Significant Science

Before we begin, John, I would like to provide a little background to readers who may not be familiar with the subjects we will cover in this interview: the use of social media in medicine, Medicine 2.0 and Health 2.0 and the e-patient movement. I am somewhat new to these subjects and as I have read around in the blogosphere and noted who tweets and blogs most eruditely and informatively on those topics I kept seeing your name. And I finally got a chance to meet you at the recent Medicine 2.0 conference where you not only chaired a session entitled, “Building Virtual Communities and Social Networking Applications For Health Professionals” you also gave a talk entitled, “Hospital Adoption of Medicine 2.0 – a Culture Shift” in a session called, “Web 2.0 Approaches for Clinical Practice, Clinical Research, Quality Monitoring.”

Clearly, your interests are broad and touch on such topics as patient empowerment, participatory medicine and social media use by medical professionals and by hospitals and other healthcare organizations as outreach and, yes, marketing tools, to current and prospective patients.

Interestingly, your LinkedIn profile
gives your title as Manager Clinical Research Informatics at Cleveland Clinic and your blog is headlined “A blog devoted to eHealth and Health IT.”

I say interestingly because don’t most people who handle Web matters for large healthcare organizations such as the Cleveland Clinic come from marketing backgrounds rather than the field of informatics and health information management?

I was previously a project manager for IT Web Services at the Cleveland Clinic for 6 years, so I worked closely with the marketing team on web development projects. In my new position, I was asked to participate in the social media initiative because of my expertise in the area.

And could you outline for us why some professional organizations use the term “healthcare information management” and others just “health information management,” whereas you use the wording, Health IT? I envision as the audience for this interview anyone in the healthcare industry who deals with Web matters. And these days that encompasses marketing staff, medical librarians, foundation heads in small community hospitals, heads of medical records staff who have to deal with public demand for their personal health information (as you and I both heard from E-patient Dave in his well-received keynote at Medicine 2.0) and so on.

Could you give us an overview of who is involved in helping hospitals cope with the brave new world of social media in medicine?

Managing social media in health care organizations requires a broad assembling of stake holders who are of a common mindset. These should include: marketing, public relations, information technology, medical education, medical librarians and clinical staff including physicians and nurses. The mix should include early adopters as well as those relatively new to social media to provide a balance. Additional stakeholders to consider are: a patient representative, an attorney (at least as a consultant), and employee communications.

Let’s say I am the CEO of a midsized healthcare organization I want to get a handle on social media. I have heard of Twitter and Facebook. My IT department is fairly conservative in its thinking, and given that it is tasked with guarding our electronic medial record system it is not too enamored of the idea of a foray into social media.

But my marketing people keep badgering me, “We have to get into this space! Our competitors down the road are and we going to lose patients to them because patients want everything on the Web.” Whom do I need to call to a meeting to address this issue and what are the first questions I should ask? Should I have risk management people in the room?

Okay, John I am done being CEO for the day. Let’s talk about what social media are used by medical people themselves in their work settings. As we know, FaceBook is banned in many hospitals. Was that originally simply to prevent employees goofing off on it updating their personal pages on company time but later because hospital IT departments saw it as a genuine threat to hospital IT systems? Can Facebook actually be used as a pathway for hackers to get into electronic medical record systems? Can Blogger? Can Twitter (which doesn’t seem to be banned yet—and is even encouraged and promoted by marketing departments for hospital-wide staff use for corporate mission promotion purposes)? What social media services pose real threats in the hospital IT environment? Given the increasing adoption of FaceBook by such groups as the American Nurses Association, the American Medical Association and American Diabetes Association is it now time for hospitals to get over their anxieties about it or is extreme caution called for?

Any system can be hacked or be potential entrance points for worms and Trojans. This is more likely to happen when employees follow links from Facebook or Twitter than within those applications themselves. Do they hold a greater risk than email links or web pages which show up in a search? It is difficult to say. If internal systems are hardened against viruses and the IT security is monitoring systems and keeping virus and worm monitoring up to date, the likelihood of a system-wide infection is low, but an individual computer might be infected. Social media sites should be judged equally with other websites – if the content is offensive or dangerous, it should be blocked. If it is potentially beneficial to business, it should not. At the same time, employees and managers need to be trained to keep personal use which can be a distraction from productive work, to a minimum.

Do you find that some entities within your organization battle for listing on your home page? For instance, as a former medical library person, I found it a little frustrating that I had to do a Google search to find the page for the medical library and could not easily find it via the homepage of the main site. Is that because the library is mainly for staff use and not so much a part of the public face of the Cleveland Clinic? Do you have any advice for medical librarians on how to increase the visibility of their services? Some medical librarians get so frustrated at seeing their pages buried deep within main corporate sites that they create their own sites. Have you seen that happening not only with medical librarians but with nurses, pharmacists and physicians who just start blogging, for instance? Have there been instances where such rogue but relatively innocuous unsanctioned experimentation has actually been embraced by hospital administrators in the end?

The main website, my.clevelandclinic.org is a consumer-focused website so that other subsites are not intended to be prominent in that context. Medical librarians can focus their appeal by creating mutual links on each other’s websites and through social media outlets like Twitter. Hospitals need to have web presence for health professionals and not just consumers. Our page at http://my.clevelandclinic.org/professionals/ includes referrals, education and research content including library and other online resources. If a marketing department does not include all stakeholders in the primary web presence, rogue websites can appear.

Please tell us about blogging at the Cleveland Clinic and what healthcare CEOs and physicians can learn from your organization’s experience. Please tell us about what policies or practices have actually changed at the Cleveland Clinic as a result of anonymous comments on the blog of the chief of the medical staff.

Blogging at the Cleveland Clinic began as a independent and unofficial blogs by a variety of physicians, nurses and IT professionals. Later, a blog was proposed for the CEO as an employee communication tool to increase transparency and the personal approach of the CEO. Later another internal blog by the Chief of Staff directed to physicians allowed for anonymous comments on his postings. Again, the desire for transparency and openness drives this blog and promotes dialogue with the Chief. There is now also a blog related to information on H1N1. The blog strategy has grown out of a trend to more transparency by the CEO.

I notice that on the homepage of the Cleveland Clinic that you offer visitors the social media options of Facebook, YouTube, LinkedIn and Twitter. But I don’t see any RSS button. Is RSS basically dead in the water on hospital Web sites and across the Web generally? Oops—hold on. I just came across some RSS feeds under the Health Information tab and the heading Events, Resources & Tools. But the fact that I came across the RSS feeds by happenstance suggests that RSS has never really gained traction in healthcare. Thoughts?

The home page is no longer news driven but other pages, particularly on health information http://my.clevelandclinic.org/health/rss.aspx uses RSS feeds for content such as, health information articles, podcasts, and web chats.

Please tell us about your Online Medical Second Opinion service. I was quite interested, for instance, that there was actually an email address right on your site. How rare and how nice! So often visitors to healthcare industry Web sites are lucky to find even an online form to fill out. What has been your experience with such openness?

The Online Second Opinion Service, MyConsult, is a long standing service the Cleveland Clinic has provided consistent with our regional and international outreach to patients who would like a second opinion without traveling to Cleveland.
Having multiple routes to contact Cleveland Clinic including a contact us form and appointment request has been a standard on the website for about 10 years. All requests are expedited to the appropriate department to reply in a timely manner.

Given your endorsement of the tenets of the e-patient movement, could you say that the Cleveland Clinic passes the E-Patient Dave, “Gimme My Damn Data!” test? Do you think hospitals that don’t offer personal health records are actually taking greater risks vis-à-vis falling behind in terms of market share and reputation than hospitals such as yours that offer state-of-the-art systems?

Through MyChart, our tethered PHR, connect to our electronic medical record, is an important service to our patients. It continues to be enhanced with health reminders and interactive features. The users can transfer their data from MyChart to Google Health. PHRs with data from EMRs are superior to PHRs which are free standing or those which receive only claims data as was the experience of ePatient Dave. Hospitals need to provide real clinical data to patients if they want patients to be full participants in their care.

What has been your experience with both Google Health and Microsoft HealthVault? What are the basic features and advantages of each and do you see Microsoft’s major move into healthcare setting the stage for static between those who are deeply into Health 2.0 and its openness to out of the box thinking and Microsoft’s history of stifling innovation and crushing startups?

The Cleveland Clinic was an early partner of Google Health which launched in March 2008. Google Health, as with all of their products, provides a simple, straightforward user interface with a growing number of tools to manage health information with now ads. Microsoft HealthVault’s unique offering is the ability to connect to home monitoring devices. Cleveland Clinic has a pilot with them using this technology. So in this case, I think Microsoft is equality encouraging innovation.

Please tell us about your live chat services. Those are quite impressive vis-à-vis the ideals of participatory medicine. But I was little confused by what to call them in my questions to you. I saw the wording, “Personalized searches by our educators” and “Chat with a Health Educator’ and “Online Health Chat—sign up to learn about medical topics from health professionals in a private, online setting.” But I was not clear as a user if the online chat was a separate service from the personalized searches and if I could choose only to speak to a physician. Do you get feedback from patients who want to talk to doctors and only doctors? Are there plans to institute such services (perhaps called “Talk to a Doc”)? Is it advisable to brand such services in memorably slangy fashion or would that be considered too crassly commercial?

Online chat at Cleveland Clinic is a scheduled discussion with a specialty physicians to answer questions on a specific topic. Personalized searches are a service provided by health educators on a topic requested by the health care consumer. Patients who request specifically to talk to a physician and only a physician are encouraged to make an appointment so that their situation can be fully evaluated.

On a related topic, do you see such services as American Well and Hello Health as threats to hospitals and health networks in that they will siphon off patients from mainstream brick and mortar institutions? Or are they creating models of participatory healthcare that local hospitals could simply adopt and engage their medical staff in, which might actually help them with staff (and patient) retention given that physicians might be more prone to stay with local hospitals that enable them to spend less time in the office but maintain their practices via Web-based means?

An eVisit service is a helpful trend in medicine but it needs to be in a controlled environment. A secure email or online service which provides communication between a physician and an established patient is the right approach. Using Facebook or less secure tools could violate HIPAA or open up other liabilities to the physician or hospital.

One of your many duties is that of dealing with the needs of the many researchers of the Cleveland Clinic. You mentioned in your talk at Medicine 2.0 that you are on the advisory board of Within3 . Could you tell us why you got interested in this firm and what makes it so promising? Do doctors and clinical researchers need such online gated communities as opposed to the free and easy atmosphere of the science rooms of FriendFeed? Is there anything comparable to Within3? Is that well beyond what Sermo can offer (which, granted, as a rule does not deal with heavy-duty clinical research).

The unique offering of Within3.com is that it provides secure, member only communities for physicians and health professionals around common interests. For instance, a newly launched community for gastroenterologist focused on their annual conference and submitted abstracts. They are also offering these closed communities for advisory boards and clinical trial groups like NCCN. By keeping the membership by invitation only, actual identities are required rather than cryptic account names which are allowed in other social networks. Also, I like to point out the Within3 is a Cleveland-based Health 2.0 startup.

You said in your talk that one of your goals is to expand Twitter presence. Please elaborate. Do you encourage notable researchers to tweet about their activities, for instance? Do you encourage employees to build up individual presences (i.e., personal brands) on Twitter? You yourself on active on Twitter. What are your favorite tools and whom you do consider people who are must reads on Twitter? Lee Aase of the Mayo Clinic? Ed Bennett?

My personal use of Twitter began at the 2008 Medicine 2.0 Congress with a group of interested and active tweeters. It provided the perfect vehicle to continue our conversations after the conference. I expanded my network to include others interested in health 2.0, research, health care reform and healthcare IT. It provides a tool to keep immediately aware of conferences going on around the world, the latest news in these fields and creative ideas like those of ePatient Dave and Jen McCabe of Contagion Health. As a result of Twitter, I actually arranged to meet with Ed Bennett when I was in Baltimore and it has lead to some speaking engagements.

Speaking of the Mayo Clinic, how do the Cleveland Clinic and the Mayo Clinic differ in their Web presences? You are both huge Web operations. What do each of the two organizations excel at? What do you think they do better and what do you think you do better?

Mayo Clinic had an early strategy to separate their health information to MayoClinc.com from its medical practice and hospitals. This has allowed them to leverage it into a for profit venture. We chose to keep our health information integrated with our service offerings. In social media, Mayo Clinic is more active in the use of public blogs and internet radio, while we have focused on our YouTube, Facebook and Twitter presences.

On a related matter, what conferences, professional organizations and fields of study do you recommend for those interested in a career in social media in medicine? Heavy duty computer programming? Marketing? What would you advise a college sophomore interested in the field to major in and what are absolute must skills?

The two most important conferences in health care and social media are Health 2.0 and Medicine 2.0. Almost any marketing conference is now offering content on social media and some independently sponsored conferences are also helpful. I spoke at a Q1 conference in Phoenix earlier this year which was well attended and included many key players.

Do you have experts on your Web design team that examine every aspect of the site with an eye to the revolution in mobile technology?

Yes, our Internet Marketing group has developed standards for web design and continues to look for improvements in usability. They are just beginning to move into mobile technology, the first of these being wellness tools.

Do you see the Health 2.0 and Medicine 2.0 movements as becoming less distinct from one another than they once were?

The Health 2.0 conference continues to focus on startups and entrepreneurs whereas Medicine 2.0 is more focused on academic medicine and research. So I think they remain somewhat distinct.

Finally, who are your heroes in healthcare, technology and in any other field of endeavor?

Dr. C. Martin Harris, our CIO, has provided visionary leadership in the areas of EMRs, PHRs and other online initiatives. Both Matthew Holt who established the Health Care Blog and the Health 2.0 conference and Gunther Eysenbach who edits the Journal of Medical Internet Research and the Medicine 2.0 Congress. But a younger generation of Twitterati are emerging as well including Jen McCabe, Cisco Grajales, Carlos Rizo and Maarten den Braber. Creative, innovative ideas will emerge from this group to lead us into the future.

Thank you for your time, John.