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

Recomendando "apps" sin frivolizar

En los últimos meses vemos un interés creciente por las aplicaciones para móviles y tabletas, las llamadas "apps", que han experimentado un crecimiento extraordinario en número y en funciones relacionadas con temas de salud y medicina.

Esta semana asistí a la interesante jornada "Apps On Health" que tuvo lugar en el Hospital San Joan de Dios, donde se han presentado las últimas tendencias en este campo. Recientemente también llamaba la atención una noticia sobre la recomendación por parte de la National Health Service del Reino Unido, de que los médicos "receten" apps a sus pacientes.

Ahora bien, ¿quién elabora los apps? ¿cómo ha sido evaluada su utilidad/calidad? ¿realmente dan información fiable sobre la frecuencia cardíaca o la dieta más adecuada para cada usuario y situación? Y aunque sea así, ¿ha sido comprobado que son más beneficiosos que estrategias, digamos, más tradicionales? ¿que son efectivos y eficaces?

Tanto medicamentos, como técnicas y dispositivos sanitarios deben seguir estrictos procesos y controles de calidad, ¿qué ocurre con los apps? Debemos profundizar e investigar en el tema.

Las Redes Sociales y sus dilemas ¿hasta dónde debemos llegar?

Ayer asistí a la jornada sobre web 2.0 organizada por el Parc Sanitari Pere Virgili. Surgieron temas interesantes, como en otras ocasiones, relacionados con la utilización de las redes sociales con fines sanitarios. Uno de las cuestiones que surgió en diversas ocasiones, fue cómo debe el profesional compaginar su actividad institucional y la personal con su identidad digital.

Una de las cuestiones planteadas por uno de los asistentes me pareció de gran interés, al respecto de que si un médico manifiesta por ejemplo su oposición a la utilización de ciertas vacunas en su blog personal, la institución para la que trabaja debería tomar o no alguna medida. Se comentó que si se trataba de un blog personal podía opinar libremente sobre dicho tema.

Creo que la respuesta no es tan sencilla. Es cierto que las redes sociales nos permiten opinar libremente de los temas que nos preocupan o manifestar el apoyo o el rechazo a una determinada acción, hecho u opinión. Sin embargo, en el caso planteado (y en otros muchos), sobre el que quizás me siento especialmente vinculado por mi actividad en diversos grupos de trabajo sobre vacunas, creo que debe hacerse una reflexión más profunda al respecto. Aunque se trataría de una opinón personal vertida por un médico en su blog, es fácil pensar que pacientes y la propia institución a la que trabaja puedan leer dicha información y de ahí que surjan algunas preguntas:
¿Cómo puede explicar a sus pacientes que debe vacunarlos si opina de forma diferente tal como ha manifestado? ¿no creará confusión entre los usuarios y pacientes y desconfianza no sólo en el propio médico, sino en la institución a la que representa?
La institución en la que trabaja, ¿cómo debe interpretar dicha opinión con respecto al ámbito del trabajo que dicho médico puede estar desarrollando en la misma? ¿no puede dudar acaso del tipo de atención que está dando en sus consultas?

Está claro que las consecuencias (positivas o negativas) de "opinar" en las redes sociales (blogs, Facebook, Twitter, etc.) sobre un tema de salud relacionado directamente con nuestro trabajo, afectará la relación con los pacientes que atendamos, con la propia institución en la que trabajamos e incluso en este caso, en la propia forma de entender la prevención en salud en el que basa la aplicación de las vacunas.

Podemos imgaginar mil situaciones similares, entonces ¿hasta dónde podemos o debemos llegar con nuestras opiniones?

Social Networks and Medical Doctors and Students

In recent years social media has grown exponentially and there has been widespread use, amongst medical doctors and students, of platforms such as Twitter and Facebook. Several studies show that the use of social media by the medical profession is common and growing exponentially. Also, Internet forums and blogs are usual resources of medical information and participation. At the same time, there are intense debates about the complexities of ensuring medical professionalism in the digital age and there is little consensus among doctors on how interactions on these networks should be managed.

With all this in mind, Web Mèdica Acreditada (WMA) recently carried out a study trying to identify relevant guidelines and recommendations, in English and Spanish. First, we made a simple search in Google using diverse queries and their combination. Second, sixteen documents were selected based on their relevance and their content was analyzed comparing the statements and items in order to find agreements and differences. There are several professional organizations that have proposed some practical recommendations to guide doctors and medical students in using social media. This study was accepted in the 4th ICST International Conference on eHealth that will take place in Malaga (Spain) next 21-23 November 2011, where we will present it.

The main conclusions were the following: 1. There is a general consensus about the key role that medical doctors have in social networks. 2. Potential negative and positive consequences (professional, personal and in medical profession) are considered depending on their behaviour in these environments. 3. A Guidance of useful practices was proposed (see the presentation, slides 7 to 16):

Social Networks and Medical Doctors

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Is Wikipedia reliable when talking about health information?

According to a recent study that was published in the Journal of Oncology Practice last week (the 15th September released online in advance), the information about cancer in Wikipedia is, in general, reliable but it was difficult to understand in terms of readability (Wikipedia is written at a college level with complex information and hyperlinks that hinder its understanding).

I would like to mention that last year we also carried out a study of the information in Wikipedia about vaccines, that we presented in the European Family Medicine Conference (WONCA, Málaga, October 2010). In that study we found out that the articles in Wikipedia about vaccines were quite good but at the same time, there was a lack of information about the authors' profile of the articles (in very few cases was the author a health professional) and there were no clues to determine the country or scenario of the immunization schedules of vaccines recommended. This last point is a very important matter because each country has different schedules (there are countries such as Spain with several schedules depending on the region where the vaccine has to be applied) and therefore the recommendations may change a lot depending on where we are.

Using Wikipedia as a source of Health Information

View more presentations from Department Web Médica Acreditada, Medical Association of Barcelona

I think that we need more studies to determine the real usefulness and applications of Wikipedia as a source of health information, for instance thinking of educational and Public Health purposes. Finally, it is very interesting to know that there are several health initiatives to promote the improvement of the medical information in Wikipedia such as Wikiproject Medicine.

Medicina Basada en la Evidencia en las consultas de AP

La atención sanitaria en los centros de salud de Atención Primaria (AP) exige satisfacer unas necesidades de información entre sus profesionales, amplias, diversas y continuas, para asegurar una asistencia de calidad, así como favorecer el desarrollo de actividades docentes y de investigación.

El acceso a fuentes de información de calidad y de Medicina Basada en la Evidencia (MBE) ha de considerarse una prioridad y debe ser facilitada en los centros de salud. Un estudio que fue realizado por Alonso et al. (BMC Health Serv Res 2009; 9:80) así lo ponía de manifiesto, señalando la inaccesibilidad a las fuentes de información de calidad, falta de tiempo y la necesidad de mayores conocimientos en la evaluación crítica de las publicaciones por parte de los médicos de AP.

Desde el grupo de MBE de semFYC hemos elaborado la "Declaración sobre el acceso a las fuentes de información científica para el médico de familia" (acceso al artículo en prensa) señalando la importancia de solucionar estos problemas y de proveer acceso a recursos MBE desde los propios centros de Atención Primaria.

Analysing social networking for Public Health measures

It is well known that the Internet can be useful in monitoring disease outbreaks as different approaches have shown in recent studies, for instance based on the use of search engines (e.g. Google Trends) and Web 2.0 channels such as blogs, Facebook and Twitter.

I would like to focus on the use of Twitter in this fashion. Recently, Paul MJ et al. have published a paper ("You are What You Tweet: Analyzing Twitter for Public Health") where the messages of social media users are analysed in order to find out information to be useful for Public Health. The idea is to aggregate millions of messages to generate relevant knowledge, in that case, trying to get diverse public health measures, taking into account that Twitter (and social networks in general) may be a new Internet-surveillance method characterized by an important message volume, frequency and public availability. One of the problems I see is the fact that these messages and people behind them may represent a certain reality that could not be applied to the majority of cases or scenarios in terms of Public Health (probably many unknown factors play role in this environment). Nevertheless, I'm sure it's a very interesting line of research that needs to be more studied in depth.

Puntuando a los médicos en la web

Cada vez es más frecuente (también en España), webs que incluyen listas de profesionales de la salud y su lugar de actividad profesional, y en las que los usuarios pueden aportar opiniones sobre dichos profesionales y la experiencia personal que se haya podido tener con la atención sanitaria recibida.

Lo positivo está en que es importante facilitar la comunicación entre los diferentes protagonistas, poder expresar libremente opiniones tanto favorables como no, pero siempre con un objetivo, mejorar el sistema en general y la atención médica en las consultas.
Lo negativo, y desafortunadamente tan importante como lo positivo o más, es el hecho de que estas plataformas no pueden asegurar (tal como suelen indicar) quién eres realmente (desde el punto de vista profesional) y lo que es todavía más preocupante, tampoco sabemos quiénes están opinando sobre un profesional, hospital o servicio. ¿Cuáles pueden ser las consecuencias de una o muchas opiniones falsamente vertidas (con buena o mala intención) en estos foros, positivas o negativas, que pueden influir sobre la decisión de otros usuarios, creyendo que la atención médica ofrecida es la mejor en el primer caso, o rechazándola de pleno al leer la pésima calidad asistencial del profesional calificado en el segundo caso?

Si queremos la bien deseada transparencia, ésta debe ser exigida a todos, no sólo a los profesionales, sino también a las plataformas y a los que opinan, así ganamos todos. Mientras tanto, podemos estar ante una peligrosa farsa basada en una buena idea, utilizada sin la mínima seguridad y ética exigibles.

Beyond e-patients

New Communication and Information Technologies (ICT) are no longer new, they are totally integrated into our lives, in our personal, social or professional relations, there is no turning back. For that reason, some terms which have made complete sense up to now are not necessary any more and should be given up.

E-patients and e-physicians turn back into patients and physicians, at present they have integrated twitter and facebook or other social networks into their day to day work, and they are using Google searches, as much as to be better informed in the case of the former and better trained in the latter and also clarify their doubts, their illness or concerns, to get support from others like them, sharing their knowledge and experience, to make an appointment, to get medical advice online and so forth.

Now the previous patient-doctor relationship in the current e-scenario is a simple reality and fortunately it is a renewed relationship and it isn't an "e-" any more. The Electronic Health Record (EHR) is shared between patients and medical doctors and the possibility to gain access to them is a fact, to recommend high quality websites is usual and it seems that online support groups and social networks will soon be incorporated in the EHR.

From now on, we may and we have to give up talking about "e"-patients, we reinvent o.s. time and again but now as "patients".