Editorial
POPULATION HEALTH MANAGEMENT Volume 13, Number 4, 2010 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2010.1341
Social Media and Population-Based Care Management Jaan Sidorov, MD, MHSA
H
ealth consumer communication is widely regarded as a core competency of organizations that offer population-based care management. Outside of health care, a new form of communication, dubbed ‘‘social networking,’’ has arisen. Using it will require acquiring new competencies and assuming additional cost. Is adopting it as another means of consumer outreach worth the trouble, or should care management providers remain on the sidelines, communicating by familiar voice, print, e-mail, and fax? Social Networking This can be defined as the Internet-based connectivity of individuals using a variety of overlapping and online formats such as chat clients, Web logs, and instant messaging. It arose in a ‘‘bottom-up,’’ decentralized, and democratic manner and allows participants to instantaneously and bidirectionally share large amounts of information across wide audiences with little attention to either time or geography. Instead of a 1-way transfer of information that has been characteristic of traditional consumer engagement, 2-way relationships develop among participants. Access can also be manipulated, restricting the communication to a select few or blossom into virtual communities that number in the millions. While the hype over social networking has been considerable, there can be little argument that the advent of ‘‘blogs’’ (Web sites with ongoing commentary and other content), ‘‘wikis’’ (interactive Web sites with collaboratively developed content), video sharing sites (eg, YouTube), personal networking (eg, LinkedIn, Facebook), and Web-based messaging (Twitter) has been a potent global phenomenon.
were addressed or corrected within 9 hours of their appearance.2 A review that used other criteria, including site design, disclosures of conflicts of interest, readability, completeness, and quality, found problems to be far more widespread.3 Lastly, despite its ‘‘coolness,’’ there is little objective evidence that social networking translates into measurable health benefits for its participants.4 Whatever its imperfections, the growing adoption of social networking in other sectors of society suggests significant numbers of health consumers would also prefer to use it for their health care. Even if little is objectively known about the phenomenon in health care settings, advocates point to its potential as an important supplement to the traditional approaches used to boost awareness of and participation in wellness, prevention, and care management programs. In addition, the fixed costs of social networking may compare favorably to traditional means of consumer outreach: services such as Twitter, Facebook, and Google blogs are available without cost to the user. Considerations for Care Management Programs in the Adoption of Social Networking What should care management organizations know about social media as a tool to help them better serve their patients?
Implications of Social Networking in the Distribution of Health-Related Information From a consumer viewpoint, social networking offers 2 advantages: There are 1) a greater number of ways to obtain and 2) a deeper level of personalization in the acquisition of information. An example is Facebook, which, according to one report, has over 750 health-related groups, devoted mostly to cardiovascular disease and cancer, with 290,000 users.1 Although health care providers may be concerned that the information found on these types of online sites is littered with inaccuracies, one study of an Internet cancer support group used experts to evaluate approximately 4600 online postings. Only 10 (0.22%) were misleading and most
Sidorov Health Solutions, Harrisburg, Pennsylvania.
175
1. The Return on Investment is Measured in Value: Of all the sectors in the health care industry, care management organizations should understand that value is also created when relationships and interdependence lead to brand awareness and customer loyalty. Beyond these business fundamentals, the question of harnessing social media to change patient behavior and reduce claims expense remains an open question. Yet, care management organizations are well positioned to simultaneously implement and rigorously study its impact. 2. This is Additive, Not Substitutive: With the plethora of increasingly complex forums for the exchange of information, architects of care management programs must anticipate that taking on new communication channels – such as personalized Web sites, blogs, and Web-based messaging - will not diminish the traditional reliance on print, telephony, and e-mail. Rather, advocates point to use of multiple overlapping channels that include social media in communication ‘‘campaigns,’’ seeking an impact that is greater than the sum of its parts.
176 3. The Demise of Credentials: By its very participatory nature, the bidirectional sharing of insights by multiple experienced, if non-credentialed, laypeople can turn out to be a far richer source of needed information for users than that provided by a smaller number of trained professionals. This speaks not only to the ability of individuals to tap into the online resources of a digitized world, but also to the ‘‘wisdom of crowds’’ in vetting advice. As a result, the authority of credentialed experts may diminish. What future role they’ll have also remains an area of inquiry for the care management industry. 4. One hundred and sixty characters6: Pundits point out that an ironic outcome of the increased availability of information is diminished attention spans. Whatever its merits, success in social networking is based on interactions that are meaningful, personalized, and short. This means new challenges in fashioning education materials that are not only accurate, but can be read in a matter of seconds. 5. The Downside: Much remains unknown about the fit of social media in the heavily regulated health care environment. By hosting participatory communities that include the exchange of information, care management organizations will need to struggle with confidentiality issues involving the Health Insurance Portability and Accountability Act (HIPAA) and vigorously monitor for fraudulent, bullying, or predatory user behavior. How Could This Work? Dissatisfied with the lack of participation in the wellness, prevention, and care management offerings among its employees, XYZ Corporation pressed its contracted care management company for a new approach to recruitment. In response, it continued to use print as well as telephonic outreach, online health risk assessments, predictive modeling, and toll-free advice lines, but initiated a tailored company-specific social media campaign. It established a Facebook account with daily short and polished posts but, more importantly, welcomed and responded to posted contributions from employees. It also created a Twitter account accessible by employees’ desktop computers and smartphones and used it to disseminate timely and important messages accompanied by links to vetted Web resources. In addition, it set up a dedicated blog with ongoing commentary and unedited feedback from employees as well as the care management nurses. This created multiple opportunities for feedback that was used by the care management program to adjust its program content by dropping some features, creating new ones, and adjusting others. Many Twitter messages linked to Facebook as well as new blog entries, and the blog posts were likewise reflected onto Facebook. When an employee posted a video about a sponsored health event at the company, it was likewise linked. Anonymous user counts involving Facebook, Twitter, and the blog were added to the traditional methodology of as-
SIDOROV sessing program participation and it demonstrated a significant increase in employee participation. There was also a boost in traditional recruitment. Conclusion Thanks to the remarkable advent of social media, care management organizations now have an additional opportunity as well as a challenge when it comes to engaging their patient populations. Although there is much to learn about its impact in health care, its potential suggests that it should be adopted while simultaneous efforts are made to better understand how it can contribute to the twin health care challenges of quality and cost. While there is no template to guide its implementation in current care management programs, social networking is best thought of as a supplement to traditional outreach that is less reliant on credentialed experts and based on short personalized and bidirectional information exchange. Architects of care management programs will also need to grapple with social media’s downsides, especially those features that could run afoul of HIPAA regulations. Despite these caveats, however, the population-based care management industry, thanks to its longstanding use of patient support, is well positioned to take advantage of this new form of communication media. Author Disclosure Statement Dr. Sidorov has no conflicts of interest or financial ties to disclose. References 1. Farmer AD, Brucker Holt CEM, Cook MJ, Hearing SD. Social networking sites: a novel portal for communication. Postgrad Med J. 2009;85:455–459. 2. Esquivel A, Meric-Bernstam F, Bernstam EV. Accuracy and self correction of information received from an internet breast cancer list: content analysis. BMJ. 2006;332:939–942. 3. Eysenbach G, Powell J, Kuss O, SA E. Empirical studies assessing the quality of health information for consumers on the world wide web. JAMA. 2002;287:2691–2700. 4. Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. BMJ. 2004;328:1166–1170. 5. DMAA: The Care Continuum Alliance. Outcomes Guidelines Report. Available at: http://www.dmaa.org/OGR_user_ agreement.asp. Accessed April 29, 2010. 6. Milian M. Why text messages are limited to 160 characters. Available at: http://latimesblogs.latimes.com/technology/ 2009/05/invented-text-messaging.html. Accessed April 29, 2010.
Address correspondence to: Jaan Sidorov MD, MHSA 413 Village Way Harrisburg, PA 17112 E-mail:
[email protected]
