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Medical Group Practice Marketing: 5 Common Facebook Pitfalls

Medical Group Practice Marketing: 5 Common Facebook Pitfalls | Social Media and Healthcare |

With marketing efforts increasingly shifting to online activities like blogging and search optimization,
marketers at medical group practices need to keep up and be able to communicate effectively with their large patient base and future prospective patients. One of the best ways to do this is through social media. Twitter, Facebook, LinkedIn and others make it so much easier for you to communicate, connect, and nurture all of your patient leads. This can be especially effective in group practices who have the critical mass to enjoy greater engagment from social media activity. The biggest social media site is, of course, Facebook.

However, you need to make sure that your Facebook marketing is tip top or you won't see the results you're trying so hard to achieve. There are major pitfalls that all group practices need to be wary of. When you avoid these pitfalls, your online marketing and social media will start to produce a real,measurable ROI.

1. Not Being Interactive

The biggest key of social media is going to be the first part of the word itself: social. If you're not making an effort to respond and interact with your Facebook fans, then you risk appearing like an organization that has poor service. This is especially true if patients are actively seeking and reaching out to your page with questions and concerns that go unanswered.

Instead, establish a policy that includes prompt timing when it comes to responding to posts on Facebook. The most ideal time frame would be within just a few hours. It may seem obvious, but you should train employees to treat patients on Facebook just as you would if they were calling you, courteously and professionally. Otherwise, they are going to have a bad memory associated with your practice.

  • Word of bad experiences travels fast on social media. 

2. No-Show Group Practices

When you create a Facebook page, the next step in the process is posting frequently enough to give a little reminder to patients that you're active on their news feed. Ideally, you will want to post content (special promotions, original content, articles, and the like) at least once a day, even asking
 a simple question or mentioning an interesting article can be enough to touch base with your patients.

Facebook allows you to schedule all of your posts for certain hours of the day, making the task of posting something that can be handled in small blocks of time.

  • Having a page on Facebook that looks like a ghost town leaves a bad impression of your organization.

3. Not Considering Your Facebook Audience

It is important to recognize what type of services your medical group practice provides and who your actual audience on Facebook is. Let's consider the example of an oral and maxillofacial surgery group. 

Like many groups, their Facebook community is made up mostly of patients who have come into the office for a procedure and were compelled to "Like" the group on Facebook. So far everything is great, working just like it should. However, many of the patients at an oral surgery group practice are coming in for a procedure like dental implants or wisdom teeth removal. These patients hope to never have to come in again for these procedures. 

Posting articles on Facebook about dental implants may fall on deaf ears, so to speak. Sure, your fans may hit "like" or even share the article with others. However, these are patients who have already come in for implants. You're presenting the wrong message to the wrong person at the wrong time. 

A better approach may be to discuss the implant maintenance and cleaning program your office just developed. Or promote cosmetic services like Botox, something a Facebook fan may still have interest in. 

  • Are your Facebook messages aimed at the right audience? 

4. Not Keeping It Somewhat Casual

Facebook is all about connecting with others and, sometimes, posting some lighthearted stuff. When most people are following brands, including group practices, they may be seeking out deals or "incentives," or they may be searching for helpful information about their health situation.

However, not lightening things up a bit from time to time will quickly make your business seem boring to your Facebook fans. While there needs to be a level of appropriateness, you can still keep it casual by discussing things that aren't directly related to work. Posting about how to eat healthy at a Fourth of July cookout while still enjoying yourself, for example. 

  • Is your Facebook page engaging and lighthearted enough to keep people's interest?

5. Posting Too Often

Yes, I just said to be careful and make sure you post often enough. However, there is a fine line and once it is crossed, your business actually starts to annoy people. A good rule of thumb is to post no more than 3-5 times per day. We know that Facebook does not show your posts to all of your fans. That said, people will get put off if your medical group practice is posting 2-3 times an hour with seemingly irrelevant information. 

  • Keep a close eye on the comments. If you start to read that people are getting annoyed it may be time to pull back on the throttle.

Avoid these pitfalls and your group practices will go very far with their social media. In fact, it can make everything seem a lot more fun!

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Social Media and Healthcare
Articles and Discussions on the intersection of Social Media and Healthcare.
Relevant to Healthcare Practitioners, Pharma', Insurance, Clinicians, Labs, Health IT Vendors, Health Marketeers, Health Policy Makers, Hospital Administrators.
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Social Media Implementation Checklist

Social Media Implementation Checklist | Social Media and Healthcare |

Set goals first. If traffic, leads and sales are part of the goal, then gotta have the next focus be on content creation. Then, using social to share. Can't get much value out of social unless you're actively creating, publishing and sharing content. 

MARGARITA's curator insight, December 31, 2015 5:15 PM

Support our people

United Home Healthcare's curator insight, June 12, 2017 12:29 PM
Being active on Social media can really help your company.
rob halkes's curator insight, September 15, 2017 6:04 AM

You might think that after 10+ years, social media for healthcare is a self evident activity,! Nothing is less true, however ;-) But here's a checklist you need if you still need to sign up ;-) 


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Social interactions can influence how physicians recommend breast cancer screenings

Social interactions can influence how physicians recommend breast cancer screenings | Social Media and Healthcare |

Perhaps rules are meant to be broken. But guidelines, according to recent research, are not always followed when physicians recommend breast cancer screening to patients.

A research letter published Dec. 4 in JAMA: Internal Medicine,explores how social interactions with friends, family and colleagues who have been diagnosed with breast cancer may affect a physician’s recommendations to patients.

Led by Craig Evan Pollack, MD, MHS, with Johns Hopkins University in Baltimore, a group of researchers surveyed 848 physicians who had a social network member diagnosed with breast cancer. Some 44.7 percent were general practitioners or specialized in family medicine, with 29 percent in internal medicine and 26.3 in gynecology. These physicians reported 1,631 social network members receiving breast cancer diagnoses, including 771 patients and 381 family members.

Physicians familiar with someone with a poor prognosis who was not diagnosed via screening were much more likely to recommend routine checks for women between 40 and 44 years old and those over 75.

“Describing a woman whose breast cancer was not diagnosed by screening mammogram and who had a poor prognosis was associated with increased odds of recommending routine screening to patients within the designated younger and older age groups for which guidelines no longer support routine, universal screening,” Pollack et al. wrote. “Our results suggest that helping clinicians reflect on how their experiences influence their current screening patterns may be an important approach to improve adherence to revised breast cancer screening guidelines.”

The researchers noted how bad experiences are recalled more frequently than positive ones, which can lead physicians to perceive a greater risk than those not familiar with dreaded outcomes.

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Social Media Impact of the Food and Drug Administration's Drug Safety Communication Messaging About Zolpidem: Mixed-Methods Analysis

Social Media Impact of the Food and Drug Administration's Drug Safety Communication Messaging About Zolpidem: Mixed-Methods Analysis | Social Media and Healthcare |

Background: The Food and Drug Administration (FDA) issues drug safety communications (DSCs) to health care professionals, patients, and the public when safety issues emerge related to FDA-approved drug products. These safety messages are disseminated through social media to ensure broad uptake.

Objective: The objective of this study was to assess the social media dissemination of 2 DSCs released in 2013 for the sleep aid zolpidem.

Methods: We used the MedWatcher Social program and the DataSift historic query tool to aggregate Twitter and Facebook posts from October 1, 2012 through August 31, 2013, a period beginning approximately 3 months before the first DSC and ending 3 months after the second. Posts were categorized as (1) junk, (2) mention, and (3) adverse event (AE) based on a score between –0.2 (completely unrelated) to 1 (perfectly related). We also looked at Google Trends data and Wikipedia edits for the same time period. Google Trends search volume is scaled on a range of 0 to 100 and includes “Related queries” during the relevant time periods. An interrupted time series (ITS) analysis assessed the impact of DSCs on the counts of posts with specific mention of zolpidem-containing products. Chow tests for known structural breaks were conducted on data from Twitter, Facebook, and Google Trends. Finally, Wikipedia edits were pulled from the website’s editorial history, which lists all revisions to a given page and the editor’s identity.

Results: In total, 174,286 Twitter posts and 59,641 Facebook posts met entry criteria. Of those, 16.63% (28,989/174,286) of Twitter posts and 25.91% (15,453/59,641) of Facebook posts were labeled as junk and excluded. AEs and mentions represented 9.21% (16,051/174,286) and 74.16% (129,246/174,286) of Twitter posts and 5.11% (3,050/59,641) and 68.98% (41,138/59,641) of Facebook posts, respectively. Total daily counts of posts about zolpidem-containing products increased on Twitter and Facebook on the day of the first DSC; Google searches increased on the week of the first DSC. ITS analyses demonstrated variability but pointed to an increase in interest around the first DSC. Chow tests were significant (P<.0001) for both DSCs on Facebook and Twitter, but only the first DSC on Google Trends. Wikipedia edits occurred soon after each DSC release, citing news articles rather than the DSC itself and presenting content that needed subsequent revisions for accuracy.

Conclusions: Social media offers challenges and opportunities for dissemination of the DSC messages. The FDA could consider strategies for more actively disseminating DSC safety information through social media platforms, particularly when announcements require updating. The FDA may also benefit from directly contributing content to websites like Wikipedia that are frequently accessed for drug-related information.

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Rare Cancers and Social Media: Analysis of Twitter Metrics in the First 2 Years of a Rare-Disease Community for Myeloproliferative Neoplasms 

Rare Cancers and Social Media: Analysis of Twitter Metrics in the First 2 Years of a Rare-Disease Community for Myeloproliferative Neoplasms  | Social Media and Healthcare |


The use of social media has now become a standard means of communication for many individuals worldwide. The use of one specific form of social media, Twitter, has increased among healthcare providers, both as a means of information gathering and as a conduit for original content creation. Recently, major efforts by users have been put forward to help streamline the unprecedented amount of information that can be found on Twitter. These efforts have led to the creation of diseasespecific hashtag (#) medical communities and have greatly enhanced the ability to understand and better categorize the available data on Twitter. Specifically, for those involved in rare cancer fields, adhering to organically designed and consistently used hashtags has led to the rapid, reliable dissemination of information and the ability to efficiently discuss and debate topics of interest in the field. For the field of myeloproliferative neoplasms (MPNs), the creation of #MPNSM (myeloproliferative neoplasms on social media) in 2015 has facilitated interactions among healthcare stakeholders from all over the world in the MPN field.


In order to better understand the trends and topics of interest to Twitter users of this novel medical community, we conducted the present analysis which focuses on Twitter analytics from the first two years of #MPNSM. In this analysis, we observed a sustained increase in the number of Twitter users, number of tweets, number of impressions, and number of retweets over time, demonstrating the feasibility of creating and maintaining a disease-specific hashtag for a rare cancer over time.

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Think before you Tweet: Social media guidelines for surgeons aim to prevent Internet regret

Think before you Tweet: Social media guidelines for surgeons aim to prevent Internet regret | Social Media and Healthcare |


Think before you tweet. That’s what surgeons should remember before they express themselves on social media.

Anger and frustration can prompt ill-advised social media postings that have a big potential for blowback, Heather J. Logghe, MD, FACS, and her colleagues wrote in the Journal of the American College of Surgeons. But so can enthusiasm about posting about a new device or procedure, a fascination with a difficult case, the sense of relief that a patient made it though a harrowing period, or even just the simple joy of tossing back a beer or two with pals at the local watering hole (J Am Coll Surg. 2017. doi: 10.1016/j.jamcollsurg.2017.11.022).

Dr. Heather Logghe
The effects of an unguarded post can be profound and long-lasting, wrote Dr. Logghe and her colleagues from the Resident and Associate Society of the American College of Surgeons.

“In a survey of 48 state medical boards, 44 (92%) reported online-related misbehavior with serious disciplinary consequences leading to license restriction, suspension, or revocation. A 2011 study of ‘Physicians on Twitter’ revealed that 10% of the physicians sampled had tweeted potential patient privacy violations. A 2014 study of publicly available Facebook profiles of 319 Midwest residents found 14% had ‘potentially unprofessional content’ and 12.2% had ‘clearly unprofessional’ content, the latter including references to binge drinking, sexually suggestive photos, and HIPAA violations.”


Dr. Logghe, of Thomas Jefferson University, Philadelphia, is a member of the American College of Surgeons’ (ACS’s) social media committee tasked with creating practice recommendations for clinicians’ use of social media. Conducting a literature review was the first step to creating a surgeon-specific document, and the team found seven online behavior guidelines directed at physicians. Groups authoring these papers included the American Medical Association, the Federation of State Medical Boards, the American Congress of Obstetricians and Gynecologists, and several international groups.

Dr. Logghe and her colleagues reviewed each one, synthesized the information, and created a practice recommendation statement specific to the ACS. While not encoded in any professional ethics requirements, “Best Practices for Surgeons’ Social Media Use: Statement of the Resident and Associate Society of the American College of Surgeons” does lay out some common, potentially problematic scenarios and offers some suggestions about how to avoid Internet regret.


Everything discussed in the paper revolves around maintaining a decorous public persona. Professionalism on and off the clock is a key tenet of the recommendations. Definitions of key terms like “professionalism” are an important basis for any practice guideline, but sometimes concepts are not easy to define, the team wrote. “Perhaps the limitation most difficult to address in any formalized guideline is the necessary subjectivity in interpreting what is ‘appropriate’ or ‘professional’ online – or in any other setting,” the authors wrote. The ACS Code of Professional Conduct does not explicitly define either of those terms or discuss the appearance of unprofessional behavior.

In the absence of a plain-and-simple definition, the authors attempted to couch the social media recommendations in terms of ACS’s commitment to maintaining the patient trust. It urges surgeons to “avoid even the appearance of impropriety.”

The practice recommendations touch on a number of areas that are potentially problematic for surgeons, including confidentiality, financial conflicts, collegial support, and general social responsibility.


Maintaining privacy is more than a courtesy to patients: It’s a federally mandated law with serious punitive repercussions if violated. Blogs, YouTube, Twitter, and Facebook offer a vast potential for sharing information with and educating the public, but postings can also easily violate HIPPA standards, the team wrote.

“In general, most social media platforms are not HIPPA-compliant,” no matter how the privacy settings are adjusted. These modes of communication are never appropriate for patient-physician communication: They can’t be archived in an electronic health record, and it is ill advised to give any medical advice by using these channels.

Discussing a particular case online, even with the usual defining details omitted, can be a bad idea.“Simply de-identifying patient information may not be sufficient. When posting information online, one must be cognizant of the context of other information available online. Such information includes the poster’s place of employment, news media, and publicly available vital statistics. Therefore even when posting general comments about hospital events, surgical cases, or patients under one’s care, it is essential to consider the sum of information available to the reader, rather than simply the information shared in the isolated post.”


Most employers have social media guidelines and don’t take kindly to violations – which can affect both current and future job postings. “A strong social media presence can be of benefit to one’s employer, [but] content that portrays a surgeon in an unprofessional or controversial light can be detrimental and even career-damaging.”


This reaches beyond professional communications online and deep into a surgeon’s personal life, the team noted, so exercise caution when “friending.”

“While this practice is inevitable, surgeons should be aware of potential conflicts. Connecting with or accepting friend requests from some but not all coworkers or coresidents could be interpreted as favoritism and may create a problematic work relationship. … Surgeons should consider primarily connecting with coworkers on professional websites if they have little contact with them outside the workplace.”

As for friending patients – just don’t, for both your sake and theirs. “Accepting a patient’s Facebook friend request may allow them access to events, details, and commentary not traditionally appropriate for the patient-physician relationship. Accepting such requests is strongly discouraged. If concerned about appearing rude or rejecting a patient’s request to be Facebook friends, the patient can be referred to society guidelines or best practices such as these.” One helpful alternative to such a request may be to invite patients to follow a practice website or other professional page.

Conflicts of interest


Online friends might not require disclosures when a surgeon posts about an exciting procedure or piece of equipment, such as whether there is a financial interest in doing so, but it’s important to be proactive. “As always, it is the physician’s responsibility to avoid even the appearance of impropriety. If it is not feasible to include a relevant conflict of interest within a post, the post should not be made.”


Irritated about a colleague? Keep it to yourself – especially if you’ve had a beer. “It is never appropriate to post derogatory comments about patients or colleagues. Surgeons should be careful not to post in anger or under the influence of any substance. Statements about a colleague’s abilities, experience, or outcomes intended in jest may be appropriate for the surgeon’s lounge, yet entirely inappropriate for public consumption. Again, the ‘pause-before-posting’ practice is likely to prevent regretful posts in this vein.”


Privacy and Permanence

The Internet goes everywhere and lasts forever. A snappy quote that’s funny at 2 a.m. might not seem so hilarious in the light of day – or even in the light of a day 5 years yet to come.

The delete key is a false friend, and that clever pseudonym you dreamed up is probably as crackable as the classic “Pa55word” password. “One should presume that all content posted online will remain there forever and may be seen by anyone. Again, ‘pause-before-posting’ is a recommended practice.”

Privacy settings should be viewed as an illusion, the team noted. In this era of face recognition and tagging, images carry just as much risk as words.

Collegial support

Maybe your mother was right when she said, “This is for your own good.” If a colleague’s postings are getting out of hand, a tactful heart-to-heart might be the best course of action. “As coined by Dr. Sarah Mansfield, ‘Looking after colleagues is an integral element of professional conduct.’ Surgeons who notice colleagues posting unprofessional content that could be damaging to both the colleague and the public’s trust in the profession should discreetly express their concern to the individual, who should then take any appropriate corrective actions. … If the action is in violation of the law or medical board regulations, it should be reported to the appropriate governing bodies.”

Physician, Google Thyself

The team acknowledged that an online presence is virtually a must for professional development. And even if you don’t create a web page, chances are your university or hospital has done it for you. The media is interested in your life, too, and may make mention of your activities – both positive or negative.

“To better understand and control this publicly accessible information, surgeons are encouraged to periodically self-audit themselves online and taking measures to ensure that the information present is accurate and professional.” Some professional service websites are more trustworthy than others. The team encouraged physicians to participate in the ACS professional pages, LinkedIn, Doximity, and ResearchGate.

Not rules – just recommendations

The team stressed that their recommendations aren’t meant to stifle personal expression. Instead, their aim is to prompt a more conscious use of what can be a very powerful tool for both self-expression and professional development.

“The authors recommend no punitive action based on a perceived ‘violation’ of these recommendations alone. While they refer to other guidelines, including laws such as HIPAA, that must be appropriately enforced, these best practices are intended to guide the practicing surgeon in the use of social media rather than act as regulations or encourage reprimand. Rather than encouraging a social media landscape as sterile as the operating theater, the authors hope these recommendations lead to conscious consideration of online behavior, to avoidance of preventable harm, and to recognition of others’ views of their posts.”

None of the authors reported any financial disclosures.

SOURCE: Logghe HJ et al. J Am Coll Surg. 2017. doi: 10.1016/j.jamcollsurg.2017.11.022.

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Use Social Media Platforms for Patient Engagement

Use Social Media Platforms for Patient Engagement | Social Media and Healthcare |

Why should you have an automated marketing platform and strategy for patient engagement?

According to Medical Group Management Association (MGMA) statistics from 2009 to 2016,1there has been a mass exodus of physicians from private practice to hospital- and system-based settings. For example:

  • Internal medicine went from 50 percent hospital and system employed to nearly 70 percent
  • Orthopedic surgeons from mid-20 percent to mid-40 percent
  • Pediatricians from just about 30 percent to more than 50 percent

It is common knowledge that in a growing number of markets physician referrals to private practices and access to marketing opportunities with physicians have dropped substantially. Practices that once had a lengthy list of loyal referring physicians are seeing their stream of new MD-referred patients dwindling. The question is not only how to find new patients but also how to nurture your current clientele to ensure that your prior patients return to your practice for additional care or refer their family and friends as well!

The answer is to develop a consistent, ongoing patient engagement tool and strategy!

Many practices are utilizing social media platforms to stay in touch with their client base and to reach other consumers. However, we are also seeing practices all across the country looking for opportunities to create ways to better engage individually with past, present, and potential patients, nurturing them through the entire physical therapy experience from intake to discharge. Practices are working on educating patients, and even engaging their family caregivers, to improve the overall quality of their experience. These practices are exploring marketing automation and engagement technologies. When employed strategically, this action yields a wide range of benefits, including a more efficient, consumer-friendly intake process, better carryover compliance, increased attendance and completion of care, as well as long-term connections and word-of-mouth referrals!

In a recent discussion with Carol Vance, a patient engagement platform developer, Vance described important factors in patient engagement.

  • Provide relevant content and messaging. Identify and deliver to your individual customer. Profiling your customers at intake and using their demographic data to target your messaging is vital!
  • Build loyalty and advocacy over time, because happy customers drive referrals. This is true of any business model—business-to-business or business-to-consumer. Your customers are your prospects, too. In fact, research from Teradata shows that 61 percent of people say they would tell their friends and family about their good experiences and that 27 percent would sign up for a company’s loyalty program.2
  • Engage customers continuously over time—with messages and content relevant to their situation that drives them toward a desired action or outcome. Being mindful of who your audience is and what resonates with them the most will help push them further along in the customer lifecycle.

With increasing copays and deductibles and busy schedules, patients’ attendance and completion of care has also become a challenge. Keep in mind that patients who fail to come to scheduled medical appointments (no-shows) create a cascade of issues for the health care system, the provider, and themselves. No-shows can affect productivity, cost and quality of care, and treatment outcomes.


1. Accessed November 2017.

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Social Media: The New Word of Mouth 

Social Media: The New Word of Mouth  | Social Media and Healthcare |

You might not like it, but social media has changed the landscape forever. Even for a dental practice, social media has made a big impact in the way that other patients send referrals and engage with the practice.

For most of my life, “word-of-mouth” referrals have always been one of the most valuable tools for dental clients. They still are, but we must recognize that social media has displaced word-of-mouth marketing, and it is now one of the best ways to help patients hear about you and your practice.

Social Media Is a Good Thing. Embrace it.

We no longer need to wait for a patient to have a run-in with a relative and take the opportunity to talk about you. When someone is looking for a referral, they will either Google the problem or they will throw their need out into their social media network and see who turns up. We see this all the time, whether it’s for car repairs, restaurants, or even a dentist.

This means that your potential reach has expanded exponentially, as it has made a referral much easier to provide.

Social media is also smart, and you can get the potential jump in before a prospective patient ever needs to ask for a referral. Allow me to explain what I mean.

Once your patients have friended/followed your profiles, your practice will be suggested to their friends as well. This becomes more likely as you find more and more patients within a target demographic.

When patients check in at your practice, mention you in a post, or leave a review, their entire social circle can see that, and that exposure/vote of confidence costs you very little.

Some Data

Our lives are entwined with our phones, applications, browsers, and social media. They all track our data. What does this mean for a dentist?

When your prospective patients are using search engines to investigate their sore tooth, learn about Invisalign, or simply find a dentist, social media platforms like Facebook and Twitter usually know about it. This increases the likelihood that you’ll be recommended as a friend or that your paid ads will reach them on those platforms, and it will have a positive effect on your local search rankings.

Research indicates that 80 percent of users will look for health information online, and 75 percent will use social media to research their health symptoms. As many as 90 percent of users aged 18–24 trust referrals on social media as much as they do in person.

There is no doubt—your prospective patients will look for referrals via social media. The only question is, who will get that referral? Will it be you?


It’s called social media because it’s supposed to be social. It’s not enough to simply create a profile and never interact with it. If you are looking to attract and retain dental patients online, you must engage with those patients online.

For dental practices, social media (and word of mouth) provides the lowest acquisition cost of new patients. I’ll admit, sometimes it’s hard to determine the ROI of social media marketing, and it’s not always an easy thing to keep up with in a dental practice.

A social media strategy that is focused on community involvement, sharing great content, and informing prospective patients can set you up with a continuous stream of referrals for the foreseeable future. The new “word of mouth” can be one of the most efficient marketing tools in your arsenal if you use it wisely.

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Social media may help chronically ill connect to doctors, fellow patie

Social media may help chronically ill connect to doctors, fellow patie | Social Media and Healthcare |

Social media groups that bring together patients, family, friends and healthcare providers can improve patients’ outlook and reduce their anxiety and depression, a recent U.S. study suggests.

In a nine-month experiment with liver-transplant patients, researchers found that participants came to rely heavily on a closed Facebook group, both for information about their condition and help in coping.

“Ninety percent of Americans are on the internet and 80 percent are using platforms such as Facebook and Twitter to find healthcare information from a supportive online community,” said Dr. Sean Langenfeld, of the Department of Surgery at the University of Nebraska Medical Center in Omaha, who wasn’t involved in the study.

“It’s a very powerful tool and offers a great way to facilitate communication among those suffering from abdominal pain or migraines to individuals diagnosed with cancer.”

For the current study, Dr. Vikrom Dhar of the University of Cincinnati College of Medicine in Ohio and his colleagues created a closed Facebook group that ultimately had a total of 350 members, about half of whom were liver transplant patients, 36 percent were family and friends and 14 percent were healthcare providers.


Of the 78 healthcare providers who were part of the hospital’s liver transplant team, 49 were active members of the group, including 7 out of the 16 physicians.

The researchers monitored the group’s interactions and surveyed a subset of participants after nine months.

Dhar’s team found that engagement with the group was high, and 83 percent of participants posted or reacted to others’ posts at least once per month. While patients tended to post supportive messages or inspirational content, the healthcare providers mainly posted educational information.

After nine months, 95 percent of the survey participants said that joining the group had a positive impact on their care, and 97 percent said their main motivation for joining was to get support from other patients and to provide it.

Social media also allows for patient-practitioner interaction between visits to the hospital or clinic, the study team notes in the journal Surgery.

This is especially important for those suffering from alcohol-related end-stage liver disease, Dhar said. “Previous reports in literature have suggested that patients who have appropriate social support have lower rates of alcohol relapse following transplantation,” he told Reuters Health in an email. “Thus, by using social media platforms, physicians may offer social support resources to patients who otherwise may suffer from disparities in accessing such care.”

Still, healthcare providers remain hesitant to engage patients through social media, the study team writes.

A 140-character tweet can result in misinterpretation of medical advice. Without a disclaimer, doctors risk being liable, Langenfeld noted. What’s more, the line between personal and professional engagement is, at best, blurred.

“Never assume there is privacy on the internet,” Langenfeld said in a telephone interview. “Statistics are vague, but in recent years over 50 percent of medical boards have inflicted serious punishment as a result of irresponsible online behavior.” This includes irresponsible behavior unrelated to one’s medical specialty.


It makes sense that the number of teaching hospitals offering social media responsibility courses is on the rise, Dhar said.

“Our study shows that in appropriate settings, physicians can utilize social media platforms including Facebook to create content that patients find positively impacts their healthcare.”

SOURCE: Surgery, online November 29, 2017.

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Doctors already use phones to share clinical images of patients – legislation needs to catch up

Doctors already use phones to share clinical images of patients – legislation needs to catch up | Social Media and Healthcare |

Imagine this scenario: you’re a recently graduated doctor working at a medical clinic in rural Australia. A person presents with a bite of what seems to be a poisonous spider - but you’re not sure. You take a photo of the skin lesion on your phone, and post it in a social media group to source swift advice from more experienced experts.

Digital image capturing devices like smartphones have enormous potential to facilitate communication for time critical medical interventions. And, as a society, we all seem to be part of a contract where we tacitly consent to immediate, mass distribution of images depicting us.

But there’s a catch: image capture and storage may fail to comply with current legislative frameworks for privacy, with significant ethical, legal and security implications.

As a society, it’s time for us to review how digital imaging is changing healthcare, security and other specialities.

Read more: Artificial intelligence won’t replace a doctor any time soon, but it can help with diagnosis

Legal use of information

Australian legislation refers to the 1988 Privacy Act framework for guidelines about the legal and ethical use of information, including images.

This legislation was developed during a time of centralised practice of medical photography – when images were physically stored at a hospital, and could not be reproduced, or accessed, without due authorisation.

But all this changed with the advent of smartphone-enabled cameras that can capture, process and mass distribute an image instantly.

Legislative changes to the Australian Privacy Act took effect in March 2014 following the introduction of the Privacy Amendment Act 2012 and the Privacy Regulation 2013.

Under these changes, people or medical professionals with unsecured patient images on their smart devices could face fines up to A$340,000, and institutions up to A$1,700,000 for breaches of patient privacy.

At a national level, mandatory data breach notification obligations will come into force in early 2018.


But it’s not clear how this federal legislation interacts with state regulation of digital images. Individual state governments apply a range of acts to meet specific requirements in some sectors.

For example, those that apply in the medical sector in Victoria include the Freedom of Information ActGuardianship and Administration ActMedical Treatment ActHealth Records ActCharter of Human Rights and Responsibilities Act and the Mental Health Act.

Different states and territories have different acts, and this is problematic. Digital images can be sent instantly across state or national borders and easily redistributed through social media. So which laws should apply?

How photos aid medical practice

Medical photographs can be an essential part of patient treatment. They allow medical staff to document the treatment of illness, to communicate among medical professionals and to teach.

A phone capture of your health image may be shared without your

Surveys of image usage in Australian hospitals suggest that medical professionals frequently capture and store patient data on smartphones, sharing them between colleagues.

Although legislation requires signed informed consent for the storage and use of images, this appears often not to be collected, especially if a patient is not in a state to be able to grant consent. This means there is a large disconnect between image usage, and legislative requirements.

Medical professionals including doctors and nurses have probably been the most progressive in enabling surveys of current professional practices. This serves as a high value source of information for considering how changes in technology and work practice may need to be reflected in consistent legislation, independent of state borders.

Also a problem in policing

Collection and application of digital imagery in policing similarly presents new legal and ethical challenges.

In Australia, various states are either trialling or using body cameras, and police may be permitted to use personal capture devices.

But guidelines for when images of a potential crime should be captured are different between Australian states. Concerns over when evidence should be collected, and who has access to such evidence have only started to be considered in Australia.

Body Worn Cameras were rolled out by the Queensland Police Service in 2016. Queensland Police/AAP

Towards solutions

We recently discussed issues relating to legal and ethical use of digital images at the 2016 Australian Ethics Network conference.

The field of ethics management aims to ensure that data is collected, stored and distributed in a way that is consistent with moral principles, and legislative framework within a given jurisdiction. The use of digital images that can be instantly transferred across state and national borders presents many challenges.

We need sector and region specific information to answer these questions. What are the benefits to a medical professional of having instant image access, how should this be balanced with personal consent if a life is in danger? How should use of images for policing be balanced with privacy if image distribution may result in the prevention of crime?

Possible technology solutions could include developing apps that securely store and manage data by restricting access to authorised persons. Such a process will require coordination between policymakers and professional sectors, and a conversation with the public on how we can best use digital images in an ethical way, not only for medicine but across research disciplines.

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Top 10 Best-in-Class Healthcare Marketing Trends for 2018 Success

Top 10 Best-in-Class Healthcare Marketing Trends for 2018 Success | Social Media and Healthcare |

Perhaps the only rock-solid prediction for 2018 is that hospital, medical group and healthcare marketing is the ever-present challenge to keep pace with change. Competition is tough, resources are precious, and performance expectations—delivering a solid return on investment—are always demanding.

To achieve a new level of success in the New Year, industry leaders and marketing professionals will adopt best-in-class methods, tactics and trends. And they will take full advantage of technology and insightful planning to deliver exactly the right message, at exactly the right time, to the specific individual in need.

Today, more than any time in the past, marketing is about engaging in a dialog, a conversation, and a relationship. Here are some of the most significant trends for 2018 healthcare marketing:

(1) Best-in-class customer service will be a top-down business priority for hospital and provider executives.

The healthcare delivery industry has professed a “patient first” perspective for several years. Although the concept is widely embraced, much of the traditional operations and functions of hospitals and medical practices are slow to change.

Often, meeting patient expectations is not expensive. Today’s consumers value convenience, appreciate the benefits of technology, and ask that the medical service process respect the value of their time (with prompt service and little waiting).

Studies tell us that 60 to 70 percent of patients would opt for health care services where the Internet is a connecting technology—and they’re willing to change providers to get it. These customers—Millennials in particular—want to communicate with their providers, pay bills, request services, see their health data, and make appointments…using the ease and convenience of technology. (Just as they do in retail product and service environments.)

Those institutions that have demonstrated the most progress owe their achievements to a top-down process. When the highest levels of leadership and management recognize and focus on patient experience, customer service, and consumer satisfaction, success follows.

What’s more, customer experience and satisfaction have an important financial impact through influential online reviews and ratings, and that positive performance is tied to reimbursement. Customer-first and the convenience of technology are often commonplace in the retail world. In the near term, technology integration will continue to embrace virtual visits, wearable devices, “care from anywhere” telehealth options, and other mobile apps and software.

(2) The digital experience in healthcare begins with mobile first—but not “mobile only.”

It’s nearly a universal fact of life in healthcare marketing that a mobile device will be present at the starting line. People demand the fast and convenient answers that are instantly available on their smartphone. The “how” is immediately at hand, regardless of the “when” or “where.”

Not only does marketing success launch with the small screen, the connectivity is sustained and enhanced by the social, local and personalized experience. By necessity, small screen sites drive focus to high-priority information, and they tend to load fast. Mobile devices are the nation’s “first screen.” Americans spend more time on their smartphones than in watching television (Average 147 minutes each day). [Marketing in a multiscreen world; MillwardBrown].

That said, each patient journey likely includes multiple devices. Consumers may initially tap into quick or social information via a mobile screen and then turn to a desktop or laptop for subsequent, deeper reviews and research. Digital healthcare marketing has the challenge of being prepared and present, compelling and engaging content via all screens.

(3) The online “User Experience” that you create for patients will make or break your website performance.

A hospital or provider website is healthcare’s new front door to service and satisfaction. Our commonplace use of retail websites has conditioned people to expect a seamless experience. Visitors’ performance expectations are packed into the first 30 seconds or less.

The alphabet-soup tech labels of UX, UI, UXD, UED mean your healthcare website needs to provide prospective and new patients with a trouble-free experience. Websites that are designed to satisfy the user experience first—to paraphrase Wikipedia—improve usability, enhance customer satisfaction, and inspire loyalty.

Extensive and continuing research by Klein & Partners regarding the state of healthcare marketing reveals that “11 percent of visitors to a hospital or health system say their website experience created new, negative feelings about that brand.”

According to principal Rob Klein, the two biggest pain points for patients are in paying bills and setting an appointment. Our target audience critically compares healthcare websites to the best retail sites such as Amazon, Zappos or OpenTable. Unfortunately, people quickly lose patience with poorly performing websites and say, “three clicks and I’m out.”

(4) Outdistancing the competition means constantly raising the bar.

Consumers—your patients and prospects—up the ante every day. They are informed, and now, demanding consumers with expectations that are higher than at any previous time. In today’s seamless search process Google envisions that sites will be optimized for multi-screen presentations including:

  • The continued rise of voice requests; faster and easier than keyboard typing
  • Local and personalized searches for “near-me,” “I-want-to-buy,” “best-reviews,” and others
  • Near-instant responses, answers and info via fast-loading sites and landing pages

A new consumerism is characterized by online visitors who are increasingly curious, demanding, and impatient. The best marketing performance in 2018 and beyond demands a significantly higher standard of personalized, relevant and authoritative experience and content.

(5) Consolidation of marketing tools, strategies and tactics is the 2018-planning watchword.

The constant introduction of new digital and social marketing options has been an “attractive nuisance,” often reducing effectiveness. Marketing and administrative executives have been tempted to stretch their efforts across many options, even when those resources have been limited.

Recent surveys suggest that several influences will be in play during 2018. These include:

  • Healthcare marketing budgets will remain lean
  • Performance expectations will remain high
  • Digital marketing tools and plans tend to be affordable and efficient

In short, digital marketing for the next 12 months will recognize–and consolidate around–the strengths of the proven promotional efforts that produced the best results in the past.

(6) Social media options engage target audiences…with the proper formula.

Although Facebook’s audience is growing, organic reach is down. For greater efficiency, future healthcare plans will focus on fewer, but proven, social platforms. And for greater productivity, plans will embrace a blend of both organic and paid social media.

Just a few of the well-established and popular social platforms dramatically outdistance dozens of others. Marketing professionals will adjust to media and algorithm changes and use their best-performing tools to extend their reach, strengthen patient/consumer relationships, and to extend online visibility and reputation.

(7) Live and streaming video are outdistancing “regular” video and text.

Not long ago, video took a popular lead from text in attention-getting and communications power. The new kid on the block is live video, a tool used by nearly 90 percent of brand marketers. A live option provides the marketing advantage of speaking to a consumer in real time—where immediacy and timeliness are important.

Video content has captured a larger share of the budget, in part, because live or near-real-time streaming has a strong audience appeal, and it has a 95 percent retention rate with viewers. In addition, video formats are more social and intimate than text or graphics.

(8) The standard for healthcare marketing will be personal, individual and location-based.

The old-school concept of “spray-and-pray” is seriously out-of-date and wasteful in the age of digital marketing. Typically, individuals routinely use several devices…most notably, the first option smartphone/computer in their pocket. Further, ubiquitous WiFi and high-speed Internet connectivity put everyone online—instantly and constantly.

Today’s sophisticated marketing systems have the ability to profile people, their personal tastes and preferences, as well as their location. The most effective relationship with the target audience is personal. It presents attention-getting individualized and relevant material or information that is close or convenient to access. The ideal marketing channel is one-to-one.

(9) Marketing Automation will be a practical option within the reach of a wider range of healthcare users.

As a software tool, the advantages of marketing automation appealed primarily to larger organizations and facilities—those holding a large database, and those with a sufficient budget. The software is complicated to use properly and expensive. And the objective is delivering the right message to the right person, at exactly the right time.

Going forward, however, software and service providers are bringing the cost and the suitable application within the reach of mid-size and growth-oriented healthcare organizations. To be clear, marketing automation software is helpful with repetitive tasks and calendars, but its use is sophisticated and detail oriented.

It is not a standalone substitute for experienced professionals. In fact, both components are required. In 2018, a broader range of hospitals and providers will benefit from streamlined efficiencies, personalized and precision-targeted tasks, and from the adoption of detailed plans.

The cost-effective benefits of marketing automation—a centralized database, engagement channels, and tracking and analytics—flow from thoughtful and detailed strategies and tactics.

10. Closely monitor the changes in social media platforms and performance.

In addition to a refocus of marketing efforts (discussed above), seemingly familiar social media faces continue to evolve—some in good ways; while others, not so much. Change can happen quickly, so watch for:

  • Expanded use of Instagram Stories for marketing via image and video sharing
  • More live streaming content and viewers on Facebook, Facebook Spaces and others
  • Street-smart organizations invest more budget and resources in online reputation management
  • Twitter—once a social darling—is growth-impaired; watch for facelift or failure
  • Virtual and augmented reality expand via social and iPhone and iPad apps

What significant healthcare marketing trends are you watching? What would you add to this list? What’s just over the horizon in your operation? Please join in our conversation.

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Should I Interact With Patients on Social Media?

Should I Interact With Patients on Social Media? | Social Media and Healthcare |

A reader asks, "Is it a violation of the Health Insurance Portability and Accountability Act (HIPAA) if a group of patients who were in a class together are social media friends with the clinical staff? Seldom—maybe never—does anyone discuss anything medically personal. It's more of a support group that is just keeping in touch and perhaps sharing something they found on the Internet, such as a positive meme or letting others know if someone in the group has passed away." The staff members recently unfriended everyone, stating that it is a HIPAA violation if they are friends with any of their patients.

The answer to this question is controversial, judging by articles already posted online by various organizations. See, for example, Katherine Chretien's Should I Be "Friends" with My Patients on Social Networking Web Sites? and Committee Opinion No. 622: Professional Use of Digital and Social Media, published in Obstetrics & Gynecology.

On the positive side, clinicians may learn of patients' concerns and informational needs, and in response post helpful information on social media. Being involved in patient support is certainly a worthy endeavor. On the negative side, the potential for violating HIPAA; crossing a professional boundary; or, in the case of befriending patients on one's personal page, giving out too much personal information such that the patient doubts the clinicians' professionalism and credibility is a risk.

Different Standards for Clinicians and Patients

A patient may share whatever he or she wants on social media. However, clinicians need to follow HIPAA's dictates, which say that a clinician may share a patient's protected health information only for the purpose of treatment, payment, and healthcare operations. Use of social media isn't treatment. So, clinicians can't disclose any "protected health information," which is any information created or received by a healthcare provider relating to the past, present, or future physical or mental health or condition, including demographic information and any healthcare provided. For information on deidentifying patient information, see Guidance Regarding Methods for De-identification of Protected Health Information in Accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

Appropriate professional boundaries conducive to a therapeutic relationship fall somewhere between underinvolvement and overinvolvement, but exactly where that "somewhere" is is not clear. The perfect balance depends on how the clinicians portray themselves online and how they handle any back-and-forth with the patients. For a discussion on boundaries, see the National Council of State Boards of Nursing document A Nurse's Guide to Professional Boundaries.


As for fostering professional credibility, a clinician can highlight his or her expertise through social media. On the other hand, a clinician could demonstrate lack of judgment, if posting unprofessional photos or divulging protected information about patients.

Clinicians who are afraid of crossing boundary lines or violating HIPAA and opt out of interacting with patients on social media as a result could be missing ways to serve their community, market their expertise, and foster community among patients with a common illness or condition. So, let's work it through using examples of appropriate and inappropriate use of social media.

Examples of Social Media Use

A practice with a social media presence. The clinician is an oncology healthcare provider whose practice has a social media page, which some patients choose to subscribe to or "friend." The practice posts relevant news articles, journal articles, and articles written by the staff. Clinicians monitor the discussion, and when there is interest in a particular topic, a clinician posts an article on that topic. The subscribers comment on the articles. Subscribers or "friends" who are patients might disclose things about themselves to the other commenters and viewers. However, the clinicians do not give out advice on the site to individuals, nor do they comment on any individual's problems or progress.


In my opinion, this is appropriate and legal use of social media. In this example, the clinician is not disclosing information about a patient. If a patient subscribes or comments and uses his or her own name, then the patient may be revealing something, even protected health information, about himself or herself. That's all legal under HIPAA. I see no HIPAA, boundary, or professional credibility issue in this example.


A clinician's personal social media page. In this example, a clinician has his or her own personal social media page, where the clinician posts vacation photos, memes, and cute cat photos. Some patients of the clinician ask to be friended, and the clinician accepts. The clinician doesn't have a separate professional page—just this personal page. A patient uses his own name and posts a comment to a picture, "Too bad my allergies prevent me from having cats." If the clinician responds, "Yes, but if you take that medication I prescribed, it would lessen the symptoms," that could be a HIPAA violation.


That does not mean the clinician shouldn't befriend the patient on social media; it just means the clinician shouldn't reveal that there is a patient/physician relationship or reveal anything about the patient's medical condition. Furthermore, the clinician should maintain awareness that patients, potential patients, employers, potential employers, and faculty members may be viewing the clinician's personal material. In addition, clinicians need to remember that the postings are documented forever, even if taken down.

The Bottom Line

If a clinician thinks it is too burdensome to be constantly attentive to what he or she says or posts on social media, then it may be best to avoid social media or, at minimum, to think twice about each post before posting. The clinician may also decide to set a personal policy not to befriend patients on social media, and may tell patients about that policy. I don't know how it affects a patient when a clinician declines a friend request.


A final consideration is that clinicians will want to be sure they aren't initiating a "duty of care" to an individual through social media. Duty of care is one element of malpractice. An individual cannot sue a clinician for malpractice if there is no duty of care. So one risk-reduction strategy for clinicians is to limit "duty of care" obligations to those seen in clinic, office, or facility. Some clinicians post disclaimers on their professional social media pages, such as "What I post here is general medical information and not meant as individualized advice. For personalized information or advice, suitable to a reader's situation, readers should consult their healthcare provider."

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Disturbing social media trend sees doctors and nurses taking selfies with dying and unconscious patients

Disturbing social media trend sees doctors and nurses taking selfies with dying and unconscious patients | Social Media and Healthcare |

In a disturbing trend that is now cropping up on the internet, nurses and medical practitioners are posting selfies of themselves with dying patients on social media, drawing outrage from netizens. The latest such selfie has seen a Russian nurse come under investigation after posting pictures of herself with some of her dying patients, mocking them, and revealing that they 'tie them to beds'.

This latest incident highlights an increasingly depraved trend of medical staff in countries such as Russia and Ukraine using social media platforms to abuse the sick, vulnerable, and elderly patients that they are supposed to be caring for.

Anna Kim described elderly patients as 'filthy and disgusting' (Source: east2west news)

The nurse in the spotlight this time around is Russian nurse Anna Kim, who described those patients under her care who required diapers as 'filthy and disgusting.' She is also said to have used social media to comment on the standard of care given to patients at these hospitals, alleging that doctors at her hospital in Sakhalin 'only help people they want to help.'

Regarding the apathy of the doctors, she wrote: "If they don't want to help, you are doomed. They don't give a s***. Patients may have extremely low blood pressure, and doctors don't use defibrillators." And despite these ill-advised and poorly thought out posts and outbursts, she has reportedly neither been sacked nor disciplined.

Kim casually says that they tie patients to beds (Source: east2west news)



Her list of infractions is a lengthy one. One of her posts captures her posing with an elderly woman patient who was 'gravely ill' and fighting for her life. The accompanying caption read: "Some patients might go out of their minds... we tie them to beds. But it's okay, this is life."

Kim works at the Sakhalin Regional Clinical Hospital, with a senior medic who commented on the incident saying: "Such violation of ethical norms showed that the person who did this requires professional psychiatric help." Some claims even suggested she may have been 'drunk on duty' when the pictures were taken, putting serious question marks on her ethics.

An investigation has been opened in her case (Source: east2west news)



Regarding the case, a local health ministry spokesman said: "An internal investigation has been carried out into the unacceptable, unethical behavior of a nurse…."

Local health minister Alexey Pak similarly condemned the behavior. He said: "Helpless people on life support devices became victims of her unceremonious filming. Dozens of professionals work to bring these patients back to active life, monitoring their health 24/7 and being ready to give any emergency treatment."



As the trend seems to grow unabashedly in Russia's medical care system, one that President Vladimir Putin has identified as a key priority moving forward, it is highlighting the privacy flaws, as well as the ease at which the system can be abused in the country. 

Kim's example is unfortunately just one of many. One of the posts on social media shows a male gynecologist in Syktyvkar, the capital city of the Komi Republic region, posing with a female patient during what appeared to be an intimate examination or medical procedure.



Similarly, in Kazan, a city in southwest Russia, 20-year-old nurse Gulnaz Yalalova was pictured posing for the camera while holding the removed spleen of a patient following an operational procedure. She would go then insensitively post that particular image alongside one of her in a bikini and was promptly rebuked for her immaturity.

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Four digital trends in global clinical trials 

Four digital trends in global clinical trials  | Social Media and Healthcare |

Could ‘digital health’ be the next worldwide phenomenon? As advanced technology continues to evolve for health information purposes, it’s important to understand what digital health is and how its adoption is likely to impact end users.

Digital health encompasses a few technologies: mobile health (mHealth), health information technology (HIT), wearable devices, telehealth, telemedicine and personalised medicine, for example. But only recently have we seen healthcare providers move from experimenting with these solutions to fully deploying them. This is paving the way for early adoption across developed and developing nations, ensuring that a patient’s data and services are kept consistent.

While the paperless trial era is not yet in full swing, it won’t be long before paper processes for data capture, labelling, global clinical trial recruiting, regulatory compliance, translation and internal centralisation are phased out. In the meantime, what tools can the industry expect to take advantage of?

1) Social media

Clinical trials are by no means excluded from social media, a modern staple for daily life. In fact, social media is used by trial sponsors and CROs across a variety of applications, from setting up recruitment websites to educating trial participants.

The importance of social media as a platform for educational content, especially to the millennial generation, can’t be overlooked. According to PwC, 40 percent of consumers say social media content affects the way they manage their health, and 90 percent of 18 to 24-year-olds would trust medical information shared by their peers.

2) Apps

Most popular for gaming, mobile apps are in fact becoming integral to the clinical trial process. As compatible mobile devices (including tablets and smartphones) face wider adoption worldwide, so do health information apps. Technology companies have even begun to develop apps for electronic labelling of investigational medicines, using QR codes that can be scanned to convey instructions for use.

Widespread adoption of mobile devices is also helping to collect patient-reported outcomes (PROs), an increasingly important endpoint in clinical trial design, and opening new channels of communication between doctors and patients. Instead of making an appointment to see their GP, patients in remote locations can use their smartphones to initiate e-consultations — a service which the NHS recently launched in the UK. Pharma and biotech companies, too, can use specialised apps to administer patient questionnaires and remind patients about scheduled trial site visits.

3) Wearable devices

Worldwide adoption of wearable devices is expected to jump from 325 million in 2016 to about 830 million in 2020 thanks to an increasingly ‘always-on’ environment. The popularity of Fitbits and other wearables has exploded, helping patients monitor their blood pressure, glucose levels and other risk factors whilst also facilitating medical access to information about symptoms, disease patterns and adverse events.

Wearables not only benefit the user but may have enormous cost-saving potential. If they motivate users to take control of their health, they can help curb unhealthy lifestyles that lead to chronic conditions. An even more exciting development is wearable tech’s ability to detect serious medical conditions.

4) Companion diagnostic devices

Much like the paperless era, the personalised medicine revolution has yet to fully take hold. However, the pharmaceutical industry and research committees are clearly moving in that direction — and advanced analytics may play a key role.

Technology companies are developing in-vitro companion diagnostic devices that pharma companies can use to target specific diseases based on patients’ personalised genomic profiles. Diagnostic tests can help healthcare providers weigh a product’s benefits and risks, and may also be helpful for data-gathering purposes. As a result they may encourage drug companies and regulatory bodies to share data.

The Compliance Factor

We can’t know for sure which new technologies will be accepted as the norm for global clinical trial recruiting and management, especially those in early development or yet to be invented. But these advances are expected to make clinical trials more efficient and possibly shorten drug development timelines, reducing the wait time for lifesaving drugs to reach the hands of those in most need.

Of course, the collection, use and exchange of personal data raise significant concerns about data storage, security and privacy. If they have not already done so, life sciences companies handling sensitive personal information will need to safeguard patient data and ensure global clinical trial compliance with privacy laws of relevant markets.

The debate, now and in the near future, is how compliance will affect the adoption of new technologies — and whether pharma companies are prepared to overcome regulatory pitfalls quickly to adopt innovations before their competitors do.

Peter Quigley is director of global regulatory solutions, life sciences, at Lionbridge

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Community health advocate hits social media jackpot with video about booster seats

Community health advocate hits social media jackpot with video about booster seats | Social Media and Healthcare |

Talking to parents about car safety can be thankless work for a health advocate, but Kelli England Will recently hit the jackpot, thanks to social media.

video that the professor at Eastern Virginia Medical School developed about child booster seat safety – not exactly riveting material compared to cat pratfalls and flash mobs – has grabbed more than 9 million views on Facebook since late November.


More than 197,000 people have shared it and 8,000 made comments. That’s a lot of views and comments, at least for the EVMS Facebook page, outpacing anything else the Norfolk school has posted.

Many were simply one person tagging another with a comment like:

“This is why I say Kevin still needs to be in a booster seat. ... so listen to me.”

And: “My kids thought I was mean and over protective. they would always say ‘my friends don’t sit in a booster seat.’ ”

And: “why did I watch this so early, nothing like tears first thing in the morning. Also we are keeping cooper in a car seat like forever.”

Will received feedback from around the globe with her “Boost ’em in the Back Seat” video. It explains the importance of keeping children in booster seats, not just until they are 8, as stipulated in Virginia law, but until they reach a particular size, which is often past that age.

Will works in the division of community health and research and has spent years crafting public-safety messages about electronic cigarettes, car safety and substance abuse. The irony is that she produced a video with the same booster seat message a decade ago. It played well in doctors’ offices and health departments, but it didn’t get the attention that social media can unleash.

She recently revamped the message by using a grant from the Virginia Department of Motor Vehicles to hire a digital company called Jpixx to produce a heart-rending video that shows a mother taking her young son to soccer practice.

The boy hops in the back seat and puts his seat belt on, but there’s no booster seat. The video cuts to a banged-up car with smoke rising from it, sirens blowing, and the boy unconscious in the back seat.

The boy and his mother are actors, but the rescue workers, hospital doctor and nurses, and public-safety advocates play themselves – and volunteered their time to make the video.

The hospital scene of the boy getting treatment includes a doctor asking, “Was he in a booster seat?” and the mother tearfully responding, “No, he’s 9, he’s almost 10!” The doctor explains that since the seat belt did not fit correctly, the boy’s internal organs and neck might have been hurt.

A crash test footage shows how a misplaced belt can harm a child.

Even though state law requires that children under 8 be in a child restraint seat, the safety recommendation from agencies like the American Academy of Pediatrics, and National Highway Traffic Safety Administration is a little more nuanced, and stringent.


Those agencies recommend that children be at least 4 feet 9 inches tall or 80 pounds and pass a “fit test.” That means they can sit with their back against the seat, with knees bent at the front edge and feet on the floor, with the belt coming across their shoulders and chest, not across the neck.

Will, who was surprised at how much the video was shared, listed some of the public message fundamentals that made it successful.

One, it takes a scare tactic to get people’s attention.

Two, find the media that fits your audience. In this case, Facebook was the perfect platform because a lot of parents use it. Teens, on the other hand, have migrated to Instagram and YouTube.

Three, follow the scare tactic with simple advice that people can accomplish.

Will said booster seat use is something that parents tend to be uncertain about, so they’re looking for clarification. The fact that the video first ran a few days before Thanksgiving, when families were traveling, also helped.

“People were tagging other family members saying things like ‘We need to get Jenny back in a seat,’” Will said.

She’s hoping for another bump as people travel during December holidays. A Spanish version is now available on the BoosterSeats4safety website.

“Social media is the most effective way to get the message out to the masses,” Will said. “It’s inexpensive and it’s easy.”

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2018 Digital Healthcare Marketing Trends That Are Here to Stay

2018 Digital Healthcare Marketing Trends That Are Here to Stay | Social Media and Healthcare |

After re-designing websites, creating apps, and getting to grips with new channels like social media, 2017 felt like the year healthcare marketers started to look beyond 'the basics' of the digital patient experience.

With the fundamental building blocks in place, the last 12 months have seen providers double down on technologies and strategies that measurably improve the patient journey, remove friction from provider-patient interactions, and move towards a more personalized digital experience for all.

So, where should you place your bets (and budget!) in 2018? 


There are already 45 million voice-enabled devices in the US, with that number expected to grow to 65 million over the next 12 months.

Needless to say, the proliferation and use of voice-enabled assistants and devices will make 2018 the year voice goes from being a curiosity to something healthcare marketers need to roadmap, budget for, and implement.

But where do you start? Listen to this podcast and learn how the digital marketing team at Northwell Health took their first step into voice assistants, harnessing the power of Amazon’s Alexa platform to better engage their patients and transform the digital patient experience.


With the rise of voice activated assistants, comes the rise of the voice powered search. Starting from virtually 0% of searches a few years ago, Comscore predicts that by 2020 50% of all searches will be voice searches.

The rise of voice search on personal digital assistants like Siri, Alexa, Cortana and Google Home has added a whole new dimension to SEO. The increase in longer phrase, spoken queries, and the ability to process natural language, mean that patients no longer have to search with simple keywords. Instead they can ask search engines questions the same way they would their doctor.

Voice search usage continues to increase as technology accuracy approaches human levels of understanding. Mary Meeker’s 2017 internet trend report highlights that Google’s advances in natural language processing have lead to a 95% voice word accuracy rate.

Digital healthcare marketers and content creators must optimize their websites, content, and publishing platforms for voice search. That includes optimizing your SEO, researching users, developing a content strategy, adjusting content language and tone, and continuous testing and iteration.

Here’s a handy guide to help you get started with voice search optimization.


Chatbots, and the AI ‘brains’ that power them, are revolutionizing how brands interact with their customers. Able to answer ever more complex questions and resolve issues in real-time, they are the very embodiment of the Micro-moment and the future of how we find information, buy, book appointments, or interface with any type of customer service.

In 2017 we saw chatbots being deployed at the beginning of the patient journey (see Piedmont Healthcare), and used as an automated way to keep in touch with patients and ensure they remain healthy post appointment or procedure.

Keen to alleviate pressure on call centers and overstretched doctors, 2018 will see a growing number of health systems, hospitals, and clinics start to experiment with chatbots throughout the patient journey.

Chatbots offer hospitals an instant, scalable, and more measurable digital touchpoint with patients than, say, communication through a website or app. Using artificial intelligence, chatbots can assess symptoms, offer patients reliable and trusted resources, determine insurance information, and connect them with the right doctor to address their concerns all in one convenient, empathetic interaction.

Take a look at how chatbots dramatically enhance communications during 3 of the most common patient and health system interactions.


Can your patients use one set of login credentials (Single Sign On) to access all their billing, booking, patient records, customer service, prescription and other services? Can they get everything they need through one app, without being pushed to a third party medical records,  billing or other patient portal?

If the answer to either of these is no, then it’s time to take a long, hard look at the infrastructure underpinning your digital patient experience. 2018 is the year providers will start to get serious about integrating their disparate systems to provide a unified, frictionless, and increasingly personalized experience for patients.

Find out more in A Marketer's Guide To APIs and API First Design.


Want to grow market share? Then work on your brand.

Brand is the new bedside manner by which providers are judged and patients are acquired. Health systems have the benefit of being able to establish strong brand equity because they, by the very nature of what they do, help people live better. And in those exchanges, there is an investment and equity that a healthcare provider can build with patients and project outwardly to burnish their standing in the minds of consumers.

Previously the doctors, and not the system, represented healthcare brands. But with patients acting more like consumers, there is an amazing opportunity to create an anticipated healthcare experience.

When it comes to seeing a brand come to life on the internet, your website content is most likely the largest touchpoint with the most reach, and it’s important to guide the way patients will interact with and perceive your content.

Click here to read more about the value of brand in healthcare today.


Millennials are shaping the future of healthcare in important ways, one of which is emphasizing the focus on preventative healthcare and wellness. In addition, they also want to access relevant health information quickly and have access to convenient healthcare options when they need them.

According to Communispace, 27% of millennials research health information online and self-treat at home, never setting foot in a doctor’s office. And with the proliferation of telehealth and quick outpatient and surgery center visits, healthcare is no longer confined to the four walls of a monolithic hospital building. Conversations around health and wellness are happening 24/7 on social media, in online health communities, and increasingly in smaller retail and convenience clinics - and that’s where you need to be as healthcare marketers.

The economic influence of Millennials is growing fast, currently representing over $200 billion in annual buying power. If you ignore the healthcare values of Millenials and market only to Baby Boomers you’re going see patient acquisition and retention plummet.

The most important thing you can do to attract Millennials is to make sure that your information is findable and accessible across devices (see Voice Search above). If it’s difficult to access symptom information or find a doctor on your site, or if your content is not mobile friendly, Millennials will simply move on to your competitors.


Along with the major trends already mentioned, here’s a couple of other areas we also expect to see develop further in 2018:


The humble CRM system has been a mainstay of consumer-brand interaction in other industries for years. The ability to track and store customer data is an essential piece of the modern marketer's toolkit and, as such, more health systems will implement CRM systems in 2018.


A single word with a multitude of technical, design, and content strategy implications, personalization is the ‘payoff’ for having a CRM system. Using the data collected, you can tailor everything from your social media advertising strategy to your website appearance to fit the individual patient, giving them a digital experience to remember for all the right reasons.

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Prescriptions for Healthcare Marketing in 2018

Prescriptions for Healthcare Marketing in 2018 | Social Media and Healthcare |

Technology is changing the game for all businesses, and marketers are also finding new ways in which to do their jobs more effectively. Now healthcare marketers are discovering the ways in which they can use technology to identify and engage their target market.

In order to identify the priorities for healthcare marketers in the upcoming year, Affect, a public relations and social media agency specializing in technology, healthcare and professional services, spoke with a panel of senior healthcare executives from organizations like, Illumina, MDxHealth, Pfizer and Phoenix Children's Hospital. Based on those discussions, it published a guide to navigating major trends in healthcare marketing in 2018 with a look at five key areas:

  1. Advanced social media use to increase awareness  and loyalty
  2. Highly customized content plus promotion
  3. Creative media relations
  4. Emerging tech campaigns
  5. Business-oriented metrics

I spoke with Melissa Baratta, SVP and healthcare practice lead at Affect, about the state of healthcare marketing in today's environment. She said that because of the increasingly important role technology is playing marketing, “the role of marketers for healthcare is shifting.”

It's a challenge for markets “to stay on top all of these tech trends in the industry” that they need to incorporate into their marketing content while also leveraging technology in their role as marketers. In fact, some marketers see their jobs as “so tech-driven” that they have to have the capability of a CIO. The call for such a high level of technological ability makes some believe that the marketer's role “may have to split into different roles” down the line.

However, that's not necessarily a negative thing, Baratta explains. “There's excitement, looking at how to put all the pieces together, trying to figure out how to use technology to their advantage.” They know that technology offers them a “better way to market now.”

Some are “incorporating more advanced analytics, using AI for big data,” she said. With so much data to work through, they find that they need to use AI tools to handle it efficiently. On that basis, they “can better segment audiences,” and work out better alignment with business-oriented metrics.

Baratta says that “more alignment between marketing and sales” is needed. “At end of the day, all are working toward same goal.” Marketers do realize that, and as a result CMOs are now very “revenue-driven, and really focused on business oriented metrics.”

Consequently, one of the focal points set for marketers for the coming year: “to have the financial metrics” in place to make sure they are on the same page as sales. This is a change from the past in which “they didn't really have solutions on metrics side.”

Precise metrics also play into fine-tuned marketing. The goal is to reach the “right audiences with at the right times with the right content” and also connect the “results back to financial metrics,” Baratta explained. “Audience segments are more important than ever,” she declared. Technological solutions can show marketers what audiences “want from a content perspective and how to reach them effectively.

Social media plays a part in that. Some people suggested that “social media is becoming its own workflow,” she said. That a change from its previous categorization as a subset of PR or even “ignored altogether.” Marketers have to recognize the increasing “opportunities for engagement” offered by social media.

Live video is one of the ways healthcare marketers are effectively reaching out to audiences. Jared Johnson, manager of marketing technology and analytics at Phoenix Children's Hospital, was quoted in the report, saying: “We started live video streaming, we began a series of Facebook Live Q&A videos with hospital stakeholders, and we were the first children's hospital to Periscope a surgery.”

Baratta said that though, the organizations was “a little bit nervous” about broadcasting the surgery live, they found it extremely rewarding. Parents responded very positively; seeing the surgery alleviated many of their worries about the procedure for their children.

I asked if mixed reality was being used in this space. She answered that a few said they were trying things in VR, but its expense prevents it from being “mainstream” now. She thinks that will take another couple of years to happen.

While some healthcare marketers are using email and text messaging, they will have to think about not crossing over into what people consider invasive. They “need to find the right balance” to deliver just “the right amount of communication” to their target audiences and not too much, she explained.

Overall, though, it's clear to Baratta that “technology is the number one thing impacting healthcare marketing.” Going into 2018, healthcare marketers have to be extremely “tech savvy” to be on top of their game.

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The 3 Social Media Campaigns to Help Healthcare Practitioners Reach Out To Prospective Patients 

The 3 Social Media Campaigns to Help Healthcare Practitioners  Reach Out To Prospective Patients  | Social Media and Healthcare |

Healthcare marketing has become a requisite for all organizations in the healthcare industry today. A significant shift is visible in the way people used to search for healthcare practitioners 10 years ago and how they do it today. According to a 2013 report by Pew Research Center, 72% of internet users look for health information online today. What does that mean for you as a healthcare service provider? It means that the smartest way to connect with service seekers is by meeting them where they are. At Social Media platforms! At Refresh Healthcare, we help healthcare practitioners and institutions connect with prospective patients using digital marketing at its best. Here’s how we can help you with the successful running of these 3 incredible campaigns. Campaign 1: Patient Awareness Programs Pick a local business such as a dentist, pharmacy or gym which isn’t a direct competitor. Partner with them by making services like flu shots, pet vaccines or specific drugs available for free or at discounted rates. For instance, you can have free flu shots at a nearby gym. This small effort will go a long way as a promotion for both - you and the gym. The event will only be a success if everyone shows up. To create awareness about it, we can help you design smart adverts, brochures and targeted digital content that will bring new patients to you. Source Campaign 2: Sharing is Caring Source Tags and shares in the pursuit of a giveaway are another great social media campaign scheme. This is especially ideal when the social presence of your institution goes stagnant and you want to reach out to more people. Promising people a special offer, discount or giveaway, practitioners can engage and connect with a wider audience using the same platform. A random winner can be selected at the end of the contest. For the successful running of any such campaign, it is important that the social media profile remains actively involved. Since most doctors and nurses won’t have the time, you can leave it to us to deliver your gratitude to all those who actively participate in the contest. We can handle your social media account and be as responsive as possible. Campaign 3: Meet the Doctor Series ‘Meet a Doctor’ series is another great campaign to connect with your doctors (current or potential) in a less formal setting. A Meet the Doctor series can embark on a rather more personal and a light journey of the doctors with them sharing the best, worst and most difficult challenges and cases in the lives of doctor’s nurses and hospital staff. The campaign can feature video interviews, a Question/Answer session in the form of a monthly newsletter, a webinar or even live session where patients can directly interact with their doctors. Source Tracking the Success Source The easiest way to track the success of your campaign and whether they lived up to your expectation or not, is by evaluating the impact it made. With the help of the right analytical tools and metrics, we can help you determine if the campaign was a hit or a miss. Using our expertise, we shall track any new likes, followers and shares on social media. We shall also trace new website visitors, what time they were most active, the number of new appointments and bookings etc. This way you will have a thorough idea of how big an impact you campaign was able to make.

Read more: The 3 Social Media Campaigns to Help Healthcare Practitioners Reach Out To Prospective Patients | Refresh Healthcare Blog |

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Two-Way Social Media Messaging in Postoperative Cataract Surgical Patients: Prospective Interventional Study

Two-Way Social Media Messaging in Postoperative Cataract Surgical Patients: Prospective Interventional Study | Social Media and Healthcare |

Background: Social media offers a new way to provide education, reminders, and support for patients with a variety of health conditions. Most of these interventions use one-way, provider-patient communication. Incorporating social media tools to improve postoperative (postop) education and follow-up care has only been used in limited situations.

Objective: The aim of this study was to determine the feasibility and efficacy of two-way social media messaging to deliver reminders and educational information about postop care to cataract patients.

Methods: A total of 98 patients undergoing their first eye cataract surgery were divided into two groups: a no message group receiving usual pre- and postop care and a message group receiving usual care plus messages in a mobile social media format with standardized content and timing. Each patient in the message group received nine messages about hand and face hygiene, medication and postop visit adherence, and links to patient education videos about postop care. Patients could respond to messages as desired. Main outcome measures included medication adherence, postop visit adherence, clinical outcomes, and patients’ subjective assessments of two-way messaging. The number, types, content, and timing of responses by patients to messages were recorded.

Results: Medication adherence was better in the message group at postop day 7, with high adherence in 47 patients (96%, 47/49) versus 36 patients (73%, 36/49) in the no message group (P=.004), but no statistically significant differences in medication adherence between the groups were noted at preop and postop day 30. Visit adherence was higher at postop day 30 in the message group (100%, 49/49) versus the no message group (88%, 43/49; P=.03) but was 100% (49/49) in both groups at postop day 1 and 7. Final visual outcomes were similar between groups. A total of 441 standardized messages were sent to the message group. Out of 270 responses generated, 188 (70%) were simple acknowledgments or “thank you,” and 82 (30%) responses were questions that were divided into three general categories: administrative, postop care, and clinical issues. Out of the 82 question responses, 31 (11%) were about administrative issues, 28 (10%) about postop care, and 23 (9%) about clinical symptoms. All the messages about symptoms were triaged by nurses or ophthalmologists and only required reassurance or information. Patients expressed satisfaction with messaging.

Conclusions: Two-way social media messaging to deliver postop information to cataract patients is feasible and improves early medication compliance. Further design improvements can streamline work flow to optimize efficiency and patient satisfaction.

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How Technology, Social Media Are Changing the Way Clinical Trials Connect With Patients

How Technology, Social Media Are Changing the Way Clinical Trials Connect With Patients | Social Media and Healthcare |

THE INSPIRATION FOR CLARA HEALTH came when co-founder Sol Chen was walking across campus at Brown University and saw a paper flier seeking patients for a breast cancer drug trial. Surely, she thought, there had to be a better way to find people who needed life-saving medications.1

For Seeker Health’s Sandra Shpilberg, MBA, the moment of clarity came when her former company, Nora Therapeutics, was struggling to find women to test a potential treatment for recurrent miscarriage.2 Instead of waiting for women to appear in clinics, Shpilberg set out to find them online—with ads that targeted women based on Facebook groups they’d joined or other common interests.

“That worked very well,” Shpilberg said in an interview with Evidence-Based Oncology™ (EBO™). “So, I decided to start a company to help many other sponsors.”

Companies like Clara Health and Seeker Health are using digital tools, including social media, to rewrite the rules of engagement that connect researchers with patients for clinical trials. In the process, company leaders say they are not only shaving months off recruitment schedules, but also finding more patients from minority groups and from rural areas. Studies show these populations need more representation in trials.3-5

Technology is poised to do more than change the way patients are recruited for clinical trials, however. As Belinda Tan, MD, PhD, co-founder and chief medical officer of Science 37, explained to EBO™, integrating telehealth and personal health technologies, like smartphones or Apple Watches, will further erode barriers to participation. Patients can be supervised remotely, with assistance from a local physician or nurse, while study drugs are shipped directly to their homes. Besides patient recruitment, Science 37’s NORA platform (no connection to Nora Therapeutics) for Network Oriented Research Assistant, meets FDA digital signature requirements6 and helps pharmaceutical sponsors with digital data collection.6 Tan’s fellow co-founder, Noah Craft, MD, PhD, DTMH, has said the minority enrollment in Science 37’s cancer trial pools is 3 times that of a standard trial.7

Tan saw what NORA could do in 2015, when Genentech used the platform to create 1 “meta-site” among more than 60 in a large international clinical trial. Science 37 was contracted to recruit 5 patients a year but instead recruited twice that number. “That was a huge win,” Tan said. “It was just a case scenario of what we could do.”

Even if they are not yet using telehealth for virtual trials, pharmaceutical companies can use digital tools like Apple’s ResearchKit to develop their own apps to connect with patients and collect data on patient-reported outcomes.8

Right now, there isn’t much collaboration with payers in this area, but those on the leading edge say there’s no reason why this can’t change. In particular, Tan would like to see solutions for hurdles in trials that require patients to already have had gene sequencing, which payers won’t fund.

Democratizing Clinical Trials

Both Shpilberg and Clara Health co-founder and CEO Evan Ehrenberg, PhD, say that unlike recruitment methods of old, these new strategies start with the patient. “For a long time, we’ve had a physician-centered approach—almost all the referrals came from hospital sites,” Ehrenberg told EBOTM in an interview. Putting patients in “the driver’s seat,” is crucial, he said, because sometimes physicians don’t know about every trial or don’t have an incentive to refer their patient to one based outside the academic center where they practice.

Contrast this with a process that starts with patients seeing what Shpilberg calls a “patient-friendly” ad on Facebook, which connects that person directly to a set of prescreening questions to find out if he or she is a potential fit. “We’re turning the process upside down,” she said.

Clara Health shares an enormous amount of content with users. Its website9 has information on every trial registered on, and it seeks to match patients with trials not only by condition, but also with help from an online digital assistant who offers to chat with users when they reach the site. Clara Health also features blogs about the clinical trial process to educate patients or caregivers.

When the company works with pharmaceutical sponsors, “our role is to make the trial as easy to access as possible,” Ehrenberg said. The presentation on doesn’t tell patients what to do if they nd an appropriate trial. In the past, if a patient found a phone number for a study coordinator on the site, it might only be answered during business hours.

“If patients have a serious medical condition, they just give up,” he said. Clara Health’s role is to take the “heavy lifting” out of the enrollment process to keep patients engaged. When necessary, the company can connect patients with groups that pay for travel and expenses to take part in a trial, and it also helps patients apply for nancial assistance.

Language matters, Ehrenberg said, and it’s something Clara Health is trying to change. “We encourage our sponsors, when they talk about participants, to treat them like people, as opposed to just numbers,” he said. “A lot of times that doesn’t happen; perhaps their IRB [Institutional Review Board] thinks it isn’t appropriate... but we don’t think people should be referred to as ‘test subjects.’”

Modern Marketing, Meeting IRB Standards

Two years in, Seeker Health has been involved in 22 clinical trials, with about 40% in oncology therapies, 40% in rare disease, and 20% in women’s health therapies, Shpilberg said. In the process, it has developed standards for reaching out to patients in cost-effective ways that still pass muster with IRBs. Seeker Health can target ads at subpopulations that have previously shown an interest in specific cancers or rare diseases, and it can even target them by finding common threads among these groups of potential patients that have nothing to do with their medical condition. For example, in the first venture, Shpilberg discovered the group of women she was seeking favored a popular novel, and that offered another recruitment path.

At the same time, Seeker Health must take steps to keep prospective trial participants from being swayed by factors other than the ad itself. Seeker Health employs a tool that achieves “comment suppression,” which means that even if an online user tries to comment on the ad, those statements remain hidden from other users. This way, Shpilberg said, no misinformation about the study or the drug is spread online.

Are new regulations needed? Shpilberg says no; all ads must meet existing FDA requirements for enrolling patients, as well as privacy regulations under the Health Insurance Portability and Accountability Act and the Health Information Technology for Economic and Clinical Health Act. A June 2017 document published by Harvard Catalyst, based on a paper published in the American Journal of Bioethics, spells out the relevant issues for IRBs and researchers and concludes that no new regulations are needed.10,11

Reducing Costs, Targeting Discrete Cancer Types

Both Shpilberg and Science 37’s Tan said cutting months out of the enrollment process will translate into savings and allow pharmaceutical companies to bring products to market faster. If technology offers solutions to rising recruitment costs, this could reverse a trend that has frustrated all parts of the research chain.

A 2016 study prepared for HHS said that maintaining research sites accounted for 9% to 14% of clinical trial costs.12 Another report from Pivotal Financial Consulting LLC found that the percentage of recruited patients who ended up enrolling in trials was declining, and that “unproductive” costs accounted for 66% of what pharmaceutical companies spend on trials.13

Thus, Tan said, the shift toward virtual trials could do something more—it could help smaller biotechs compete by letting them know quickly whether further studies are worth pursuing.

“The benefit of being fast is that it gives enough evidence, enough of a signal to go out and get more investors, or it gives companies con dence to shift resources to something they know has more promise,” Tan said. “If there’s no signal of e cacy there, they can say, ‘OK, let’s not waste more time on this.’”

Oncology, especially, she said, begs for this type of model, where small companies can work on discrete solutions but find patients from all over—and conduct virtual trials with patients supervised in tandem with a local physician. “In cancer, people have talked about how the decentralized trial model would be ideal. We’re going to have more targeted therapies, more molecular [DNA] signatures,” she said.

“Ultimately,” Tan said, “as cancer becomes more like a rare disease, where the percentage of people with a particular pathway with a molecular mutation is very small, you can use this model to reach an entire base of people and not be limited by geography, by having to go to the local cancer center. This becomes a more tenable type of trial to do.”

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Can participating in Facebook groups improve patient satisfaction? 4 findings

Can participating in Facebook groups improve patient satisfaction? 4 findings | Social Media and Healthcare |

The use of social media, specifically Facebook groups, in clinical practice can help healthcare providers incorporate an effective patient support community, according to a pilot study published in Surgery.

To explore how social media use affects patient engagement and satisfaction, the researchers created a Facebook support group for liver transplant patients to use as a virtual community forum in September 2016.

The researchers then reviewed the group's activity and conducted a survey to evaluate how patients viewed their participation in the group.

Here are four findings from the study.

1. Over the nine-month study, 350 users joined the group. Fifty percent were liver transplant patients, 36 percent were caregivers and friends, and 14 percent were healthcare providers. 

2. During the study, participants created 339 posts, 2,338 comments and 6,274 reactions in the group. Group members commented on or reacted to 98 percent of posts.

3. After the study, 95 percent of survey respondents said joining the group positively affected their care.

4. Ninety-seven percent of respondents said they were motivated to join the Facebook group to provide or receive support from other patients.

More articles on patient engagement:
New patients wait an average of 2.7 weeks to be seen: 5 things to know
Study finds addition of music therapy can improve treatment for depression
23% of healthcare consumers switched primary care physicians more than once in the last 5 years: 7 things to know

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Understanding impact of health information on social media - Patient Information Forum

Understanding impact of health information on social media - Patient Information Forum | Social Media and Healthcare |

A study published in the Journal of Medical Internet Research (JMIR) has explored how promotional health information related to Lynch syndrome impacts laypeople’s discussions on a social media platform (Twitter) in terms of topic awareness and attitudes.

The authors identify that whilst social media is being used by various stakeholders (ie, pharmaceutical companies, government agencies, health care organisations) to engage audiences to raise disease awareness, it is unclear what effects this health information has on laypeople.

They used topic modeling and sentiment analysis techniques on Lynch syndrome–related tweets to answer the following research questions (RQs):

  1. What are the most discussed topics in Lynch syndrome–related tweets?
  2. How promotional Lynch syndrome–related information on Twitter affects laypeople’s discussions?
  3. What impact do the Lynch syndrome awareness activities in the Colon Cancer Awareness Month and Lynch Syndrome Awareness Day have on laypeople’s discussions and their attitudes?

The study used a set of keywords to collect Lynch syndrome–related tweets from October 26, 2016 to August 11, 2017 (289 days).

Of all tweets (N=16,667), 87.38% (14,564/16,667) were related to Lynch syndrome. Of the Lynch syndrome–related tweets, 81.43% (11,860/14,564) were classified as promotional and 18.57% (2704/14,564) were classified as laypeople’s discussions.

The most discussed themes were treatment (n=4080) and genetic testing(n=3073). The topic distributions in laypeople’s discussions were similar to the distributions in promotional Lynch syndrome–related information.

Most people had a positive attitude when discussing Lynch syndrome. The proportion of negative tweets was 3.51%. Within each topic, treatment (16.67%) and genetic testing (5.60%) had more negative tweets compared with other topics.

When comparing monthly trends, laypeople’s discussions had a strong correlation with promotional Lynch syndrome–related information on awareness (r=.98, P<.001), while there were moderate correlations on screening (r=.602, P=.05), genetic testing (r=.624, P=.04), treatment (r=.69, P=.02), and risk (r=.66, P=.03). They also discovered that the Colon Cancer Awareness Month (March 2017) and the Lynch Syndrome Awareness Day (March 22, 2017) had significant positive impacts on laypeople’s discussions and their attitudes.

The authors conclude there is evidence that participative social media platforms, namely Twitter, offer unique opportunities to inform cancer communication surveillance and to explore the mechanisms by which these new communication media affect individual health behaviour and population health.

The full study can be accessed on the JMIR website.

Bian J, Zhao Y, Salloum RG, Guo Y, Wang M, Prosperi M, Zhang H, Du X, Ramirez-Diaz LJ, He Z, Sun Y

Using Social Media Data to Understand the Impact of Promotional Information on Laypeople’s Discussions: A Case Study of Lynch Syndrome

J Med Internet Res 2017;19(12):e414

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How healthbots can assist patients and HCPs

How healthbots can assist patients and HCPs | Social Media and Healthcare |

Remember to put ice on that bruise tonight,” says healthbot Gyant via Facebook Messenger. Gyant adds that Chris, the user engaging with the bot, could try playing Vanilla Ice's “Ice Ice, Baby” to speed up the healing process.

The dialogue is conversational. Over the course of three to four minutes, Gyant asks around 20 questions to get at the cause of the user's discomfort and offer possible diagnoses or recommendations. Users can also ask Gyant questions via Amazon's Alexa.

“We've noticed the number of questions doesn't matter as much as how you ask them and how you respond to people's answers,” said Stefan Behrens, co-founder of Gyant. “If you ask question after question, it's like filling [out] a form. We make sure our questions are asked in the nicest way possible, as human as possible.”

A year after Gyant launched, it has reached 800,000 users, Behrens claimed. Since Gyant originated as a resource to screen patients for Zika, much of its traffic comes from Latin American countries such as Brazil, Mexico, and Colombia. The company is also generating traction in the southern parts of the U.S., Behrens added. Gyant is currently available in English, Spanish, Portuguese, and German, and there are plans to expand in French, Chinese, Arabic, and Hindi.

Florence, Health Tap, Buoy Health, and Your.MD are among the other healthbots currently offering medication reminders, symptom checkers, health tips,doctor referrals, and other services.

“As doctors are more stretched for time, there's a lot of frustration in the healthcare system,” said Paul Balagot, chief experience officer at Precisioneffect. “I think the appetite to use [bots] as a support tool is high.”

A new report by the Association of American Medical Colleges predicts that the shortfall of doctors will approach 90,000 by 2025. That number could reach nearly 105,000 by 2030.

According to Balagot, healthbots can potentially reduce the workload of healthcare professionals while providing an engaging experience to patients. They can help focus the patient-doctor conversation by checking initial symptoms and tracking patient history, then provide post-treatment support after the initial interaction.

For conditions such as diabetes, physicians may be able to help patients combat the overt symptoms. Still, they sometimes are unable to follow up with patients who need to make changes to their diets and exercise regimens. Behrens believes healthbots can provide the necessary support.

See also: Voice assistants may ease EHR burden for docs, but challenges exist

In addition, healthbots may ultimately help reduce the volume of unnecessary doctor visits. “If you look at primary care physicians, many of them will tell you that they can't help 40% of the patients they see every week, because [the patient has] a viral infection, for example,” said Behrens. “So it's, ‘Go home, get some rest, and take some ibuprofen,' but you can't do much about the source of the condition.”

In some cases, especially those where there is a stigma tied to a condition, chatbots have become a preferred means of securing healthcare advice. Behrens said many users ask Gyant mental and sexual health-related questions, which sometimes trigger feelings of shame and anxiety.

“A lot of the users are relatively younger — around 16 to 25 — and come from developing countries, where there is a lot of social stigma around marriage and social norms,” Behrens continued. “We see a lot of questions around, ‘I did this. Could I be pregnant?' or ‘I have this rash.'”


Dawn Lacallade, chief social strategist and healthcare practice lead at social customer experience firm LiveWorld, senses a similar trend among clients like Anthem, Johnson & Johnson, and Boehringer Ingelheim. While she declined to offer program specifics, Lacallade said LiveWorld has helped one client develop a bot to collect data about sexual health in adolescents, with the ultimate aim of offering STD education.

“There's often an intimidation factor when you're talking to an HCP,” Lacallade explained. “A bot is a great tool to recap a conversation with an HCP, putting it in language to make it more understandable.”

As bot technology gets more sophisticated and chatbots secure HIPAA compliance, healthbots will start to realize their full potential.

“The first generation of chatbots was a bit robotic and didn't have the advancements of natural language, sentiment, and emotion,” said Balagot. “With AI technology advancing, the chatbots are becoming increasingly empathetic and natural, and more engaging.”

It's hard to be HIPAA-compliant when paired with social media platforms like Facebook, however,  which is why Gyant  is developing an app of its own. “We're taking the same technology and chat experience, and putting it in an app or secure website. That will allow us to seamlessly move the conversation to an actual human provider, be it a doctor or administrator,” Behrens noted. “Ideally, we want to [help] people get prescriptions or [sign up for] a telemedicine visit.”

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:Social Media: Taking the Plunge: Pharma and Social Media 

:Social Media: Taking the Plunge: Pharma and Social Media  | Social Media and Healthcare |

Pharmaceutical companies are increasingly embracing social media as a forum for reaching patients. For example, 40% of adults use social media for health-related issues, such as connecting with patients with similar issues. Social forums allow pharmaceutical companies to not only engage with consumers or patients, but also hear what they have to say directly, rather than sifting through external forums to find out what patients are saying, for example, about side effects.

Disease awareness is a particularly popular use of social media for pharma companies. These forums are recognized by companies as good ways to improve knowledge about diseases and to encourage discussion about conditions. Examples include Above MS, which is supported by Biogen; Chron’s & Me, sponsored by UCB; Eczema Exposed supported by Sanofi US and Regeneron Pharmaceuticals; GSK’s; HIV information and support site Stop the Virus sponsored by Gilead; and Speak Your Migraine from Amgen and Novartis, among many others.

In addition, companies have begun supporting wellness sites, such as Merck Engage, to encourage consumers to make healthy choices.

With some diseases, particularly rare diseases, social platforms can prove valuable in connecting geographically dispersed patients and providing them with a voice. Social media groups can also be invaluable in providing patients with a forum for sharing concerns and information.

Overcoming Barriers

The industry has faced several constraints with regards to social media. One is certainly the lack of clear guidelines. While the FDA provided draft guidance on the use of social media, those guidelines haven’t been finalized. However, companies must ensure information about risks is made clear. For example, Duchesnay received a warning letter from the FDA after posts by Kim Kardashian promoting its morning sickness pill Diclegis didn’t mention side effects or risks.

Twitter is considered an excellent two-way communication forum, but again lack of guidance leaves companies uncertain as to how to embrace it, at least when it comes to speaking about their products.

In a conversation on this issue with Forbes, cardiologist and blogger Dr. Kevin Campbell warned that pharmaceutical companies would have to tread carefully when hosting any commercially driven discussion and be aware that during recalls or negative press, they could open themselves to legal issues.

The good news, however, is that as of mid-November 2017 the Office of Prescription Drug Promotion (OPDP) had issued only two enforcement letters on marketing communications, showing a marked drop in such activity from the regulators. While these letters aren’t specific to social media, they do indicate a positive trend generally.

Media forums themselves have sometimes created barriers for the industry. For example, in 2011 Facebook announced that all Facebook pages would have to allow comments. This resulted in companies removing many disease-state groups because they lacked the mechanisms and resources to handle comments and remain in compliance. Facebook later rescinded the requirement; however, pharmaceutical companies struggle to find a way to effectively communicate with patients in such forums.

Another barrier has been uncertainty over communicating directly with patients, and in particular, concerns over how those patients will react.

Best Foot Forward

Statistics show that pharma is tapping into social media, albeit more slowly than other industries. Research company eMarketer estimated that in 2016 pharma and healthcare marketers spent $1.64 billion on mobile and online advertising, but projected that would rise to $2.55 billion by 2019.

The social media companies themselves are looking at how to engage pharma companies from a commercial point of view. On June 6, 2017, Facebook hosted a Health Summit for pharmaceutical marketers, and the organization is looking at changes it needs to make to cater to pharmaceutical companies, which increasingly are moving ad budgets from television to digital media.

Google and Twitter have been tapping into the market for a while, hiring teams to focus on pharmaceutical ad campaigns.

Experts in social media advise pharma companies new to social media to take the plunge because patients and caregivers are eager to use these forums to engage. Those new to social platforms might be best advised to start with well-traveled forums such as Facebook and working closely with medical, legal, and regulatory teams to avoid any nasty surprises later. Another sound approach is to start in one disease area and learn as they go.

Companies are also advised to measure the effectiveness of their social media campaigns, especially when it comes to branded campaigns. To avoid falling foul of regulators, some experts recommend companies develop a controlled environment, such as a website for a product, to ensure information is accurate. But if companies provide a patient chat room they may face obligations to correct misinformation.

Social media market intelligence firm Unmetric assessed the metrics, content, and campaigns of 15 brands in terms of social media presence and found most brands put efforts into just a few channels, that fan base is less important than the ability to expand that base, and that reach and impressions don’t correlate with frequency of posting.

Leading the Way

Despite concerns, many pharma companies do recognize the value of social media as a way to reach patients whether in a non-branded way to open the conversation on disease states, or — though less so — from a more commercial perspective.

Some companies have appointed digital leads to advance their social positioning, including: Biogen, which has a head of digital strategy; Sanofi US, which has a head of digital intelligence and connected marketing; Boehringer Ingelheim, with a senior digital manager; and Takeda, with a head of digital acceleration, to name a few.

One of the most successful campaigns was Boehringer Ingelheim’s post during Brain Awareness Week in March 2016, which included a puzzle to highlight cognitive tasks. The post marked the company’s foray into the therapeutic area of CNS, including mental illness.

One strong proponent of social media is Ron Cohen, M.D., CEO of Acorda Therapeutics, who started a digital-innovation-and-strategy group at the company. This has led to several innovations, including a self-help application called MS self that lets users track metrics related to their health. The company is also using digital technology to recruit patients for clinical trials, using multichannel methods to find patients with a condition and inform them of the clinical trials, and providing click throughs so patients can find out more.

Another company looking at social networks for patient recruitment is Bioverativ, which has turned to MyHealthTeams to better understand the unmet needs of hemophilia patients and potentially get them into trials for an upcoming hemophilia drug. Once it gathered input, the company designed its trial to address unmet needs by gauging two key issues raised: continued pain and help with depression.

Companies must take a considered approach to their social media. Sandra Velez, content strategy leader at Merck, says companies must understand their customers’ needs, have two-way conversations with them, and be on channels that customers expect them to be on. She emphasizes the importance of creating a customer persona and understanding that their emotional needs will vary depending on their persona — patient, provider, or payer, for example.(PV)

nicholas yearwood's curator insight, January 16, 9:20 PM
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How to Make Your Patients Follow Your Chiropractic Practice on Social Media

How to Make Your Patients Follow Your Chiropractic Practice on Social Media | Social Media and Healthcare |

We hear it all the time: “Engage patients!” Sounds like a valid and proven marketing advice, right? But what are the best and most efficient strategies for engaging your patients? Every medical practice is different, and so there is no one-size-fits-all mantra to follow. However, there are a few ideas you can implement that, when blended with research data and experience, can help you gain traction in the social sphere. Active patient engagement on social networks will help your chiropractor practice and is an important step toward increasing the conversion rate.

Social networks such as Facebook and Instagram are changing the way medical practices operate and interact with potential and existing patients. However, the key to success on these platforms is to have an active and engaged following. Engaged patients are great assets as they tend to spread the positive word about your practice and its services.

Why Do Patients Follow Your Brand?

Have you ever wondered why someone would even want to follow a healthcare brand on social media? Most of us will dislike a site that throws a three-minute pop-up ad at us while we are trying to read a two-minute blog post.

So, why would your patients be willing to follow your chiropractor practice on social media and have your content show up in their social feeds for free? Don’t you want to think about it?

As social networks become more prevalent and essential to marketing strategies, healthcare marketers need to have a solid understanding of the various reasons that existing and potential patients choose to follow, engage and interact with brands on social media.

It is important to understand the underlying reasons as to why your target audience would choose to follow your brand on social networks. This understanding will make the process of attracting and retaining those followers much simpler.

According to research, relevant content is one of the top reasons patients follow healthcare facilities on social networks. If you are looking to ramp up your conversion rate and brand awareness and increase the number of leads, check out these reasons why patients follow chiropractors on social networks:

1. For updates on products and services: Majority of patients turn to social networks for their daily dose of updates about the latest products and services. If an existing or potential patient is interested in your products or services, he or she may choose to follow your brand on social networks to be “in the know” when new products and services are launched. So whenever you have news about your products or services, make sure you share the information on your social media pages. You can even consider sharing a short video or images related to the update.

2. To learn of exclusive offers and promotions: Your followers need to be rewarded for their loyalty. You can keep your patients glued to your social media pages by offering special discount codes, exclusive offers and other promotions. Nearly 70 percent of people follow brands to take advantage of special offers, promotions and special deals. While social networks are not the ideal place for throwing deals and discounts, such posts can help you generate leads and attract potential patients. As a bonus, in order to make your followers feel exclusive, you can announce a special discount only for them. However, you will have to be careful because posting discounts and offers frequently can make you look desperate. So limit the number of such posts. According to a survey, having access to special promotions is one of the top reasons patients follow a brand on social media. These discounts and incentives serve two main purposes: They attract potential patients to your page, and they help retain existing patients by positioning your brand at the top of their minds.

3. To find customer support: An increasing percentage of patients are turning to social networks for customer support. For a lot of people, contacting their doctor on social media is a quicker and more convenient way of expressing concerns and asking for help. According to research, 71 percent of patients who received positive customer service on social networks are more likely to recommend the doctor to their family and friends. Social networks are excellent platforms for engaging with your patients and showing them that you care about their experiences. If an existing or new patient posts feedback about your chiropractor practice on social media, a quick reply is an effective way to show gratitude and resolve concerns.

4. To keep in touch with your practice: Some patients will follow your brand simply because they like its unique identity and personality. Almost 32 percent of patients follow your brand on social media just because they want to stay connected and informed about the activities of your brand. From a healthcare marketer’s point of view, this proves the value of social networks as an effective tool for patient engagement and feedback. Your brand’s social media page serves as a useful resource where patients can see the latest updates from your practice without having to visit your website. Whether you are posting about a new product launch or an exclusive discount offer, following your practice presents the opportunity to keep informed about all the important updates.

5. To post an online review or feedback: If a patient is following you on social media, it is highly likely that he or she is already a loyal patient or is interested in learning more about your services. Patients often follow brands they care about and give feedback about the doctor on their experiences. Social media can give your patients a public voice, so it is critical to take feedback and reviews constructively. Social networks are an excellent way to see what your patients think about your practice and where your strengths and weaknesses lie. Practices that are more open in soliciting the feedback of patients will send the message that the feedback matters, and this can have a positive effect on patient loyalty.

However, not many patients will bother to leave feedback unless they feel passionately enough about your practice to make an effort. Your social media pages will often be one of the first platforms that your patients will turn to when they want to post a review or leave feedback.

And, Why Do Patients Unfollow Your Brand?

Acquiring a massive social media following is incredible, but it is pointless if you keep losing those followers. It is important to understand what is making your followers leave. Being unfollowed is an expected part of the social media journey.

You may think you know your patient demographic inside and out, but do you really know what they want to see on your social media pages? Unknowingly, you might be committing social media mistakes and forcing them to hit the unfollow button. So where could you be going wrong? As a healthcare marketer, it is almost impossible to please every single patient. Here are five key reasons patients unfollow a practice on social media:

1. Irrelevant or boring content: According to research, 21 percent of patients will unfollow a brand if the content is uninteresting and repetitive. If the content you are sharing is not exciting, your target audience will unfollow you. The truth is, there is a lot of competition out there, and you need to be innovative in order to stand out from the crowd. Your patients are following your practice for a specific reason, and if you continue to share boring content, you can kiss those followers goodbye. Your followers demand and deserve fresh and informative content.

2. Over-promotion: Of all the reasons patients unfollow practices on social media, “posting too frequently” is one of the biggest turn-offs. Unfortunately, many practices still approach social media as if it is a broadcast channel where they are allowed to post updates every hour or two. It is important to understand that social networks require two-way communication – brands post, target audience responds and engages. But how much is too much on social media? The answer is, most followers expect the brands to post only once or twice a day. If you are posting updates more than six times a day, you need to slow down. The best way is to stick to a social media schedule so your target audience knows what to expect. However, stick to whatever schedule you decide on.

3. Lack of engagement: The goal of social media presence is to be social. Social networks are designed to help you engage with your followers and make your brand seem accessible. However, if a follower messages you and you ignore him or her, it can defeat the purpose. It is critical to use your social presence as a medium to interact with your followers. As a healthcare marketer, you must engage with your target audience. Communicating with them in a personal and friendly manner is crucial. Nearly 39 percent of patients expect doctors to engage with them when they post on their social media pages. Engaging with your followers can help improve conversion rate, drive traffic to your website and attract new patients.

4. Your competitors are more engaging:A small portion of your followers can unfollow your brand if they come across a competitor who shares more compelling content and is more appealing than you are on social media. However, this is more of personal choice than a social media mistake. You cannot do much to stop such incidences. Your only option is to try to be better than your competitors by keeping an eye on their social media activities. It is important to take note of things they are doing right, and include those in your social media strategy.

5. Posting too little: While posting too frequently can cause you to lose followers, not posting enough can do as much harm. When you do not post for two months, and then all of a sudden post a promotional offer, your patients may wonder why they are following you in the first place. If you are too quiet and only posting rarely, your patients will find it pointless to follow you and most likely click the unfollow button. Again, it is advised to set up a social media schedule and adhere to it. You must post at least once a day. Being consistent will show your patients that you are present and active. The idea is to find a good balance when posting content on social networks.


Social networks help in brand promotion. Healthcare brands need to make the most of these platforms by posting useful content frequently.

An important thing to remember is that your followers expect high-quality content that fits their requirements. Social media is a two-way communication platform, so be careful not to overwhelm your followers with frequent updates and promotional content. But if you are too quiet and only posting rarely, your patients will find it pointless to follow your brand and will most likely click the unfollow button.

Engaging patients through social networks can be challenging for some chiropractors, but it is the first step in creating loyal patients and for promoting your practice in earnest. It tells potential patients that you are listening and are actively involved. Social media engagement should be a pillar of your healthcare marketing strategy.

If you need more help with managing your social media profile, feel free to contact our social media services team today.

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Doctors turn to Twitter to highlight ‘third world conditions’ in A&E departments

Doctors turn to Twitter to highlight ‘third world conditions’ in A&E departments | Social Media and Healthcare |

“Battlefield medicine”, “third world conditions” and a system “on its knees” are some of the expressions being used by doctors to describe the situation in England’s Accident and Emergency departments.

Dr Richard Fawcett, an emergency medicine consultant at University Hospitals of North Midlands NHS Trust, said he was heartbroken to see so many frail and elderly patients languishing in corridors.

On Twitter, he apologised to patients in the Stoke area for “3rd world conditions of the dept due to #overcrowding”.


His colleague Dr Gareth Davies also took to Twitter to say: “Royal stoke on its knees.

“But we definitely saved a very unwell man’s life this am.

“Keep going team ED…you are amazing!”

The trust sent out a statement recognising the “sustained pressure” in the system in the region, adding: “Our staff want the very best for our patients and at times they find the situation frustrating, which can be reflected on social media.”

Dr Anu Mitra, a consultant in emergency medicine at Imperial College Healthcare NHS Trust, wrote: “Like everyone else we’ve been practicing corridor medicine on a brutal shift today.

“This is battlefield medicine.

“For next few weeks it won’t be exception but norm.

“That we’re retaining any semblance of kindness, politeness and teamwork is testament to our remarkable staff.


“But it’s TOUGH, and it’s SO hard to do things well when ED’s >200% of capacity.”


Another NHS doctor, Chris Turner, wrote: “It’s 0400 and I’ve been lying awake for the last hour worrying about how we manage the department when my shift starts in 12 hours time.

“The last time the job felt so impossible for me was Mid-Staffs.

“This can feel like a personal failure to staff; it’s not, it’s a system fail.”


The hashtag #NHSCrisis has become one of the top trending UK topics on the social media site.


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