best of all possible worlds (and I mean that as Leibniz intended and not scornfully, a la Voltaire)

#Vascular2013: More Songs About Buildings and Food

ImageAfter 2.5 days and 230 tweets I have bowed out of the Vascular 2013 conference.

With more than 6000 delegates from four major clinical specialty areas (cardiology, diabetes, stroke and hypertension), the meeting was arguably the largest clinical gathering ever held in Canada. But from the perspective of social media use in medicine and Twitter as a communication and engagement tool, Vascular 2013 made it clear – once again – that Twitter and new media in general have yet to find their way into routine use.

The conference organizers cannot be faulted for this. The conference had a Twitter hashtag that was well-defined in advance – as did each of the subspecialty groups. Double hashtags can be annoying but in this instance they served to provide both a unifying factor for the conference while allowing those with specialized interests (e.g. diabetes) to channel tweets in that area. Key sponsoring organizations such as the Canadian Diabetes Association (CDA) and the Stroke Congress also did their part by posting official tweets and doing a good job of tweeting their own sessions.

In addition – in a conference centre where the regular cost of wifi was $150/day – the organizers made sure all delegates had access to a reliable and free wireless feed.

No, what we were lacking is a culture that integrated Twitter and other social media into the mindset of the delegates. And while it can, and has, been argued that delegates have better things to do such as concentrating on the presentations they are hearing, my personal experience is that other clinical conferences outside of Canada have far more active participation by delegates in the Twitter stream.

And it’s not just Twitter. Perhaps more important in the larger scheme, apart from one pre-conference session on helping CDA delegates understand social media, I saw no presentations or research that tested the ability of social media to help provide cardiovascular, stroke, hypertension or diabetes care. For those who feel online patient communities and other initiatives can help engage patients and improve outcomes it must surely be disappointing that nobody seems to be researching these areas.

All that aside, there were positive sides to the meeting as well.

As with each new clinical meeting I attend, new physician champions emerge who seem to take naturally to Twitter as a communication vehicle – and as a result help widen the scope of knowledge and communication. Without slighting any non-physicians who also put on a stellar showing, or those I may have missed, I would like to single out Dr. Amer Johri (@amerjohri), a cardiologist and imaging specialist from Queen’s University, Kingston. Long may he tweet.

In many instances the #vascular2013 twitter feed also well served what I believe should be its primary purpose which is to inform and educate those not able to attend the conference. Clinicians, patients, and other providers often chimed in to retweet information or better still question or challenge a tweet relayed about what the speaker was saying. Here I would reference the Canadian Agency for Drugs and Technology in Health (CADTH)  which provided solid research from that organization on the issue of whether warfarin is still relevant in preventing stroke in patients with atrial fibrillation. The tweet from CADTH in turn led to comments from other physicians and if not a lively debate, at least an exchange in views ensued.

I must end this on a more generic plea – more power outlets please in major conference venues. Wandering around looking at the walls for a power outlet and then having to sit on the floor to ensure a decent power source for a laptop is so unseemly.

Oh, and the title of this blog post. Well, it’s the title of an old Talking Heads album and all summer I have been wanting to use it, knowing it is unlikely to ever fit whatever I am writing about.



#Vascular2013 – You try tweeting ‘acute cerebral hemorrhage’

ImageA hard day’s tweeting on the first day of Vascular2013 in Montreal – an unprecedented gathering of some of the biggest medical associations in Canada – has left me contemplating some of the benefits and shortcomings of Twitter as a communications tool.

As someone who has been hugely enthusiastic about the benefits of Twitter and the use of the hashtag to bring together tweets from medical conferences, I have been quite unquestioning about how to use Twitter at these meetings – I play reporter (well, I once was one in real life) and tweet in headlines of 140 characters.

But using Twitter at this particular meeting – which brought together plenary presentations, new research and poster sessions for the Canadian Cardiovascular Society, Canadian Diabetes Association, Stroke Congress and Canadian Hypertension Congress – had me pondering a number of issues which I want to explore over the next couple of days.

My first point is about how easy it is to Tweet some presentations and how impossible, others.

My day started with an interesting lecture by the scientific director of the Canadian Stroke Network, Dr. Antoine Hakim, tracing the 20-year history of the network and developments in stroke diagnosis and treatment over that period.

Dr. Hakim’s presentation was eminently tweetable as his quotes and factoids could be easily compacted into interesting tweets – even when you included both the main conference hashtag and the appropriate sub-meeting hashtag (the fact this meeting was utilizing at least six hashtags could be the subject of another blog).

For example:

Only 3% of pts who suffered a stroke were treated in stroke unit in 2002/03 and tPA rarely used: Hakim #strokecongress #vascular2013

Fast forward to one of the afternoon presentations from Dr. Sandra Davidge, from the University of Alberta, Edmonton on estrogen and the endothelium. This lecture consisted of complex but important information on the interaction between estrogen and vascular disease in women.

Due either to my lack of in-depth knowledge about the subject and the topic’s its intrinsic complexity, the talk did not lend itself to tweeting. All I could manage were trite summaries or abbreviated snippets of the main points. To wit:

Estrogen may protect against vascular injury: Davidge #vascular2013 #CCCmtl


Thinking back I realize the same is true of many presentations at medical meetings no matter what the specialty. Even poster presentations can be divided into those who lend themselves to great, summarizing tweets or those that have to be passed over because the research involved is just too convoluted to fix into 140 characters.

All of this means some caution is needed when following a conference twitter-stream because it may not be giving a comprehensive picture of what is going on by the very nature of the medium itself. But it also speaks to the value of multiple tweeters at conferences to provide a more comprehensive picture of what is happening. The fact there seem to be just a few stalwart few tweeting from this conference is a topic for another day.


And how was your visit?

For all its talk of equal and universal access, Canadian medicare is now an environment where every physician is offering a somewhat different experience to his or her patients which could be leading to dramatic variances in the quality of care provided
This may sound like an exaggeration. But consider the fact that for the first time in hundreds of years the fundamental process whereby a physician records the patient visit has changed.
It used to be – and in many instances still is the case – that you went in to see a doctor and he or she took notes with a pen or pencil and entered this information into your chart which was then manually stored in a big room with hundreds or thousands of other charts.
But since the advent of the electronic medical record (EMR) that has changed.
Physicians who use EMRs enter your medical information electronically and this is stored in a medical record which again is digital. EMRs are different, and absent enforced standards, the taxonomy by which that information is stored or portrayed can differ from practice to practice.
Now within that population of physicians who use EMRs, the degree of sophistication they apply to using that digital information varies across a huge spectrum. While some just store the data electronically and use it for basic record keeping, others use the available technology to improve the care they deliver such as sending reminders to patients who have been identified as requiring screening tests. Yet others are working with other health care providers and sharing the electronic record to provide integrated care or advanced disease management support.
But nobody mandates that they have to do any of this. Writing your medical information down with a pen and keeping it in a paper chart is still perfectly acceptable. And even with physicians who do use EMRs, the overall sense is that the majority are still just using the new technology for basic record keeping, albeit in a more legible form.
So, the adoption of EMRs which already varies widely depending upon which region in which you live and the practice characteristics of your doctor, is further varied by the degree to which the physician is using the functionality available.
The EMR may yet to prove a holy grail in the delivery of better patient care but until all doctors are using the technology equally well, we have a long way to go until we can ensure all patients are getting the standard of care available to them.