About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

18 comments on “Facebook and Healthcare … A Wrap Up

  • Great wrap-up. Interesting we all spoke up about the issue.There’s going to be a range of opinions on hospital access to social media.What I didn’t cover in my post – because I wanted to focus on the fear factor – was the logistical matters that hospitals will have to face. There are security and abuse concerns – but as I said in my post, healthcare is used to managing risk.

  • @philbaumann No question…. this is a multi-tentacled issue. But fear seems to be the primary issue about opening up servers to allow access. Coming up with a robust, fluid policy and enforcing it is not a straight forward process either…. but they have to start the discussion and *come to the table*. Abuse (workflow) etc issues might be a problem, but there are sophisticated systems to address that… anybody on Facebook or twitter while sitting at a busy nurses station is bound to be noticed within seconds. Appreciate the comment.. Not a simple, straight forward issue… but not an issue that can be ignored. Better to spend the time on a policy and education process then to play catch up when an employee uses their own cell phone and breaches patient privacy on *your* dime. Pro-active vs Reactive … too many institutions still very much reactive… on this and many other issues. Yes, funding and solvency issues are at the top of the list of issues many C-suite execs are facing, but Soc Med shouldn’t be at the bottom.

  • Totally agree. One approach to the abuse issue is to actually *encourage* use within the right context. That is, if the general culture is that these media have (some) business relevance, employees are more likely to feel like respected professionals.It’s possible Fear foments Forbidden Fruit Syndrome :)Phil

  • I know @paulflevy has described Facebook as ‘a highly effective communications tool’ and that therefore it shouldn’t be blocked completely from a hospital’s server. But are doctors and nurses in a hospital ward or outpatient clinic to be involved in communications on the hospital’s behalf? What would those communications look like? Would it be marketing particular hospital services such as the dialysis unit, or post-operative care following hip replacement? We know that Facebook is not appropriate for direct patient contact so it wouldn’t be communication of that nature,As I said in a comment on HealthisSocial, for the last few years my access to Facebook has been blocked on NHS computers. Does that do any harm to me or my patients? I don’t think so. I don’t think it has even impacted on my social life! If I had access to twitter blocked it would have no direct impact on my care of patients either.I suspect that since you have just set up your Facebook page @hjluks, that your patients wouldn’t suffer if you had no access from the hospital either. I completely agree with those who state that access to Facebook is not the cause of disrespectful behaviour and breaches of patient confidentiality. But that does not mean that I can see any good reasons why staff should have access to Facebook. Perhaps I need to write my own blog post on this from a UK perspective!Thanks,Anne Marie

  • @Anne MarieI think where we’re coming from (at least me) isn’t as much as how useful Facebook is clinically.Rather, what I’m going after is the underlying thought-process in (some…maybe many) hospital policies that may be taking the view that these media aught to just be blocked, versus taking a truly committed approach to understanding what roles they should or shouldn’t play.So, form my perspective, it isn’t Facebook’s utility per se, but rather the challenge to some of the thinking that goes on in some organizations.It’s really about ensuring that the leaders understand the nature of 21st Century communications. I can tell you that here in the US, there are some pretty scary feelings about “those computer Internet thingies I read about in the newspapers”. (Believe me, it’s out there.)What I”m hoping for isn’t an embracing of Facebook – but rather the problems with confront with an evolving Internet. Blocking Facebook is easy. Easy isn’t always thorough.

  • @philbaumann Thanks Phil. So if Facebook is not useful clinically then why are we worried about clinical staff not having access? I can understand that many see Facebook as a potential way of marketing hospital services but I don’t think that clinical staff need to be engaged in that process, certainly not from the ward or outpatient clinic.My perspective is that when we start being open and honest about the limitations of current services, such as Facebook, we will be taken much more seriously by colleagues who are resistant to considering possible uses of social media. Telling them that clinical staff should have access to Facebook because it builds community will be met with met with much eye-rolling.Blocking Facebook in the US can’t be as easy as you suggest or else this hospital’s actions would not be news. As I say, Facebook is blocked in most NHS facilities in the UK, and the news is when employees manage to get their way round this.http://www.dailyrecord.co.uk/news/scottish-news/2010/07/19/nhs-24-staff-disci…OK, I could write more but I will leave this here.

  • Our hospital blocked access to all social media in ‘clinical areas’ about a year ago, and the VA systme has had a fairly tight filter over the internet for a number of years. I think it’s actually pretty easy to do, and is probably pretty common not only in healthcare, but in many other industries. As you state, I think there are a host of potential reasons. However, I think you can not throw out the idea that it looks bad to have a health care worker sitting on a work station in view of patients methodically checking their FB friends or the Twitter feed. Especially if the patient is potentially waiting for someone to answer a call light, etc.That being said, I think there is a great fear that something will be posted that is grossly inappropriate. I also know that at the VA there are many warnings given about misuse of government property, and I think there is some (probably justifiable) notion that there is a difference between a post placed through an industry sponsored station vs a person device (ie a smart phone). Hence why the ruling does make some sense from the sense of an employer. That being said I agree that most people already understand the basic rules of what should and should not be posted. But even well-meaning, intelligent people will make stupid mistakes, and that is why the gates are closing.I also think that no one has really come up with good applications to prove that FB or other open source social media adds value in the point of care setting. If you could point to some concrete examples of health care workers using social media in a clinical care setting to do something productive, hospital administration would begin to yield. At present, I just haven’t seen many places where this is currently happening. Thus, most healthcare workers would be accessing FB to check up on the pics from their brother-in-laws vacation during downtime, but not to interact with patients or other heatlhcare workers. I think there are potential ways to utilize FB, but the privacy issues are obvious. Anybody know of utilization of FB that is happening currently on FB that would benefit a clinical provider in a hospital/clinic setting?

  • @philbaumann @ammcunningham and #hcsm #hcr and #hcsmSV followers. Anne Marie… no need to “stop short”, I truly enjoy your commentary and thought provoking nature of the discussions you initiate by your presence ;-) Now that we have gone back on forth on a few blogs/twitter and my new FB fan page :-) I THINK it is (maybe) safe for me to *assume* that your interests lie mostly in the clinical realm of doctor-patient, nurse-patient, *hospital*-patient communications and the inherent limitations of the current systems brought on by both technological limitations, health care privacy policies, and institutional restrictions. I, like Phil, was coming at it from a different slant, and perhaps did not articulate that well enough:-( Yes, I am a clinician, yes I like to teach… and yes I typically spend a lot of time and effort explaining issues to patients in my office— but Facebook and similar social media networks are simply not the appropriate, nor legal medium (at this time) to allow for direct physician to patient engagement. Time, HIPAA law changes, etc may change that…. but not for quite a while. The *semantic* 3.0 completely inter-connected “know everything” web, where the majority of the planet is engaged in ways we can not even conceive of is not far away. Many patients are fluent in 2.0 technologies and may not even realize it— yet most institutions are stuck in a Web 0.5 or 1.0 world, at best. It is not only about Facebook, but about embracing communications principles and Web 2.0 technologies as the backbone of their own internal and/or external communications infra-structure (Social Cast and iMedExchange can change that now). Worldwide, video communication adoption is rising rapidly… yet Tok Box or Skype are not allowed on most servers either. From a PR perspective, you will hold a person/patient’s attention when watching a video far longer than you will hold the attention of someone reading a static out-dated web page. So engaging the patient base at large does offer certain ROI *feeding* initiatives, if utilized and framed properly. Now… and this is a blog post I have been working on for a while, but will briefly mention some key issues here. Facebook can be utilized by staff and can be utilized to help tell your local potential base what your hospital offers, what they excel at and (like Paul Levy) where your faults lie and what initiatives are underway to improve the care you offer. No reason why the nurse mgr on Orthopedics can’t be active on a discussion about potential total joint patients — What to expect during the hospitalization on day 1, day 2, etc. No reason why the physical therapy director or appointee can not engage on a discussion thread about the daily goals for a typical total joint replacement patient. Can they in turn respond to a direct post from an inpatient or past patient, no, but their use of Facebook or a similar medium has served a useful meaningful purpose. Human beings are innately social and health care is very social. For both patients and providers. What if a discussion thread allowed patients admitted for a bone marrow transplant to interact with one another. Someone near the end of the process can help coach the patient who just entered a hospital today and is scared to death about what lies in front of them. Can all this take place on Facebook? Probably not… but technologies exist to allow this to happen in a HIPAA compliant manner. Now… I will stop here…. I believe that utilizing Web 2.0 technologies can go a long way to improve a hospital’s own communications infra-structure, their outreach to their potential patient base (I didn’t know you performed liver transplants and rank #2 in your state) and improve upon the information an admitted patient needs to take a more active role in their management. But the institutions need to be convinced of this… phew :-)

  • OK! That is a helpful post.Not having to engage in marketing I don’t understand all the terminology you use but I can understand some of the points you make! Thank you for responding to my request for specific examples. Facebook polarizes people at the moment. In some ways the social media savvy are moving away from it lock, stock and barrel because of privacy concerns *see these tweets http://twitter.com/dougsymington/statuses/21527762575 and http://twitter.com/ThinkingFox/statuses/21531499152* but that is happening just as the mainstream is signing up and getting really engaged. As @ajcann states Facebook “continues to dominate the attention economy”. http://scienceoftheinvisible.blogspot.com/2010/08/facebook-whispers.htmlFor that reason, it may just about make sense to use it as a way of communicating generic information to patients although I still have reservations.I know the author of this slideshare wants to market his own product but he makes many good points: https://www.slideshare.net/myhealthcomm/to-facebook-or-not-to-facebook-the-que…Allowing patients to access the kind of information you mention here is important. No one could disagree with that. Whether Facebook is an appropriate platform is the next question. Ii it worth using Facebook even though we have privacy concerns because people are there, rather than try and get them to sign up to another secure platform? Interesting discussions indeed!

  • This is spot-on:”What to expect during the hospitalization on day 1, day 2, etc. No reason why the physical therapy director or appointee can not engage on a discussion thread about the daily goals for a typical total joint replacement patient…”As a patient, I want to know what to expect, I want to hear insights from experienced caregivers.When I was pregnant with twins I spent far too much time on “pregnant with multiples” forums, but it would have been much more enlightening to hear from docs/nurses from the NICU or the obstetrics ward of any hospital.

  • Can I just chip in from a bit more of a community health angle? Much of the material and comments seem to approach the issues from what I perceive as a kind-of ‘pure clinical’ perspective – in terms of what’s communicated. Meantime I’m working on a project to do with self-management of long-term conditions, when the key factoids & issues include a) that if you’re self-managing, direct contact with your HCP is only on average 3 hours/year b) what most ppl with LTCs have told us is that they want to be able to find people who’ve been through a similar experience, who could chum them through what they’re undergoing just now. It strikes me that a lot of the communication involved in this is ‘health-y’ rather than ‘health’ still less ‘pure clinical’. But are HCPs to shut themselves off from self-managing people (they’re Not Patients, they say :-)), digitally…in the context of encouraging self-management as a significant strategic response to the risk of healthcare provision becoming unsustainable under demographic pressures?Just a thought – thanks for the interesting discussion above.

  • “No discovery can be of general utility, while the practice of it is kept in the hands of a few.”-William Buchan MD (1794)Came across this quote, and thought it sums up why health care professionals should be engaged in social media.

  • @peterashe This conversation has been about ‘clinical’ because my understanding is that it started from ‘should front-line health professionals have access to Facebook?”. I don’t think anyone here is talking about shutting of from patients/those with LTCs. My main issue is that Facebook is unlikely to be an appropriate platform. I’ve just had a quick look and I can see hat the Diabetes UK fanpage is massively popular. More than 16,000 likes and lots of interaction. Should I encourage patients to join this public site to seek support for their diabetes? Diabetes UK seems to operate a two-tier system here, They do provide a members-only private network for those who pay membership of Diabetes UK (can set any amount but has to be done by direct debit or debit/credit card so would probably exclude many of my patients with diabetes) or there is the free-for-all public Facebook page. You know my concerns about how inequalities offline are reflected or magnified online and this is a good example. We (activists/health professionals/patient organisations) should be trying to advocate for opportunities for all patients to network in privacy. The example of http://www.healthunlocked.com/ is an interesting one and we will probably start hearing a lot more about services like this. My own experience is that people do care about privacy. I was a member of a patient community (list-serve) from the mid-1990s(as a patient). It was very successful and gave many including myself much support. But for some reason, last year it migrated to Google Groups. The community died. There was great uncertainty about whether posts were private and whether membership of the group would show on google profiles. There is much more to discuss here but I thought I would try and clear this up for you. Without managing to be clear about topic asynchronous communication is pretty hard. It will be one of the challenges for future health professionals and patient interactions no matter what the platform is!

  • @amcunningham – interested you mention Diabetes UK Anne-Marie – this reminded me of the Forums I saw on ChildrenwithDiabetes community ages (it must have been at least 15 years) ago, where a couple of mums could be discussing how to get a particular type of insulin pump working well, or diet, or a whole slew of things about the care of their children with diabetes, and there would be HCPs chipping in helpfully in the conversation thread. It struck me then – as it still does – as the best sort of ‘care management’ support. Not necessarily assuming some sort of pre-existing clinical relationship, meanwhile within a meaningful community where understood (implicit & explicit) ground rules were available. Appropriately marginal in aspiration within the overall context of the mums and children’s lives, successfully mimicking the sort of advice you’d surely get in RL, but digital. And really, just as public as chipping in on Diabetes UK fanpage might be, as far as I can see.Also, re being able to network in private, another thing that came across strongly from ppl with LTCs, when we worked with them this spring, was that they didn’t want to network *just* with ppl with the same condition. It seemed that conversational snippets about diabetes would be more helpfully handled along with all sorts of other snippets about experiences – which could be in common with those associated with a wide range of other conditions, and indeed, other life-circumstances. This might bear upon existing consultation models, I wonder?Might there perhaps be some potential sense in which clinicians, with good intentions, sure, want people to come and converse on their turf – about clinical-things-which-need-to-be-private – but are unwilling to participate in the conversational space that patients inhabit? In lots of other domains (mostly egov) that I participate in, where engagement is being promoted, those involved are quite clear that ‘we’ have to ‘go where people are’ and engage in discourse there. How this is best, and successfully, done in practice, is as yet a challenge I grant you;-)Given the strategic bind that health services seem likely to be in in times to come, and the desire to promote self-management as one way to help ameliorate things, I wonder gently whether clinicians aren’t going to need to do more about ‘going where people are’ and talking with them there? Come and join the throng…Happy to stand corrected, of course :-)yours aye (as they say locally)Peter

  • @peterashe I’m writing a blog post myself but you will see that I have made the appoint above that it may be a case of trading privacy for ‘where the people are’/large stake of attention economy.I haven’t seen the community you are talking about from 15 years ago but I will bet money that it is not nearly as public (in multiple ways) as a Facebook fan page.By the way, I don’t consider patient communities to be the turf of health professionals at all. It should belong to patients. Health professionals should only be there as guests. I think you may have misunderstood my point. But my blog post might explain better.More later!

  • These staff members were not good employees.The nurses and medical staff who chose to publish photos of a seriously injured patient not only show extremely poor judgment in use of social media but display a value and ethic that runs against everything I know as a patient care provider. Patient care is priority one, attending to their safety, comfort and intervening to save lives is what the essence of emergency room care is all about. These staff members show serious disregard for their medical duties. The difference between mistakes made by inappropriate emails vs posting patient personal protected health information on a platform that is accessible by millions of users worldwide (Facebook has 500 million active users) is serious and something regulators will be addressing. The ACLU has also begun to address them as well. We couldn’t agree with you more here at MyHealthCommunity on your recommendation to develop a comprehensive social media engagement policy, educate their staff, set acceptable parameters, track or monitor usage, remain vigilant. We would also recommend that healthcare organizations develop a social media strategic plan matching tools and platforms to function, purpose, and audience. Medical care is different. It is not like business. We don’t choose to have cancer or a heart condition. But when health conditions strike we can be penalized in job options, insurance both medical and life, and socially discriminated against ( abortions, HIV,etc) When patients want to find out more information then a hospital should consider having a private online community where questions can be addressed while maintaining patient privacy. Hospitals must be vigilant in educating staff and their community of online media users on how to tell their medical stories without revealing PHI. If you would like to read further we have written two papers and have short presentations on these topics. Visit our website at http://www.myhealthcommunity.net/?page=resources or you can find us on Slideshare at myhealthcomm.

  • Dr. Luks agree with the separation of utilizing Facebook and other public facing social media for general promotion and education for patients. The discussion about what to expect typically for a procedure or surgery is also spot on.Certainly it is a way to distinguish one hospitals strengths and expertise from another. I also think it is a great way to help the public understand your ratings, how healthcare is rated, what can affect those ratings and what you are doing to bring your hospitals quality up in the ratings. These social media can serve a useful and meaningful purpose. But I caution hospitals using patients to tell their personal stories or worse their children’s personal medical stories all over the internet treads on patient privacy rights.More importantly I agree that there needs to be a different way to interact in specifics about a patients medical condition while still sharing their stories. There is much to be gained havig discussions, sharing and supporting but redirecting to a more appropriate platform is our answer. That is why we are working hard to develop a private and secure social media solution. Thank you for this discussion.

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