Health Is Social

Infusing Social Media into Healthcare

I’m going to be considered a pariah in social media circles for this (it won’t be the first time) but it needs to be said: the core value of social media in healthcare isn’t “about relationships” nor “engaging with each other” nor “being social”. Are those nice things? Yes. Are they core? No. They’re peripheral uses if we so choose them – ancillary benefits of a process which run wider and deeper than social media. So what’s core?

Here are four:

Decision-making

As of today, most people who turn to the Web concerning health are seeking content and information about symptoms, diseases, treatments, and providers. The two primary ports for that seeking include Search and Social. Search dominates, but Social is growing. As people use the Web more and more, and find themselves mixing social media and healthcare, they’ll start to navigate between Search and Social – either for improving their gathering of information, or for people who can help them.

Ultimately, this information gathering and head-hunting is about decision-making. The key weakness of Healthcare social media may not be so much in information accuracy, but rather Interpretation. It’s the interpretation of medical data which eludes common sense.

So a core problem – and opportunity – of social media in healthcare is addressing Interpretation. Knowing how to deploy Twitter or Facebook or a blog is a joke compared to that task. Today’s frenzy of discussion of social media in healthcare is primarily due to a lack of Web literacy in the industry.

Behavioral Change

If there’s no change in behavior – of some kind – then what’s the point? Whatever people are doing on social networks or with healthcare applications ultimately has to come around to behavioral shifts – either shifting behavior from unsafe to safe and effective, or in shifting moderately healthy behavior upward.

For the most part, social media are not going to impact behavior – not in and by themselves. Not by a long stretch for most instances. Social media and other digital technologies may play parts – placing the right kinds of interfaces at the right time and context and process.

And even if social media may play a bigger role, the specific kinds won’t be consumer media like Twitter and Facebook. (You can read about what might here.)

The Consequences of Relationships

Do relationships matter? Yes, of course! But in health, it’s the consequences of those relationships which are central to the benefits/costs of social media in healthcare. Generally and psychologically speaking, it’s a pretty safe bet to agree that human interaction has a positive impact on health. We pretty much know this.

But what about the other consequences? Do we know the long-term benefits/costs of these relationships in terms of actual behavioral outcomes?

Given that the medium is the message (not just shapes the message, it is the message), whatever relationship develop online must somehow account for the media. We haven’t yet figured that out yet. I would plead for my Twitter friends to reflect a moment on the flavor of their relationships they’ve developed via Twitter – there’s that certain something about them, isn’t there? Think about it, man!

The point is that we need to get over the whole “it’s about relationships” meme – not only is it tiring, it’s distracting us from the work that matters – effecting positive learning experiences while shifting behavior in accordance with good health.

The Statement of Shareholder Equity

Money, it’s a hit – don’t give me that do goody good…

Ah, the dollar! The topic of social media conversation everybody works to explain away (after all, it’s all about relationships, engagement and being social πŸ˜‰

Well, my friends, there is no such thing as a free cheesesteak. Everything is an opportunity cost. If you’re doing one thing, you’re not doing another – and the name of the game is to do that which offers most value. (Back to decision-making above.)

The fact is, for us to get to a state of Healthcare Social Media which truly unleashes its power to connect, enable, empower and ease suffering, we are going to need the contributions of providers, institutions, payors, pharmaceutical and medical device producers. These are not players who can do this on their clock without some kind of re-funding – be it direct or indirect.

A particular social medium doesn’t have to provide direct financial ROI, but an overall online presence does need to have some favorable impact on ROE – these two measures are often confused (for instance the sum of individual ROIs on capital projects do not add up to total ROE for an enterprise).

Financial flows aren’t solely the only enhancer of equity – there *are* intangible activities and organization-external assets which can grow its equity. Goodwill is the classic one, but in today’s media environment there are others shaping.

But if you recognize that every item on a company’s financial statements is ultimately the result of social transactions (Revenues: relations with customers; Expenses: relations with vendors, employees, financial intermediaries; Equity: the net of those revenues and expenses *and* relations with stockholders), it’s clear that social media has a financial place to hold, and should not be dismissed and explained away as too often happens.

We are entering a new kind of economic physics, and I suspect we’re currently experiencing an evolutionary inflection between the history and future of Capitalism. For social media have brought forth the possibility of fusing the means of production with its ownership on an unprecedented scale. The clearer insight we have into the financial implications, costs and benefits of social media activities, the better will be our understanding of Healthcare economics – and, consequently, on social media’s true meaning in Healthcare.

@PhilBaumann – @HealthIsSocial – Newsletter

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  • Phil Baumann

    I told you I’d be considered a pariah (this post was up for 5 minutes and I’ve already gotten the “oh you don’t get it” feedback in backchannels.

    I love the Web πŸ˜€

  • I can’t really process all of this — it’s a lot. But this isn’t about “getting it” or not, right? There’s nothing to get about health care social media right now. We are still learning. I think these conversations are necessary, but we also may not be ready for this “cold” truth either. I would like to question warmly πŸ˜‰

    I am wondering what you mean here: “The key weakness of Healthcare social media may not be so much in information accuracy, but rather Interpretation…Today’s frenzy of discussion of social media in healthcare is primarily due to a lack of Web literacy in the industry.”

    Digital media literacy is really important, especially the intersection between health literacy and digital literacy. We don’t talk about it so much in health, mostly in education. Is that what you mean by “web literacy”?

    You also mention the medium is the message. I think, if that’s true, than we have an opportunity here to influence and perhaps predict any negative affects that may come from social media as well. I don’t think the consequences are always good despite psychological benefits from human interaction. Some of the interaction and behavioral outcomes can be harmful as well.

    • Hi Erica

      So let me clarify some of the points I’m making.

      – Web literacy. I was referring to organizations which need to to be Web literate – the focus on the lag in understanding the simple stuff: Twitter, FB, etc. – that part is an easy fix but it seems like such a hurdle; thus all the (understandable) conversation about it.

      – Cold hard truth. I frame it this way, because those of us in this discussion would like to point out that it isn’t all about Twitter and FB and blogging and Foursquare and all these other media. That there are deeper issues which we need to questions, flesh-out and scratch-test. The amount of energy and focus on just the surface of social media is at the expense of discussing these things.

      – Interpretation. That goes to the issue of using the Web for actual healthcare – what are the limits? What’s the safety of “self-diagnosis” based solely on information (even if the info is accurate, the interpretation is an entirely different but critical matter).We haven’t yet worked that out, which is why we need more providers and researchers involved.

      – Medium is message. Yes, there can be harmful effects, and that’s another “cold hard truth” – too often we’re hearing about the positive stories (the appendicitis diagnosed by a doc, etc.). All wonderful stories, but there are cases where it doesn’t work out – I wonder how much of that gets missed, since they may go unreported (eg, person gets sick, goes online, gets bad advice or info or interprets it wrong but doesn’t tell provider).

  • Anne Marie Cunningham

    Phil,
    I think this is great. You definitely get it- big time:)
    AM

    • Phil Baumann

      Thanks – there’s so much ground to cover. πŸ˜‰

  • Mark

    Phil: I agree 100% with your analysis and observations. I would offer up this support. If we assume people seeking HC knowledge are seeking solutions to problems they wish to solve (Malcolm Knowles) we can then accept that social media along with search etc. are part of learning. There are two core principles of learning for it to be effective. It must have an affect and it must be social.

    Finding solutions to HC problems have a huge affect on the learner. They are personal and important they drive the uptake of knowledge. When we add SM to it we create the second principle. People learning from others, sharing experiences, and reflecting. I would like to see us and LGI have chats and seminars on how to search, what to search, and how to understand what you’ve learned. That way I can apply it. And to understand others experiences with similar problems in order for us to have better knowledge.

    Decision making as you noted is critical in taking new knowledge and applying it to HC problems. This is where we need to help learners critically appraise what they’ve learned to improve decision making. If I download a study from PubMed and read it without the help of others (SM) I may find it difficult to apply what I learned to my behavior. I can improve what I’ve learned with the help of others. This is not a blind advocacy of SM.

    I agree it is not about the relationship but what did the relationship offers me as part of that HC problem I was seeking a solution too. Someone else’s experience helps me reflect on my experiences and helps me change or not my behavior. It is the key point of learning reflection on action. I reflect on what I learned and take action or not. Accuracy is accomplished as part of a larger process of the learning experience, not just SM.

    SM and ROI, it is my opinion that the ROI should not be linked to SM directly but an overall educational strategy made up of multi tactics tied to objectives and measured with outcomes. Programs are fundable because they are part of a strategic plan. Tactics are destined to fail.

    What you’ve served up here are some very keen insights and observations that we all need to consider, discuss, share experiences, and reflect on. But most important is the need to apply what you’ve offered to what we do. We need to help SM live up to its potential as a learning tactic within an educational strategy in HC.

  • Cyrus

    It is “peripheral” or “antecedent” to what your describe as “core”?

    Without engagement their would be no exchange of information to interpret in the social realm.

    • Could be both.

      I mean ‘peripheral’ in the sense that social media opens possibilities that run deeper than exchanges.

      Think of a fun-house with a porch – there periphery is the porch, but the crazy stuff – the core – goes way deeper than the exchanges and engaging on just the porch.

      • One must pass through the porch to get into the fun-house – unless you teleport in or go through the garage….:)

        Clearly, inside the fun-house is where the heavy lifting is going to get done but whose fun-house will be visited the most on Halloween? The one with the most interesting porch regardless of what’s inside, for better or worse.

  • Hate to dash your aspirations, but this wise post doesn’t make you a pariah — not with me, anyway!

    I will say that you seem to have set up a false dichotomy between being about relationships/engaging with each other/being social and the four “core” uses. Like Cyrus, I would say that social engagement is an antecedent — necessary but perhaps not totally sufficient — to get to desired outcomes like behavior change, etc. Make sense?

    • See my reply to Cyrus.

      The exchanges are on the surface. The core runs deeper – it’s not easy to see if you view social media from only the angle as “social” media. I see them in a wider view, so I don’t see any false dichotomy.

  • Phil,

    Great post – and timely. Study published a week ago highlights the fact that 85% of respondents would not use social media or instant messaging channels for medical communication if their doctors offered it. Only 11% said they would take advantage of social media like Twitter/FB to communicate with their doctor and 20% said they would use chat or instant message. Even among Millenials (18-29) – only 21% said they would take advantage of an online forum if offered.

    What was high – were admin functions – like appointment setting (56%), access to EHR (50%), and online bill payment (48%). The one other bridge was email where 52% were favorable to conferring with docs that way.

    I didn’t see the full report – but the article/highlights are here: http://bit.ly/fuiMlO

  • Interesting post and comments. I agree that decision-making, behavior change, consequences of relationships and stakeholder equity are all important factors.

    I also believe that some of the impact of social media is and will be hard to measure, because it does involve an inflection point (as you allude to), involving new ways of seeing and doing, what I like to refer to as platform thinking, de-bureaucratization and the redistribution of agency.

    Your & Erica’s comments on digital or web literacy reminds me of some of the observations made by Doug Rushkoff in his recent book, Program or Be Programmed, in which he notes that with each new medium, “most of society remains one full dimensional leap of awareness and capability behind the few who manage to monopolize access to the real power of any media age”.

    I hope that social media will provide a truly participatory platform for greater awareness, capability and engagement in shared decision-making, changing behavior, connecting with consequential strangers and acquaintances, and achieving a true leveling of the field of play (or battle), as the current distribution of power in healthcare seems to be rather lopsided.

  • Phil – As always, you do a great job of holding a mirror up and pointing out some salient aspects of the HCSM movement.

    Fundamentally, I agree with you 100%. I might take slight exception with your preamble where you dismiss the importance of engagement (read another way, are you dismissing the repetitive hollow calls for engagement? I could get behind that). I might argue meaningful engagement is a means to and end, particularly when it comes to decision making. Put another way, an empty facebook page or twitter stream doesn’t do much for search results and social “promotion”. If you want to be available for decision makers, you need to have some content (how am I doing on buzz word bingo?). One way to have good content, either for social search or social promotion, is to be engaging… or available… or whatever we want to call it.

    That said, as I’ve tried to make clear, there is a distinction between talking about the weather and helping someone find a doctor – engagement has to be meaningful.

    Finally I want to highlight this quote:
    “SM and ROI, it is my opinion that the ROI should not be linked to SM directly but an overall educational strategy made up of multi tactics tied to objectives and measured with outcomes.”
    Spot on Phil! Measure the outcomes, not the tool – love the way you state this. Along the lines of being meaningfully engaging, if we really are out to alter health outcomes (which may be different than changing behaviors) then we need to use health outcomes as our ROI and not be hung up on the tools we used to get there, even if social media is a part of that toolkit.

    • Hi Nick!

      Regarding engagement: I’m not dismissing engagement, but I am arguing against making such a big deal about it. If that’s all there was to social media, then there’s nothing else to say except “engage”. So yes, I’m pleading for the repetitive calls for engagement – if it’s not obvious to someone, then engagement isn’t the problem. Think about it πŸ˜‰

      As I get more experience, I’m starting to realize just how vacant a lot of the talk about social media has become, so it’s time to advance.

      To paraphrase Yoda: “Do or do not, there is not tweet.”

  • Phil,

    I didn’t think you ever were or will be a pariah. Truth tellers aren’t.

    You see the landscape for what it is. As a patient, and member of patient communities, I’ve been trying to say in many different ways that social media is terrific in that it can immediately connect patient groups. It does not however, override the weight of a doctor’s recommendation (many patients use social media for support, not decision making) or necessarily insure that a patient is getting “good” information.

    Smart people will always find their way to “smart” “good” evidence-based medicine. They always have. At one time we did this by — heaven forbid — phone. Linda Ellerbee, Betty Rollin….all of these cancer advocates/pioneers wrote and spoke about the need to understand the disease you had to face, by reading, listening, asking questions with a clear mind.

    But social media isn’t the end-all to be all if we don’t use it wisely, as another “tool” to begin eliminating health disparities and health literacy. This will be — I hope — one of its greatest assets.

    Thanks so much. I could write all day about this. The topic matters,
    Jody

  • Phil,

    Let’s not ever underestimate just how profound a request it is to ask one to alter their belief systems. This is a crucial step often missing. One must first believe there is reason to change behavior patterns before attempting the equally daunting task of actually making a change, though if the first is not executed, the latter effort is pointless.

    In the case of social media integration and your reference to decision making for example, one must decide that they are going to exercise the same mindful weighing of options between two sources in the social media realm as they would two differing physician opinions. Otherwise, digital approach is treated as secondary to primary such as in a doctor visit. Digital need be seen as a philosophy, not a gadget. Changing this belief is integral to one being able to make the aforementioned decision about weighing of options.

    Changing belief systems is at the root of your straight up truth in my view. Please give me any feedback applicable if I am missing the boat anywhere on your message. Good call Phil. Feel free to slap me about the head, neck, and face with cold, straight up truth any day partner.

    • Phil Baumann

      Hi Jason

      I like “Digital need be seen as a philosophy, not a gadget.”

      I’ve always argued that tech is more than gadgetry – that it’s a way of thinking and seeing; and with that in mind: believing.

      Belief is definitely key – and that in fact may be were the communicative elements of social media need to well-placed. Content can empower a mind to shift its belief – at least partially.

  • BTW – I am building a porch called healthpushers.com. Let me know what you think of the name as I am being advised to change it due to its controversial nature.

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