On 2/4/14, I presented a talk at Memorial Sloan-Kettering Cancer Center "Connectivity, Collaboration, and Disruption: Social Media and the Oncologist." I created a special hashtag - #msk_hcsm14 and used it to schedule a series of tweets to go out during the talk with some of my references.

1. #msk_hcsm14
Connectivity, Collaboration, and Disruption:
Social Media and the Oncologist
Solid Tumor Conference
Memorial Sloan-Kettering Cancer Center
February 4, 2014
Robert S. Miller, MD, FACP, FASCO
Clinical Associate, Breast Cancer Program
Johns Hopkins University School of Medicine
Oncology Medical Information Officer
Sidney Kimmel Comprehensive Cancer Center

2. #msk_hcsm14
Disclosures
No relevant financial relationships to disclose
Non-FDA approved uses of drugs or products
discussed
- None

3. #msk_hcsm14
Does social media matter in
health care?

4. #msk_hcsm14

5. #msk_hcsm14
Wireless Sensors
Genomics
Creative
Destruction
New Medicine
Mobile Technology and Bandwidth
Internet
SUPER
CONVERGENCE
Imaging
Social Networking
Computing Power + Data
Universe
Information systems
Old Medicine

6. #msk_hcsm14
Social
media
is
user
generated
content
that
is
shared
over
the
internet
via
technologies
that
promote
engagement,
sharing
and
collabora8on.*
*
Defini(on
from
The
Social
Media
Guide.com
weill.cornell.edu

7. Social
media
is
the
second
Internet
revolu8on.
#msk_hcsm14
Used
w/
permissions
GNU
License
h;p://en.wikiversity.org/wiki/File:Web_2.0_elements.png
h;p://en.wikiversity.org/wiki/File:Web_1.0_elements.png
weill.cornell.edu

8. #msk_hcsm14
http://www.flickr.com/photos/interactegypt/6882960792
Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)

9. #msk_hcsm14
“Facebook hits milestone of 1 billion users”!
--Washington Post 10/4/12
(CC) JD Lasica, socialmedia.biz
Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0)

10. #msk_hcsm14

11. #msk_hcsm14

12. #msk_hcsm14

13. #msk_hcsm14

14. #msk_hcsm14
Social media categories & applications
— Blogging – WordPress, Blogger (Google)
— Microblogging – Twitter, Tumblr
— Social networking – Facebook, Google+, LinkedIn
— Collaborating – wiki’s, Google Docs
— Multimedia content sharing – YouTube, Flickr, podcasts,
Instagram, Pinterest, Prezi, Slideshare
— Social bookmarking – Diigo, Delicious, CiteULike
— Rating/reviewing – Yelp, Epinions
— Location-based social networking – Foursquare

15. #msk_hcsm14
http://instagr.am/p/nm695 via @DouglasWRay

16. #msk_hcsm14
“Why would any physician bother
with this stuff?”
“Isn’t it risky and a total waste of
time?”
“I don’t get Twitter.”

17. #msk_hcsm14
Our patients are online, and they
expect us to be there, too…

18. #msk_hcsm14
Patient engagement and
empowerment - trends
1. The rise of the e-patient
--democratization of medical information
2. Patient portals/online access to medical records =
part of Meaningful Use
3. Patients online and engaged in social media (long
before physicians)
4. Peer-to-peer healthcare

19. #msk_hcsm14
http://www.pewinternet.org/~/media//Files/Presentations/2012/Sept/FoxMed2Panel_PDF.pdf

20. #msk_hcsm14
U.S.: Different sources for different information
http://www.pewinternet.org/Presentations/2013/Jul/Epatients-and-their-hunt-for-health-information.aspx

21. #msk_hcsm14
Mobile health
— 91% of U.S. adults own cell phones
— 56% of U.S. adults own smartphones
— 19% of smartphone owners use health
apps
— Self-tracking/“Quantified self ”
— Exercise, fitness, pedometer, pulse monitoring,
BP, diet, food/calories, blood sugar, mood,
sleep

22. #msk_hcsm14
http://www.jmir.org/2013/12/e287
1. 295 unique apps
2. Purpose: raise awareness (32%), educational
info about cancer (29%), early detection
(12%), fundraising (10%), support disease
management (4%), prevention (2%)
3. Few apps took advantage of smartphone
capabilities (no mobile sensing, limited
communication w/ medical team, other pts)
4. 0/594 articles w/evaluation of cancer app

23. #msk_hcsm14
Data ≠ Information ≠ Knowledge

24. #msk_hcsm14
Our institutions are online…

26. #msk_hcsm14
3
ways
physicians
might
use
social
media
1. To
treat
–
engaging
directly
w/
pa8ents
about
care
2. To
teach
–
providing
8mely
&
credible
educa8on
3. To
learn
–
sharing
of
medical
informa8on/knowledge
Bucket
1
Bucket
2
Bucket
3

27. #msk_hcsm14
Bucket
1
Bucket
2
Bucket
3
Care
Info
Info

28. #msk_hcsm14
The
“Meaningful
Use”
of
Social
Media
by
Physicians
Brian
S.
McGowan,
Ph.D.
Senior
Director,
Oncology;
Medical
EducaDon
Group,
Pfizer
Inc
Chair,
Commi;ee
on
Emerging
Technologies
in
Educa8on
Alliance
for
Con8nuing
Medical
Educa8on
Consult
Columnist,
Social
Media
Connec(ons
Medical
Mee8ngs,
A
Mee8ngsNet
Magazine
Presented
at
“Medicine
2.0”
September,
2011,
Stanford,
CA

29. #msk_hcsm14
Defining
‘Sharing
Medical
Informa8on’
• Sharing
medical
knowledge
is
defined
as
the
exchange
of
informa(on,
advice,
ideas,
reports
and
scien(fic
discoveries
with
other
physicians
in
the
medical
community.
Bucket
3

30. #msk_hcsm14
Adopters
versus
Adamant
Non-­‐Adopters
%
of
Physicians
80
71
70
60
52
50
40
33
30
20
10
13
6
40
36
27
26
25
23
21
19
19
21
18
16
16
13
11
11
9
7
0
Will
Never
Use
Current
user
9
5
1

31. #msk_hcsm14
http://www.jmir.org/2012/5/e117
• 24% use SM daily to explore/share medical
information; 14% use SM daily to
contribute
• 60% say SM improves quality of pt care
• Oncologists more likely to use SM due to
“personal innovativeness”
• PCP’s more likely to use SM to have access
to peers

32. #msk_hcsm14
January 2010

33. January 2014
#msk_hcsm14

34. Academic oncologists on Twitter
—
Sunil Patel (MDACC)
—
Mark Lewis (MDACC)
—
Julie Gralow (Univ of WA)
—
Wafik El-Deiry (Penn State)
—
Ray Dubois (ASU)
—
Larry Norton (MSKCC)
—
Anas Younes (MSKCC)
—
David Johnson (UT-Southwestern)
—
Naoto Ueno (MDACC)
—
Michael Fisch (MDACC)
—
Lee Ellis (MDACC)
—
John Sweetenham (Huntsman)
—
Charles Blanke (OHSU)
—
Rich Schilsky (ASCO)
—
Yousuf Zafar (Duke)
—
Tom Beer (OHSU)
—
Nathan Pennell (Cleveland Clinic)
—
Don Dizon (MGH)
—
Mark Robson (MSKCC)
—
Miguel Perales (MSKCC)
—
Robert Orlowski (MDACC)
—
Antonio Wolff (Hopkins)
—
Evan Lipson (Hopkins)

35. http://rsm2800.blogspot.com

36. http://jop.ascopubs.org/site/podcasts/index.xhtml

37. #msk_hcsm14
Why I like Twitter
— Low barrier to entry
— Platform agnostic
— Minimal requirements for content production (140-
character tweets vs. 500-word blog posts)
— Emphasis on frequency, breadth not depth
— Asymmetric (“following” does not require
reciprocation)
— Ability to embed shortened links
— #hashtags = metadata
— Instantaneous dissemination of information

38. #msk_hcsm14

39. #msk_hcsm14
Diagram of a Tweet
“@” + username
calls that user’s
attention to
message
“shortened”
link
Actions you can
take after posting
Science at the heart of medicine
# Hashtags =
easier way to find
groups of tweets
| 39

40. #msk_hcsm14
#Tweetchats
— Virtual meetings usually held on a repeating basis
organized around a specific topic and hashtag
— Healthcare Hashtag Project -
http://www.symplur.com/healthcare-hashtags
— #BCSM = Breast Cancer Social Media (Mon 9 pm ET)
— Moderated by 2 breast cancer advocates @jodyms & @stales
and an LA breast surgeon @DrAttai

41. #msk_hcsm14

43. #msk_hcsm14
Je n’ai fait celle-ci plus longue que
parce que je n’ai pas eu le loisir de la
faire plus courte.
--Blaise Pascal, Lettres Provinciales (1657)
“I would have written a shorter letter,
but I did not have the time.”

44. #msk_hcsm14
How I use Twitter - outbound

45. #msk_hcsm14
1/25/14 – 1/31/14:
• 44 mentions/RTs
• 8 favorites

46. #msk_hcsm14
How I use Twitter - inbound
— Twitter accounts I follow:
§ Oncologists & other MD’s
§ Thought leaders in organized medicine & IT
§ Journalists, bloggers, patient advocates, public figures
§ Professional societies, institutions
§ Not necessarily everyone who follows me
— New insights – patient empowerment, patient-centered
health IT, safety/quality
— New professional opportunities (but not academic
advancement…yet)

47. #msk_hcsm14
How can there possibly be
enough time to do this?

48. #msk_hcsm14
Consider the value:
— Unexpected connections & networking
— Crowdsourcing questions
— Establishing own digital footprint/reputation
management
— Promote your science

49. PLoS Biol. 2013 April; 11(4): e1001535
“ In the age of the internet, social media tools
offer a powerful way for scientists to boost their
professional profile and act as a public voice for
science.”
“[I]n today’s technology-driven world, lack of an
online presence can severely limit a researcher’s
visibility, and runs the risk that undesirable search
results appear before desirable ones…”

50. How and why to use social media as
a scientist
— Online tools improve research efficiency
§ Keeping up with new developments via Twitter
§ Online communities for niche topics
§ Blogs as medium for extended scientific conversations
— An active online presence may enhance credentials
measured through traditional metrics
— Social media enhances professional networking
— Communicating science to the general public
§ To patients/lay audience – teach, translate
§ Combat pseudoscience (vaccine/autism example)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635859

51. Use of Twitter at medical conferences

52. #msk_hcsm14
Twitter usage at ASCO Annual Meeting
— #ASCO10: 684 users, 4456 tweets (14 MD’s=979 tweets)
#ASCO11: 1537 users, 8188 tweets (34 MD’s=1477 tweets)
Chaudhry A, Glode LM, Gillman M, Miller RS (2012). Trends in Twitter use by physicians at the American Society of Clinical
Oncology Annual Meeting, 2010 and 2011. J Oncol Pract 8:173-178.
http://jop.ascopubs.org/content/8/3/173.full

53. San
Antonio
Breast
Cancer
Symposium
12/10/13-­‐12/14/13

54. YouTube
PromoDng
clinical
trials

55. PromoDng
ParDcipaDon
in
Clinical
Trials
Providing
links
to
Clinicaltrials.gov

56. SWOG.org
1/20/14

57. #msk_hcsm14
Social media & clinical trials
— Engage your institution’s media department and the
sponsor before creating Facebook page/Twitter account
— Determine if IRB review required
— No proprietary information
— Avoid claims about efficacy or discussion about side effects
— No disclosure of trial results
— Monitor posts to avoid HIPAA violations
— No screening of subjects via social media
— Link only to sites for more info (e.g., clinicaltrials.gov)
— No blogging about conduct of study (can be viewed as
advertising)
Adapted from Table 3 in Dizon DS et al J Oncol Pract Sep 1, 2012:e114-e124

58. #msk_hcsm14
http://33charts.com/2011/12/physicians-risk-opportunity-social-media.html

59. #msk_hcsm14
Professionalism in the Use of Social Media
(AMA Policy 11/8/10)
— Always maintain patient privacy/confidentiality.
— Monitor own Internet presence/use privacy settings
on SM (know they are not absolute).
— Maintain boundaries when interacting with patients
online.
— Consider separating personal & professional online
accounts.
— Police colleagues’ online behavior.
— Online behavior can affect reputation & undermine
trust in the medical profession.
http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medicalethics/opinion9124.page

60. #msk_hcsm14
http://jop.ascopubs.org/content/8/5/e114.long
http://annals.org/article.aspx?articleid=1675927

62. #msk_hcsm14
Potential problem areas
— Establishing a patient-physician relationship via social
media
— Communicating directly with existing patients via
social media/online friendships and connections
— Writing about patients on social media
— Googling patients
— Product endorsements and advertisements
Chretien K, Kind T. Social media and clinical care: Ethical, professional, and social
implications. Circulation 2013; 127:1413-1421
http://circ.ahajournals.org/content/127/13/1413

63. #msk_hcsm14
Ten tips from ASCO (Tips 1-5)
1. Get involved
2. Engage often
3. Always identify yourself
4. Protect patient confidentiality and
privacy
5. Contextualize your activities

64. #msk_hcsm14
Ten Tips….
6. Avoid impropriety
7. Give credit where credit is due
7. Professionalism is critical
8. Separate the personal from professional
9. Be aware of your institutional guidelines
http://www.asco.org/about-asco/social-media

65. #msk_hcsm14
Mayo Clinic
12 Word Social Media Policy
— Don’t Lie, Don’t Pry
— Don’t Cheat, Can’t Delete
— Don’t Steal, Don’t Reveal
--Farris Timimi, M.D., Medical Director, Mayo Clinic Center for Social Media
http://socialmedia.mayoclinic.org/2012/04/05/a-twelve-word-social-media-policy

66. #msk_hcsm14
My version…
— Don’t be anonymous
— Don’t be stupid
— Remember everyone’s watching
— Developing trust in your online community takes time
– maintain a healthy skepticism

67. #msk_hcsm14

68. #msk_hcsm14
How to get started
— Be a lurker first
§ Read blogs, listen to podcasts, learn how to use RSS feeds for journals & news sites
— Join Twitter
§ Pick a short, descriptive handle, use a real photo as an avatar
§ “Who to follow” Twitter suggestions, follow people others follow
§ Give it time to grow
— Share content – links to articles and stories that
interest you
— Create content – blog
— Cultivate your network – RT’s, #FF, @replies

69. Public network skills every physician
should have --Bryan Vartabedian, MD (33 charts
blog)
1. The ability to confidently shape and compose an idea
2.
3.
4.
5.
or opinion in under 500 words
The ability to summarize and share an idea in a few
hundred characters
The ability to shape an idea and put it on a short
video clip
Understanding of the limitations of patient-specific
dialog in public networks
Understanding of how to manage input and
consumption of information
http://33charts.com/2013/09/public-network-skills-physicians.html

70. New physician literacies in the digital
age --Bryan Vartabedian, MD (33 charts blog)
1. Network Awareness/Collaboration
-Physicians no longer control information
2. Input management
-Too much to know (balancing information, attention, and
filters)
3. Creation/Translation
-Moving online from
observationàconversationàcurationàcontent creation
4. Mindfulness
-Balancing technology with attention to patients
http://33charts.com/2012/09/new-physician-literacies.html

71. #msk_hcsm14
Conclusions
— The Internet has democratized information and
eliminated traditional filters constraining access to
medical knowledge; social media (SM) is the
communication channel resulting from this change in
paradigm.
— SM provides an unparalleled opportunity for the
authoritative voice of the physician to be heard in patient
education & health messaging.
— Physicians can effectively use SM for connection and
networking with other physicians and scientists both inside
of and outside of traditional spheres of influence.

72. #msk_hcsm14
Conclusions (cont.)
— Concerns about patient privacy, liability, and time
commitment do not negate the value of participation in
SM.
— Physician professionalism and patient-centered focus
trump all other considerations.

73. Track this talk on Twitter
#msk_hcsm14
Follow me on Twitter:
@rsm2800
Read my blog:
rsm2800.blogspot.com