Ben Carson M.D.

 

 

Medicine’s new rock star is a quiet but outspoken Pediatric Neurosurgeon, the Head of the Pediatric Neurosurgery Department at John Hopkins University School of Medicine in Baltimore, Maryland. He received the Presidential Medal of Freedom in June 2008 the highest civilian award in the United States. It recognizes those individuals who have made "an especially meritorious contribution to the security or national interests of the United States, world peace, cultural or other significant public or private endeavors

Presidential Medal of Freedom

Carson’s ratings have skyrocketed since his keynote speech at the National Press Club’s annual event.  Sitting at the dais with Barak Obama at this right, Carson set a high benchmark for values and morality.  Obama who considers himself a benchmark for social justice seemed dazed and unable to respond.

 

America !  Ben Carson has your attention, so listen  carefully. The attacks on Carson have begun, with PC statements about ‘gays’ which Carson apologized about.

The best way to divert attention from the message and/or messenger is to introduce chaos with a totally irrelevant complaint. Carson’s message is one every American, politician and decision maker needs to keep in his mind (and heart) while they go about their business.

Although famous in a relatively small subspecialty of medicine, Carson was not well known to the general public.  His academic and surgical skills have taught many neurosurgeons to accomplish what once seemed impossible.¹

Thus far he has been accused of being disrespectful to the leader of the free world, using derogatory remarks about gays.  Soon there will be accusations of infidelity, pedophilia (he does operate on children).  Of course none of which are true.

Did I tell you that he was born into a poor black family ?  Images of his hard working mother standing watch over him and his brother insisting they read each night.  Ben’s life could have gone in the opposite direction. 

Carson is at the age of retirement from his medical practice, however we will be hearing a lot more from him about social issues.  I recommend everyone read his biography, and the other books he has written on his Amazon Page .

Carson has the ability to carve out the essential forces at work in society which have become over-riding and interfering with proper decision making which threaten the fabric of American ideals.

We now live in a ‘comfort zone’ where decisions are based upon the profit, either in money or influence, rather than the true value of a decision.

Ben Carson MD is one of the true voices of American Medicine, he deserves all our support regardless of your mode of practice, solo, group, integrated health system.

His essential message to  us all is to maintain our integrity of beliefs and insist they be met by our health system.

His not so shocking message is not that surprising to any of us at all. The shocker is that he makes it so plain that maybe even a President could understand it.  President Obama has made no comment, thus far.

The Republicans seem anxious to appropriate him for their own selfish purpose.  I advise Ben to stay independent.

 

 

Technorati Tags: Ben Carson,Barak Obama,Presidential Medal of Freedom,National prayer breakfast

The ‘INBOX"’ for the Health Train Express

 

My morning routine opens with GMAIL, followed by my Google notifications, often they duplicate each other since I have my preferences set to notify me via email of notifications. (I know it seems redundant, but it helps somewhat to organize priority notifications.

Next is reviewing Google Reader (in the process of syncing with Feedly and Old Reader. as well as Newsblur).   At first the news about Google Reader going to the happy hunting ground was devastating, however we have adjusted accordingly with some unexpected positive consequences for all.

  

At this point I am reading my inmail subscriptions to several internet medical newsletters, including California Healthline and iHealthbeat, both publications of the California Health Care Foundation. (a non-profit organization) There is some redundancy in their reporting but not always. There are also a variety of subscriptions, such as the Medicare News Report, Inside Health Policy and a number of health care related social media sites filtered by hashtags on twitter. The only thing I will miss in Google Reader is it’s tight integration with Google + and Gmail overall.

My next stop is on my #hcsm twitter feed (I use tweetdeck as well to follow the following # tags,  #hitsm #aca #mhealth. Each week I review meetings that are being held. I can usually find their #tag at Symplur (the Hashtag Directory) I belong to several groups on Linkedin in the HIT and healthcare group  as well.

There’s more, however I have drifted away from health related issues..

Technorati Tags: google reader,feedly,old reader,newsblur,hashtags,#hitsm,#aca #hcsm,#mhealth,symplur,linkedin,hit

Health Train Special Edition

 

Thanks to  the “Galen Institute”  Health Train Express is privy to this information, which falls under the FOIA. (Freedom of Information Act)

In order to qualify and seek eligibility information regarding how to become insured under the terms of the Affordable Care Act (Obamacare), you will be able to go online and file.

Appication(s)

Health Benefit Exchange. HBE EZ form

Health Benefit Exchange.  HBE Long form

 

The Red Tape Tower: The pièce de résistance at the moment is the Red Tape Tower (#RedTapeTower) showing all 20,000 pages of the ObamaCare regulations that had been issued as of March 8.  The tower was a star at CPAC, and Senate Minority Leader Mitch McConnell received hoots and applause when it was rolled out for so graphically visualizing the incredible burden this law is placing on the health sector and economy.  National Review tells the story and has the photo.

The Patient Protection and Affordability Act has grown from an adorable 2,700-page binder full of rules and kickbacks into a towering 7-foot-3-inch, 300-pound behemoth totaling more than 20,000 pages of byzantine mandates and regulations.

The “red-tape tower” has been making its way around Washington, D.C

The NPR article and photos are making the rounds on social media,  including twitter #redtapetower and Facebook

Promises we cannot keep !

For those who like charts and pictures

Our New Health Care System

My thanks to Grace-Marie-Turner and the Galen Institute

 

Technorati Tags: health benefits exchange,red tape tower,foia,galen institute,health train expeess,obamacare

Don’t Leave Home Without Me

 

 

Op-ed:   Gary M. Levin M.D.

The Riddle

The Health Train Express is leaving the station and perhaps the tracks with many physicians not onboard. This despite health providers never ending pleas to delay the departure.

Many have not boarded because the train really does not know where it is going, nor what the actual fare will be, nor it’s destination.  (Sound familiar?) It should, because that is what the Accountable Care Act offers.  Despite the goal of taking everyone to some destination, and providing ‘free tickets or deeply discounted fares, there is much reluctance to believe or trust the conductors or the barons of the train industry.

For some, the ACA is good news and virtually guarrantees employment for nurse practitioners, physician assistants, and many physician extenders.

There is a serious disconnect between providers, hospitals and payers, not just in reimbursement needs, but in overall organizational liason.  Every hospital and provider seems to be on it’s own track, and the patient comes in dead last. Hence the badly needed patient-centric approach.

Why not ?  It’s complicated.

As far as electronic records are concerned it is far more complex than the ubiquitous ATM (long used as a comparison between banking and medicine).  The advocates were wrong.

FDA and Mobile Health Apps

 

The Sprawling leviathon Food and Drug Administration Complex is struggling to keep up with drug review, and is now facing additional challenge of mobile health regulations in the face of  [Governmental Sequestration.]    [Washington Post Opinions]

Sprawling leviathon Food and Drug Administration Complex struggling to keep up with drug review, now facing additional challenge of mobile health regulations in the face of Governmental Sequestration.

Three days of congressional hearing with the FDA concluded with discussions about the FDA’s role in monitoring and producing guidelines for mhealtlh applications. There were no specific guidelines, nor binding regulations forthcoming at this time.

 

iHealthbeat reported this yesterday, along with other topics.

Telehealth

Flawed HER Designs

Lag of Long Term Facilities in HER adoption

 

HIMSS Hot Topics:

 

 

HIMSS13: Mostashari Says Data & Incentives Matter

HIMSS13: Federal Officials Stress Commitment to Health IT

HIMSS13: Sequester Will Affect Medicare EHR Pay, ONC Budget

11 Experts on Health IT Progress, Frustrations and Hopes for 2013

With 2012 now behind us, we asked 11 leaders in the health IT field to reflect on the progress and missed opportunities of the past year, as well as their hopes for health IT in 2013.

The meeting at HIMSS 2013 produced an intense focused forum for discussions about the progress of digitizing health information.  Most leaders in HIT were present, and many vendors were present on the meeting floor.

Unable to attend in person Digital Health Space monitored several live twitter streams, and also video live streams.  Microsoft’s health division and Dell Systems sponsored an evening meeting for a roundtable discussion of some high points of the meeting.

Hashtags from Dell's HIMSS Meeting:

You can  follow the tweets via the hashtag #DoMoreHIT or the participating tweeps in the conversation: @drandylitt, @ahier, @egpierro, @techguy, @lsaldanamd, @cthielst,@2healthguru, @jloveloc, @norabelcher, @boltyboy, @shahidnshah and @healthcarewen.

Implementation of HIT is turning out to be a “Big Bang”, an issue which challenges our ability to get our hands around it.

Presenters indicated how costly the effort has become, estimating that about $ 25 billion USD is the annual HIT budget at present, just to maintain current systems. At the same time most indicated that this offered employment security for many people at that meeting.  In the midst of the economic crisis it is not yet apparent what or if any of the HIT federal incentives will suffer.  Health now provides employment for a large segment of the U.S. Economy and reductions in health expenditures may be felt in the unemployment rates.

The topic of ‘BIG DATA” emerged as to how it would enter into the equation. Attendees at the Dell sponsored forum were sure Big Data would play a major role. The theory is that analysis of this forthcoming tool will improve outcomes and reduce costs.  The Kaiser model seems to bear that out, but it will take immense effort to convert the rest of American Health Care.  Other countries in Asia, and Europe are significantly ahead of the United States.

Big Data was vaguely defined. It was unclear if analytic systems were really in place to understand it, although it was mentioned that some large integrated systems such as Kaiser were already utilizing “Big Data”.  Most participants agreed that most hospitals and providers were not at all prepared for “Big Data”, that a large challenge is to educate 800.000 providers, and several thousand hospitals.

What organizations can encompass this ? State, county, Public Health, Health Information Exchanges.  The ‘baby” is still in the womb….what will emerge is still unknown.

Finally the topic of personalized medicine was discussed, in connection with advances in genomics. Exponential decreases in the cost of analyzing one genome have occurred due to immense increases in computer power.   We will be discussing personalized medicine and genomic in one of our next blog posts.

At times there are more questions than answers, a good sign of interest in solving our health challenges. 

The choices for organizational hierarchy changes, rapidly expand in number and perhaps we need an IBM Watson to analyze our organizational structures of health care to prepare a diagnosis and then a treatment plan  for our health system ills. How about several second opinions before the operation?

Technorati Tags: ibm watson,big data,kaiser,dell health,microsoft health,himss,fda,mobile health,mhealth,mostashari,ihealthbeat,sequestration

First Amendment Extends to Health

 

2004 Democratic Convention Freedom of Speech Zone.

We physician bloggers and social media gurus have a tremendous responsibility as we take risks reaching out to our patients, legislators, insurers, and other pundits when we express our honest opinions.

Ben Brown wrote in his blog a well written and graphic  appraisal about the ‘Deceptive Income of Physicians”.  There are over 800 comments, 95% in agreement, 3% opposed and 2% saying it’s true but we should not ‘complain’ because we are “so lucky” and fortunate.  I disagree.

In fact I posted  a reply,  “Physician Privilege”  which drew some critical comments from some very highly respected “authorities” on health systems.  The reply to me was at the same time,  right, and wrong. Wrong because they felt I diminished my stature by my anger and frustration at what has happened to our privileged and beloved profession., and the fact that the wheels are coming off the bus, along with the rest of our society. We all have a right to express our thoughts, good, bad or indifferent. Disagreements can occur among agreeable people. Legally it’s protected by the First Amendment (Freedom of speech).

There is passion on both sides of this ‘fence’. The fence established a boundary, both protecting  each from the other, and a barrier to understanding and agreements. Perhaps this is human nature.

 

Technorati Tags: physician income,freedom of speech,ben brown,first amendment

Heavy Weight in the Mobile Health Zone

 

Several years ago Google Health was developing  a personal health record. It failed to attract much interest  due to consumer apathy and  lack of interoperability with electronic medical records and an inability to download information from the clinic EMR.

About the same time, Microsoft developed Microsoft Health Vault. It has languished in a torpor and now that Microsoft has entered the mhealth zone, with ‘Surface”, “Windows Phone” and Windows 8 Microsoft.  These are all based upon Windows 8 GUI, which features large icons, a simple main menu and touch screen functionality.

The early edition of Microsoft Health Vault was tied to the desktop or laptop until very recently.

Microsoft has correctly read the marketplace, albeit very late. They finally came to the table with Windows 8RT, and Windows 8 Professional as well as a well designed tablet, Surface.

Microsoft also recognized the  exit from desktop and fixed locations. The transition to mobile should empower and engage patients to  get their healthcare from where they are, at work, in the car, or even outside.

Health Vault in the past several years has attracted many to the platform, laboratories, pharmacies, health and wellness, remote monitoring and more.

What can you do with HealthVault?

Microsoft HealthVault  is a free web-based platform that enables patients to collect, store, and share their health information, without charge.

Take the Tour

Prepare for an emergency

Use HealthVault to make your most important health info available

Browse the App Directory

Browse the Device Directory

Pulmonary Flo-meter        Pulse Oximeter

Examples:

 Discover apps & devices

There are now several hundred mobile and remote sensing devices which interface directly with Microsoft’s Health Vault.  There is easy access to information and the ability to purchase apps and devices. All of this is designed to be patient-centric and user friendly, HIPAA compliant and requires authentication for secure transmission of data.

Microsoft Health Vault SDK  provides  a software developers toolkit for developing applications.

HealthVault-connected apps are websites, computer software, and mobile apps that can help you get more out of—and put more into—HealthVault.
You can choose apps to help you stay motivated, analyze trends, and receive education and recommendations to keep you at your best. And it is designed for the rapidly growing niche of mobile applications, available almost anywhere.

It is a welcome addition to the PHR market.

The most interesting part is the list of devices for remote monitoring and health and wellness .

Microsoft even has social media engagement for many of their products.

Twitter            Facebook       

YouTube     

Empowering Patients

   

Health Vault in Action

If you’re like most people you just don’t want to sit there and enter your health records into a personal health records..Well, now there is a cure for that as well. Unival PHR  is a service for obtaining your records from wherever they may be.

yourPHR, part of the yourHealth suite of services, offers three solutions for getting your medical information into HealthVault. Choose one or all of the following:

• Full data conversion of your medical records by a trained, experienced nurse abstractor
• Direct import of organized, scanned documents
• An online interface to complete specific aspects of your personal health record such as demographics, insurance information, etc.

The Problem with ACO’s

The most efficient means of using ACOs is to employ physicians by a hospital.  Kaiser get’s around this because Southern California Permanente is a foundation which employs the doctors and Kaiser Hospital contracts with that medical group.  That is because hospitals were previously forbidden to hire physicians.  Time and trends have altered that formula, however legally hospitals are banned from controlling physicians due to a conflict of interest.  I believe it should still be the same, and it may be that in certain regions ACOs may fall under anti-trust regulation.

Many physicians have ‘rolled over’ and succumbed to threat of insolvency, brutal administrative loads, the threat of malpractice, long hours and irregular call schedule.

Social media is playing a larger role with open communications which are transparent and reveal how dissatisfied physicians have become with the system, the dysfunctional way the accountable care act is attempting to correct increased costs, and improve outcomes. The addition of electronic records, while having some merits has added to expense, decreased efficiency,  and has converted a highly skilled physician who usually generates at least $ 200.00/ hour in gross revenue (before overhead and tax burden) into a clerk (hire for 12.00/hour),  The wise thing to do is pay a clerk $96.00 dollars/day + adjunctive costs such as health insurance, overhead for workman’s compensation, liability, vacation time, etc.  It is often said that an employees salary is double by ancillary cost.  Using that formula that clerk would cost about $180.00 per diem.  However each time you hire an additional employee it adds to the complexity of the human equation, absenteeism and more.

Add to all the above the mandate for outcomes, reduced readmissions, and demand for analytic data pushes the balance toward ACOs

Physician Employment Statistics

 

Technorati Tags: aco,accountable care,outcomes,hospitals,social media

EHRs Lose Money for 1/4th of Physicians, Study Says

 

Medscape, an online service for physicians offers continuing medical education and presents the results of many studies in medicine.

Medscape reported the following from  a study published online today in the journal Health Affairs.

Attribution is given to the authors who produced the information in this report.

Lead author Julia Adler-Milstein, PhD, an assistant professor at the University of Michigan, and coauthors projected the average physician to lose $43,743 over 5 years and only 27% of practices to achieve a positive return on investment (ROI). That percentage of in-the-black practices would increase to 41% if they received $44,000 in meaningful-use incentive payments over 5 years.

The good news in the otherwise discouraging report is that practices achieving a positive ROI did so in part by using their EHRs to significantly boost their revenue.

Dr. Adler-Milstein and coauthors based their findings on a survey of 49 practices in a large EHR pilot program called the Massachusetts eHealth Collaborative (MEC), organized by the American College of Physicians and the Massachusetts Medical Society. MEC paid for the EHRs and the consultants who helped the practices implement the technology from March 2006 through December 2007.

The study did reveal differences in the return on investment between very small practices and those with six or more providers using EMR.

The elimination of paper records coupled with change management in the practice combined to offset some of the investment in EMR.

The figures varied substantially as to ROI and the time to running in the black. Although the average physician was expected to lose $43,743 over 5 years, the damage was not as bad for physicians in primary care, who lost $29,349 compared with $50,722 for specialists. Unlike smaller practices, groups with 6 or more physicians posted a positive though meager ROI — an average of $2205.

Dr. Adler-Milstein and coauthors write that an investment in an EHR system may not pay off for practices who fail "to make the operational changes required to realize benefits."

Even more significantly, the 13 practices with positive ROIs averaged $114,613 in additional revenue attributable to their new EHR systems compared with only $9204 for the 36 practices with negative ROIs. Five of the practices with positive ROIs reported that their EHRs allowed them to see more patients per day. And 9 practices boosted revenue through improved billing. Their EHR systems produced more error-free claims, resulting in fewer rejections. Plus, the technology allowed physicians to more accurately code their work, which solved the problem of undercoding and led to higher reimbursement.

However, the study authors note that revenue gains based on more accurate coding highlight "the potential misalignment between optimal provider use of EHRs and the savings that policymakers hope will result from greater EHR adoption, underscoring the recent concern about the potential for EHRs to drive up healthcare costs."

This occurrence would fly in the face of attempts to decrease cost based upon procedural coding, not outcomes, nor quality of care.

The authors write that more small practices might recoup their investment on EHRs and then some if the federal government increases the size of meaningful-use incentive payments. However, a "more compelling approach" would be to pursue policies that reduce the cost of EHR adoption and increase its benefits. Encouraging small groups to join larger ones could shrink adoption costs through economies of scale. And more practices could learn how to reorganize their operations to exploit EHR technology if the government increased funding for so-called regional extension centers that help with implementation.  This however would introduce complexity into management of a practice. It also involves merging differing corporate cultures, which can doom mergers. Increasing practice size may financially seem desirable, negative offsets can cancel out other gains.

Coauthor David Bates, MD, MPH, reported serving on 2 advisory groups for the federal Office of the National Coordinator for Health Information Technology and having financial relationships with a number of medical device and information technology firms. The other coauthors have disclosed no relevant financial relationships.

Health Aff. 2013;32:562-570. Abstract

 

Technorati Tags: david bates,health affairs,onchit,medscape,adler-milstein,emr,incentive payments,mehc,roi,univ of michigan

Cautionary Tales from (The Crypt) HIT Consultants

 

At times when I hear the words EMR, ONCHIT, and Meaningful use and incentive payments,  it brings me back to the television program

Digital Health Space continues to monitor the progress of EMR implementation, HIX development and Meaningful Use Incentives.

Should you apply for EMR incentives at this time? (or ever).  CMS continues to promote EMR and incentive programs, but are they honest or just driving a data collection system that has not yet proven it’s worth.  They report a continual growth in physicians who have adopted some form of  EMR which is compliant with meaningful use criteria.

If you are confident that EMR is a good thing, promotes better patient care and is in the best interest of the patient, and if you are willing to take a one in four chance that your EMR will not have an ROI in four years. Those are the latest statistics from Sunday’ Health Affairs.  Factor another risk factor into your equation. The likelihood your EMR vendor will become insolvent, be acquired or merged with a stronger financial partner.  Or what about your software being purchased and then deprecated, losing support.

In addition to those numbers, loss of efficiency, possible loss of staff from workflow frustration and disruptive technology may cancel or even negate use of EMR.

Incentivization only covers the cost of immediate capital outlay, not ongoing maintenance which has been shown to cost as much as the initial system acquisition.

Julia Adler-Milstein of the University of Michigan and colleagues reviewed survey data from forty-nine community practices in a large Massachusetts EHR pilot and projected that only 27 percent of practices would achieve a positive return on investment in five years; an additional 14 percent would be in the black assuming they received the $44,000 federal meaningful-use incentive, the researchers write in the March issue of Health Affairs. The biggest determinant of whether practices achieved a positive return was whether they used EHRs to increase revenue by seeing more patients or through improved billing. The incentives had a larger impact on practices with more than six physicians and those that provided primary care, compared to smaller and specialty practices.

And this very feature flies in the face of a paradigm shift for payments to eliminate procedural based fees.

Most current EMRs are not designed to base billings on  outcome studies, or increased efficiency. Each philosophy is counter to the other.   At this time there is little  connection (if any) between hospital billing and physician outpatient billing.

The unstated purpose and result of ACO formation is to employ physicians to be paid by a larger entity such as a hospital or a healthplan. (which in many cases is already in place)  There are fewer plans now based truly on indemnification.

Health Train Express and Digital Health Space’s mission is to aggregate, focus and opine on the course of health reform, giving the healthcare community a knowledge base to bring factual information to physicians, hospitals, health consultants and legislators.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at www.healthaffairs.org.

Technorati Tags: emr,incentive payments,meaningful use,aco,health affairs,milstein

Health Reform Office Hours

 

Those who are implementing  the accountable care act are not the same as those who wrote the law.

Scott Gotllieb who is a practicing physician and also writes for the Wall Street Journal points out that many of the centrists who wrote and refined the accountable care act have left the White House Office of Health Reform.

President Obama has at the controls as his right hand woman Jeanne Lambrew, not the Secretary of Health and Human Services,  Kathleen Sebelius.

Who's In Charge Of Implementing Obamacare And Why It Matters

It’s a relevant question now that the White House is finally releasing the pivotal regulations that outline the shape of the new insurance scheme.

Scott Gotllieb  wrote more almost three years ago, in the New York Post, that many of the Obama Administration’s economic centrists were leaving the White House. Left behind were some of the most progressive staffers. They would be the ones implementing the law.

That transition now seems to be complete. The few remaining centrists thinkers inside the White House, mostly scattered across the National Economic Council and Treasury, are gone – or largely marginalized when it comes to issues around implementation. The people drafting and reviewing the regulations are mostly centered in the White House and its Domestic Policy Council — and they mostly work for Jeanne Lambrew.

Normally, the Office of Management and Budget and the National Economic Council would be heavily engaged on the issuance of regulations tied to a major law like Obamacare. Not the Obama White House. The economists still play on the fiscal issues related to Medicare and Medicaid. But when it comes to Obamacare implementation, they are not calling the shots. The power is centered on Lambrew.  Lambrew is a highly competent policymaker and power player with deep experience in healthcare. A former Senior Fellow at the Center for American Progress, she is also unabashedly liberal – often serving as the architect of her party’s most progressive ideas on healthcare reform. 

After laws get passed, the principals in an administration move on (especially in a second term). The implementation work is left to the policy wonks. Those wonks tend to be a party’s true believers, representing the ideological wings of their political parties. Lambrew is deeply progressive, and will hew in that direction at the many regulatory decision points that the law leaves murky.

The only difference in this White House is how little influence the economists seem to have. And how successful Lambrew has been at consolidating her power.  It seems all the moderates and centrists were dejected as to how it turned out and abandoned ship, not to be labelled with the coming failures of Obamacare.

A major stumbling block for passing a workable law was the defeat of Senator Daschles’ appointment as head of HHS in lieu of Ms. Sebelius. Daschle’s defeat was another political twist in the hanging of health care in the United States.

Technorati Tags: jeanne lambrew,scott gottlieb,white house,center for american progress,omb,tom daschle,kathleen sebelius

CMS Demonstration Project Proposed

 

BREAKING NEWS: Congress to make MedAccess (Community MedPac) a Pilot Program!

BREAKING NEWS............................
The U.S. Congress has sent a letter to the Centers for Medicare and Medicaid Services to make MedAccess (parent organization of Community MedPac) to become a pilot program under both Medicare and Medicaid. A letter from one of the many members of Congress who directly supports us can be read here:  Letter from Congresman Alan Grayson

Want to be apart of our pilot program, send an e-mail to mdtaber@me.com for more information.

Technorati Tags: cms,pilot,cms demonstration program,medaccess,alan grayson,community medpac,mdtaber

“Being the Best We Can Be”: Medical Students’ Reflections on Physician Responsibility in the Social Media Era

I considered another title for this blog edition, “Kindergarten for MDs in Social Media”

Many medical schools have incorporated the use of social media into a medical ethics course. By the time students have entered clinical practice they are comfortable using social media in their daily tasks.

More senior physicians are in a quandary with social media and exhibit discomfiture with social media, not certain where to categorize it.

You can use social media in a variety of settings, but not for discussion of patient events which are not deidentified.

In my experience the best way to take on social media is to watch, listen, and learn.

 

The University of Southern California (Keck School of Medicine) took the easy going environment of social media and did an academic study with a peer reviewed evaluation of social media and it’s characteristics along with an analysis of it’s participants.

Lie, Désirée MD, MSED; Trial, Janet EdD; Schaff, Pamela MD; Wallace, Robert MD, MBA; Elliott, Donna MD, EdD
They preface their article with the following

“There is scarce literature on a curriculum to address this emerging need in professionalism education. Importantly, little is known about whether and how students respond to such curriculum and how effective it may be at changing personal online behaviors. We therefore conducted a mixed-method study with first-year medical students to examine whether a brief, required, two-hour intervention embedded within a professionalism course was associated with a change in students’ attitudes and use of online social media. We hypothesized that the intervention would be associated with increased awareness and action among students to change their online presence to reflect their new professional roles.”

During the Professionalism and the Practice of Medicine (PPM) course, we introduced this new curriculum. PPM is a 200-hour required course that spans the first two years of medical school.¹⁸Two faculty mentors teach the course weekly in groups of 24 to 30 students using a standardized, case-based curriculum that includes professionalism, bioethics, narrative medicine, cultural competence, integrative medicine, community health, health policy, and the business of medicine. In 2011, we added a two-hour session that covered the 2011 AMA social media use guidelines.¹

In an era when the public and patients can easily access physicians’ personal and professional information online,^27–29 and physicians may be (rightly or wrongly) judged by their online social media presence,^24–29 educating medical students early about the implications of their online presence will be integral to professionalism teaching. Our study suggests that students already have a strong Web presence and engage in online social networking when they enter medical school, are open to discussing this presence, and, more important, are ready and able to edit and monitor their presence during the course of their training. Early education has the potential to make students partners and peers in the construction of meaningful guidelines and policy about appropriate social media use, both for educators and for institutions.²⁸,³⁰,³¹ It remains to be determined whether further curricula spread throughout training are needed to refresh students’ awareness of the need to monitor their online presence. Future studies should examine whether reinforcement throughout training is needed, whether the inclusion of more complex ethical and policy issues that involve patients in the curricula would reinforce learning, and whether curricula presented at different developmental stages by different instructors or mentors have different effects on students’ behaviors and attitudes.”

There are many other sources for training in Social Media, for the nuts and bolts of it all, and the ethical considerations.  One of the outstanding programs is the Mayo Clinic Residency in Social Media .

 

Technorati Tags: #hcsm,mayo clinic,social media,ethics,residency,guidelines,keck,usc school of medicine