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Assignment Content Health care consumers receive various communications about different health care options. It is important to understand consumer demographics to be able to determine the impact (positive or negative) media, social networks, branding, marketing, and communication play in health care consumer choices. Complete the attached worksheet. NCBI Resources How To Go to: Go to: Go to: Go to: Go to: Go to: Go to: Journal List P T v.39(7); 2014 Jul PMC4103576 P T. 2014 Jul; 39(7): 491-499, 520. PMCID: PMC4103576 PMID: 25083128 Social Media and Health Care Professionals: Benefits, Risks, and Best Practices C. Lee Ventola ▸ Author information ▸ Copyright and License information Disclaimer This article has been cited by other articles in PMC. INTRODUCTION Many social media tools are available for health care professionals (HCPs), including social networking platforms, blogs, microblogs, wikis, media-sharing sites, and virtual reality and gaming environments. These tools can be used to improve or enhance professional networking and education, organizational promotion, patient care, patient education, and public health programs. However, they also present potential risks to patients and HCPs regarding the distribution of poor-quality information, damage to professional image, breaches of patient privacy, violation of personal–professional boundaries, and licensing or legal issues. Many health care institutions and professional organizations have issued guidelines to prevent these risks. WHAT ARE SOCIAL MEDIA? The definition of “social media” is broad and constantly evolving. The term generally refers to Internet- based tools that allow individuals and communities to gather and communicate; to share information, ideas, personal messages, images, and other content; and, in some cases, to collaborate with other users in real time. Social media are also referred to as “Web 2.0” or “social networking.” Social media sites provide a variety of features that serve different purposes for the individual user. They may include blogs, social networks, video- and photo-sharing sites, wikis, or a myriad of other media, which can be grouped by purpose, serving functions such as: Social networking (Facebook, MySpace, Google Plus, Twitter) Professional networking (LinkedIn) Media sharing (YouTube, Flickr) Content production (blogs [Tumblr, Blogger] and microblogs [Twitter]) Knowledge/information aggregation (Wikipedia) Virtual reality and gaming environments (Second Life) Participation in social media by the general public has increased sharply over the past nine years. In the U.S., the proportion of adults using social media has increased from 8\% to 72\% since 2005. The use of social media is prevalent across all ages and professions and is pervasive around the world. In 2012, Facebook users exceeded one billion people worldwide, a number that represents one-seventh of the world’s population. In addition, each day 100 million active Twitter users send more than 65 million tweets, and two billion videos are viewed on YouTube. Social media have been linked to highly significant political events, such as the Arab Spring revolution, as well as to widespread societal trends, including the shortening of individuals’ attention spans and the decline of print news media. PARTICIPATION IN SOCIAL MEDIA BY HEALTH CARE PROFESSIONALS Social media provide HCPs with tools to share information, to debate health care policy and practice issues, to promote health behaviors, to engage with the public, and to educate and interact with patients, caregivers, students, and colleagues. HCPs can use social media to potentially improve health outcomes, develop a professional network, increase personal awareness of news and discoveries, motivate patients, and provide health information to the community. Physicians most often join online communities where they can read news articles, listen to experts, research medical developments, consult colleagues regarding patient issues, and network. There they can share cases and ideas, discuss practice management challenges, make referrals, disseminate their research, market their practices, or engage in health advocacy. A growing minority of physicians also uses social media to communicate directly with patients to augment clinical care. A survey of more than 4,000 physicians conducted by the social media site QuantiaMD found that more than 90\% of physicians use some form of social media for personal activities, whereas only 65\% use these sites for professional reasons. Nearly a third of physicians have reported participating in social networks. However, both personal and professional use of social media by physicians is increasing. Unlike physicians, pharmacists have been relatively slow to adopt social media. Much of the growth in the professional use of social media among this group appears to involve pharmacist-specific social networks. Surveys have shown that many pharmacists use Facebook. Although this use is most often for personal communications, more than 90 pages on Facebook are related to the pharmacy profession, such as the Pharmacists Interest Page, the American Pharmacists Association, and the Cynical Pharmacist. Only 10\% of pharmacists use Twitter, and a search for “pharmacist” on LinkedIn identified 274,981 profiles. SOCIAL MEDIA SITES FOR HEALTH CARE PROFESSIONALS Social Networking Sites As social networking has evolved, medically focused professional communities have been established. These networks are often private and protected from nonmembers, such as the lay public and even members of other health professions. Funding sources for these sites vary, with financial support often being provided by professional associations, advertising or data sales, research funding, and pharmaceutical companies. Sermo is a “physician-only” social networking community that verifies the credentials of new members during registration. Physicians representing 68 specialties in all 50 states gather on this site to network, to discuss treatment options, and to query peers for expert advice. As of April 2014, Sermo boasted a U.S. membership of 260,000 physicians, most of whom use pseudonyms for anonymity. Sermo consists primarily of a large message board on which physicians create topics for discussion. It also provides a rating system by which doctors rank posts on the site on the basis of perceived credibility. Doximity is a newer “physician-only” social networking community that offers text and images that are compliant with the Health Insurance Portability and Accountability Act (HIPAA), which allows point-of- care information crowdsourcing. As of 2013, more than 100,000 physicians and students were members. Doximity uses a national database to create “placeholder” accounts with demographic and contact information for all U.S. physicians. Therefore, although only 12\% of U.S. physicians are active members of Doximity, nearly 100\% can be messaged through the network. The Medical Directors Forum (www.medicaldirectorsforum.skipta.com) is a social networking site for medical directors that provides a verified, secure, closed-loop environment for peer-to-peer interaction. The resources on this site include a comprehensive library, discussion groups, calendar postings, and alerts. The site also provides dedicated group pages for medical directors working in a wide range of sectors, including: hospital, veterans affairs, Medicare, group practice, employer, behavioral health, managed care, correctional facility, and long-term care. Other physician networking sites include QuantiaMD (www.quantiamd.com), Doctors’ Hangout (www.doctorshangout.com), and Doc2Doc (doc2doc.bmj.com). Many of these sites require doctors to submit their credentials to a site gatekeeper, recreating the intimacy of a “physicians’ lounge” in an online environment. The nonprofit Student Doctor Network is a popular social community site for undergraduate and practicing physicians, dentists, and veterinarians in the U.S. and Canada. It claims more than 40,000 active members and 1.5 million unique monthly visitors. The forums on Student Doctor Network focus on clinical career topics, do not support detailed user profiles or “friending,” and encourage anonymity. Social networking sites are also available for pharmacists. These sites include ASHP Connect (www.connect.ashp.org), which is sponsored by the American Society of Health-System Pharmacists; PharmQD (www.pharmqd.com); and The Pharmacist Society (www.pharmacistsociety.com). Professional networking forums for nurses include the American Nurses Association’s ANANurseSpace (www.ananursespace.org), NursingLink (www.nursinglink.com), and SocialRN (www.twitter.com/socialRN). In addition, HCPs can easily connect with each other via “general purpose” online social networks, such as Facebook, Twitter, and LinkedIn. Facebook is the most popular social media site in the U.S., while LinkedIn is the most popular professional networking site. Blogs The “blog,” a term formed by truncating “Web log,” is the oldest and most established form of social media, which has been used in medicine since as early as 2004. Blogs can reach wide audiences, especially if one writes content that is of significant interest. Posts that garner enough interest can be shared and viewed again and again by readers (referred to as “going viral”). Content that goes viral can establish a reputation or an online presence. Blogs can also provide the opportunity to publish large amounts of information in a variety of media (text, video, and audio) in an open forum. Most blogging platforms allow readers to respond to published content by posting their own comments. This enables an ongoing dialogue between the blogger and his or her audience. Examples of widely used free “long-form” blogging platforms include Tumblr (www.tumblr.com), WordPress (www.wordpress.org), and Blogger (www.blogger.com). Some physicians use blogs to communicate with other HCPs or the public. For example, the Clinical Cases blog (www.clinicalcases.org) features case studies in a wide range of medical specialties. This blog also includes a special section on admission note templates, procedure guides, and related material. Blogs are becoming more popular among pharmacists, but approximately two-thirds of these blogs are written anonymously. Microblogs Microblogs provide the most dynamic and concise form of information exchange via social media. This format allows users to post a large number of brief messages or updates over a short period. Numerous microblogging platforms exist; however, Twitter is the most prominent. On Twitter, users publish messages (called “tweets”) that consist of a maximum of 140 characters. Tweets can be supplemented with hyperlinks to other online media, such as videos or websites. Tweets can also include “hashtags,” a form of information indexing that allows people to search for tweets that are related to a particular discussion or topic. Hashtags followed by HCPs include #HCSM (for Health Care Social Media), #MDChat, and #Health20. There are more than 140 reported uses for Twitter in health care. The Penn State College of Medicine has used Twitter to facilitate discussions between students and instructors, to conduct course evaluations, to solicit class responses, and to monitor students’ progress. A Twitter Journal Club also provides advance posts about papers and questions to be discussed, along with a hashtag, so that students, doctors, and anyone interested in the subject can interact. Twitter has also been used at medical conferences to discuss and enhance speaker presentations by posting real-time comments from the audience. Some physicians have used Twitter to develop a large following, enabling them to reach a broad audience and potentially even affect health policy decisions. Wikis Wikis are public forum websites featuring text and multimedia content that can be edited by users. “Wiki” is a Hawaiian word meaning “quick,” which refers to the speed with which information on a wiki can be accessed, added, edited, or deleted. Surprisingly, Wikipedia is the most commonly used wiki in the medical community. It is often used as a reference by clinicians, despite its known shortcomings, such as errors and narrow breadth of information. One study found that 35\% of 1,056 pharmacists used Wikipedia, although only 19\% trusted it. In another survey of more than 1,000 pharmacists, one in five respondents said they trusted Wikipedia, but only one in four knew that anyone could edit the site. One reason for the popularity of Wikipedia is its prominence in Google searches. A study found that 70\% of 35 junior physicians used Wikipedia to find medical information during a week-long period, with 93\% citing ease of use as their primary motivation. As the accuracy and completeness of Wikipedia are often debated, the drug information on that site was compared with a validated and trusted information source, the Medscape Drug Reference. This analysis found that Wikipedia included approximately 76\% of the content found in Medscape and had very few factual errors (most were errors of omission). In contrast, other studies have found that Wikipedia includes factual errors and has a lack of depth compared to traditionally edited, peer-reviewed, evidence- based information sources. Other wiki projects emulate Wikipedia in that they crowd-source medical content. However, to maintain editorial credibility, they also verify the credentials of contributors. RxWiki (www.rxwiki.com) allows only pharmacists to add or edit drug information. This was also the model for Medpedia (an initiative from Harvard University, Stanford University, the University of Michigan, and the University of California at Berkeley), which verified authors’ credentials before allowing them to generate content. However, when most articles posted on “author verified” wikis were compared with open initiatives, such as Wikipedia, they were found to be shorter, to be of equal or lesser quality, and to include fewer references. Wikipedia was also found to promote quality and accuracy more actively over a period of 90 days because of crowdsourcing, compared with Medpedia, which had a comparatively restrictive editorial process. Media-Sharing Sites Media-sharing sites, such as YouTube, offer a large selection of social media tools that are optimized for viewing, sharing, and embedding digital media content on the Web. They also provide features that are typically found on other types of social media sites, such as profiles, connections, comments, and private messaging. Most media-sharing sites are easy to use, provide free basic accounts, and are accessible from both desktop and mobile devices. In medicine, media-sharing sites can be important resources for education, community building, marketing, and branding. Among the most notable media-sharing sites for HCPs is The Doctors’ Channel (www.thedoctorschannel.com), which hosts videos featuring medical news, continuing medical education, and health care-related entertainment. Virtual Reality and Gaming Environments Multi-User Virtual Environments (MUVEs) are three-dimensional environments that allow users to interact with each other through a virtual representation of themselves (known as an avatar). The application of MUVEs in health care is growing rapidly. They are increasingly being used for patient education, for the simulation of epidemiology and mass prophylaxis, for psychotherapy, for surgery, and for research. However, the fact that MUVEs are often perceived as computer games rather than as serious clinical tools may impede their adoption by health care institutions. MUVEs can be classified as general-purpose or health care–specific. The most well-known general- purpose MUVE is Second Life. This general-purpose environment, however, is often used for health care education. One study found 68 health-related virtual locations on Second Life. These included the Centers for Disease Control and Prevention (CDC) education center, which aims to influence the real-life decision-making abilities of visitors. Health care–specific MUVEs are typically used for one purpose, such as medical education (e.g., CliniSpace [www.clinispace.com]), surgical simulation (e.g., OpenSim [www.opensimulator.org]), or psychiatric treatment (e.g., InWorld Solutions [www.inworldsolutions.net]). USES FOR SOCIAL MEDIA IN HEALTH CARE Professional Networking The most popular social media sites for physicians are those where they can participate in online communities, listen to experts, and network and communicate with colleagues regarding patient issues. The use of social media by pharmacists also frequently focuses on communication with colleagues. The social-networking platforms used for professional networking are often solely accessible and specifically cater to people within these professions. Besides clinical topics, discussions on these sites address diverse subjects, such as ethics, politics, biostatistics, practice management, career strategies, and even dating in a medical environment. They can also provide a supportive environment for HCPs who subspecialize. Another example of professional networking among HCPs is crowdsourcing, which involves harnessing the knowledge and skills of a community to solve problems or to gather information and opinions. Social media can also be used to connect HCPs in third-world countries with specialists in more medically advanced locations. For example, surgical procedures can be streamed via the Internet and questions can be asked via Twitter in real time. Thus, social media provide a new communication channel for HCPs to network professionally to share and exchange medical information in ways and at a pace that was never before possible. Professional Education The communication capabilities provided by social media are also being used to improve clinical education. The high usage rate of social media by 18- to 29-year-olds has motivated the adaptation of clinical curricula to reflect the changing habits and culture of incoming students. Many studies have described the use of social media tools to enhance clinical students’ understanding of communication, professionalism, and ethics. Universities are also using social media to recruit students, to increase access to academic libraries, and to create virtual classrooms and office hours, as well as other unique learning experiences. Social media are also being widely implemented in undergraduate pharmacy curricula. One-third of pharmacy programs have reported using Twitter in some capacity. A 2011 survey also found that 38\% of pharmacy faculty members use Facebook for teaching, with half reporting that they plan to use social media in the future. In one example, an instructor in a geriatric pharmacotherapy course at the University of Rhode Island used Facebook to encourage class discussions and to connect students with senior citizens who had volunteered to participate in the course. This experience improved student perceptions of older adults and also introduced the senior citizens to Facebook. At Auburn University, instructors established Twitter handles so that pharmacy students could participate in class discussions anonymously. By semester’s end, 81\% of students felt Twitter had let them express opinions they wouldn’t have shared otherwise, although 71\% thought that Twitter had been distracting. Online social media platforms have also influenced the educational experience for nurses, with one survey reporting that 53\% of nursing schools are now using these tools. For example, Twitter has been used to enhance the clinical decision-making skills of nursing students in critical care situations. The students viewed videos of clinical scenarios and tweeted their observations on the patient’s condition for instructor feedback. Other uses of Twitter in nursing education include posting a live stream of student insights during class, or creating a class hashtag so that resources such as videos, websites, articles, and photographs could be shared. Media sharing sites such as YouTube can also be used in the classroom to stimulate discussion, to illustrate a point, or to reinforce a concept. Students can view a video and then respond to questions that promote clinical reasoning. The incorporation of social media into clinical education has met with mixed reviews, however. Courses that incorporate such tools have generally been positively received, but in some cases, students have reported feeling that the use of Facebook for teaching purposes is an intrusion into their social lives. Balancing the enhanced communication opportunities provided by social media with the downside of increased distraction in an educational environment is also a challenge. Unfortunately, standards guiding the appropriate use of social media tools in education are in their infancy. Organizational Promotion Health care organizations, including hospitals, health systems, professional societies, pharmaceutical companies, patient advocacy groups, and pharmacy benefit companies, are using social media for many purposes. Uses include communicating with the community and patients; enhancing organizational visibility; marketing products and services; establishing a venue for acquiring news about activities, promotions, and fund-raising; providing a channel for patient resources and education; and providing customer service and support. It has been estimated that 70\% of U.S. health care organizations use social media, with Facebook, Twitter, and YouTube being the most popular. Blogs are also used by many medical centers and hospitals. Studies have shown that this use of social media can greatly enhance the image and visibility of a medical center or hospital. In one study, 57\% of consumers said that a hospital’s social media presence would strongly influence their choice regarding where to go for services. A strong social media presence was also interpreted by 81\% of consumers as being an indication that a hospital offers cutting-edge technologies. In another study, 12.5\% of surveyed health care organizations reported having successfully attracted new patients through the use of social media. The rate of social media adoption by nonprofit health care organizations is also increasing. The Mayo Clinic became an international leader in such efforts when it established the Social Media Health Network (http://socialmedia.mayoclinic.org) in 2010. In its mission statement for the network, the clinic said it sought to provide an “authentic voice for patients and health care professionals, building relationships through the revolutionary power of social media.” To that end, this initiative has created a presence on Facebook, YouTube, and Twitter. It also provides a vast library of blog posts, podcasts, conferences, and webinars to engage various community stakeholders. The Mayo Clinic and other educational health care institutions have also used blogs to foster peer-to-peer learning and to implement new protocols. Many universities also have a branded YouTube channel, where videos can be shared through the university’s social media site. Social media also allow pharmacies to communicate with large groups of customers simultaneously, to conduct surveys, and to enable patients to feel that they are part of a pharmacy community. Many pharmacies use social media to reach out to followers about products, services, discounts, newsworthy events, and health information. Several large pharmacies and insurers have piloted programs that provide prescription refill and appointment reminders via social-media text messaging. Patient Care Although there has been a reluctance among HCPs to use social media for direct patient care, this practice is slowly being accepted by clinicians and health care facilities. For example, Georgia Health Sciences University has provided patients with access to a platform called WebView, which allows the patients to reach their doctors to ask questions or to request prescription refills. Recent studies have found that physicians have begun to develop an interest in interacting with patients online. Some physicians are using social media, including Twitter and Facebook, to enhance communication with patients. Approximately 60\% of physicians were found to favor interacting with patients through social media for the purpose of providing patient education and health monitoring, and for encouraging behavioral changes and drug adherence, with the hope that these efforts will lead to “better education, increased compliance, and better outcomes.” However, other studies have shown that considerable resistance still exists to using social media to interact with patients. In a survey of approximately 480 practicing and student physicians, 68\% felt it was ethically problematic to interact with patients on social networks for either personal or professional reasons. Evidence indicates that electronic communication with patients can improve their care and health outcomes. Studies have shown that supplemental electronic communication emphasizes physicians’ advice and improves adherence for patients with chronic diseases. It may also improve patient satisfaction by increasing the time spent communicating with and having questions answered by their physicians. A survey of patients at an outpatient family practice clinic found that 56\% wanted their HCPs to use social media for reminders, for scheduling appointments, for diagnostic test results, for prescription notifications, and for answering general questions. Patients who did not use social media said they would start if they knew they could connect with their health care provider. Patient Education Social media can also improve patients’ access to health care information and other educational resources. In the U.S., eight in 10 Internet users search for health information online, and 74\% of these people use social media. Through social media, patients can join virtual communities, participate in research, receive financial or moral support, set goals, and track personal progress. Physicians are also using social media to promote patient health care education. They tweet, make blog posts, record videos, and participate in disease-specific discussion forums focused on patient education. Such forums provide an important opportunity for physicians to distribute evidence-based information to counter inaccurate material on the Internet. In some social media forums, the public is provided with an opportunity to participate in these discussions. Unlike other health advice that a patient might encounter online, physicians could use social media to develop messaging that may be more likely to resonate with and be acted on by patients. Some physicians believe that social media would be particularly beneficial for patients with chronic, rare, or fatal diseases; with questions about maternal or infant care; or with personal health-related goals, such as weight management. The distribution of credible information has been proved to motivate observable behavioral changes within social networks. Research has begun to show that interventions based on social media can positively affect weight loss, tobacco cessation, risky sexual behaviors, and physical activity. Patients are also using social media to connect with others affected by similar conditions. For example, the social networking site PatientsLikeMe (www.patientslikeme.com) provides a venue for patients to access information, suggestions, and support from other people who have the same disease or condition. Facebook groups also frequently focus on specific medical conditions. These groups actively engage in peer-to-peer support as well as fund-raising efforts for affiliated organizations and individuals. Public Health Programs Social media have created vast global networks that can quickly spread information and mobilize large numbers of people to facilitate greater progress toward public health goals. Social media can therefore be a powerful tool for public education and advocacy regarding public health issues. Some states’ public health departments are using Twitter and other social media for these purposes. Other public health organizations use keyword content from Twitter and other social networks, in combination with location-tracking technologies, to respond rapidly to disasters and to monitor the health and welfare of populations. The CDC maintains an active presence on Twitter and Facebook to track “tweets” that might indicate a flu outbreak and to share updates about such incidents. The CDC has also used social media to locate and monitor sources and suspected cases of Legionnaire’s disease. Organizations such as the Red Cross track Twitter posts during natural disasters, such as hurricanes and earthquakes, to gather information about where the greatest needs are. Citizen-report blogs have also been monitored by hospitals for information about potential mass casualty events. When used in this way, real-time social media sites provide greater agility and enhanced preparedness for responses to disasters and public health emergencies. Social media sites also provide disaster and emergency response personnel with a means to rapidly share and access important information provided by agencies such as the CDC and the U.S. Preventive Services Task Force. The widespread use of social media can also influence public health behaviors and goals through social reinforcement. Because human beings are a highly social species, they are … HCS/490 v11 External Influences on Consumer Choice Worksheet HCS/490 v11 Page 2 of 2 External Influences on Consumer Choice Worksheet Health care consumers receive various communications about different health care options. It is important to understand consumer demographics to determine the impact (positive or negative) media, social networks, branding, marketing, and communication play in health care consumer choices. In this assignment, you will research managed care plans to determine what impact social media and other external influences have on consumer behaviors. Research the different managed care insurance plans listed below by reviewing various health care organizations or resources (e.g., Kaiser as an HMO). Consider within your research who might access the health care systems (i.e., age, generation, socioeconomic status, military/veteran, and health care insurance plans, etc.). List 2 advantages and 2 disadvantages of HMOs, PPOs, and POSs in the following chart. Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Point of Service (POS) Advantages 1. 2. 1. 2. 1. 2. Disadvantages 1. 2. 1. 2. 1. 2. Write a 90- to 175-word response to the following prompts. Consider the information you listed in the chart above as well as what you know about consumer behavior when you compose your response. · Explain the impact media and social networking have on consumers when choosing the most appropriate managed care health insurance plans. Consider the positive and negative impacts. · Describe how branding, marketing, and communication influence a consumer’s choice when considering an appropriate managed care health insurance plan. Consider positive and negative influences. · Explain how communication and education to consumers differ by generation when marketing managed care health insurance plans. Consider why it is important to communicate and educate differently across generations. Cite 2 peer-reviewed, scholarly, or similar references. Copyright 2021 by University of Phoenix. All rights reserved. Copyright 2021 by University of Phoenix. All rights reserved.