Stop Diabetes: Start in Lowell-Towards a state-of-the-art
Diabetes Care Center
Rajaa Nahra, MD
Endocrinology, Diabetes and Metabolism-Lowell General Hospital
Digital Strategies for Health Communication (HCOM512)
MS candidate-CTSI-Tufts University, Sackler School of Graduate Biomedical Sciences
Table of Content
1
Executive summary......................................................................................................
2
About Lowell General Hospital .....................................................................................
3
Mission .........................................................................................................................
4
Planning Horizon..........................................................................................................
5
SWOT Analysis ............................................................................................................
6
Goals ...........................................................................................................................
7
Personas and Stories...................................................................................................
8
Competitive Analysis....................................................................................................
9
Social Media ................................................................................................................
10 Mobile technology ........................................................................................................
11 Recommendations for digital strategy ..........................................................................
12 Conclusion ...................................................................................................................
13 References ..................................................................................................................
14 About the author ..........................................................................................................
Organization Name: Lowell General Hospital
1-Executive summary:
Effective diabetes management requires medication usage and behavioral changes to
improve glycemic control with a goal to ultimately reduce excess morbidity and mortality.
Emphasis has shifted from physician-directed management to patient self-management as 95%
of the variance in glycemic control is due to patient-level factor(1). Technological advances such
as remote monitoring devices and electronic diaries are changing chronic disease management
(2). According to recent Pew reports, 59% of adults in the U.S. have looked online for health
information in the past year. In 2012, 1000 consumers were surveyed by the consulting firm
PwC and nearly a quarter of patients reported that they are using social media to manage their
health care. Many patients said they are interested in making appointments online, receiving
appointment reminders through texts and interacting with physician practices through secure
emailing options.
In 2011, 51.1% of type 2 diabetes patients in Lowell were likely to be of working age (18
to 64). As type 2 diabetes shifts from a disease primarily affecting older adults to one affecting
the younger generation and specifically the working force, it is important to utilize technological
devices that may better serve in self-management. When it comes to meeting goals in diabetes
care, the shares of type 2 diabetes patients with an A1c level greater than 9.0% increased in
Lowell to 10.5% from 9.9% in 2011. Health care limited to clinic visits does not meet the needs
of many patients with diabetes. Care systems that use digital strategies in communication
provide an opportunity to shift the focus in health care away from the office and toward patients’
daily lives at home and therefore, can have positive impacts on self-management of chronic
illness(5). This approach is well consistent with the vision of the Institute of Medicine and the
Patient-Centered Advanced Medical Home (3-4).
In this paper, I propose a Lowell General Hospital Diabetes Care Center web strategy. I
recommend: (1) a diabetes care center dedicated page on the hospital's website that offers a
user-friendly content and structure, (2) developing a mobile application for the Diabetes Care
Center to bypass the hospital's website for those patients without access to computers or who
simply do not use computers. The mobile application will provide a user-centered simpler form
of technology, (3) creating personas, and (4) having a social media plan for the Diabetes Care
Center to post updates and general health reminders.
Lowell General Hospital can position itself as one of the state's leaders in State-of-theArt Diabetes Care.
2-About Lowell General Hospital:
Lowell General Hospital is a community hospital serving Greater Lowell (MA) with a fullrange of health and wellness services and specialties for all ages. Lowell is the fourth largest
city in Massachusetts with a population of 107, 584 as of the 2011 census. Lowell is an
ethnically diverse city, with 62.5% of the population being Caucasian, 16.5% Asian, 14% Latino,
4.2% Black, and 2.5% other ethnicities. Lowell has the second largest Cambodian population in
the United States. The city has a diabetes prevalence of 10.1% as compared to 7.5% in the
state of Massachusetts as reported by MassCHIP in 2010.
Lowell General Hospital has been ranked among the top 10 hospitals in the metropolitan
Boston area and 12th overall in the state of Massachusetts for 2013-2014. The U.S. News &
World Report's 24th annual Best Hospitals ranking identified Lowell General Hospital among the
high-performing hospitals in the nation in the area of Diabetes and Endocrinology. Currently, the
hospital does not have a diabetes care center.
3-Mission:
The hospital's mission is "Patients First In Everything We Do".
"We are sensitive and responsive to the individual needs of our patients and their family
members; we are committed to providing quality care to our patients through a highly trained
and motivated staff, state-of-the-art equipment, progressive clinical care, and collaborative
teamwork; we continuously evaluate and improve our services to meet the needs of our patients
and the community we serve; we go the extra mile to serve our customers with kindness,
compassion, and respect."
My proposed additions to align the mission statement of the Diabetes Care Center with that of
the hospital are the following specific points:



The Diabetes Care Center's mission is to prevent and treat diabetes keeping "patients
first in everything we do".
Diabetes management requires continuing medical care and ongoing self-management
education and support. We believe that by effectively engaging people living with
diabetes, we can sustain behavior change.
We strive to be the leading regional provider of comprehensive diabetes care services to
improve both the quality of life and the health status of people living with diabetes.
4-Planning Horizon:
I suggest the following planning horizon which pertains to the Diabetes Care Center digital
strategy.
Phase 1: Create a new dedicated Diabetes Care Center page and sub-pages on the Lowell
General Hospital website.
Phase 2: Reach out to content creators to build a user-centered and socio-technical design and
involve end-users during system design and development (user-centered design).
Phase 3: Focus on external outreach through social media, email updates, and advertising.
Phase 4: Evaluation and Revision
Phase 1 and 2 could be conducted at the same time depending on staffing availability. These
phases could take anywhere from one to two years at a minimum. Phase 3 is a continuous
process but could show increases in use within a few months. Phase 4 is also an ongoing
process and would enhance the goals of previous phases.
5-SWOT Summary:
A digital strategy needs to maximize the potential of the strengths and opportunities while
minimizing the impact of the weaknesses and threats. A SWOT analysis illustrates where an
organization currently stands internally and in the context of an external environment.
Strengths
Weaknesses
- Strong unified community health care system
- One of the top 10 hospitals in metropolitan
Boston area
- Visionary leadership
- Dedicated staff
- Existing hospital website with social media
presence
- First hospital in MA to deploy iTriage, a
smart-phone app that allows consumers to
locate medical information and local medical
services
Opportunities
- Current homepage is crowded, difficult to
navigate and has complex content
- Diabetes Care Center is not developed yet
-No mobile website and iTriage tab is not well
known or readily visible
- Limited options for other languages
-You tube uploads outdated
- Face book and twitter focus more on the
organization
- Strong rapport with partners and state and
local public health departments
- Already a trusted resource for health care
- Other community, regional and even
academic hospitals do not have a digital
strategy for their diabetes care center
-Public’s growing need for mobile information
- Build on and learn from the experience of
others
-Medical landscape changing in MA; patientcentered care
- Saturated Diabetes Care in Boston with
Joslin taking all the attention
-Waiting too long to implement strategies
-Competing projects within organization
- Patients do not have electronic access to
their health information
Threats
6-Goals and measures of success:
This step of the strategy is important to guarantee any project or task serves to meet at least
one goal. Setting a measurement for each goal tells you if your efforts were successful.
Goal 1 (Internal): Create a new dedicated Diabetes Care Center page and sub-pages on the
Lowell General Hospital website.
Measure of success 1: a- Evaluate webpage traffic
Goal 2 (Internal): Reach out to content creators to build a user-centered and socio-technical
design and involve end-users during system design and development (user-centered design).
Measure of success 2: a- Evaluate webpage traffic
b- Survey webpage visitors and users about content
Goal 3 (Internal): Use a blog on the website to educate consumers and patients by providing
correct information and to counteract wrong medical information posted online
Measure of success 3: a- Evaluate blog' s number of comments and their quality but also
readers’ participation and feedback
Goal 4 (External): Increase awareness of the website and the Diabetes Care Center among
consumers, patients, healthcare providers and partner organizations.
Measure of success 4: Survey healthcare providers, patients, consumers and partner
organizations to see if they know what the website offers and therefore what services are
available at the Diabetes Care Center.
Goal 5 (External): Overarching goal would be to assist clinics with limited resources or
personnel and who are not connected to large health care systems in diabetes management
through telemedicine.
Measure of success 5: Partnership with centers within a large geographic area to
improve diabetes care through telemedicine
7-Personas and Stories:
Personas are fictional users. They are compelling because they identify the user motivations,
expectations and goals responsible for driving online behavior. They bring users to life by
putting a personal human face on otherwise abstract data about consumers and patients.
Name: Juan Cruz
Category: The self employed
About Juan: Juan is a 46 year old Latino male who owns a landscaping business. He is married
and has 2 sons, 2 daughters and 2 step-sons. His wife is a stay-at-home mom. He was
diagnosed with type 2 diabetes 6 years ago and has been on oral medications. His diabetes has
not been well controlled as he has not had a primary care doctor and has not had the time to
take care of himself. He has a low level of health literacy. He does not use a desktop computer
at work; but always carries his Blackberry. Both his mother and father who live in Puerto Rico
have diabetes. His father has kidney problems related to diabetes and is on dialysis. His mother
has severe numbness and pain in her legs due to diabetes. She had ulcers in her right foot and
underwent amputation of her right big toe.
A day in the life: Juan wakes up at 10 AM even though he is supposed to wake up earlier to
make sure that the "guys who work for him are all set". He stays up late watching TV and
struggles to wake up in the morning. His wife wakes up early and gets the kids ready to go to
school. She prepares breakfast for Juan as he enjoys eating a big meal in the morning. Juan
has eggs and bacon with potatoes for breakfast. He also likes to eat bread with butter. He does
not have any routine exercise as he has to get to work but he is active at work. He drives his
truck around 11 am and goes to different houses in the Lowell area to help his guys with the
work. Juan has not been feeling well lately. He feels thirsty all the time and has been going to
the bathroom a lot. His energy is low and the guys keep telling him he needs to see a doc. Juan
thinks his symptoms are related to high sugar. He has a lot of questions and has tried to look for
some answers on his blackberry. He does not have time to look through all the information and
decides to discuss with his wife when he gets home.
Scenario: Juan gets home at 7 pm. He feels very tired. His wife has prepared dinner and he is
very hungry. He ate a burger from MacDonald's for lunch. He does not have a glucometer and
does not check his sugar. His wife told him that he should call Lowell General Hospital and get
some help. He calls the operator who suggested he goes to the emergency room. Juan told his
wife that he cannot do that as they have a large deductable through his medical insurance. He
will check on his blackberry to see if the hospital has a website and if they talk about diabetes.
He finds the website hard to look through on his blackberry. He presses the "patients and
visitors" tab but does not find any information about diabetes. He also does not find anything in
Spanish. He felt very overwhelmed and called the operator again who suggested again he
should go to the emergency room.
Name: Mary Jones
Category: The University of Massachusetts-Lowell new director of graduate admission
About Mary: Mary is a 52 year old female who moved to Lowell from Dallas, Texas to accept a
position at Umass Lowell. She was diagnosed with diabetes 12 years ago and has been on
insulin for the last 3 years. She is very active and is a runner. Her diabetes is under good
control. She is very interesting in new diabetes technology. She injects insulin 4 times a day.
She is very interested in going on insulin pump. She has met with the diabetes educator in
Dallas but decided to wait to go on insulin pump until she moved to Massachusetts. She has
heard about Joslin clinic but does not want to go there as she has heard Lowell General
Hospital is one of the best hospitals in the state. She knows that they are amongst the most
wired hospitals in the country and she is hoping to get all her diabetes care locally.
A day in the life: Mary wakes up at 6 AM and goes for a run. She has met a longtime employee
of the Graduate School who is also a runner and they have formed a team. Mary mentions to
her friend and colleague Joanne that she has diabetes and that she wants to go on an insulin
pump. She told her that the pump allows more flexibility. Joanne mentions that her niece is a
nurse at Lowell General Hospital. Her niece talks all the time about the state-of-the-art pain
center that she is working at. Mary is pleased to hear that and says that she is confident the
hospital has an equally good diabetes care center. She goes back home after her run as she
lives close to campus. She showers and gets dressed. She then has a protein shake and some
berries and gets ready to walk to work.
Scenario: She googles Lowell General Hospital as soon as she gets to her office. She finds the
website to be rich but crowded. She clicks on "patients and visitors" tab but does not find any
information on diabetes. She clicks on "services and specialties" but she does not find a
diabetes care center tab or a pump program. She types "diabetes" in the "search site" and
learns that that there is a diabetes support group. She only finds information about time of
meeting and a phone number. She scrolls down and finds an HTML page for useful links and
one for endocrine system WK. Mary is a strong diabetes advocate and has attended several
meetings sponsored by TCOYD ( Taking control of your diabetes). She really likes their website
and thinks Lowell General Hospital should partner with them to become a leader in the region
on diabetes education and management. She believes TCOYD is a national leader in focusing
on the importance of diabetes education and self-advocacy. She likes their online reality-based
series that educates the world on the lives of those living with diabetes. She thought the content
on the Lowell General website is organization-centric and that there is a lot of cluttering. She
was surprised that the website does not allow visitors to choose between three font sizes, and it
does not incorporate assistive technology . She has come to learn about the different cultures in
Lowell and was surprised that the website lacks versions in Spanish and Khmer.
Name: Chandra Ty
Category: The Cambodian Physician assistant
About Chandra: Chandra is a 38 year old female who graduated as physician assistant recently
and will start working at the Metta Health Center in Lowell. She has a 14 year old son Josh who
has type 1 diabetes. He has been managed at Joslin Diabetes Center and is on insulin pump.
Commute to Boston has been very difficult. Chandra is a single mom and has struggled to take
her son to all his appointments over the last 3 years since he was diagnosed. At that time she
was going to school in Boston and was living there. She has accepted a full time job at Metta
Health Center. She is very worried about keeping up with the commute to Boston and having to
work 8 am till 5 pm every day.
A day in the life: Chandra wakes up at 6:30 am to get ready to go to work. She wakes up her
son so he can get ready to go to school. He has to check his blood sugar before he eats
breakfast. He does not like to check his blood sugar and has not been coping well since they
moved to Lowell. His blood sugar has been running high and he does not feel well most of the
time. Chandra has been very supportive and tries to spend a lot of time with him. She is very
involved in his diabetes management. She coaches him all the time about healthy lifestyle and
eating habits. She makes sure he checks his blood sugar and boluses insulin before he eats.
She checks on him frequently at night to make sure his blood sugar is not low. She is getting
very concerned that she will not be able to spend enough time with him because of her new job.
He has done well over the last couple of years and has not had diabetic ketoacidosis
necessitating hospital admission but she attributes this to a great team of providers that he had
at Joslin. He also had friends who, like him had diabetes, and were on insulin pump. He was
less angry and frustrated when he was around them. Since they moved to Lowell, he has had a
very difficult temper. Today in particular, he woke up and was very upset. He was screaming at
his mother. Chandra decided that she cannot go to work and leave him alone. She called her
supervisor at work and explained the situation. Her supervisor suggested that she call Lowell
General Hospital to inquire about their diabetes care services.
Scenario: Chandra goes on the Lowell General Hospital website but does not find anything
about a diabetes care center or a support group for youth with diabetes. She gets very excited
when she sees Merrimack Valley Moms blog. She was a bit disappointed to see that the blog is
not very current and not very influential. She learnt from the website about the partnership of the
hospital in Lowell with the Floating Hospital for Children at Tufts Medical Center. She was able
to find the Health Library Home but this was not an easy task. She felt that an institution of the
caliber of Lowell General Hospital should provide enough support for families who have kids
living with type 1 diabetes. She is very concerned about her son but mostly about her ability to
keep up with the demands of the new job and the health needs of her child. Chandra is very
active on social media. She saw the social media icons on the Lowell General Hospital website.
She thought a Diabetes Care Blog would be a great tool for the hospital to communicate with
people living with diabetes and those who care for them. A blog would also provide more trust
and may attract patients who have been seeking diabetes care elsewhere.
Name: John Stuart
Category: The Andover native who donates to Boston hospitals
About John: John is a 72-year-old retired COO of an Andover-based biotechnology company.
He is married and lives in Andover with his wife, Estelle. They have two sons who are married
and live with their families in New York City. They are both COO's at reputable financial firms in
the city. John is a highly educated white male. He owns a six-bedroom home in Andover; three
cars; and a small private jet. John and his wife Estelle are very active in the community. He has
a high level of health literacy and uses a desktop computer at work; an iPad at home; and
always carries his iphone.
A day in the life: John and Estelle enjoy a healthy life. They wake up early and go for a run.
They go to the city often as they are on the board of trustees of several health care
organizations in Boston. They have a driver and enjoy the ride chatting about their plans for the
week. They are staying in Boston tonight at a hotel as they are attending several events in
Boston over the next couple days. They eat a healthy diet and are conscious of their food
choices. They have both funded several collaborative projects to increase charitable giving to
various healthcare organizations around the city but also to Holy family Hospital in Methuen.
They have ties to the Joslin Diabetes Center as Paul, their older son was diagnosed with type 1
diabetes at the age of 8 and was followed at the Joslin Center for 14 years. They are big
supporters of the Joslin Diabetes Center and have a lot of friends there. They are attending the
High Hopes Gala which is Joslin’s largest annual fundraiser, drawing support from individuals,
organizations and corporations across the diabetes spectrum.
Scenario: At the High Hopes Gala, John and Estelle meet Chandra, a single mom whose son
has type 1 diabetes and who started working at the Metta Health Center in Lowell recently.
Chandra was invited to the event by her new boyfriend who is a physician at Joslin. Chandra
spent some time chatting with John and Estelle. She told them about her fear of not being able
to meet the health needs of her son in Lowell as there is no diabetes care center or support
groups for kids like her son. John and Estelle really like her and feel bad for her. She appears to
be a very smart person and a very caring mom. They shared with her their son's story and his
years of attending the Joslin Diabetes Center. They understood her fears and promised to help.
They have not been very involved with Lowell General Hospital as they are more affiliated with
Holy Family Hospital. They have learnt that Lowell General Hospital is one of the top ranking
hospital in the state. They were surprised to learn that the hospital does not have an established
diabetes care center even though the prevalence of diabetes in Lowell is higher than the state
average. They promised Chandra that they will work with her to make a change and that they
would support her in any initiative to bring what Joslin offers to Lowell. When they returned to
their hotel, John and Estelle look the Lowell General Hospital website. They were able to find a
"Donate" button immediately on the home page. They like what they saw on the website but
thought it is somehow crowded. They thought the website could use more functionality and work
on being more appealing to the eye. John was concerned that visitors may not find information
easily. He did not see that the not-for-profit status of the hospital is clearly communicated. John
and Estelle would like to learn more about the hospital's strategic planning and they plan on
getting in touch with the right people when they return to Andover at the end of the week.
As more Americans access the internet to engage in their own healthcare, and with the
government actively transforming healthcare, we are in the “eHealth” era. These new
requirements and capabilities represent nothing less than the digital transformation of the
practice of medicine. Each of the personas I chose represents a type of user that may access
the Lowell General Hospital Web site. They are looking for information, services provided or
ways to donate. I created these personas keeping in mind the hospital's most profitable patients
in terms of their distribution across service lines, geographic, demographic and socio-economic
profiles. Given the higher prevalence of diabetes in Lowell compared to the rest of the state, it is
vital for the hospital to develop a program for diabetes management to match the organizational
culture and values and maintain a clear and consistent message through online presence.
Each persona has a unique reason for visiting the Lowell General Hospital website and
if they are not able to find it quickly and easily, they are likely to look elsewhere. Users refuse to
be bogged down with sites that fail to deliver information expediently. The goal is to create a
smart, scalable architecture for the Diabetes Care Center website that is easy to update and
manage, with intuitive and logical paths to information. Even if the website uses the most
sophisticated tools to draw users to information, one thing to keep in mind is that they should be
able to read and understand the message.
Looking at Lowell General Hospital's website, it is clear that they are doing many things
well. The Web site is divided into sections clearly-labeled tabs that include 'About Us', 'Services
and specialties', 'Patients and visitors', 'Careers', 'Health and wellness', 'health professionals',
'Pay your bill'. However, when one goes a bit deeper, there are is room for improvement.
Firstly, as we saw with Mary’s experience, she felt it was an organization-centric content and
thought that the hospital should eliminate clutter in messaging and features. Visitors are not able
to choose between three font sizes, and there is no assistive technology that makes online
environments accessible to people with physical disabilities especially when thinking about
people with diabetes complications such as neuropathy and retinopathy. As for John, he noted
that the non-profit status was not clearly posted on the Web site. He again emphasizes the
importance of user-centered design. Thus, it would be important to conduct usability testing for
the Diabetes Care Center website allowing users to help make design decisions. Lastly, Juan
needed to look up information on his blackberry. He did not understand the iTriage. He is
someone who needs a mobile website to access information about the Diabetes Care Center.
8-Competitive Analysis:
I will analyze four websites as below. Lowell General Hospital does not have a diabetes care
center but I will use the Center for weight management and bariatric surgery to conduct the
competitive analysis. Joslin Diabetes Center and Cleveland Clinic Diabetes Center are amongst
the nation's best in diabetes care. Scripps Health was voted to have the second best hospital
website by a study published in the journal of Healthcare Management.
I.
Lowell General Hospital: http://www.lowellgeneral.org/go/services-and-specialties/centerfor-weight-management-and-bariatric-surgery
1- Purpose: Tagline and pictures make the purpose of the weight center clearly evident. Tagline
is a bit commercial. "It's more than the way you look, it's how you live. It's more than a new
body, it's a new way of living. Losing weight is a lot more important than a new pair of pants. It's
sleeping comfortably through the night. It's joining your kids in a game of hide and go seek."
Figure 1: Screenshot of Lowell General Hospital Center for weight management
2-Target audience: patients, consumers, health care providers, job seekers, donors/volunteers
3-Users: Well told and visible success stories/testimonials and pictures of patients who
underwent surgery.
4-Design: Modern, good use of photos on homepage but too many photos. Engaging "learn
more" button.
5- Section organization: A bit confusing as there is a menu "interact with us" on the top of the
homepage and there are tabs with drop menus on the left and the right. The right tabs feature
the centers of excellence. Homepage is cluttered. Site map at bottom of page.
The Center for Weight Management page has "sections" and "features" which also makes it
also confusing to choose from.
6- Layout and navigation: visible links to social media channels. Difficult to navigate overall.
Not patient or consumer centered. No real segmentation of target audience. Prominent "Donate
now" button. Different colors for left and right-hand navigation.
7- Organizational branding: Logo and tagline clearly displayed.
8- External affiliations: No HONcode certification. Hospital affiliates are listed.
9- Expert content: Headlines by HealthDay News. Limited otherwise.
10- Authors and oversight: 3 bloggers on Moms blog. Authors not listed otherwise.
11-Currency: no copyright at bottom of page, individual pages not dated, last post on health
news 8/4/2013. Last post on New at Lowell General 8/1/2013. Classes and events are up to
date.
12- Readability and language: Limited resources available in Spanish but title "weight
management information sessions-Spanish".
13-User-generated content: Users actively post on Face book page and can comment on blog
posts. Patients testimonials in success stories.
14-Policies: privacy policies in place. No information on organization modification of usergenerated content.
15-Registration: There is registration or possibility to create a user profile in the feedback
section. For the e-Newsletter service, the user only provides email address. Online
appointment or registration is available.
16-Add-ons: Users can email questions to program coordinator but no clear statement
regarding how quickly answers should be expected and no disclaimer that this is not the right
venue for urgent matters. Users can subscribe to e-Newsletter or take surveys.
17-Social media and content sharing:
-Face book 1590 likes,119 talking about this, 228 were here (no dedicated face book page).
-Twitter 1184 followers, 4168 tweets, 838 following ( 2 twitter profiles for the hospital).
-You tube, 68 subscribers.
-Moms blog.
-E-newsletter.
18-Financial/membership: Community Benefit Report is available.
19-Overall assessment:
-Homepage busy and cluttered with top, left-hand and right-hand navigation
-Nicely featured success stories with pictures pre and post surgery
-Logo and tagline clearly displayed
-You tube uploads are outdated
-Social media focus more on self i.e. organization
-iTriage not very visible
II.
Joslin Diabetes Center: http://www.joslin.org/index.html
1- Purpose: Concise mission and vision say a lot about Joslin. Logo and seal are
professional without a commercial tagline."Our mission is to prevent, treat and cure
diabetes. Our vision is a world free of diabetes and its complications."
Figure 2: Screenshot of Joslin Diabetes Center mission page
2-Target audience: patients (US and international), consumers, healthcare providers,
researchers and research participants, job seekers, donors/volunteers
3-Users: Stories by users on Joslin communication/ Joslin Diabetes blog. Donor stories.
4-Design: Great slideshow on homepage. Bright and crisp, inviting yet professional. Good use
of multimedia.
5- Section organization: Top navigation with clear user segmentation but not fully patient
centered. Access to multicultural programs at the bottom of the homepage.
6- Layout and navigation: visible links to social media channels. Busy homepage and can be
hard to navigate. Joslin eNews sign up is not a simple one step process. There is a "donate" tab
and a "support Joslin" tab in the top navigation.
7- Organizational branding: Logo clearly displayed
8- External affiliations: Joslin affiliates through Joslin branding. No HONcode certification.
9- Expert content: State-of-the-art expert content by leaders in the field.
10- Authors and oversight: Authors listed on blog.
11-Currency: Copyright 2013 at bottom of webpage. Individual pages dated. Last post on blog
8/2/2013. News release last 7/24/2013.
12- Readability and language: Patient -geared content is easy to read and is available in other
languages but still uses terminology that is above 6th grade level. Language used on the
homepage is directed at physicians, researchers and individuals with high education.
13-User-generated content: Users actively comment on Face book page and share. They are
able to ask Joslin on the Blog and get answers. They can leave comments. They can participate
in the Discussion boards thereby communicating with others who have diabetes and their
families. Users are very engaged.
14-Policies: privacy policies in place as well as guidelines for social media use. Users post
content; organization can review and take down if inappropriate.
15-Registration: There is registration or possibility to create a user profile for the e-Newsletter..
For the e-Newsletter service, the user can choose to provide email address only. Online
appointment or registration is available.
16-Add-ons: Users can subscribe to e-news, take online diabetes classes, participate in
discussion boards, and blog.
17-Social media and content sharing:
-Face book 15127 likes
-twitter 13859 followers, 445 following, 1490 tweets
- joslin blog
-LinkedIn 317 followers
-you tube 323 subscribers
18-Financial/membership: No financial information on the website. Users can donate,
subscribe to feed, e-news. They can become members of the online learning center.
19-Overall assessment:
-Professional but inviting slideshow on homepage
-Moderate to high literacy level
-Multicultural programs
-State-of-the-art expert content
-Active patients/users participating in blog, discussion boards
-Good use of multimedia
-Real time education
III.
Scripps Health: http://www.scripps.org/services/metabolic-conditions__diabetes
1- Purpose: Nicely stated mission without a commercial tagline. Purpose is clear and
professional. "Its mission is to improve the quality of life for individuals with diabetes through
innovative education programs, clinical expertise, leading-edge research and professional
cross-disciplinary collaborations in pursuit of prevention and a cure."
Figure 3: Screenshot of Scripps Health Diabetes Services
2-Target audience: patients, consumers, media, healthcare providers, researchers and
participants, job seekers, donors/volunteers.
3-Users: Some stories and images but not very visible.
4-Design: Extremely clean and clear. Bright, reassuring. Only static images.
5- Section organization: The organization is fairly simple with user segmentation yet the main
focus is on the patient. Patients can choose from different categories at the top of the page and
each option has expandable sub-options (see below). Text is big and simple. Big box on the
right hand side makes it very easy to find number to call.
6- Layout and navigation: visible links to social media channels
7- Organizational branding: Logo clearly displayed
8- External affiliations: None. No HONcode certification.
9- Expert content: "Scripps in the news" features articles on several topics by experts.
10- Authors and oversight: Authors and their credentials listed.
11-Currency: Copyright 2013 at bottom of webpage. News releases and classes and events all
up to date. Individual pages not dated.
12- Readability and language: Big text that is easy to read. Good balance of text and white
space. Patient brochures are amazing and are available in different languages. Information in
brochures is well explained and is at 6th grade level or less. Different size font to highlight or
enhance subject of interest. Short paragraphs.
13-User-generated content:
14-Policies: privacy policies in place. No information on organization modification of usergenerated content.
15-Registration: There is no registration or possibility to create a user profile. For the eNewsletter service, the user only provides email address.
16-Add-ons: Users can subscribe to e-newsletter, have access to healthy recipes and health
library.
17-Social media and content sharing:
-Face book 8370 likes ( no dedicated face book page for the diabetes center)
-twitter 15914 followers, 5168 tweets, 5834 following
-you tube 378 subscribers (to the organization's channel)
-e-newsletter
18-Financial/membership: Users can donate, subscribe to e-news.
19-Overall assessment:
-Extremely clean and clear design with the patient or consumer as the main focus
-Very inviting and engaging
-Very easy to navigate
-Coordinated social media programs
-A wealth of multilingual educational handouts
-Good customer service
IV.
Cleveland Clinic: http://my.clevelandclinic.org/endocrinologymetabolism/departments-centers/diabetes-center.aspx
1- Purpose: Purpose of center is clearly stated. Logo is professional without a commercial
tagline "The Diabetes Center provides patients access to a multidisciplinary team, including
endocrinologists, diabetic educators, dieticians and a nurse practitioner. The goal of the
Diabetes Center is to encourage patients to receive early specialty care and education –
getting them on the right track with their diabetes management before returning them to their
primary care physicians for ongoing management."
Figure 4: Screenshot of Cleveland Clinic Diabetes Center
2-Target audience: patients (US and international), consumers, healthcare providers,
researchers and participants, job seekers, donors/volunteers.
3-Users: Featured stories are not easy to find and not visible.
4-Design: Clear and engaging for the hospital's homepage. Modern yet professional. Lacks
good imagery. Imagery focused on providers on Health hub and not patients/ consumers on the
hospital homepage and also the diabetes care center. The home page for the diabetes care
center is boring and not innovative.
5- Section organization: Top navigation with focus on patients and consumers for the main
navigation menu. Other users such as health care professionals, job seekers etc have smaller
tabs on top.
6- Layout and navigation: Visible links to social media channels. Top navigation with suboptions focused on patients and consumers makes it very user friendly. No clutter on first page.
7- Organizational branding: Logo clearly displayed
8- External affiliations: HONcode certified. Energy Star partnership. Cleveland Clinic locations.
9- Expert content: State-of-the-art expert content by leaders in the field.
10- Authors and oversight: Authors and their credentials listed on Health hub
11-Currency: Copyright 2013 at bottom of webpage. Health hub updated daily. Individual pages
not dated.
12- Readability and language: Text heavy pages. Moderate to high health literacy in "Health
Information".
13-User-generated content: Users actively comment on Face book page and share. They are
able to chat online with a Health Information Search specialist. Users can get answers to health
questions from Cleveland Clinic experts. They can leave comments on the Health Hub. They
can send feedback. They can take quizzes. Users are very engaged.
14-Policies: privacy policies in place, as well as guidelines for social media use. Users post
content; organization can review and take down if inappropriate.
15-Registration: For the e-Newsletter service, the user only provides email address. There is
secure connection to portions of the medical record, to request images or to "get online second
opinions from top specialists".
16-Add-ons: amazing list of tools and resources for patients and consumers to gain knowledge
about different topics segmented by topics and tools/resources. Also, Cleveland Clinic mobile.
17-Social media and content sharing:
-Face book 551k likes (no dedicated face book page for the diabetes center)
-twitter 126775 followers, 1742 following, 13222 tweets
-pinterest 23 boards, 474 pins, 3113 followers, 900 following
-Google+
-LinkedIn 39218 followers
- you tube 4775 subscribers
-mobile apps
-Health hub from Cleveland clinic
-e-newsletter
18-Financial/membership: Community Benefit Report available. Cleveland Clinic facts and
figures. Users can donate, subscribe to e-news.
19-Overall assessment:
-patient/consumer centered top navigation
-engaging design of the hospital's website but not the diabetes center per se
-lack of good imagery
-coordinated social media programs
-real time education
What have you learned from the competitive analysis that you can:
Borrow from:
1-Clean and clear design, inviting (Scripps Health).
2-Patient centered top navigation main menu with a smaller font top navigation menu for other
users. Clear segmentation of target audience with straightforward navigation (Scripps Health,
Cleveland Clinic).
3-Multilingual illustrated handouts (Scripps Health)
4-Joslin Blog to communicate with people living with Diabetes and those who care for them.
5-Patients testimonials and stories with pre and post surgery photos ( Lowell General Center for
weight management)
6-Multicultural programs at Joslin:
7-Eye catching searching and browsing box "what can we help you find?" (Scripps Health).
Do better:
1-Home page is cluttered with no clear segmentation of target audience. There is top, left-hand
and right-hand navigation.
2-Create a Diabetes Care Center webpage
3-A 'Health Information" tab that is easy to access and navigate where patients or consumers
can find information easily by subject, topic, keyword or resource.
4- Users can post content on Face book but organization should review and take down if
inappropriate
5-You tube uploads outdated
6-Don't always talk about yourself on Face book and Twitter
Distinguish yourselves or be different:
1-You are one of the most Wired Hospitals in the country. Be the first community hospital in
Massachusetts and the Country to have a state-of-the-art Diabetes Care Center website. Work
on fitting the technology to the needs and requirements of the patient, and increase userfriendliness to increase adoption rates.
2-Start a Diabetes Care Center Blog that is updated twice a week to disseminate the latest
information in the field to patients, consumers and providers.
3-Promote your expertise and spread your wings to the wider geographic area to empower
patients located in remote locations where clinicians’ visits are costly and difficult.
9-Decisions about Social Media Technologies:
Among adults with diabetes, social support improves adherence to blood glucose selfmonitoring, recommended dietary intake, physical activity, and glycemic control. Among
racial/ethnic minorities, social media provides potential opportunities to engage people in healthrelated issues, stimulate an active role in their own healthcare, connect them with others and
evidence-based interventions, and create social action focused on social determinants of health
disparities.
1. Employ "sentiment analysis tools" with a goal to interpret the positive or negative attitude of
current participants in Lowell General Hospital social media.
2. Develop and maintain a blog with two to three posts a week. Interview doctors and clinicians
and write posts on hot and timely topics. Mix up the content and provide a variety of fun,
interesting and helpful articles. Share them on other social networks too.
3. Create great videos to share through your networks. Look for great patient stories. These are
priceless as patients living with diabetes like to hear from their peers and learn how they are
doing.
10-Decisions about Mobile Technologies:
Cellular phones/devices have been found in several studies to have a positive impact on
diabetes self-management. They can be used to communicate with clinicians, run dedicated
software for diabetes self-management, or access the self-management specific programs.
Electronic diaries have been observed to increase compliance and assist in behavioral
modifications.
1-Featuring different Diabetes Apps on the Diabetes Care Center website can help people living
with Diabetes choose what is best for their personalized health needs. Different Apps can cater
to basic and advanced users separately thus fostering a more conducive user-centered
approach in self-management.
Some Diabetes Tracker Apps that are highly rated by users on the App Store:
Glooko Logbook
Glucose Buddy:
GoMeals:
2.With at least one of the personas having no access to computers, a Diabetes Care Center
mobile website would be important to reach a wider target audience. It would enable patients
like Juan to send glucose level, medication and diet information to clinicians; (b) inquire about
some health related issues; (c) access their electronic medical record; (d) visualize physiological
and medical data; (e) gain case-specific diabetes education and medication information; and (f)
obtain feedback from clinicians.
3.With mobile device pervasiveness, a Diabetes Care Center mobile website has the potential
to connect underserved and underrepresented populations to important health information
resources and to build social supports for those affected by healthcare issues.
11-Recommended Digital Strategy:
Recommended Initiatives (with justification):
1. Design a Diabetes Care Center website that is user friendly and easy to navigate. The best
way to incorporate users’ requirements is by involving end-users during system design and
development (user-centered design) from the get-go. Fitting the technology to the needs and
requirements of the patient, and increasing user-friendliness can increase adoption rates.
2. Focus on content. Even educated readers prefer low-literacy text. Choose language and
approach to reflect this. Keep in mind that people living with diabetes (your main target
audience) are overwhelmed with the many tasks of self-management and they may have limited
time and technical knowledge. Consider creating a Spanish version of the site, or at least have
key content available in Spanish.
3. Develop a Diabetes blog to disseminate new information to patients, consumers and also
providers on the new developments in the field as well as success stories, ongoing research
and clinical trials for interested participants. But mainly use the blog to shift the dynamic, from a
one-to-one and one-way communication of diagnosis and directives to a conversation. Patients
talk to each other—and they talk back. The “engaged patient,” empowered by electronic-health,
becomes a powerful factor in improving health and reducing costs.
4. You tube is one of the largest social media sites and number two search engine. It is the
easiest and safest for hospitals. Use it for educational videos relating to diabetes physiology,
insulin use, new technology relating to insulin pump and continuous glucose monitoring. For
twitter use real time education: series of live Diabetes Twitter-casts, Q & A with CDE's/clinicians,
updates in real time.
One Wild Recommended Initiative:
Develop Diabetes Care Center mobile site with a Spanish and Khmer version. The site would
have multilingual patient handouts that are easily accessible and cover all the common issues
and topics in diabetes care. Furthermore, a mobile-based application could grant patients with
uncontrolled diabetes the ability to consult with a nurse educator, nurse practitioner or a
physician about their health issues, and visualize their clinical data through interactive graphs
24 hours a day. Internet intervention would be primarily employed for transmitting blood glucose
data and other patient data to the nurse educator, nurse practitioner or a physician and
receiving feedback about their health condition. The feedback provided by the provider will
motivate patients to take an active role in self-managing their diabetes, improve diabetes care
and decrease or prevent complications of diabetes.
12-Conclusions:
As e-health technology becomes more ubiquitous in our health and health care environments, it
is crucial for health care organizations and providers to implement e-health interventions to
address the serious growing challenge of Type 2 diabetes. It is my hope that by exploiting the
full potential of telemedical systems through the use of platform based solutions: data are
recovered from biomedical sensors, hospital information systems, care-givers, as well as
patients themselves, and are processed and redistributed in an either centralized or, more
probably, decentralized way; we can stop diabetes, starting in Lowell.
13-References
1- Roblin DW: The potential of cellular technology to mediate social networks for support of
chronic disease selfmanagement. J Health Commun 2011;16:59–76.
2- Ahern DK: Challenges and opportunities of eHealth research. Am J Prev Med
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3- Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21st
Century. Washington, D.C., National Academy Press, 2001
4- Vuong et al. Factors Affecting Acceptability and Usability of Technological Approaches to
Diabetes Self-Management: A Case Study. Diabetes Tech & Ther. Volume 14, Number 12,
2012
5- Blue Ribbon Panel of the Society of General Internal Medicine: Redesigning the practice
model for general internal medicine: a proposal for coordinated care: a policy monograph of the
Society of General Internal Medicine. J Gen Intern Med 22:400–409, 2007
6- El-Gayar et al. A systematic review of IT for diabetes self-management: Are we there yet? Int
J Med Inform. 2013 Aug;82(8):637-52
7-Chomutare et al. Designing a Diabetes mobile application with social network support. Stud
Health Technol Inform. 2013;188:58-64.
8-Harris et al. Local health department use of twitter to disseminate diabetes information, United
States. Prev Chronic Dis. 2013 May 2;10:E70
9-Glasgow et al. Understanding Who Benefits at Each Step in an Internet-Based Diabetes SelfManagement Program: Application of a Recursive Partitioning Approach. Med Decis Making.
2013 Aug 1
14-Appendix: About the Author
Rajaa is a master's degree candidate in Clinical Research and Translational Science at the
Tufts University, Sackler School of Graduate Biomedical Sciences. She was a primary care
physician in Lowell Massachusetts for 10 years before she came back for Tufts Medical Center
to pursue a fellowship in Endocrinology, Diabetes and Metabolism which she finished in June
2013. She went back to Lowell to work as an Endocrinologist and to start a Diabetes Care
Program. She is passionate about Diabetes management and wants to make a difference in the
lives of the people that she treats. With recent research paper citing that "physicians who skip
social media risk alienating patients", the author decided to make a first step towards " the
bleeding edge of digital health". She attended this course to learn tools and technologies that
she can implement in her career to have positive impacts on self-management of a chronic
illness such as diabetes. She plans to educate her peers and colleagues on emerging
modalities in digital health with the hope to update their approach to the practice of medicine so
they can interact with patients, data and each other in important new ways.