Farris Timimi, MD
Medical Director, Mayo Clinic Center for Social Media
September 20, 2012

Agenda
•   Mayo Clinic ʼ s progression into social media
•   Case studies of practical use
•   Why involvement in social networking is not really optional for health care
•   Morality and Professionalism
•   Discussion

Involuntary Social Networking Presence: http://myspace.com/mayoclinic

Facebook: 11/7/07

not

They Do Face This …

•   Established July 27, 2010
•   Our Raison d ʼ etre : The Mayo Clinic Center for Social
Media exists to improve health globally by accelerating effective application of social media tools throughout Mayo Clinic and spurring broader and deeper engagement in social media by hospitals, medical professionals and patients.
•   Our Mission: Lead the social media revolution in health care, contributing to health and well being for people everywhere.

Social Media Health Network
•   Membership group associated with Mayo Clinic
Center for Social Media
•   For organizations wanting to use social media to promote health, fight disease and improve health care
•   Dues based on organization revenues
•   Industry members eligible, but no grant funding
•   >100 member organizations

A Sample of Network Members
•   American Hospital Association
•   Radboud University Nijmegen Medical Center
•   Jamestown Hospital
•   National Cancer Institute
•   Vanderbilt University Medical Center
•   See Full List at http://socialmedia.mayoclinic.org/network/

Health Care Decision-Makers Aged 25+
Total
18.6%
7.6%
6.1%
3.4%
2.5%
1.8%
1.6%
1.3%
2010 US Consumer Brand Monitor, decision-makers 25+, n=5,279
©2011 MFMER | slide-17

Sources Influencing Preference for Mayo Clinic
Word of mouth
News stories
Hospital ratings
Internet
MD recommendation
Personal experience
Advertising
Direct mail
Social media
Insurance plan
2010 study (n=119)
Consumer Brand Monitor, Base: Respondents who prefer Mayo Clinic;
*differs significantly from Q2-2010
©2011 MFMER | slide-20

Mayo Clinic’s First Social Networkers

Mayo Clinic Medical Edge
Syndicated News Media Resources

First Foray in “ New ” Media
•   Existing Medical Edge radio mp3 files
•   August 2005: 900; September 2005: 74,000
•   8,217% download increase

ʼ

8 Seconds out of 22 Minutes

Recovering 99.41% for the 1-2%
•   Required almost no incremental MD effort in production
•   Process change - microphone on physician and interviewer
•   90 minutes of editing per interview
•   More than 60,000 “ hits ” and 62 comments

Podcast Blog Enables Dialog
2009 Patient Brand Monitor, n=900
©2011 MFMER | slide-18

•   Video of elderly couple from Ankeny, Iowa playing piano in Gonda atrium
•   Video shot by another patient in Sept. 2008 and uploaded to YouTube by her daughter
•   Video had been seen 1,005 times in six preceding months since upload
•   Embedded in Sharing Mayo Clinic , posted to
Facebook, Tweeted on April 7, 2009

The next day...

Six days later...

April 22

Sunday, May 3

May 4

Cinco de Mayo

May 10

May 11

May 12

May 15

Early Morning May 26

May 26, 2009: Live in Studio
Good Morning America

Results to Date
•   More than 8 million views on YouTube
•   >1.5 million views on Sharing Mayo Clinic
•   From 200 views/month to 5,000 views/hour
•   National TV coverage in U.S. and Japan

What made this work?
•   Adorability of Mr. and Mrs. Cowan and the joy they brought to every viewer
•   Infrastructure for easy sharing and rapid growth
•   Sharing Mayo Clinic blog 3 months old
•   Mayo Clinic Twitter account 11 months old
•   Mayo Clinic Facebook 18 months old

Jayson Werth ʼ s Experience

Nov 12, 2009
USA Today
3031031-7

Last Friday
3031031-9

Less than 24 hours after my initial appointment, I not only had a new diagnosis - a UT split tear - but had surgery to correct the problem. As I write this, my right arm is in a festive green, but otherwise annoying cast. The short-term hassle, however, should be more than worth the long-term gain - the potential for a future without chronic wrist pain. A future, that without Twitter and those in the medical community willing to experiment with new communications tools, might not exist for me.
3031031-10

Case #4
Demand Generation

Case Study #5: Research
Spontaneous Coronary Artery Dissection
•   Who Drives Research?

F indings being published in
M A Y O CLINIC
PROCEEDINGS
S ep t ember 2011 issue
S C AD?
©2011 MFMER | 3139261-

Case #6: The archived nature of social media

Lessons Learned
•   Be Ready
•   Grow it for Patients
•   Social Media is the Right Thing to Do, not a
Marketing Strategy
•   Providers have a Range of Involvement
Options

One more case … .
©2011 MFMER | 3139261-

St. Vincent Medical Center-Portland
©2011 MFMER | 3139261-

Criteria for Mayo Clinic Heart Video Project
•   Not a “ me too ” copycat
•   Could (should) be fun, but with a serious educational purpose
•   Dancing to a popular song not enough
•   Well-known original song for which we can do a meaningful parody
©2011 MFMER | 3139261-

©2011 MFMER | 3139261-

©2011 MFMER | 3139261-

©2011 MFMER | 3139261-

Our “ Know Your Numbers ” Premise
•   It ʼ s 30 years since their first encounter
•   Tommy is a changed man
•   He ʼ s slowed down a bit
•   He ʼ s no longer obsessed with Jenny ʼ s phone number
•   He drives a minivan
•   Jenny hasn ʼ t changed her phone number
•   He ʼ s calling to tell her about some more important numbers. Instead of 876-5309, they are...
©2011 MFMER | 3139261-

See full video on our Mayo Clinic Facebook page
©2011 MFMER | 3139261-

•   YouTube Video
•   Facebook application with interactive calculators for
•   Heart attack risk
•   LDL cholesterol
•   Body Mass Index
•   Contest site at http://knowyournumbers.me
/

Professionalism online and the morality of social media

What is professionalism?

Heart and Soul of Medical Care
•   Professionalism means safe care
•   Health care is delivered by teams who need to communicate well, honestly, respectfully, confidentiality and responsibly
•   That team includes all of us in health careincluding patients and their families

Core Values
•   Professional competence
•   Honesty with patients
•   Patient confidentiality
•   Maintaining appropriate relations with patients
•   Improving quality of care

Core Values
•   Improving access to care
•   Just distribution of finite resources
•   Scientific knowledge
•   Maintaining trust by managing conflicts of interest
•   Professional responsibility

Is part of being professional being online?

How is being online part of professionalism?
•   Unique moment in history-two overlapping trends
•   Information overload at the same time as evolving information transparency
•   Less daily time for direct patient care at the same time as more time spent by patients online

Information Overload
•   PubMed-21 million citations, one new/min
•   Over 200 Cardiology journals
•   497 cardiology guidelines
•   More and more knowledge is being made available online and in a transparent fashion

Who is the lived expert?

Where did our time go?

Time, the most precious commodity …
Direct Care-20%
Documentation-35%
Assessment/
Vitals-7%
Medication-17%
JONA, 39, 6:266-275
Care Coordination-21%

Why we need to be online
•   Is it any wonder that 61% of us have sought knowledge and support online?
•   The value of that conversation is purely dependent on two factors: access to the conversation and the quality of the knowledge shared

Where are our patients spending their time?
•   Three most common activities online: Internet search, e-mail and seeking health care information
•   Time spent online in social media: 110 billion minutes/day worldwide
•   22% of time spent online is spent in social networking

Why we need to be online
•   Yet, all too often, we in health care are absent from that conversation
•   “Don’t want to be sued!”
•   “Who will pay for my time online?”
•   “What about HIPAA?”

Is part of being professional being online?
•   Each of us are all the lived experts of our own disease
•   All of us will soon have access to the same shared knowledge
•   If we are strategic we can partner with patients and walk with them on their journey online as well as offline
•   We can help shape the conversation, leverage information and ensure that credible content fills the void

What happens when we stay on the sidelines?

The Impact of Silence:
Vaccine Hesitancy
•   Efficiency
•   Each discussion averages 5-10 mins
•   By 24 months, 14 vaccines over 8 visits
•   80% of primary care providers report 1 vaccine refusal/month; 8% of providers report
1 in 10 parents refused vaccine
•   Liability
•   Several law suits brought by parents whose children suffered from vaccine refusal

Vaccine Hesitancy
•   Health Care
•   13 years since Wakefield, dramatic drop in
MMR in EU with a marked increase in measles and mumps
•   EU-2011-major measles outbreak in 33 countries, to include 10,000 in France alone

Is part of being professional being online?
•   We must partner with patients in content creation, curation and decision making
•   Leverage the content, leverage the conversation, leverage the good

Advocate for those who may be excluded
•   Remember the access angels, libraries, houses of worship
•   Consider mobile capable information
•   Remember the disabled and chronically ill
•   Remember those with rare disease who geography isolates

Key elements of professionalism in health care social media

Social Media and Professionalism
•   Online behavior should seamlessly merge with offline behavior
•   Social Media can highlight professional lapses
•   But it can also empower our mission in domains of practice, research and education
•   Social Media can facilitate a professional culture

Professionalism and Social Media
•   Before you take the leap
•   Develop/Review your organizational social media policy guide
•   Define your opportunity and operational goals
•   Remember you represent your organization as well as yourself
•   Know and review your privacy settings

Professionalism and Social Media
•   After the plunge
•   Be real
•   Be professional
•   Be respectful
•   Learn the rules of the road before driving
•   Just like a good marriage, you will be judged more by how you listen then what you say

Professionalism and Social Media
•   After the plunge
•   Foresee and count to 3
•   1-Who is your audience?
•   2-Is this appropriate for all ages?
•   3-Am I adding value to the ongoing conversation?

General Concepts
•   Unless it is still in the cache, you can ʼ t put it in the trash
•   Always surmises that HIPAA applies
•   Speak on your behalf, not that of staff
•   Anonymity is really gimmicky
•   If you chat about your company, identify abundantly

General Concepts
•   Don ʼ t endorse as a matter of course
•   Supervisors: Don ʼ t initiate an employee friend request at your own behest
•   Separate your circle of friends from patient ʼ s you mend
•   Corporate logo in your username is a no go
•   Adding a disclaimer is probably saner
•   Don ʼ t practice on the Internet, regardless of your good intent

Remember
•   Errors will occur
•   Develop a social media policy
•   Provide orientation and training
•   If a mistake happens, remember it is one game in a season

e-Hippocratic Oath-Scott Albin, M.D.
•   “ What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of a patient, I will keep confidential holding such things shameful to spread online. I will conduct myself online in accord with the professional ethical standards I have sworn to uphold and keep myself far from all ill-doing and seduction ”

Professionalism and Social Media
•   Don ʼ t Lie, Don ʼ t Pry
•   Don ʼ t Cheat, Can ʼ t Delete
•   Don ʼ t Steal, Don ʼ t Reveal

For Further Interaction:
•   @FarrisTimimi on Twitter
•   timimi.farris@mayo.edu
•   http://socialmedia.mayo.clinic.org
•   https://www.facebook.com/MayoClinic
•   http://pinterest.com/farristimimi

Know the risks-know how it to avoid them

What do we know about behavior online
•   From a general vantage
•   From a medical vantage

General Online Behavior
•   47% of Facebook users have profanity on their wall
•   56% of profane posts/comments come from friends
•   Most common is derivations of “ f-word ” , second most common is derivation of “ sh*t ”

Online Behavior and Job Application
•   89% of recruiters and HR staff research candidates online - from this morning ʼ s Tweet to last night's Facebook picture
•   Over 80% admit to rejecting candidates due to findings

Survey, 2007: 271 Medical Blogs
•   Over half provided sufficient information to reveal the bloggers identity
•   Individual patients were described in 42%
•   Patients were portrayed positively in 16%, negatively in 18%
•   11% promoted products either by images or descriptions

Microblogging: Tweeting Docs
•   2011 one month survey
•   260 Users, 5156 Tweets
•   Less than 3% of Tweets were characterized as unprofessional
•   0.7%-potential patient privacy violation
•   0.6%-profanity
•   0.3%-sexually explicit material
•   0.1%-discriminatory statements

National Survey of State Medical Boards
•   71% of boards responded
•   92% of boards reported at least 1 online violation
•   Most common: inappropriate patient communication online, Internet prescribing without an established clinical relationship and misrepresenting credentials online
•   In total, these transgressions represented a relatively small percentage of the total board actions in the FSMB database

Professionalism and Social Media
•   Social Media Tools do not cause professionalism violations
•   They leverage behavior and errors to a larger audience
•   By doing so, they “ educate ” a larger audience of transgressions

Professionalism and Social Media
•   Previously, if you accepted concert tickets from a vendor, only you and the vendor knew
•   In a social media platform, if you accept tickets from a vendor, everyone following either you or the vendor will know

Offline Breaches of Professionalism
•   Legal Departure
•   Altering a medical record
•   Performing duties outside scope of care
•   Ethical Departures
•   Carrying out inappropriate orders
•   Failure to support a patient ʼ s basic right to privacy
•   Practice Departure
•   Neglecting signs that result in patient suicide

Online Breaches of Professionalism
•   Legal Departure
•   Internet prescribing without an established clinical relationship
•   Ethical Departures
•   Derogatory or racial comments in a social media platform
•   Practice Departure
•   Tweets that represent potential patient privacy violations