Social Media in Pediatrics: A Call for Guidelines Jennifer Lonzer, MA1, Deb Lonzer, MD, FAAP2, Michelle Medina, MD, FAAP3, and Giovanni Piedimonte, MD, FAAP, FCCP4
A
t Cleveland Clinic, we have an in-depth social media policy that tells our employees everything they cannot do online. This keeps our employees Health Insurance Portability and Accountability Act (HIPAA) compliant, but we wonder if it is the best way to serve our patients. There is a widening generation gap between children’s hospital executives, outpatient practitioners, and their patients’ families. Additionally, with the growing threats to the parent–pediatrician relationship, including retail-based clinics and health apps, we must remain relevant to those we seek to serve. Social media participation certainly comes with risks that are well defined in our social media guidelines. What is not clear for physicians is how they can use social media professionally, without harming their reputations or breaching patients’ privacy, to engage and support patients through a popular vehicle—on their smartphones and tablets. We reviewed relevant literature in order to identify safe and effective ways to connect with our patients’ parents— as medical decision makers—online. Health information seeking habits increasingly favor digital media (ie, WebMD, Google searches, and social media). In the target population for expanding pediatric practices, 86% of adults aged 18-29 years and 72% of adults aged 30-49 years1 who use the Internet are active on social networking sites. Those in Generation Y are increasingly connected by social media: 81% are active on Facebook daily and 45% read blogs every day.1 This generation does not have a single source of trusted information (ie, their parents or pediatricians), but many sources. Does this translate to outright rejection of the physician as a trusted source of healthcare information? Not according to the Pew project,2 in which more than 70% of people reported wanting help from their physicians, but via social media. Another study of health information seeking revealed that although 49.5% of women prefer to discuss their concerns with their physicians before going online, only 10.6% actually do. The rest conduct online searches before contacting their physicians.3 Although many businesses have embraced social media as a public relations tool, the majority of physicians are late adopters.4 Coupled with a general uncertainty about being reimbursed for their time spent online and concern about being inundated with e-mails, fear of breaking the law is enough to keep many pediatricians away from social media.
The Solution: Use Social Media to Build and Enhance Relationships
depending on their chosen strategy, can be creators or curators of online content.5 Depending on the time and resources a pediatric practice has to commit to its social media plan, the physician (or a social media specialist employed by the practice) can vet information for patients, sharing evidencebased data and health advice on Facebook or a blog. By filtering and forwarding useful information to busy parents, and perhaps adding a note about why it is valuable, physicians maintain their roles as trusted experts.6 A PriceWaterhouseCooper study7 identified several other activities in social media deemed valuable by patients: scanning a doctor’s availability and making their own appointments, appointment reminders, specialist referrals, discount offers, support, online reviews of physicians, and prescription reminders. Research shows that digital communications effectively improve health knowledge and understanding, as new media allow for the tailoring of messages, encourage peer-to-peer and patient–provider interactions, and promote collaboration. Especially when a diagnosis requires daily care and monitoring, patient education and support are important aspects in providing quality patient care.8 Integrating social media into pediatric practices enhances trust and further develops provider-patient relationships.9 Social media gives parents a platform for sharing successful treatments, parenting tips, and positive interactions with clinical staff. Browsing the practice’s content on Facebook allows new patients to get a sense of a practice before making an appointment, and participation in this sort of social networking site can build a sense of community within a practice.10
Responsibility and the Development of Guidelines When governing bodies and professional associations adopt guidelines that only restrict rather than guide, they do members a disservice. The American Medical Association’s opinion on professionalism in the use of social media come closest to giving positive examples of social media use among physicians.11 However, the American Medical Association guidelines do not address the situation in which many
From the 1Cleveland Clinic Children’s Hospital; 2Outpatient Operations and 3Quality and Safety, Department of Community Pediatrics, Cleveland Clinic Children’s Hospital, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University; and 4Cleveland Clinic Pediatric Institute and Children’s Hospital, Cleveland, Ohio The authors declare no conflicts of interest.
Despite the slow adoption, medical professionals bring a great deal of specialized knowledge to the social media table, and,
0022-3476//$ - see front matter. Copyright ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.11.032
511
THE JOURNAL OF PEDIATRICS
www.jpeds.com
pediatricians find themselves: it is not the patients themselves who make health decisions, but the parents that physicians need to engage in order to take advantage of the wealth of opportunities to raise awareness of health and safety issues that social media provides. The American Academy of Pediatrics12 provides guidance for discussing adolescent social media use with patients and families, and for social media use in local chapters. Pediatric practices need guidelines for using social media for health education and marketing. Pediatric groups need to work closely with their public relations professionals and legal counsel to establish social media best practices for their specialties that maintain their reputations as respectable resources of pediatric information, maximizing the opportunities, identifying potential legal pitfalls, and exploring the ethical quandaries associated with social media use.
Suggested Use Guidelines The following are some best practices for pediatric practices seeking to use social media: (1) bring valuable expertise and experience to the conversation; (2) be relevant, accurate, and transparent in your posts; (3) adhere to any social media use guidelines that govern your organization, including, but not limited to, Health Insurance Portability and Accountability Act; (4) do not speak on behalf of a business, organization, or society unless authorized to do so; (5) be respectful—do not post anything profane, threatening, abusive, hateful, or embarrassing; (6) avoid endorsing any political party or candidate, or reference to religion; (7) establish a terms of use agreement as current issues in pediatrics can be offensive to some—you will need a terms-of-use agreement explaining that although you encourage conversation, you expect it to be respectful and profanity-free; (8) do not establish unwanted provider– patient relationships by offering anything that could be construed as a diagnosis online—answer parent questions in broad, general terms and never give instructions about a specific patient; and (9) be careful whom you “friend”—do not use a personal account for professional purposes. This article addresses the need for guidelines for social media use in pediatric practices primarily for the purposes of expanding practices and educating parents. Additional guidelines for pediatricians who might want to engage their adolescent patients via social media, and for managing the
512
Vol. 166, No. 3 additional costs of maintaining a social media presence would also help pediatricians moving forward. n We thank all of our colleagues at the Cleveland Clinic Pediatric Institute and Children’s Hospital for the many interactions and conversations that led to this article. Reprint requests: Giovanni Piedimonte, MD, FAAP, FCCP, Cleveland Clinic Pediatric Institute and Children’s Hospital, 9500 Euclid Avenue/A-111, Cleveland, OH 44195. E-mail: [email protected]
References 1. Protalinski E. 600 billion of Facebook’s 1 million users are mobile. http:// thenextweb.com/facebook/2012/10/04/facebook-now-has-600-millionmonthly-active-mobile-users/. Accessed October 25, 2013. 2. Pew Research Internet Project. http://www.pewinternet.org. Accessed December 9, 2014. 3. Plantin L, Daneback K. Parenthood, information and support on the internet. A literature review of research on parents and professionals online. http://www.biomedcentral.com/1471-2296/10/34/. Accessed September 7, 2013. 4. Redsicker P. AMA’s social media policy: Minimizing healthcare’s engagement risk, http://www.wordviewediting.com/amas-social-media-policyminimizing-healthcares-engagement-risk/; 2012. Accessed October 31, 2013. 5. Timimi FK. Medicine, morality, and health care social media. BMC Med 2012;10:83. 6. Brown J. Grow your practice using social media. CDS Rev 2012;105:8-10. 7. PWC Health Research Institute. Social media “likes” health care: from marketing to social business. http://pwchealth.com/cgi-local/hregister. cgi/reg/health-care-social-media-report.pdf. Accessed April 2, 2014. 8. Nordqvist C, Hanburger L, Timpka T, Nordfeldt S. Health professionals’ attitudes towards using a Web 2.0 portal for child and adolescent diabetes care: qualitative study. J Med Internet Res 2009;11:e12. 9. Mark B, Fuller K. Social media helps Kansas City pediatrician connect to patients. http://www.kctv5.com/story/21190143/pediatrician. Accessed March 28, 2013. 10. Mueller A. 7 reasons why pediatricians should use social media. http:// www.healthcarecommunication.com/Main/Articles/7_reasons_why_ pediatricians_should_use_social_media_6807.aspx#. Accessed September 7, 2013. 11. American Medical Association. Opinion 9.124 Professionalism in the Use of Social Media. http://www.ama-assn.org//ama/pub/physician-resources/ medical-ethics/code-medical-ethics/opinion9124.page. Accessed January 17, 2014. 12. American Academy of Pediatrics. Media and Children. http://www.aap. org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-andChildren.aspx. Accessed January 17, 2014.
Lonzer et al
A
t Cleveland Clinic, we have an in-depth social media policy that tells our employees everything they cannot do online. This keeps our employees Health Insurance Portability and Accountability Act (HIPAA) compliant, but we wonder if it is the best way to serve our patients. There is a widening generation gap between children’s hospital executives, outpatient practitioners, and their patients’ families. Additionally, with the growing threats to the parent–pediatrician relationship, including retail-based clinics and health apps, we must remain relevant to those we seek to serve. Social media participation certainly comes with risks that are well defined in our social media guidelines. What is not clear for physicians is how they can use social media professionally, without harming their reputations or breaching patients’ privacy, to engage and support patients through a popular vehicle—on their smartphones and tablets. We reviewed relevant literature in order to identify safe and effective ways to connect with our patients’ parents— as medical decision makers—online. Health information seeking habits increasingly favor digital media (ie, WebMD, Google searches, and social media). In the target population for expanding pediatric practices, 86% of adults aged 18-29 years and 72% of adults aged 30-49 years1 who use the Internet are active on social networking sites. Those in Generation Y are increasingly connected by social media: 81% are active on Facebook daily and 45% read blogs every day.1 This generation does not have a single source of trusted information (ie, their parents or pediatricians), but many sources. Does this translate to outright rejection of the physician as a trusted source of healthcare information? Not according to the Pew project,2 in which more than 70% of people reported wanting help from their physicians, but via social media. Another study of health information seeking revealed that although 49.5% of women prefer to discuss their concerns with their physicians before going online, only 10.6% actually do. The rest conduct online searches before contacting their physicians.3 Although many businesses have embraced social media as a public relations tool, the majority of physicians are late adopters.4 Coupled with a general uncertainty about being reimbursed for their time spent online and concern about being inundated with e-mails, fear of breaking the law is enough to keep many pediatricians away from social media.
The Solution: Use Social Media to Build and Enhance Relationships
depending on their chosen strategy, can be creators or curators of online content.5 Depending on the time and resources a pediatric practice has to commit to its social media plan, the physician (or a social media specialist employed by the practice) can vet information for patients, sharing evidencebased data and health advice on Facebook or a blog. By filtering and forwarding useful information to busy parents, and perhaps adding a note about why it is valuable, physicians maintain their roles as trusted experts.6 A PriceWaterhouseCooper study7 identified several other activities in social media deemed valuable by patients: scanning a doctor’s availability and making their own appointments, appointment reminders, specialist referrals, discount offers, support, online reviews of physicians, and prescription reminders. Research shows that digital communications effectively improve health knowledge and understanding, as new media allow for the tailoring of messages, encourage peer-to-peer and patient–provider interactions, and promote collaboration. Especially when a diagnosis requires daily care and monitoring, patient education and support are important aspects in providing quality patient care.8 Integrating social media into pediatric practices enhances trust and further develops provider-patient relationships.9 Social media gives parents a platform for sharing successful treatments, parenting tips, and positive interactions with clinical staff. Browsing the practice’s content on Facebook allows new patients to get a sense of a practice before making an appointment, and participation in this sort of social networking site can build a sense of community within a practice.10
Responsibility and the Development of Guidelines When governing bodies and professional associations adopt guidelines that only restrict rather than guide, they do members a disservice. The American Medical Association’s opinion on professionalism in the use of social media come closest to giving positive examples of social media use among physicians.11 However, the American Medical Association guidelines do not address the situation in which many
From the 1Cleveland Clinic Children’s Hospital; 2Outpatient Operations and 3Quality and Safety, Department of Community Pediatrics, Cleveland Clinic Children’s Hospital, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University; and 4Cleveland Clinic Pediatric Institute and Children’s Hospital, Cleveland, Ohio The authors declare no conflicts of interest.
Despite the slow adoption, medical professionals bring a great deal of specialized knowledge to the social media table, and,
0022-3476//$ - see front matter. Copyright ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2014.11.032
511
THE JOURNAL OF PEDIATRICS
www.jpeds.com
pediatricians find themselves: it is not the patients themselves who make health decisions, but the parents that physicians need to engage in order to take advantage of the wealth of opportunities to raise awareness of health and safety issues that social media provides. The American Academy of Pediatrics12 provides guidance for discussing adolescent social media use with patients and families, and for social media use in local chapters. Pediatric practices need guidelines for using social media for health education and marketing. Pediatric groups need to work closely with their public relations professionals and legal counsel to establish social media best practices for their specialties that maintain their reputations as respectable resources of pediatric information, maximizing the opportunities, identifying potential legal pitfalls, and exploring the ethical quandaries associated with social media use.
Suggested Use Guidelines The following are some best practices for pediatric practices seeking to use social media: (1) bring valuable expertise and experience to the conversation; (2) be relevant, accurate, and transparent in your posts; (3) adhere to any social media use guidelines that govern your organization, including, but not limited to, Health Insurance Portability and Accountability Act; (4) do not speak on behalf of a business, organization, or society unless authorized to do so; (5) be respectful—do not post anything profane, threatening, abusive, hateful, or embarrassing; (6) avoid endorsing any political party or candidate, or reference to religion; (7) establish a terms of use agreement as current issues in pediatrics can be offensive to some—you will need a terms-of-use agreement explaining that although you encourage conversation, you expect it to be respectful and profanity-free; (8) do not establish unwanted provider– patient relationships by offering anything that could be construed as a diagnosis online—answer parent questions in broad, general terms and never give instructions about a specific patient; and (9) be careful whom you “friend”—do not use a personal account for professional purposes. This article addresses the need for guidelines for social media use in pediatric practices primarily for the purposes of expanding practices and educating parents. Additional guidelines for pediatricians who might want to engage their adolescent patients via social media, and for managing the
512
Vol. 166, No. 3 additional costs of maintaining a social media presence would also help pediatricians moving forward. n We thank all of our colleagues at the Cleveland Clinic Pediatric Institute and Children’s Hospital for the many interactions and conversations that led to this article. Reprint requests: Giovanni Piedimonte, MD, FAAP, FCCP, Cleveland Clinic Pediatric Institute and Children’s Hospital, 9500 Euclid Avenue/A-111, Cleveland, OH 44195. E-mail: [email protected]
References 1. Protalinski E. 600 billion of Facebook’s 1 million users are mobile. http:// thenextweb.com/facebook/2012/10/04/facebook-now-has-600-millionmonthly-active-mobile-users/. Accessed October 25, 2013. 2. Pew Research Internet Project. http://www.pewinternet.org. Accessed December 9, 2014. 3. Plantin L, Daneback K. Parenthood, information and support on the internet. A literature review of research on parents and professionals online. http://www.biomedcentral.com/1471-2296/10/34/. Accessed September 7, 2013. 4. Redsicker P. AMA’s social media policy: Minimizing healthcare’s engagement risk, http://www.wordviewediting.com/amas-social-media-policyminimizing-healthcares-engagement-risk/; 2012. Accessed October 31, 2013. 5. Timimi FK. Medicine, morality, and health care social media. BMC Med 2012;10:83. 6. Brown J. Grow your practice using social media. CDS Rev 2012;105:8-10. 7. PWC Health Research Institute. Social media “likes” health care: from marketing to social business. http://pwchealth.com/cgi-local/hregister. cgi/reg/health-care-social-media-report.pdf. Accessed April 2, 2014. 8. Nordqvist C, Hanburger L, Timpka T, Nordfeldt S. Health professionals’ attitudes towards using a Web 2.0 portal for child and adolescent diabetes care: qualitative study. J Med Internet Res 2009;11:e12. 9. Mark B, Fuller K. Social media helps Kansas City pediatrician connect to patients. http://www.kctv5.com/story/21190143/pediatrician. Accessed March 28, 2013. 10. Mueller A. 7 reasons why pediatricians should use social media. http:// www.healthcarecommunication.com/Main/Articles/7_reasons_why_ pediatricians_should_use_social_media_6807.aspx#. Accessed September 7, 2013. 11. American Medical Association. Opinion 9.124 Professionalism in the Use of Social Media. http://www.ama-assn.org//ama/pub/physician-resources/ medical-ethics/code-medical-ethics/opinion9124.page. Accessed January 17, 2014. 12. American Academy of Pediatrics. Media and Children. http://www.aap. org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-andChildren.aspx. Accessed January 17, 2014.
Lonzer et al
