Hey Doc, Pay it Forward

Every Sunday night physicians from all over the globe gather online to participate in a community twitter chat. They use the hashtag “hcsm”. It stands for healthcare social media. It’s like a speakeasy’s not so secret password used to connect the stream of tweets between the medical pros.

Mostly the conversation revolves around what should be shared, protecting patient confidentiality and which social platforms work best. But every few weeks the question of money comes up. Specifically, should doctors get paid for using social media?

The deft communicators work around the subject with carefully phrased tweets. It’s a little boring. So, I tried to imagine what the responses might be if the conversation was happening at a cocktail party and not online. I think it might go a little like this:

The early adopters like my friend Dr. Howard Luks might say, “I think we have a responsibility to be part of the conversation.  All of us should be participating in some way.  Ideally we should be making the stuff that starts conversation.  At a minimum we should be contributing to the dialog.”

His friend who leads a successful OBGYN practice might answer, “But there are only so many hours in a day.  Turning my ideas and experiences into tweets and posts takes time and energy that’s hard to work in between my clinic work, deliveries and family obligations. I don’t have time to whip up even the fifteen-second videos now seen on Instagram.”

“Oh, you two” the communications person from the office noses in to say “that kind of work is just part of maintaining a professional reputation.  The marketplace belongs to whoever finds the time or resource to translate what they know and share it with others.”

Look, I believe that some providers should be paid to participate professionally.  Maybe the big health systems and larger practices should dedicate staff to sharing, curating, talking and making content for social media.  It would be more than a public relations move. They’d be able to share their expertise in such a way so as to become a sort resource for the smaller practices, patients and family members of those with chronic health concerns.

Sharing information that is helpful to others via social media and providing hands-on patient care should not be seen as mutually exclusive, but rather as complementary.

And so as my imaginary cocktail party winds down one physician might say to another, “Hey Doc, only you know whether or not a public presence is the best use of your time but people value our voice and wisdom. And whether or not there’s a billing code for it, until we can get paid, I say let’s pay it forward.” And the other would reply, ”Let’s do it."

Want to talk about it? Find me www.twitter.com/timbigfish 

Hey Doc, Your Website is Dead

Remember the Tamagotchi? It was popular with teens and preteens in the late 1990s. Owners of these pocket-sized toys were told, “The Tamagotchi is a tiny pet from cyberspace that needs your love to survive and grow. If you take good care of your Tamagotchi pet, it will slowly grow bigger, healthier and more beautiful every day. If you neglect your little cyber creature, it may grow up to be mean or ugly.”

The question or game of it all was to know, “How old will your Tamagotchi be when it returns to its home planet?” Or, as the kids knew, before it died.  Its survival was up to the owner, or virtual caretaker as the toy manufacturer referred to them. But its death was inevitable. As with everything else that comes into the life of a child, it runs its course. The ecosystem for the pet would change considerably if the owner discovered the opposite sex, lost his backpack, was grounded, joined a cheer or sports team, or otherwise got busy with something more interesting than the digital pet in their pocket.

It’s that way in the real world too.

We live in an always tuned in, on-the-go world where apps own every conversation and Facebook is the Internet. Yet, you have a website that like that forgotten Tamagotchi hasn’t adapted to the changes in the (web) ecosystem. And now? It’s dead.

It’s dead to the referring physician upon whom you rely for business development.

It’s dead to prospective patients who rely on it to determine the role you might play in their care beyond medical jargon and outdated resources.

It’s dead to the caregiver, referring physician or healthcare partner who learns through images and video.

And it’s dead to anyone who might dare expect to connect, gather or interact with you when they’re sitting with an ailing family member or on the bleachers at soccer practice.

It’s dead because five changes occurred within the web ecosystem and you failed to adapt.

The web became about shared experiences. People want to be where their friends are and where people with shared values or common interests and concerns can interact.

The web became about personalization. People want to know that you know who they are.  You have to know what returning audiences find useful, recognize what they need more of and allow them to share what they’ve found useful elsewhere.

The web became about engagement. Users are no longer content to simply look at your info. They want to talk about it. Leave comments. Share ideas. See comments from others. See comments from you regarding their comments.

The web became mobile. Smartphone ownership is a pandemic. Your website has to have meaningful functionality and legible text on the smartphone form factor. For many, it has become the preferred touch point. But at the very least it must be a capable companion to the desktop experience.

The web became more visual. Pictures are still worth a thousand words. And they are among the most valuable assets your website can use to communicate your values, present your service, educate your audience and entice them to share what they learned on your site with others through a variety of sharing utilities.

What happened to the web ecosystem? It became social. You know social, right?

It’s that thing you do every time you share an article, click like, reply to a friend’s comment, upload a photo or subscribe to content from those who engage and inform you. And it’s not just for Facebook, Twitter and Pinterest. It should drive your website strategy.

People on social websites feel like somebody. And while you might not have noticed, sites that use social plugins and methods have empowered your patients and their friends. They’ve set an expectation for something more than well, what you’re doing on your website.

The Tamagotchi had a speaker. It was the cyber pet’s mouth, so to speak. Certain tones or beeps would convey the pet’s status – I need water. I need sleep. I need you to play with me – it’s plea that you’d something.

So, consider this your website’s plea for you to do something. The savvy Tamagotchi pet owner knew how to reset the toy when he or she recognized it was near death. I bet I know a kid or two who might be able to reset your website. And now you know what must be done for it to “grow bigger, healthier and more beautiful every day.”

Hey Doc, Do You Play Ball?

Sharing information has to start with this – know to whom the information belongs. Hint: it’s not you, Doc, even if you’re the one holding it.

It’s like it was yesterday. It was the first day of school in the second grade. I’d carried my baseball glove and ball for a game of catch during recess. Ricky had done the same. We chose to use his ball. He’d painted it green and yellow to honor his beloved Oakland Athletics. Mine just had a big “T” on it. I left it on my desk.

On the way to recess the new kid asked if he could use my ball. He didn’t have one but he looked like he knew how to play. And since Mom had taught me to share, using mine was fine.

When recess ended I went to retrieve my ball. The new kid threw the ball back to me. But it got by me and the teacher politely picked it up. She and I talked baseball on the way back to class. We were settling back in our seats before I realized that she still had the ball. I watched her put it in her desk drawer. Cool. It would be safe there until I needed it.

After class I went to her desk to ask for the ball. I waited as she talked to another kid. Meanwhile, Mom was waiting in the carpool line. Knowing that, I reached for the handle on her desk drawer to retrieve my ball.

The teacher slapped my hand with a ruler and said, “You can’t look in there.” “Yes, ma’am. But I’m just getting my ball while you’re busy with another patient (oops, I mean student).”

My ball. Someone else used it with my permission. She now stored it. I wanted to use it. She suddenly acted like it was her ball. Okay, maybe I needed some sort of permission to access it. Maybe she had stuff in there from other kids. But at some level it should have been reasonable to let me get my ball – even a second grader knew that.

So is the way it goes with patient data. The ball Ricky and I used was green and yellow. Maybe you’ve heard of the “blue button”.  The Department of Veteran Affairs initially implemented it. Other public and commercial health plans have since adopted it. More than a million patients currently have access to their health data with the tool as found on health plan websites.  And here’s what we learned about its use and patient views on personal health information at last summer’s Consumer Health IT Summit:

Who owns it – “It’s my right to have it,” said one veteran who suffers from a heart condition and Type 2 diabetes. “They’re my medical records and, with the Blue Button, I’ve got control of them.” Not only does he own it, he knows that it can be easy to access.

Who stores it  – “There’s a wide perception out there that HIPAA is a barrier,” said Department of Health and Human Services Director of the Office for Civil Rights Leon Rodriguez, JD. “HIPAA is a valve, not a blockage. HIPAA is meant to regulate health information so that it is used to benefit the patient and for no other purpose.”  So maybe the IT guy should stop offering, “We can’t do that. It’s a security issue,” in response to how it’s stored and accessed and admit that it’s really just an attitude issue. Most of your patients are accessing confidential information from other sources (i.e. the bank). They don’t see their health record as any more valuable than their banking information or any more difficult to access or secure.

Who uses it – allowing access “moves us from personal health records tethered to particular providers to the concept of a personally controlled health record,” National Coordinator for Health IT Farzad Mostashari, MD, ScM, said. Rather than just viewing the record, users are encouraged to take ownership of their data. Patients can add information, point out errors in their records and share their health information with whomever they like.  Heck, they could even put a big “T” on it if it’s theirs.

Individually owned health information is expected to produce better health outcomes in the patient-centered future of healthcare. So let’s agree that the patient owns the data. Let’s let them share it as they like. And let’s accept the notion that whether on the clinic’s system or in the teacher’s desk drawer – we’re going to have to allow the owner to access it when they like even if it’s just for another game of catch.

Hey Doc, (ahem) There's an App for That

First the dramatic lead. We’re facing a health care crisis of enormous proportions. The cost of care is already rising, but the combination of an aging population and changes to diet and lifestyle leaves a growing percentage of the population susceptible to chronic health conditions, such as heart disease and diabetes, which further drive health care costs.

Now, for an overly simple response to the dramatic lead. Then let’s not do those things that will lead to higher health care costs. Well, one of those things is desirable – to age would suggest that we’re continuing to live. So, let’s focus on the others – changes to diet and lifestyle.

Affecting changes to lifestyle or diet may not be as expensive as you think. In some cases it might even be free. And, it may even be fun. But it won’t happen in the exam room. After all, that’s where you raise the flag for your patient and where it later becomes clear as to whether or not what you have suggested is working.

Since it’s not the exam room, then where? Your patient’s ever present smartphone. Yeah, let’s tap into that and see if we can affect their behavior toward a better health outcome.

Did I say, “Tap into?” Uh huh. And that leads us to this: Five Apps That Promote Health and Wellness via patient smartphones.

  

1.     My Medical ($2.99) Start by being organized. This app allows patients to manage their medical conditions by maintaining better records including recent doctor visits, labs, X-rays and medical procedures. Patients can keep track of their records, family members and loved ones, which is helpful for parents and caregivers – and you

2.  Pill Reminder ($.99) Months ago we discussed the impact a text reminder had on health outcomes for those taking prescription meds. Clearly, people have trouble remembering to take their medication whether it’s a daily multivitamin or a medication for treatment of a chronic condition. This app could save a life by simply reminding the patient to take their medicine.

3.     Meal Snap ($.99) What if you could snap a photo of your meal and automatically know how many calories of food were on your plate? This app does that. Could calorie counting get any easier? You can also share what you’re eating with others to build a network of social accountability. Maybe someone will call you out the next time you snap a photo of a beautifully plated chicken and waffles.

4.     White Noise (Free) Studies say that most of us aren’t getting enough sleep and many of your peers suggest that certain health issues could be managed by meditation instead of medication. But how do you get the rest or take the time out? The white noise app drowns out distracting sounds so that you can relax or sleep. Sleep or meditate instead of medicate? I like the sound of that.

5.     Pedometer (Free) Your patient probably has to put down the smartphone when you walk into the exam room. It’s ever present. So, why not use the built-in GPS to transform their iPhone into a pedometer that tracks how far they walk? Set a goal for your patient to walk however many steps a day. Regular exercise can lead to weight loss, reduced blood pressure, improve cholesterol and lead to other positive health changes – one step at a time.

Look, that’s just five that help patients be better organized, take their meds, eat better, rest better, and get regular exercise. I’m not even going to get into the apps that allow patients to pee on a stick to determine whether or not they have an STD. Or, apps that allow users to study intestinal wellness by comparing photos of their stools to healthy stools on the way to your helping them to diagnosis bowel related illnesses. Oops, too late guess I did get into those.

So let’s keep it simple. Perhaps you can help your patient focus on their well being and we can all work to lower health care costs by simply learning to utter what in most industries is already a tired phrase, “there’s an app for that.”  Sorry, I had to say it.

Wanna talk about it? Hit me up at www.twitter.com/timbigfish