This session will explore the integration of social media and underlying technologies into a healthcare organization’s communication and patient engagement strategy. It will include a review of opportunities to leverage social media as tools for business intelligence, enhancing care coordination processes and facilitating effective communications. The role of social technologies in clinical and operational initiatives and processes across the entire care continuum and for improving health outcomes will be highlighted. About the Speaker: Christina Thielst, FACHE, is Vice President of Social Media at TOWER, a patient experience consulting group. She advises healthcare organizations on strategies to engage consumers across the continuum of care and apply emerging technologies to positively transform experiences – from the patient’s perspective. Christina has blogged since 2005 and is a thought leader in the continually evolving field of health IT. Her book, Social Media in Healthcare: Connect Communicate Collaborate is now in its second edition and a new book of social media innovation case studies is scheduled for publication in early 2014. Christina received a Masters of Health Administration from Tulane University, School of Public Health and Tropical Medicine and is a member of the American College of Healthcare Executives, Health Care Executives of Southern California, Health Information Management Systems Society (HIMSS), American Telemedicine Association and The Beryl Institute.

1. Social Technologies: Engage Patients
Across the Continuum of Care
ePatientExperience.com
December 3, 2013

2. Learning Objectives
• Recognize the contributions of social media to
the engagement of patients and their family
caregivers
• Identify opportunities to include social
technologies in clinical and operational initiatives
and processes

3. Great Tweet!
@msbluebells
I feel the same way about hospital gowns as I
do using social media... I am never sure what I
might be showing... :)
3:02 PM - 16 Feb 12 via web · Embed this Tweet

4. Social Media Defined
Electronic tools that enhance communication, support
collaboration & enable users to generate and share
content
– At least bi-directional
– Dialogue and collaboration in building content
– Easily accessible – anywhere, anytime -- on a mobile device,
laptop or desktop computer
– Immediate – right now

5. Apps &
Widgets
Virtual
Worlds
Microblog
Blog
Social
Gaming
Social
Technologies
Wiki
Bookmarking
Brands
Social
Networks
Photo
Sharing
Aggregators
RSS
Video
Sharing
Podcast

6. Healthcare Continuum of Care
Participatory Model
Inform Me
Engage Me
Empower
Me
Partner with
Me
Support my
eCommunity
Static
Transactional
Interactional
Self
Management
Interoperability
EMR
Patient
Portal
Patient
Empowered
Portal
Patient
Empowered
Portal
Information
Exchange
Public
Website
Copyright © 2013 Tower Strategies

7. Social Media Across the Care Continuum
Patients
& Family
Create a sense of trust
that this is the provider
of choice by beginning
to deliver a smart and
personalized
experience
 Engaging
disease/condition
information
 Self-management
tools
 Physician blogs
 Maps & directions
 Virtual tour
 Health tips
 Following tweets
 Clinical trial
recruiting
Pre-Treatment
Educate and prepare
for the
what, where, how and
why of treatment
 Self assessments
 Social support &
networking
 Campus & indoor
navigation
 Interactive learning
 Multidirectional
information sharing
 Text reminders
Active Treatment
Provide the right support
at the right time in the right
way to improve the
patient’s treatment
experience





Journaling
Social networking
Interactive learning
Messaging
Bookmarking &
organizing information
 Care coordination
 Patient generated data
and information
 Caregiver support
Post Treatment
Support a positive
‘return to life’
experience
 Reminders &
monitoring
 Self-care tools
 Messaging
 Social support &
networking
 Sharing story &
feedback
 Ways to give back
 Ongoing
engagement
Copyright © 2012 Tower Strategies
Worried Well

8. DRIVERS & TRENDS

9. Consumer Preferences
on Social Media
• 50% prefer a health provider social networking site
• 14% prefer an integrated approach of hospital
websites and social media
• 57% say a hospitals social media connections would
strongly affect their decision to receive treatment at
that facility
• 81% feel a strong social media presence indicates a
hospitals clinical functions are cutting edge

10. Online Customer Experience Priority
• Link established between online satisfaction and
financial success
• Highly satisfied visitors report being:
– More likely to return (177%)
– Recommend site to others (185%)
– Use as their primary resource (234%)
• Average satisfaction score for hospitals & health
systems is 74 (100 point scale)
10

11. New
Payment
Models
Shrinking
Revenue/
Margins
Population
Health
Integrated
Delivery
Systems
Patient
Satisfaction
Healthcare
Climate
Digital &
Mobile
Shift
Accountable
Care
Quality &
Safety
Penalties
Clinical
Outcomes

12. Enhancement to EHR
• Can’t anticipate every question
• EHR information is rarely written in way
understandable and actionable for patients with
basic or below basic health literacy (90M)
• Too often include long text and use of medical
terms
• Estimates of 77M people with a poor
understanding of basic medical vocabulary and
health concepts (at greatest risk for poor outcomes and readmissions)

13. Patient/Physician Education
In the exam room 37% of the physician’s time is
spent on patient education
– Patients failed to report 68% of problems
– Physicians report 54% of patients missed their
most important health problem

14. Understanding Home Care
Instructions
80% of patients discharged from
the emergency department don’t
understand their home care
instructions
14

15. Caregivers of Young Children
• 47.8% made dosing errors
after standard medication
counseling and 38% did
not adhere to all
instructions
• With pictogram dosing
error rate fell to 5.4% &
only 9.3% did not adhere
to all instructions
15

16. Evidence-Based Communications
Customized to the learning and language needs of the individual patient
•
•
•
•
•
Patient is part of the team
Advocate for patient
Engage patient
Closed-loop communications
Handoff

17. Readmissions
• California’s goal is to reduce readmissions by 20%
• The average readmission costs $8000 to $13,000
• Common drivers identified for readmissions:
– Lack of standard discharge processes
– Lack of engagement or activation of patients and families
– Patients call 911 or return to emergency room instead of
accessing a different type of medical service
– Ineffective or unreliable sharing of relevant clinical
information
– Patients did not understand/did not correctly take
medications.
17

18. Readmissions Opportunities
• Causes
– Heart Failure and Pneumonia (50%)
– COPD (16%)
– Diabetes (13%)
• 51% of discharges did not have timely followup within 30 days*
– 10 times more likely to be readmitted
18

19. APPLICATIONS ACROSS THE
CARE CONTINNUUM

20. Patient Online Information Needs
• When questions arise (not always in the exam room)
• Relevant, contextual information on their
condition preferred
• Provider endorsement of information preferred
• User-friendly tools to document and transmit

21. Apps (Widgets)
• Product selection and communication with
allergist about symptoms and experiences
• Individualizes strategies for managing PTSD,
tracking symptoms, finding local support and
obtaining anonymous assistance for military &
veterans
• Top consumer apps:
– weight loss & exercise – downloaded & more data
– pregnancy – actual use
21

22. mHealth Apps by Category
Verisoni, 2012
22

23. Pre-Treatment
• Floyd Medical Center Preoperative Patient
Guide
• Pre-Conception Assessment – Gabby
– High risk of poor reproductive health & family
planning outcomes
– Sixth grade reading level & replay aids in
comprehension
– Relevant, contextual communications based upon
responses

24. Pre through Post Treatment
• Columbia Valley Community Health
- reach out to and communicate with young, immigrant
and underserved mothers-to-be
• West County Health Centers FQHC
- eliminate the social stressors and underlying barriers
to care
- sharing experiences
- accessing condition specific educational content
- engaging patients to self-manage their chronic
conditions

25. Active Treatment
• Boston University Discharge Advocate
–
–
–
–
–
Education & aftercare plan
helpful with low literacy
51 min vs. 81 min for live DA
preferred by 74% of patients
encourages patients to be active
participants in their care
– Estimate a 30% decrease in ED
and hospital utilization
– Estimate at least $145 direct cost savings
per patient discharge

26. Treatment & Post-Treatment Phases
• Northern California Health Centers
– Private social platform to extend care
– Patient engagement outside of provider visits
• United Health Centers of San Joaquin
– Safety-net provider
– Online and mobile platform for providers and
patients to manage chronic disease

27. Treatment & Post-Treatment Phases
• Children’s Hospital Dallas
– Secure online social networking community
– Current and former patients and families
– Personalized security settings
– Increase communication, support and connections
– Patients/families create and join communities

28. Post-Treatment
• Social Networking platform for those recovering
from addiction(s)
– Secure access to support 24/7 used by payors and providers
– Case managers
• track across transitions
• filter activity to assess risk of relapse
• Prioritize outreach activities
– One health plan realized a two-thirds reduction in relapse
readmissions over first year
– 67% reduction in readmission rates for those out of treatment
for more than 270 days
– App for anywhere/time access to support
28

29. Addiction Recovery Results
• Improved handoff communications during transitions
• Improved outcomes with increases support and regular
tracking of progress
• Stronger peer support networks and means to stay connected
• More relevant case management from scheduled check-in and
reporting (e.g. cravings, depression, pain)
• Creation of a behavioral record over time (e.g.
achievements, emotional status, relapse)
• Regular clinical assessment of an individual’s risk of relapse
• Comprehensive reporting of aggregate data
• When these patients relapse, they usually go online first to get
support

30. Survivorship Research
• Boston Children’s Hospital
– Social media to augment traditional surveillance
methods - hypoglycemia in diabetics
– Expand knowledge of complications from bidirectional conversations among participants
– Learn about experiences that may not be severe
enough for emergency treatment
– Impact on behaviors

31. Extending to Mobile: Texting
• 90% of text messages are read within 3
minutes*
• Secure, encrypted, protected, traceable texting apps
for physicians, nurses and other staff
communications
• Bandwidth: 1-minute call = 800 text messages**
• Text 911 now available in some markets
• Preferred by young, minorities & Medicaid
beneficiaries
31

32. Text Message–Based mHealth in Emergency
Department Patients With Diabetes
Adults with diabetic issues who visited an urban,
public ED received two diabetes-related text
messages daily during a 6 month period
– Motivational messages daily;
– Medication reminders three times per week;
– Healthy living challenges twice per week; and
– Trivia questions twice per week.

33. TExT-MED Results
• blood glucose levels fell by 1.05% and self-reported
medication adherence increased from 4.5 to 5.4 on an
eight-point scale in the intervention group
• 35.9% of patients who received such text messages
visited the ED, compared with 51.6% of those who did
not receive such messages
• effect on medication adherence & disease control was
higher among Spanish-speaking individuals
• Overall, 93.6% of patients who were sent text messages
said they enjoyed receiving them

34. Partners Healthcare – Texting
• Several studies and findings include:
– Patients feel better connected to care team and
received higher quality of care
– Improved adherence to care plans
– Decrease in “no show” rates
– Sustained behavior changes
• What’s next? Support and feedback improving
weight lost and diabetics outcomes
34

35. Results: Sunscreen Use
Center for Connected Health

36. MANAGING THREATS
& RISK
36

37. What languages does your community speak?

38. Social Media Learning & Influencing
• Identify attitudes, perception and behavior about
brand and trends
• Social intelligence – listening posts across the
spectrum of social media outlets (today’s newspaper
clipping service)
• Social customer relationship management
(CRM)
• Word of “mouth” promotions

39. 39

40. What patients share….
• “Inefficient process, long wait”
• “…Bring something to do while you wait”
• “Losing your parking stub is a pain in the ass –
don’t do it.”
• “Dr. xxx is a miracle worker”
• “Free Wi-Fi!”
• YouTube Video of staff brushing hair

41. Push Content & LISTEN

42. Related Patient-Centered
Technologies
• Mobile: extend the reach of care and stay
connected with patient populations
• Enterprise portals: single sign-on, proxy access
• Personalization: Contextually relevant
information and education

43. Patient Experience Improvement
Process
Monitor
Performance
Collect
Information
Build
Strategy &
Roadmap
Engage Top
Down &
Bottom Up
Establish
Shared
Vision

44. Best Positioned Hospitals
•
•
•
•
Offer social engagement opportunities
User-centered designs
Benefit from resulting patient perceptions
Leverage social media as a care coordination
platform
• Change the way care is provided – esp. post-discharge
• Use social intelligence and directed networks to
advance goals

45. Christina Thielst, FACHE
Vice President, Social Media
thielst.typepad.com
@TowerStrategies
@cthielst
cthielst@towerstrategies.com
Christina@cthielst.com
805 845-2450