May 18, 2009

Healthcare Atwitter Over Social Networking
By Elizabeth S. Roop
Radiology Today
Vol. 10 No. 10 P. 12

Some forward-looking healthcare organizations are working to include sites such as Facebook and Twitter into their marketing plans.

From YouTube and Facebook to Twitter, the University of Maryland Medical System has established a presence within the social networking world that helps the nine-hospital system connect to hundreds of potential new patients each day.

As many as 700 people per day watch the system’s 117 YouTube videos, which range from a four-minute promotional spot to interviews with medical experts, patient success stories, surgical Webcasts, and overviews of programs and services. Several of those videos also populate the system’s Facebook page, along with news, audio podcasts, commentary, and patient questions posted on the wall to which the system responds as appropriate.

The social networking system Twitter helps the medical system promote its latest educational offerings and other noteworthy activities in short messages called Tweets to its more than 540 followers and refer them to one of the other social networking sites for more detailed information.

“We’ve gained an additional audience that would never have come to our Web site,” says Edward Bennett, the University of Maryland Medical System’s director of Web strategy. “Right now, we’re tracking 650 to 700 videos watched per day on our YouTube channel. We also have videos embedded on our public site that get about 1,500 views per day. That [number] didn’t go down when we launched on YouTube.”

For the medical system, expanding its online presence to include the most popular social networking sites was a natural extension of its existing marketing and outreach programs. By creating online communities across which it can deliver tailored educational and informational materials, the health system has broadened its community boundaries to encompass the globe.

“It’s a question of the hospital deciding to extend its conversation and outreach by being on this media,” says Bennett. “Millions of people are on these sites talking to each other. Once in a while, those people are talking about us. They’re having the conversation, but if we’re not in the room, not on the site, they can’t call us over and say, ‘We’re talking about you. What do you have to say?’ These conversations are going on whether we’re in the room or not. It’s better to be in the room.”

In addition to boasting nearly 350 million users, social networks are quickly becoming the preferred resource for individuals seeking healthcare information. Patients turn to social networking groups to find others who are battling the same diseases, while clinicians connect to share information and learn from each other.

So it may come as a surprise to learn that hospitals and health systems have not embraced social networks with the level of enthusiasm their potential would suggest. According to a study conducted by Oneupweb, even the nation’s most elite health systems are behind the curve when it comes to the social networking aspects of their Web strategies.
After studying the 19 facilities that were ranked by U.S. News & World Report as America’s Best Hospitals in 2008, Oneupweb found that while many were doing a number of things right in terms of online marketing, the use of social networks was one area where they consistently fell short.

“It was surprising because healthcare is so centered around quality and reputation management. The online space provides tremendous opportunity to interact with patients and prospective patients, as well as the opportunity to monitor what is being said” about the facility, says Carly Desmet, Oneupweb’s director of marketing. “Healthcare traditionally focuses all of its high-end technology on raising the level of care and falls behind on marketing.”

Desmet notes that while the facilities studied by Oneupweb, a digital marketing agency, were making good use of their online presence to influence local audiences, they were not optimizing their use of the Web. Specifically, they tended to neglect best practices in terms of search engine marketing, pay per click, social media marketing, online media campaigns, and the like.

Further, while 70% of the facilities Oneupweb identified as being top tier in terms of online marketing offered both a blog and a podcast, only 29% of middle tier facilities had blogs. Only one of the bottom five had a blog and just two offered podcasts.
“What’s missing is that patients are looking for you online. A fully optimized presence will drive them to your facility,” says Desmet.

Although healthcare organizations must deal with a unique set of challenges when it comes to establishing and maintaining a presence on social networking sites, they should nonetheless be taking the steps to utilize these sites and tools to reach out to patients and consumers. It is also imperative to monitor what is being said about them by others in the social media space to protect their brands and reputations.

According to Phillip Baumann, CEO of CareVocate, LLC, a Web presence consultancy focusing on healthcare, many hospitals shy away from social networking sites because of concerns over privacy and confidentiality. However, these challenges are far from insurmountable. In fact, in many ways, using social networking sites to communicate with patients, consumers, and other clinicians is no different than using traditional forms of media.

“It’s really no different as long as they’re compliant with HIPAA,” he says. “The only thing I would note is that in social media, providers will have to bear in mind that they are dealing with real-time information, and they need to be mindful that they are dealing with privacy and personal dignity.”

That is why he suggests most facilities start small by creating a blog, which is one of the best ways to learn how social media works while engaging consumers in a controlled conversation. It is also a good way to begin establishing the metrics by which return on investment (ROI) from social media can be measured.

For example, it is relatively easy to set up a dashboard that measures the number of visitors to the blog, the number of positive vs. negative comments, and the categories of topics people are discussing related to the blog. Early analytics such as these can pave the way for the additional resources necessary for an expanded presence in the future.

“Some say forget about ROI, that [social media] is a human thing. Others say no, that we’re in the business of producing remarkable healthcare and we need those analytics. I’m right in the middle. We need both,” says Baumann. “The hardest thing is convincing executive leadership about the value. Part of that is getting them to be aware of these tools, to understand what social networking is and what the benefits are, and also the cost of not getting into social media.”

It is also important for the healthcare industry to have a sizable online presence to ensure that consumers aren’t misled by faulty information. When healthcare organizations set up blogs, Facebook pages, and the like, it gives the public someplace to go for reliable content and advice. The key is to develop a social media strategy and then research which sites are the most appropriate for a facility’s messages.

“You have to start where most people are gravitating,” says Bennett. “When we started to research, it wasn’t hard to decide we were going to be on YouTube, Facebook, and Twitter. That may expand as we do more research, but they get the bulk of all social networking activity now.”

It is also important to know just how much control the facility can have over the content posted to the sites with which it is affiliated. For example, while Facebook can be complicated with multiple options for designing a page, it also offers control over what is posted to that page and allows the owner to establish rules for how people will interact over its page.

Blogging provides an even higher level of content control and is one of the best ways to continue conversations with people who may come across a facility on Twitter or Facebook. By following links from the facility’s blog, visitors can access more in-depth information in a highly controlled environment.

“The big advantage of a blog over social network sites is the ‘walled garden’ problem,” says Bennett. “With a blog, I own the content. If I spend time putting content on Facebook, etc, and that site goes away, I’ve lost all that content. … We have to be on social networks, but if you want a place to point people to continue a conversation, you need to have a blog.”

Starting with just one or two social networking tools also helps keep the resources required to manage the facility’s online presence to a minimum. Most hospitals already have video and audio recordings that can easily be repurposed for streaming online across YouTube or on Facebook. The same is true of written content, such as announcements, clinical breakthroughs, and current events that hospitals and clinicians are already publicizing in more traditional print and online media.

“It’s a grand experiment and it may fail, but the cost of entry is so low. It’s not like we have to decide to spend a million dollars to participate on Facebook. It’s more like investing a percentage of an employee’s time to set up an account,” says Bennett. “Hospitals should be saying ‘We’re here and we’re ready to talk to you.’ … You can just post press releases, or you can become very chatty and friendly. You’ll find out what the best match is for your personality and the way you think of yourself.”

As noted previously, there are several areas of concern related to a healthcare organization’s presence on social networking sites. Privacy is a significant one, as is reputation management. However, by practicing some mindful control and maintenance, most facilities will find that the solution to these problems already exist within normal practices.

For example, while streaming video or Twittering details of a surgical procedure in real time can generate controversy, it is actually no different than having news cameras in the surgical suite—a practice that has been around for decades.

“With anything new, someone will say it’s controversial even though it’s truly nothing different. It’s just a different way of communicating. … In a typical conservative hospital environment, anything that’s new is suspect,” says Bennett. “You have to be very careful of how you frame things and what you do. Also, everything is recorded and searchable. There is some similarity to customer service calls, but the big difference is that a call is not usually recorded and is never there for the world to search, find, and repeat.”

The rules of conduct and behavior for healthcare organizations on social networks are still emerging. That is why Bennett recommends not only listening to criticism but also approaching the process with the same level of confidence with which other marketing activities are approached.

Part of that involves being selective when it comes to accepting friend and follower requests on sites such as Facebook and Twitter. Bennett says the University of Maryland Medical System only connects with those organizations and individuals it feels are “totally above reproach. … If someone comes to the medical center’s Twitter account and they see who we are following, we are basically endorsing them.”

It is also important that once a facility makes the decision to jump into the social networking fray, it dedicates the resources necessary to keep its content current and the communications flowing.

“Social media is a tremendous tool. It can also be a huge undertaking. One of the worst things that can happen is that you go out, start establishing a social presence and interacting with your patient base, and then abandon them because there isn’t time to keep up the conversation,” says Desmet. “It takes an actual investment in time and effort.”

— Elizabeth S. Roop is a Tampa, Fla.-based freelance writer specializing in healthcare and HIT.


Physicians and Social Media
Just as hospitals are recognizing the value of tapping into social networks, a growing number of physicians are launching blogs discussing everything from life in the trenches to specific medical cases. If and how the hospitals with which these physician are affiliated should regulate their online activities is a gray area.

The University of Maryland Medical System, for example, is working to define the role of individual physicians in its social networking strategy. In addition to the obvious concerns regarding privacy and security risks, the medical system must also deal with if and how to best manage the use of social media tools by its closed medical staffs and the community-based physicians affiliated with several of its hospitals.

“We have hospitals in our system that fall under both categories, so we have to keep an eye on things in both arenas. The closed model gives you a little more leeway to do things within the framework of the hospital network, while a completely community-based model requires you to either accept transmissions from outside the network or require the physicians to do their [social media] posts from inside the network,” says Mark Kelemen, MD, senior vice president and chief medical informatics officer for the University of Maryland Medical System. “We are really just dipping our toe in the water with the notion that we want to support social networking for our physicians. We’re not quite sure what the future state holds.”

Currently, the University of Maryland Medical System does not have an established policy governing how its employed and affiliated physicians can utilize social networking tools such as blogs. Rather, they are taking it on a case-by-case basis. They are also working with their physicians to explore several avenues that will mitigate the privacy and security risks social media can present.

“We are very concerned about protected health information getting out, but most doctors are cognizant of that,” says Kelemen, adding that ensuring social networking tools don’t consume too much of the system’s technology bandwidth is also a concern. “We have core processes internally that already take up a lot of bandwidth. If [physicians] are moving large images around for the purposes of social networking, there are potential problems there.”

The medical system’s physicians are currently evaluating a handful of physician-oriented social networking organizations. After initial vetting to determine which most closely meet the needs of the facility and physician users, the system will likely work with each finalist to determine whether it will be feasible to construct secure public and private networks that will allow physicians and other users to make appropriate use of social media without introducing unnecessary risks to the medical system.

On the individual level, Phillip Baumann, CEO of CareVocate, LLC, recommends that physicians interested in blogging first check with the hospital to determine whether there are policies in place that dictate what they can and cannot do in the blogosphere. Even if there are none, he urges physicians to at least gain the hospital’s buy-in to avoid complications down the road.

Beyond that, physician blogs should always include a disclaimer that clearly states the opinions in the blog do not reflect those of the hospital unless otherwise stated nor are they intended as a substitute for medical advice. Bloggers should also ensure that anything contained within the blog is HIPAA compliant and handled in a manner that maintains patients’ privacy and dignity.

“If you’re a doctor and you’re blogging about a procedure, it’s very easy not to disclose [private] information,” says Baumann. “But if I’m a patient and you don’t have my permission to talk about me, but I find you online and can triangulate it [back to me] even if you don’t name me, it’s a problem. … It’s not a matter of a law at that point; it’s a matter of personal dignity. Explicit, clear permission is important as is really being intelligent about the consequences of what you put online.”

Finally, for those physicians who intend to share medical information and guidance, securing HONcode accreditation by the Health On the Net Foundation will lend credibility and assure readers that the blog follows the basic ethical standards in the presentation of information.