TO TWEET OR NOT TO TWEET THAT IS

TO TWEET OR NOT TO TWEET? THAT IS THE QUESTION William Lewis MD, FAAFP, Assistant Professor, Family Medicine, West Virginia University; Clinic Director – Harpers Ferry Family Medicine David A. Baltierra, MD, FAAFP, Assistant Professor, Family Medicine, West Virginia University; Program Director - WVU Rural Family Medicine Residency David Roelkey, MD, third year resident at WVU Rural Family Medicine Residency 12/4/2010 S

Objectives 1. On completion of this session, the participants will be able to identify what new technologies are available for patient and resident communication and interaction. 2. On completion of this session, the participants will be able to identify and implement specific teaching strategies. 3. On completion of this session, the participants will be able to identify advantages of and barriers to implementation and limitation of these new technologies.

Harpers Ferry Family Medicine Located in Jefferson county in the eastern panhandle of West Virginia in the town of Bolivar Founded in 1982 as NHSC site Multi-specialty group with 35 providers 36, 000 visits annually

WVU Rural Family Medicine Residency First resident started in 1996 44 graduates 5 -5 -5 residency 90% of graduates for past three years practice in West Virginia

Twitter Micro-blog and social networking site. Members send and read posts (tweets). Tweets can be up to 140 characters. Followers subscribe to authors and receive their tweets. Author can restrict access. Access is available over a variety of formats. Twitter web site Short Message Service (SMS), texts Applications for phones

Twitter Uses Micro-blogging – what am I doing? I am going to gym. Stuck in traffic My leg itches Breaking News – often real time tweets provided by people on the ground Hudson river plane crash Michael Jackson's death traffic updates

Twitter Uses Communication – Questions to the community Celebrities and athletes bypass media interacting directly with public CDC providing H 1 N 1 information Public Address System – announce events Group text Feedback Crowd-sourcing – ask question of community (tweet what you eat) Informal Polling Sales and Marketing

Tweet Content [4] 1. 2. 3. 4. 5. 6. Pointless babble 40. 55% Conversational 37. 55% Pass along value 8. 70% Self promotion 5. 85% Spam 3. 75% News 3. 60%

Twitter Users [1] 59. 1 million unique monthly users in US Higher percentage of women than men. Higher percentage of African American and Hispanic users than related sites.

Who is on Twitter Celebrities Athletes Politicians News organization Government Offices - CDC Companies Professional organizations – AAFP Local groups – Freedoms Run, Harpers Ferry National Park Individuals

Twitter’s Most Followed [3] 1. 2. 3. 4. 5. Lady Gaga Britney Spears Ashton Kutcher Justin Bieber Barack Obama

Twitter in Health Care 1. 2. 3. 4. 5. 6. Goodhealth Whole. Foods sanjaygupta. CNN Women. Health. Mag Fitness. Magazine WSJHealth. Blog

Why Twitter? Cheap (free) Easy to use Available on a variety of platforms Rapidly growing medium Used for news and information dissemination rather than social networking (we can be the media) People choose to follow us- does not require lists as does email

Resident Education Opportunities Exposure to use of emerging technologies for patient communication Preparation of patient-focused educational materials Opportunity to participate in research Enhance residency communication

Office Tweets Clinic hours, closings Appointment availability Immunizations Clinic events (sports PE) Health announcements Websites/patient info

Obstacles Remembering to tweet University policy Are patients using Twitter

Hypothesis Patients have more access to twitter, due to multiple platforms, than email or other web based communications Rural communities are ready for communication via twitter Twitter is an effective way for doctors to communicate with public Improve patient communication Improve health information – twitter group using better web sites Improve satisfaction with practice and care

Assessing Initial survey of our patient Demographics Cell phone, text, and internet access Twitter use vs. other social network sites Desire to have electronic communication from clinic Type of information patients would like to receive Where patients are receiving health information

Demographics 370 patients surveyed Female 74. 9% Male 25. 1% Age 18 -79 Race White 92. 4% Black 3. 8% Hispanic 1. 9% American Indian 1. 6% Asian 0. 6% 53. 5% with children under 12 22. 75% with 12 -17 year old

Education

Income

Internet and Cell Phone 97. 4% of patients have either internet or text access Internet - 86. 4% with access 80. 4% at home 32. 4% at work Cell Phone – 94. 6% with cell 70. 8% with text messaging 48. 6% with internet access from phone

Health Information Where do you currently get health information? Health care professional - 76. 4% Friends and family – 38. 9% Television – 14. 9% Internet – 60. 8%

Health Information Where do you get health information from the internet? Search engines – 49. 9% Wikipedia – 15. 4% Chat rooms/Forums – 2. 7% Web. MD – 50. 3% Government sites – 13. 5% Other – 2. 4%

Health Information Currently receiving health updates - 15. 6% E-mail – 10. 8% Social media - 0. 5% Other (mail) – 5. 4%

Health Information Would you like to receive health updates from your health care provider? Yes – 66. 4%

Health Information What type of health information would you like to receive? Clinic hours – 17. 6% Personal health information – 40. 9% Appointment reminders/availability – 60. 0% Lab/test results – 55. 9% General health alerts – 40. 5%

Health Information How would you like to receive health information from your health care provider? E-mail – 47. 8% Cell phone/text alerts – 17. 3% Tweets – 0% Other (mail)– 4. 6%

Social Media Use Do you use social media? – 63. 1%

Social Media Use Do you use social media? – 63. 1% Facebook – 61. 6%

Social Media Use Do you use social media? – 63. 1% Facebook – 61. 6% My. Space – 12. 2%

Social Media Use Do you use social media? – 63. 1% Facebook – 61. 6% My. Space – 12. 2% Twitter – 4. 1%

Income Correlations Significant relationships Income-education Income-internet access No relationships Income-cell phone Income-social media Income-text

Education Correlations Significant relationships Education-internet access No relationships Education-cell phone Education-text Education-social media

Gender Correlations Significant relationships Gender-social media No relationships Gender-internet access Gender –cell phone Gender-text

What We Want to Do Start office Twitter site Distribute general health information and clinic information Allow residents to develop Tweets

Things in Our Favor Nearly all patients have a way access to Twitter. Majority of patients use social media. Patients would like to receive health information from us.

Problems Need university approval for site. (cuts way down on the easy part of Twitter) Next to no patients on Twitter No one interested in getting Tweets

Solutions Try Facebook? Forge ahead?

Twitter Policy Content Following If you follow we will not automatically follow you back. This is to provide protection for personal health information, to discourage the use of direct messaging and so that you can easily identify other key Twitter users that we think are relevant. Being followed by HFFamily. Med does not imply endorsement of any kind. Availability Content will be restricted to office and general health information. No personal health information will be discussed. If you have a question about your health care please call the office 1 -304 -535 -6343 If you follow us, you can expect between 2 -10 tweets. We will update and monitor our Twitter account. Twitter may occasionally be unavailable and we accept no responsibility for lack of service due to Twitter downtime. Replies We welcome feedback and ideas from all our followers, and will to join the conversation when possible. However, we will not be able to reply individually to all the messages we receive via Twitter.

Following Who we will follow Relevant government and professional organizations Community groups and organizations Who we will not follow Individuals We will state that following does not imply we endorse

References 1. 2. 3. 4. 5. twitter. com - Quantcast Audience Profile. Quantcast. com. http: //www. quantcast. com/twitter. com. Retrieved 11 -10 -2010. Mc. Giboney, Michelle (3 -18 -2009). "Twitter's Tweet Smell of Success". Nielsen. http: //blog. nielsen. com/nielsenwire/online_mobile/twitters-tweet-smell-ofsuccess/ Retrieved 12 -6 -2009 http: //twitterholic. com/ Retrieved 11 -10 -10 Kelly, Ryan, ed. (8 -12 -2009), "Twitter Study - August 2009" (PDF), Twitter Study Reveals Interesting Results About Usage, San Antonio, Texas: Pear Analytics, http: //www. pearanalytics. com/wp-content/uploads/2009/08/Twitter-Study. August-2009. pdf, retrieved 12 -6 -2009 Williams, Neil (7 -21 -2009). "Template Twitter strategy for Government Departments". Cabinet Office Digital Engagement blog. http: //blogs. cabinetoffice. gov. uk/digitalengagement/post/2009/07/21/Templa te-Twitter-strategy-for-Government-Departments. aspx. Retrieved 9 -2 -2009