Why Social Media is Just What the Doctor Ordered

Until very recently, physicians have been unable to take advantage of what these connections have to offer

Apr 28, 2012 - Production Blog Author

Editor’s Note: Alex Blau, MD, is Doximity’s Medical Director. This
essay originally appeared as a guest post on VentureBeat.com.

These days, particularly in the wake of Facebook's $5 billion S-1 filing, few will argue the explosive impact that social media is having on the way we live. We see it in the way relationships build, the way messages spread, and the tremendous amount of data that’s been assembled about who we are and what we do.

The potential is huge; but until very recently, physicians have been largely unable to take full advantage of what these connections have to offer. Specifically, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 prevents doctors from using email or text messaging, much less open platforms like Facebook or Twitter, to communicate about patient care without risk of being fined or fired.

Still, opportunities for physician-focused, web-based networks are many, and HIPAA-compliant tools and sites have indeed started to take shape and populate. Healthcare itself has been (often rightly) criticized as slow to change. In fact, Dr. Leslie Saxon recently published an insightful article on why the Internet hasn’t yet had any real impact on how medicine is practiced. But research has shown that as far as technology goes, doctors themselves tend to be early adopters. Having seen the kinds of conversations that have already begun to take place, I strongly believe that the future of digital medicine will be anchored in these kinds of connections.

Think, for example, of the impact of having a rural doctor in Alaska be able to send pictures of a complicated emergency case to a former classmate now working at a stroke center in Boston — and getting real-time feedback. This is where, in my mind, social networking truly goes from entertaining to life-changing.

With physicians connecting in real time across specialties and beyond the traditional bounds of hospital walls, patients may soon be able to stop worrying about getting access to the right specialist. Medicine’s brightest minds will be accessible from the remotest spots — on an airplane, at an underserved clinic, or in the thick of a disaster zone. Soon, any doctor with a mobile device will have the resources and reach to pull together a personalized, patient-specific team of experts for any given case. Sometimes, it will take as little as a question to the right expert in a sub-specialty to change the course of treatment for the better. In other instances, more lasting and meaningful collaborations might take shape.

Information itself is poised to travel differently, too. Facebook and Twitter are already showing us how effectively networked communities can transmit important data, and even bring obscure new ideas to the forefront of cultural debate. For doctors, who have historically relied heavily on sifting through a surfeit of medical journals, this kind of hive-minding can help ensure that the most promising and thought-provoking research or techniques rise to the surface and reach a wider audience. Moreover, by posting, sharing, and commenting on articles and cases within their professional networks, physicians will become more active and engaged participants in the future of medical research and learning.

The existence of these large and overlapping communities of doctors promises to tap a goldmine of public health data. Using discussion threads about symptoms and outbreaks, the spread of infectious disease can be tracked automatically, as can the efficacy and speed of treatment plans. Complications of new therapies, previously unknown risk factors for common diseases, even entirely new disease entities may be identified from increased sharing of data that has until now lived in the filing cabinets and memories of individual physicians.

The social power of networks like Facebook and Twitter to connect, entertain, and enrich our lives is undeniable. It’s time to extend the networking paradigm to healthcare and reap an even more substantive set of rewards.

Why Online Social Networking Should Change What We Know about Health Care

The rise of ubiquitous online connectivity is bringing a new era to healthcare

Apr 14, 2012 - Production Blog Author

Editor’s Note: Henry Wei, MD, is a board-certified internist and a
Clinical Instructor in Medicine at Weill-Cornell Medical College. He is
currently a Senior Medical Director at Aetna, where he leads Clinical
Research & Development for ActiveHealth Management. (The views expressed
here are the author’s alone and do not represent those of his employer.)

Introverts make up about half the population. In any given year, about 7% of
Americans are also suffering from social phobia, a fear of being in public so
great that’s defined in part by a tendency to get in the way of daily life.
What happens to the health care experience for these demographics? If it’s at
best uncomfortable and at worst panic-provoking to venture out into the world,
does it become impossible for some to seek psychiatric care, let alone regular
medical care?

My bet is that the online experience is changing this, and in particular, doing
so for health care interactions. What happens when computers, tablets and
smartphones start to allow patients to communicate with doctors and therapists
in a virtual space? The rise of ubiquitous online connectivity between patients
and their physicians is bringing a new era to those who prefer to interact from
the safety of their own environments. As a result, there’s currently no
shortage of telepsychiatry startups in the current Health IT bubble, among them
BreakThrough, iCouch, Cope Today, and HealthLinkNow. Behind
the safe, bullet-proof glass of, say, an iPhone or iPad with a front-facing
camera, perhaps it becomes easier to think about visiting a mental health
professional. (Parking, at least, is no longer a concern.)

These seemingly innovative startups may owe a lot to Dr. Warner Slack, a
passionate but otherwise mild-mannered forefather to modern medical
informatics. In the 1960s, while still a neurology resident, Dr. Slack was at
the front of the incipient patient empowerment movement. He was also wildly
optimistic about the use of computers in medicine–this, in the pre-PC era. By
the end of that decade, he had developed computer systems that could directly
engage with patients. Already then, he noted in one seminal paper, nearly 50%
of the 275 patients he studied preferred interacting with the machine, while
only 30% preferred interacting with the doctor. Furthermore, a small but
significant contingent indicated that they preferred both!

Dr. Slack’s findings about how people interface with computers to disclose and
explore their health information would go on to be replicated in different
ways. Other researchers, for example, would show that people in emergency rooms
are more likely to disclose sensitive information about domestic violence and
substance abuse to a computer than to a human clinician. Importantly, we see
these behaviors even more strongly today: On social networks such as Facebook
and Twitter people often feel at liberty to not only reveal the mundane, but
also to expose the deepest, most personal aspects of their lives online.

So, as physicians, we may be foolish to believe that our in-person, one-on-one
scheduled ~12 minute way of interacting with patients will last. Increasingly,
that’s a tough sell when compared to a longitudinal, technology-based
engagement with 24/7 access–all with the benefit of being able to solicit more
in-depth information from introverts or social phobia patients in particular.
It might feel heretical to think that a doctor wouldn’t be the person to figure
out, for example, if patients blood pressure medications are ruining their sex
lives. But in good technology, there’s not only a certain non-judgmental facade
of the machine, there are also ways to gather information that aren’t mutually
exclusive with good bedside manner.

I’ll go out on a limb here to suggest that we can no longer accuse medicine of
being a profession of luddites. For approximately, two decades, we’ve seen
doctors claim that poor electronic medical record adoption is due to old timers
“just not getting it.” That excuse is wearing thin.

We’ll need to push together to figure out the right way to adopt the best
models to start using technology not just for keeping records or ordering drugs
or tests, but to interact with patients. To this end, it would behoove
physicians to consider the opportunity for social networking platforms to
elicit deep, meaningful conversations about the patient experience–check out
IAmA posts on Reddit for example.

As Wendy Sue Swanson(@seattlemamadoc) recently stated it, and as I’ll
horribly paraphrase, we can certainly follow defensive guidelines on the use of
social media such as the AMA Policy: Professionalism in the Use of Social
, but what we need are pioneers to help guide us as how to unlock and
unleash the power of these platforms to effect positive change. While the AMA
policy suggests that physicians’ actions online may negatively affect their
reputations, we yearn for a guideline that suggests other physicians’ actions
online may positively affect entire patient populations.

If social platforms Facebook and Twitter played an instrumental role in
fomenting the Arab Spring uprisings, in mobilizing, empowering, shaping
opinions and influencing change, we physicians are perhaps overly conservative
if we still think Twitter is for twits, rather than a revolutionary channel for
public health.

Warner Slack saw much of this in 1968: computer-based, online patient
interactions can be our avenue into richer, more fundamental patient histories.
They don’t replace good doctors–they augment them. And they’re not just fancy
survey tools. To borrow a cue from Harvard medical anthropologist and
sociologist Dr. Arthur Kleinman, it’s the phenomenology–the “what’s at
stake”–that truly matters for patients’ health care lives. Online patient
interactions and social networking platforms are now combining to elicit and
share deeper, more candid, and more sensitive accounts and narratives of
illness and health–a collective, rather than individual, patient phenomenology.
Needless to say, this is about to change medicine as we know it. If physicians
aren’t there to seize the opportunity now, in 2012, shame on us for once again
not taking the lead.

Social Media and Health Care: The Power of Networked Physicians

Eighty percent of Internet users say they now go online to find health information

Apr 10, 2012 - Production Blog Author

Editor’s Note: Jeff Tangney is Doximity’s CEO. This post originally
appeared on HealthWorksCollective and The Doctor Weighs In.

The impact of social media on health care has been nothing short of
game-changing. Researchers have used sites such as Twitter to track the spread
of disease so that medical providers can respond to epidemics more quickly.
Among potential patients, eighty percent of Internet users say they now go
online to find health information, and 18 percent report using the Web to
connect with others who share their health issues or concerns, according to a
2011 Pew Internet study.

For doctors, who’ve long relied on sifting through medical journals for new
information, networked communities such as Facebook and Twitter have opened up
whole new paths for receiving relevant news quickly. Web searchers and
databases have put targeted information at their fingertips. Indeed, a recent
Google survey found that 86 percent of physicians now use the internet to
research health topics.

Yet in large part that’s where the story’s ended. While patients are free to
discuss their symptoms and cases online, the Health Insurance Portability and
Accountability Act
(HIPAA) of 1996 precludes doctors from using email, text
messaging and social networking platforms to communicate about patient care.
Violations are taken seriously. Last year, for example, a Rhode Island doctor
made headlines when he was fined and fired for posting about a patient on
Facebook, even though he included no identifying information.

Doximity was created to meet what we believe is one of the next major
challenges in health care: facilitating online communication among doctors. Our
service is often described as a kind of LinkedIn for physicians, and in the
year since we launched, we’ve quickly become the largest medical professional
network in the country. To create a framework of trust and expertise, we verify
each member’s identity. To ensure that messages are sent securely, we employ
dual passwords for each user so the message will be encrypted end-to-end. In
other words, what gives us deep value within our particular community is that
we’re a private, real-name and HIPAA-secure means of exchanging information.

This February, we officially launched iRounds, a forum similar to Facebook,
Twitter, and Google+ feeds, where users can expand their reach beyond just
exchanging messages and toward tapping larger communities to discuss patient
cases, new research, emerging medical technologies and more. Already, our
members have put iRounds to work, using it to talk about everything from
practice management or what new EHR platforms are best to some truly
jaw-dropping cases. Among them, for instance, a doctor treating a patient who
had accidentally swallowed a metal bristle from a barbecue grill was able to
connect with someone who had, believe it or not, seen a similar case.

It’s not difficult to imagine these kinds of real-time, long-distance
collaborative teams becoming the norm. We think there’s a tremendous value to
be gained by filtering cases and data through an interactive platform composed
exclusively of doctors, each of whom is able to attach unique clinical insights
to information as it travels. In this way, with each physician linked to a
broad network of experts, treatment stands to become more targeted, specific
and personalized than ever.

The rebirth of primary care

Medicine has clearly evolved to favor specialists

Mar 27, 2012 - Production Blog Author

Editor’s note: Doximity Advisory Board member Peter Alperin, MD, is a
board certified internist currently practicing at the San Francisco VA
Medical Center
. He previously led informatics at Brown and Toland Medical
, and has also worked at Epocrates.

By 2015, according to the American Association of Medical Colleges, the
U.S. health care system will be short approximately 30,000 primary care
doctors. Yet, everything we read says that primary care physicians are the
linchpins of the new (really rediscovered) coordinated care models being talked
about by health care policy cognoscenti. What gives?

Since the mid-1990s the number of medical students pursuing a career in primary
care has been on a steady, sinking decline, a trend likely fueled by the
realization that the traditional Marcus Welby-style primary care practice
doesn’t pay the bills. Throw in hefty malpractice insurance fees and the
average overhead often hits 60 percent. There’s also the question of boredom
and prestige. In medical school, future physicians are exposed to a breadth of
compelling cases; in primary care, they’re asked to refer the majority of those
away. And if you are interested in interesting procedures, medicine has clearly
evolved to favor specialists.

And about the pay disparity–it is stark. Most residents looking at a career in
primary care can expect to earn about $29.58 an hour. This, compared to $74.45
per hour as a specialist (by retirement, specialists will have earned about
$3.5 million more). The main reason is that the options for reimbursement in
traditional primary care practice are limited. Much of what PCPs do is
cognitive work–checkups, simple diagnoses, referrals–and that just doesn’t pay
as well. As for the reimbursable procedures that PCPs are able to perform,
they’re few, but of a wide variety; getting such a breadth of claims paid is
often a job in itself.

So here’s something surprising: In 2010 and 2011 the number of primary care
residency matches increased by ten percent per year. For 2012, those gains were
at least maintained, when the National Resident Matching Program last week
reported a one percent rise in such matches.

Two factors may be accounting for this welcome change of tide. First, there’s
accountable care. Within this premise of having one group–an accountable health
care provider network–hold all the risk and be paid on quality measures and
outcomes, primary care physicians can be even more effective quarterbacks,
coordinating care for a team of specialists. Even more targeted are
patient-centered medical homes, currently being tested within a number of ACOs.
Here, PCPs are available for consultation, and for mapping out care, which is
then put into action by a staff of physician extenders.

The second development is the Direct Care (also referred to as
Concierge) model, such as One Medical and MD VIP, which have
become a viable economic model for PCPs who want to maintain a
traditional primary care practice. While the exact structure of direct
care practices can vary widely–whether insurance is accepted, or scope
and kinds services a patient can expect, for example–they all rest on
the idea that patients pay annual or retainer fees to their primary care

If these trends continue, the primary care doctors of the future will
have to be experts at communication, system change and quality
improvement. They will need to focus less on traditional hospital tasks
like putting in a central line (already largely atrophied skills given
the widespread use of hospitalists), and more on skills like promoting
teamwork, being able to build consensus and persuasively articulating
ideas. Many will become experts in healthcare IT. What’s interesting is
that already we’re seeing more young doctors and residents who possess
these skills. We find them every day on Doximity, coordinating
referrals and patient care–using a state of the art platform for
communication. It is these physicians who will lead the charge of
translating medicine into the digital age.

Doximity Notes from the Road: SXSW Recap

We had a great time catching up with some of our favorite physician leaders

Mar 20, 2012 - Production Blog Author

On March 9, the Dox Blog packed up and trekked out to Austin for the SXSW
conference. We had a great time catching up with some of our favorite physician
leaders, including Bryan Vartabedian and Wendy Sue Swanson, both of
whom we bumped into at one of the week’s seemingly endless stream of happy

We learned about some nifty products, among them, iTriage, an app enabling
patients to look up their symptoms and get guidance on what steps to take next,
and Basis, a device to be worn like a watch that tracks heartbeat,
temperature, and more–all to be tabulated into daily feedback for its user.

Seed accelerator Rock Health wowed us with its ZenDen (they had us at
coffee and a free chair massage), and the health initiative StartUp Health
introduced us to an impressive lineup of health entrepreneurs. We also had some
time to talk Doximity shop. That Saturday, Nate Gross, Doximity’s Product
Manager, had a chance to talk with NBC Austin about some of what we’re
doing on the site. Here’s what he had to say about technology and physician

Now that the dust has settled a little, we’re interested in hearing your
impressions of the conference, whether as an attendee or from what you saw on
Twitter, Facebook and various blogs. In your view, what were the big takeaways
this year?