Using Twitter in Health Events to think over Public Health applications for Social Media

Twitter was proposed by several studies as means to track public health trends such as influenza outbreaks and swine flu, but more information is needed about its usefulness and potential health applications.

To analyse the impact of Health Events on Twitter messages and to think of the potential usefulness in public health activities we (MA. Mayer, P. Ruíz, A. Leis and A. Mayer) carried out an observational study based on monitoring Twitter messages posted between November 18 and December 4, including the World Aids Day (December 1, 2011). This work will be presented at the WONCA Europe 2012 Conference that will take place in Vienna next July.

During the days of the study, there were more than 1.1 million tweets related to AIDS (over 50% were mostly posted on December 1 and the day before and after it). These messages were obtained via Application Programming Interface search engine when the word AIDS was mentioned in Twitter. Mobile and smart phones were the devices more used to post messages (tweets). There were over 0.7 million unique users. Information links about AIDS, World Aids Day and jokes respresent the most numerous tweets and re-tweets.

It seems clear that Health Events generate an important interest and have a big impact amongst Twitter users with a very important rise number of posts and users tweeting about AIDS. For that reason, Twitter and Social Media sites in general, could be used as a means to spread news and health information of general interest via web, above all, using mobile phones (mHealth) with diverse potential educational and public health purposes. It's very important the promotion of more analysis and qualitative studies to better know users' profiles and the semantic of these messages for Twitter to become effective as healthcare and public health tools.

How Medical Doctors and Students Should Use Social Media: a Review to Propose some Practical Recommendations

Social Media (SM) has grown exponentially and in the last few years there has been an increasing use amongst medical doctors and students. At the same time there is intense debate about the complexities of ensuring medical professionalism in the digital age and especially on using open and massive online services.

We carried out a review of the main SM guidelines with the following objectives (today it has been accepted as a full paper in the European Medical Informatics Conference (MIE) 2012 that will take place in Pisa next August):

1. To gather the main recommendations on using Social Media platforms and websites by medical doctors and students, which are proposed by several international organizations, institutions and universities and
2. To propose a set of practical recommendations, based on the comparison of the statements and items of the guidelines, in order to find agreements and differences among them and select the most common and practical items stated. 

Based on the review of the different guidelines and documents analyzed, ten points of general practices when using social networking websites are proposed as a first approach:

1. The use of Social Media for professional purposes opens new ways to communicate with patients, general public and colleagues but used as a professional tool it is necessary to consider different aspects to guarantee their safer, useful, legal and ethical utilization.
2. Use conservative privacy settings in social media sites and platforms although be aware that not all information can be protected on the Web and how easily accessible it is.
3. Maintain standards of patient privacy and confidentiality and be sure that any patient cannot be identified by the combination or sum of information posted online. Likewise, respect information and content copyrights.
4. Remember that what is online is probably long-lasting so be careful about what you say and how you say it.
5. It is not recommendable to give any kind of medical advice in social networks. When using Social Media platforms for services such as general health information or education, explain clearly the objectives, features of usage and limitations. Also, remember to include in Electronic Health Records (EHR) any kind of interaction with your patients using SM.
6. Medical doctors shouldn’t be friends with everyone in Social Media and in general it is prudent not to become an electronic friend of a current or former patient (consider separate clearly personal and professional content online).
7. Follow the guidelines of your health organization or company on using social media and if they are not established yet, seriously suggest its implementation as soon as possible, taking into account that if it is the case, they should be considered as one more service among those offered by your organization.
8. Clarify when you are speaking on behalf of your company or institution, if it is not the case, clearly state that you are making personal remarks.
9. If you are identified as a medical doctor, any statement must especially reflect good standards of conduct and professional behavior.
10. Any form of inappropriate online behavior can potentially harm doctor-patient or colleague relationships, be careful with comments made about colleagues and even health departments. Maintain good and respectful manners.

There are many questions that remain under discussion, such as how to manage the digital identity, where the limits between personal and professional presence online are or how to give answers to open ethical and legal concerns related to potential doctor-patient relationships established online. The paper will be soon published in the Proceedings of MIE. Original translation in Spanish in Web Mèdica Acreditada website

A comprehensive list of the Medical Social Media guidelines reviewed is displayed:

• American Medical Association: Policy in the use of Social Media
• Australian Medical Association Council and the New Zealand Medical Association: Social Media and the Medical Profession
• Avvo: Being influential Online: Social Media Tactics for Physicians
• British Medical Association: Using Social Media - practical and ethical guidance for doctors and medical students
• Canadian Medical Association: Professional Standards and Guidelines. Social Media and Online Networking Forums
• Cleveland Clinic: Social Media Policy
• Florida Academy of Family Physicians: Social Media Policy
• West Virginia University: Health Science Centre Guidelines for appropriate use of Internet and Social Media
• Indiana University School of Medicine: Guidelines for Use of online Social Networks
• Iowa Hospital Association: Comment Policy
• Kaiser Permanente: Social Media Policy
• Massachusetts Medical Society: Social Media Guidelines for Physicians
• Mayo Clinic: Comment Policy Blogs
• Ohio State Medical Association: Social Networking and the Medical Practice
• Webicina.com: Open Access Social Media Guide for Pharma
• Hospital Sant Joan de Déu: Política de Redes Sociales
• Roche: Principles
• Sentara Medical Group: Sentara Medical Group: Social Media Policy
• Sutter Health: Policy for Social Networking
• Symplur, LLC: Healthcare Social Media Policy for Physicians and Staff
• The College of Physicians and Surgeons of British Columbia: Social Media and Online Networking Forums
• University of Minnessota Physicians: Terms of Use Social Media
• Vertex Pharmaceuticals: Twitter Guidelines
• Wisconsin Department of Health Services: Social Media Guidelines
• World Medical Association: Statement on the Professional & Ethical use of Social Media