Portal de Periódicos da CAPES

Social media in vascular surgery

2013; Elsevier BV; Volume: 57; Issue: 4 Linguagem: Inglês

10.1016/j.jvs.2012.09.065

1097-6809

Jeffrey Indes, Lindsay Gates, Erica L. Mitchell, Bart E. Muhs,

Digital Marketing and Social Media

There has been a tremendous growth in the use of social media to expand the visibility of various specialties in medicine. The purpose of this paper is to describe the latest updates on some current applications of social media in the practice of vascular surgery as well as existing limitations of use. This investigation demonstrates that the use of social networking sites appears to have a positive impact on vascular practice, as is evident through the incorporation of this technology at the Cleveland Clinic and by the Society for Vascular Surgery into their approach to patient care and physician communication. Overall, integration of social networking technology has current and future potential to be used to promote goals, patient awareness, recruitment for clinical trials, and professionalism within the specialty of vascular surgery. There has been a tremendous growth in the use of social media to expand the visibility of various specialties in medicine. The purpose of this paper is to describe the latest updates on some current applications of social media in the practice of vascular surgery as well as existing limitations of use. This investigation demonstrates that the use of social networking sites appears to have a positive impact on vascular practice, as is evident through the incorporation of this technology at the Cleveland Clinic and by the Society for Vascular Surgery into their approach to patient care and physician communication. Overall, integration of social networking technology has current and future potential to be used to promote goals, patient awareness, recruitment for clinical trials, and professionalism within the specialty of vascular surgery. Five hundred million is the number of worldwide users that Facebook, the largest social networking site to date, can claim have accessed its site.1Eckler P. Worsowicz G. Rayburn J.W. Social media and health care: an overview.PM R. 2010; 2: 1046-1050Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Of this group, 142 million users are found in the United States alone, with 61% of them being 35 years and older.1Eckler P. Worsowicz G. Rayburn J.W. Social media and health care: an overview.PM R. 2010; 2: 1046-1050Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar In fact, looking at the 19 most popular social networking websites in the United States, the second most prevalent group of users, at 19%, are between 45 and 65 years old.1Eckler P. Worsowicz G. Rayburn J.W. Social media and health care: an overview.PM R. 2010; 2: 1046-1050Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar Social media is one of the most rapidly growing and evolving technologies of today. No longer limited to just teenagers and young adults, it is showing rapid yearly growth in the population 50 years and older. This, coupled with its increased integration in individuals' daily routines, shows it is only natural that health care systems and providers are exploring how to better utilize this tool to provide improved patient-physician communication and resources. Vascular surgery is one area of medicine that, like social media technology, is also evolving at an alarming rate. The challenge will be to determine what role social media will play in the future of vascular surgery and how vascular surgeons can interact with a growing high-tech, interactive, and inquisitive patient population. What is social media? The term social media refers to the use of web-based and mobile technologies to turn communication into an interactive dialogue. Social media can take on many different forms: Internet forums, weblogs, social blogs, microblogging, wikis, podcasts, photographs or pictures, video, and social bookmarking. Kaplan and Haenlein2Kaplan A.M. Haenlein M. Users of the world, unite! The challenges and opportunities of social media.Business Horizons. 2010; 53: 59-68Crossref Scopus (8241) Google Scholar recently created a classification scheme for different social media types, dividing them into six distinct groups: collaborative projects (eg, Wikipedia), blogs and microblogs (eg, Twitter), content communities (eg, YouTube), social networking sites (eg, Facebook), virtual game worlds (eg, World of Warcraft), and virtual social worlds (eg, Second Life; Table).3Bennett E. Hospitals and social media: a survey of best practices [Internet]. Available at: http://ebennett.org/hsnl/. Accessed April 6, 2012.Google Scholar There are several advantages of utilizing these different types of social media over traditional media (books, magazines, television).4Social media [Internet}. Available at: http://en.wikipedia.org/wiki/Social_media. Accessed April 4, 2012.Google Scholar First, they have enormous reach, capable of covering a global audience. They are “accessible” for little or no cost, and many applications are considered “user friendly,” requiring very simple directions and little specialized or advanced knowledge of computers or programming. Social media is immediate, and communications can be instantaneous, unlike industrial media where lag time can be days to weeks. However, there still are some limitations. Social media can be less permanent than traditional media, communications can be edited and altered at any time, and end user content lacks accountability.TableSocial media types as determined by use and functionTypeDescriptionExamplesExamples in health careCollaborative projectsEnable joint and simultaneous creation of content by many end-users.Wikipediawww.wikipedia.orgMedpediawww.medpedia.comOpen Medicinehttp://livewiki.openmedicine.caBlogsOnline journals where authors share their opinion and/or experiences on various topics. Consists of discrete entries or “posts.” Usually, the work of a single individual, themed around a single subject.Bloggerwww.blogger.comLiveJournalwww.livejournal.comSharing Mayo Clinic:www.sharing.mayoclinic.orgAmerican Red Crosswww .blog.redcross.orgContent communitiesWeb sites on which users share photos/videos/files. Uploads arc scarchable and often can be downloaded and spread by linking to them.YouTubewww.youtube.comFlickrwww.flikr.comDuke University Medical Center on Youtubewww.youtube.com/user/dukemedicineSocial networking sitesAn online service, platform, or site that focuses on building social networks or social relations among people. People can share updates about themselves, photos, links, etc. A key function is linking to other profiles.Facebookwww.facebook.comMySpacewww.myspace.comVeterans Health Administration of Facebookwww.facebook.com/VeteransHealthVirtual game worldsPlatforms that replicate a 3D environment in which usuers can appear in the form of personalized avatars and interact with each other as they would in real life. Require users to behave according to strict rules in the context of massive multiplayer online role-playing games.World of Warcraftwww.us.battle.net/wow/en/Ever Questwww.everquestcomWeb-based virtual reality simulation “games” utilized for medical student educationVirtual social worldsSimilar to virtual gaming worlds, allows inhabitants to choose their behavior more freely and essentially live a virtual life similar to their real life. There are no rules restricting the range of interactions.Second Lifewww.secondlife.comSecond life-heart murmur simulator Open table in a new tab The influence and utilization of social media in vascular surgery alone is not well studied. However, a number of health care organizations have already established a social media presence. Currently, 1229 hospitals could be found on one or more social networking sites in 2011, with over 4118 pages. Facebook was the most common with 1068 pages, followed by Twitter with 814 accounts.3Bennett E. Hospitals and social media: a survey of best practices [Internet]. Available at: http://ebennett.org/hsnl/. Accessed April 6, 2012.Google Scholar Among surgical subspecialties, preliminary data show that plastic surgery has had success utilizing social networking websites in their practices. A recent study published in the Aesthetic Surgery Journal looked at seven major cities and the utilization of social media by plastic surgeons in those cities.5Wong W.W. Gupta S.C. Plastic surgery marketing in a generation of “tweeting.”.Aesthet Surg J. 2011; 31: 972-976Crossref PubMed Scopus (49) Google Scholar Data showed that 30%-50% of successful practices had a presence on one or more social networking sites.5Wong W.W. Gupta S.C. Plastic surgery marketing in a generation of “tweeting.”.Aesthet Surg J. 2011; 31: 972-976Crossref PubMed Scopus (49) Google Scholar For vascular surgery in particular, one area in which social media could potentially be instrumental is in the recruitment of patients for clinical trials. A recent survey conducted by a patient recruitment specialist revealed that of the 179 adults surveyed, only 30% of these patients were aware of clinical trial websites such as clinicaltrials.gov and the National Breast Cancer Foundation. Once informed of these trials, 81% of this group of identified “e-patients” was interested in participating in relevant clinical trials. This particular article argued that health communities could use these social networking sites to present a public face to the consumer, establishing trust quicker with future patients.6Nowotarski M. Do not steal my avatar! Challenges of social network patents [Internet]. IP Watchdog; January 23, 2011. Available at: http://www.ipwatchdog.com/2011/01/23/dont-steal-my-avatar-challenges-of-social-networking-patents/id=14531/. Accessed April 21, 2012.Google Scholar Utilizing social media sites could also be influential in providing vascular surgeons with a more effective vehicle to communicate with patients, providing resources, educational material, or services. The goal would be to provide a customized approach to patient interaction as well as increase referrals, develop a patient base, and create a positive reputation. The Miller Family Heart and Vascular Center at the Cleveland Clinic is an example of this type of interactive, customizable patient-centered media approach. This group hosts their own Facebook page (www.facebook.com/clevelandclinic) with direct links to their website. It allows for patients, physicians, and hospital representatives to post messages on their wall in a continuously streaming nature. One of the links takes patients to the Cleveland Clinic's hospital website, providing patients with detailed information from A-Z with respect to only vascular diseases. Another link is to a Twitter account (www.twitter.com/ClevClinicHeart), on which representatives from their hospital can post “tweets” related to heart and vascular care. Other links will take users to webchats (www.clevelandclinic.org/webchat) on various topics in vascular surgery or to videos that describe the vascular center and various milestones or procedures in vascular surgery. This static content is supplemented by an active and evolving monthly blog entitled “The Beating Edge” (www.thebeatingedge.org), which is designed to keep patients informed about cardiovascular and thoracic diseases, in addition to keeping them current on the institution's research. It features an attached forum for patients to post comments, stories, and feedback. The Cleveland Clinic is not alone in its presence on social networking sites. The Society for Vascular Surgery (SVS), in addition to its website (www.vascularweb.org), has recently joined interactive sites such as Facebook, LinkedIn, Twitter, and YouTube. At the most recent vascular annual meeting, Twitter was used extensively for communication between attendees. Podcasts being added regularly to YouTube feature society members providing information on various topics related to patient care, practice-related issues, and information for medical students and residents about training in vascular surgery. With all of the available options, how to effectively utilize social media and establish an online presence can be a difficult decision. For most health care providers, the simplest starting point would be a professional website. This website can be used as a hub to all other online activities. It should be professionally designed to convey the purpose of a provider or practice to future clientele. Most providers will need to seek assistance from third-party contractors that have experience and a credible reputation in working with the health care community. Once a main site is created, links can be established to other websites such as YouTube, for presenting videos of procedures or device demonstrations; Facebook, for direct interaction with patients; or personalized blogs or chats about different specialty-centered discussions. Either a provider or an outside contractor, depending on the physician's or center's aptitude, can generate a site's available content. Generally, it is useful to provide patient resources (forms, routine questions, visit information), procedure information, and specific information about the practice and staff. However, it is important to remember to remain diverse. Diversifying a provider's online presence will increase visibility and reach a wide-ranging population. Equally important as diversity, is for providers to remain active. Engage in online activities such as patient chats or professional forums, and be diligent with keeping all content up to date with the latest available data. It can be best for novices to start with one main type of social media and then expand according to the needs and purpose of the practice. All of these activities will boost a physician's or center's reputation as an expert among both patients and other professionals within the specialty. Social media can be an effective communication tool; yet, there are potential downfalls with social media utilization in a vascular surgery practice that should not be overlooked. First, patients may come to rely on social media as a substitute for immediate communication with providers, failing to be available for office visits and phone calls. This could potentially delay diagnoses or treatments, which could harm overall patient care. In addition, patient privacy could become a legal issue with certain online communications. Under the Health Insurance Portability and Accountability Act (HIPAA), health care providers are designated as “covered entities,” meaning they have a legal obligation to safeguard protected patient information from disclosure to third parties without authorization.7Health Insurance Portability and Accountability Act of 1996. 42 U.S.C. 1320D-9. 2012.Google Scholar In April 2011, this obligation became the basis of a landmark legal case against a physician from Rhode Island after she posted specific medical information online about one of her patients, ultimately resulting in the termination of her medical license. In this case, the patient's name and other personal identifiers were not included; however, due to the specific medical information listed, the judge ruled that it would be possible for the patient's small community to discover his or her identity. This is one of the first of a limited number of cases involving disciplinary actions concerning the use of social media. The resultant harsh disciplinary decisions have set precedence by the courts of low tolerance for violators.8Lambert K. Risk management and legal issues with the use of social media in the healthcare setting.Am Soc Healthc Risk Manage. 2012; 31: 41-47Crossref PubMed Scopus (55) Google Scholar In response, many institutions have strict policies in place that prohibit physicians from using the Internet to communicate about or with patients to avoid such potential violations. In a 2010 survey of state medical boards in the United States, 92% indicated that violations of online professionalism were reported in their jurisdiction. Violations ranged from inappropriate contact with patients to misrepresentations of credentials or clinical outcomes. Growing concerns spurred the Federation of State Medical Boards to come together to create a policy with provided guidelines on the appropriate use of social media and social networking in medical practice.9The Federation of State Medical Boards. Model policy guidelines for the appropriate use of social media and social networking in medical practice [Internet]. Available at: http://www.fsmb.org/pdf/pub-social-media-guidelines.pdf. Accessed May 9, 2012.Google Scholar The policy outlines the need for parity of ethical and professional standards applied to all aspects of an individual's practice, including online interactions. As well as further discussing acceptable physician conduct and communication, it outlines potential disciplinary actions that state medical boards have the authority to enact upon violators. In spite of the challenges posed by the usage of social media by a vascular surgery practice, if providers take direct control of their use and implement strict policies that include disclaimers about public postings, physician communications, and medical information, they may safeguard themselves from future liability without sacrificing all of the benefits of this growing technology. Social media can potentially be used as a tool for vascular surgery providers to promote practice goals, patient awareness, and recruitment for clinical trials, as well as improve communication and professionalism within the specialty. With the growing popularity among users within the vascular surgery demographic, increasing utilization and prevalence on social networking sites seems like a logical next step for this specialty as well as the health care community as a whole. Conception and design: JI, LG, BM Analysis and interpretation: JI Data collection: Not applicable Writing the article: JI, LG Critical revision of the article: JI, LG, EM Final approval of the article: JI Statistical analysis: Not applicable Obtained funding: Not applicable Overall responsibility: JI The authors would like to acknowledge the following individuals for their help in obtaining information related to this article's content: Betsy Stovsky, RN, MSN, Cleveland Clinic; Jill Goodwin, Society of Vascular Surgery; Lois A. Killewich, MD, PhD, The University of Texas Medical Branch; David Armstrong, DPM, MD, PhD, The University of Arizona; Norman M. Rich, MD, FACS, DMCC COL, MC, USA (Ret), USUHS; Matthew Eagleton, MD, Cleveland Clinic; Jeffrey Kaufman, MD, Springfield, Mass; and Kenneth Ouriel, MD, Cleveland Clinic.