Social Media Make Inroads as a Health Care Delivery Tool

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Report/Produced by: Rachel Dornhelm on 9/11/2013 in iHealthBeat

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Social media is starting to take off in the health care industry after a relatively cautious start. While some provider groups and patients urge continued scrutiny of issues like privacy, success stories are emerging, particularly around changing unhealthy behaviors. This is an audio report for iHealthBeat, a daily news service of the California HealthCare Foundation. I’m Rachel Dornhelm.

SFX [phone ringing] Sebastopol Community Health Center. This is Adriana, how can I help you?

This community health center, less than an hour north of San Francisco, is bustling. It is one of four sites run by the not-for-profit West County Health Centers. In an office near the waiting room, Medical Director Jason Cunningham is training medical assistant Karina Gomez on a new tool.

(Cunningham): “You’ll actually sign them up, help them set the goal in WellFX and have them post something …”

The medical tool isn’t a specialized piece of equipment. It is a social media platform — called WellFX — for patients who are working to improve a health problem through behavior change.

(Gomez): “So we’re going to be taking our computers into the room?”
(Cunningham): “Yes, we’ll have our iPads in the room.”
(Gomez): “Oh, iPads. Okay!”

Cunningham tells Gomez that she’ll be key to encouraging people to sign up. Cunningham says connecting patients with others grappling with similar challenges is the future of primary care.

(Cunningham): “The biggest determinant of early death, somebody who dies earlier than they should, is behavior. What we eat, what we’re addicted to, who we’re around, how much exercise we do and the current way we do care delivery in all of health care is not really conducive to changing those behaviors.”

But social media is conducive to that, says Cunningham. He says the health centers first tried to roll out the program to its in-person support groups that met for diseases like diabetes, but the number of heavy social media users in each group was limited. The goal in bringing the program to all of their clients over the next six weeks is key to get critical mass.

(Cunningham): “You need enough patients to be on board to interact on their own without you pushing it. But then it also takes a lot of encouragement. And there are a lot of workflows that have to be set up to say, ‘How are you doing?’ and what’s the reinforcement. And the best-case scenario is with staff the patients know and trust. But it has to be this focus.”

Bruce Springer agrees about this focus. He is the CEO of OneHealth. OneHealth was founded to help people struggling with substance misuse support each other with reward systems and social forums.

(Springer): “Folks that are in smoking cessation typically join our stress and anxiety communities because that is the root cause of the reason why they smoke. Or it could be depression.”

Springer says patients don’t always talk to their providers about emotional factors. OneHealth has now expanded to cover other health issues, with members referred by employers, health plans and providers including Aetna, Boston Medical Center and Safeway. Springer says in less than five years, he can imagine patients leaving their doctor with a prescription for social media.

Some in the medical community are taking a closer look at regulations as these changes appear. Humayun Chaudhry — the president and CEO of the Federation of State Medical Boards — says the organization has an ethics committee looking at whether they should have specific language guiding social media use for doctors. In the meantime, he has these words for providers …

(Chaudhry): “Pause before you send. Sounds straightforward, but you know think through what you just put together and as you’re about to send to your patients or somebody else, think about the unintended consequences.”

His organization issued a joint policy paper about online interactions with the American College of Physicians in April. Chaudhry says while there are concerns about privacy, there are benefits for doctors to the move online as well.

(Chaudhry): “There are organizations and sites such as Doximity, which is essentially a Facebook for physicians in which they can discuss ideas and exchange thoughts. Something we historically did in hallways of hospitals, but now we can do online with a physician who is maybe thousands of miles away.”

Christina Thielst — vice president at Tower, a patient experience consulting group — says it may be useful to start using different language to refer to the trend.

(Thielst): “I’ve been using the term social technologies more because that kind of gets people away from the fear of, you know, ‘I don’t want to do patient care on Facebook.’ But that’s okay. You can implement a social networking platform that’s secure and use that technology to accomplish your goals.”

For instance, using a health site with a HIPAA-compliant backend. Ramona Nelson, a professor emerita of nursing at Slippery Rock University, co-wrote a book on social media in nursing. While she says she has concerns about how privacy issues online will play out, she also believes privacy is an evolving concept. When she was growing up, she says, you wouldn’t talk about someone having breast cancer. And yet …

(Nelson): “Even though I say, well, it’s changing as far as what we define as privacy, I think that what is private to a person is private to that person. Some people would not hesitate to tell you what they weigh. Other people would be humiliated if they had to tell you their weight.”

Nelson says another challenge for health care is the change social media could bring to the relationship between provider and patient.

(Nelson): “We’ve always called it the therapeutic relationship but the concept that the provider is the knowledgeable one has always been part of this whole process.”

Now she says social media and the information flows to patients push the relationship further along the path to more shared decision making, where patients are more in the position of colleagues. Nelson says as policies governing social media in health care are developed, it’s important that providers, patients, the government and industry are all at
the table.

This has been an audio report for iHealthBeat, a daily news service of the California HealthCare Foundation. If you have feedback or other issues you’d like to have addressed, please email us at iHB@CHCF.org. I’m Rachel Dornhelm, thanks for listening.

Report/Produced by: Rachel Dornhelm on 9/11/2013 in iHealthBeat