How do eHealth start-ups add value to Health Systems?
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How do eHealth start-ups add value to Health Systems?
Attempting to describe the ways through which digital entrepreneurs are innovating and adding value in healthcare
Curated by Camilo Erazo
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How social media empowers patients

How social media empowers patients | How do eHealth start-ups add value to Health Systems? |

(...) "There are many ways that social media inspires us to connect with each other and share information, and healthcare is no exception. Today, we thought we’d share three people on Twitter who have used social media to share their stories and inspire others. Facing scary health challenges, each of these three people has used their stories to spread awareness and motivate others. Their accomplishments alone would be admirable, but their spirits are the strongest illumination, reminding us of the power we have as individuals to make a difference.

"Andrea Nugent

Andrea has bravely battled Epilepsy and Breast Cancer. Throughout her journey, she has grown from suffering in silence to talking openly about Epilepsy and Breast Cancer. Now she’s on a mission to spread the word about both diseases. She runs a nonprofit group and has written three books, all while being a single mom. (...)

"Keegan Taberner

This 18-year-old honor roll student from Campbell River, Canada, sailed 800 miles circumnavigating Vancouver Island to raise money and awareness for Juvenile Diabetes. His website states: Diabetes management and its complications have always been a large part of Keegan's life over the past sixteen years, but he has always made a point of not letting it restrict him in the pursuit of his dreams. Now Keegan wants to help with the research, treatment and curing of diabetes, as well as show other diabetics that you shouldn’t let diabetes restrict your life; You can do something amazing!” (...)

"Katherine K Leon

After surviving spontaneous coronary artery dissection (SCAD) and double bypass surgery, Katherine searched the Internet to connect with other survivors. Taking matters into her own hands, she collected the basic information of 86 women on the Inspire hosted WomenHeart online support community. She took this information to Mayo Clinic, where she joined forces with Dr. Sharonne Hayes, who has taken on the cause, and together with Dr. Marysia Tweet, two research studies are in progress. (...)

Via Marie Ennis-O'Connor, Philippe Marchal, Giuseppe Fattori
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Healthrageous gets Partners financing, sees progress on hypertension biofeedback | Healthcare IT News

Healthrageous gets Partners financing, sees progress on hypertension biofeedback | Healthcare IT News | How do eHealth start-ups add value to Health Systems? |

(...) ""We made a major bet on machine learning as a key variable and differentiator in our solution," he says. "That's an ongoing development project. For really good machine learning, you need data. And we're just now getting to the point where the amount of throughput, the amount of data coming through our platform is sufficient to do some rather sophisticated mathematical computations, like neural networking."

The reason for that, of course, is that there are more Healthrageous users. "We've got about a 10x increase in participants on the platform," says Lee. "So we're getting a lot more data."

That's led to some "impressive results in our best biofeedback loop, which is the hypertension loop," says Lee.

The October issue of American Heart Journal spotlights some of that success: reporting on six-month, controlled trial, conducted at Hopkinton, Mass.-based EMC Corporation that demonstrated how a Web-based self-management program has helped individuals with prehypertension or hypertension achieve significantly lower blood pressure." (...)

[CE: Value creation driven by data?]

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Links between Twitter and medicine grow closer

MDs role in addressing health equity (Links between Twitter and medicine grow closer ¦ CMA (HT @cmaer) #hcsmeu...)...

When did Twitter start to enter the medical mainstream?

An argument can be made that the moment came in September during the 5th World Congress on Social Media, Mobile Apps, Internet/Web 2.0 at Harvard Medical School, when two of the most active and cited tweeters were MDs. This was no mean feat, given that the conference, which attracted 500 delegates from 36 countries and produced several thousand tweets (#med), trended as one of the top subjects of interest worldwide Sept. 15 and 16.

In addition to tweeting nonstop during the conference, Dr. Alex Djuricich (@medpedsdoctor), associate dean of continuing medical education at Indiana University, and Dr. Ryan Madanick (@RyanMadanickMD), a gastroenterologist at the University of North Carolina School of Medicine, participated actively in live discussions.

Djuricich described his use of Twitter during grand rounds, while Madanick participated in a panel discussion on the value of Twitter in medical education and as a life-long learning tool. "The collaborations that have emerged as a result of Twitter and Medicine 2.0 will be priceless," Madanick wrote later in his blog.

Twitter also has its share of skeptics within the medical community, although Dr. Ronan Kavanagh, an Irish rheumatologist and active blogger and tweeter, was quick to challenge them. "As someone who spends a lot of his time on Twitter, it hurts to think that the majority of my colleagues might think I am wasting my time," he wrote.

That comment was prompted by a tweet from the conference, which noted that an audience member said a survey of his large medical practice found that 86% of physicians feel participating in social media is a waste of time.

"Engaging in health-related activities on social media channels is the most important thing I have done for my medical life since completing my specialist training," Kavanagh responded. "It has renewed my fascination for health care in a way I haven't felt since I was a medical student, and doing so has undoubtedly quelled a mid-life ennui with my career.

"It has transformed the way I learn - I had all but stopped learning - and introduced me to new and interesting friends." (...)

Via Lionel Reichardt / le Pharmageek
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Doctors Use Social Media to Connect With Patients | Social Media ...

Doctors Use Social Media to Connect With Patients | Social Media ... | How do eHealth start-ups add value to Health Systems? |
As reported in a previous article, the healthcare industry is recognizing the potential for social media to strengthen the connection within the community for existing healthcare centers, patients, and physicians, while attracting ...

(...) "There's a stereotype that says doctors shun technology that might threaten patients' privacy and their own pocketbooks. But a new breed of physicians is texting health messages to patients, tracking disease trends on Twitter, identifying medical problems on Facebook pages and communicating with patients through email.

So far, those numbers are small. Many doctors still cling to pen and paper, and are most comfortable using e-technology to communicate with each other — not with patients. But from the nation's top public health agency, to medical clinics in the heartland, some physicians realize patients want more than a 15-minute office visit and callback at the end of the day.

Kansas City pediatrician Natasha Burgert offers child-rearing tips on her blog, Facebook and Twitter pages, and answers patients' questions by email and text messages. "These tools are embedded in my work day," Burgert said. "This is something I do in between checkups. It's much easier for me to shoot you an email and show you a blog post than it is to phone you back. That's what old-school physicians are going to be doing, spending an hour at the end of the day" returning patients' phone calls, she said." (...)


Via Denise Silber
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The internet and the future of the NHS - Public Service

The internet and the future of the NHS - Public Service | How do eHealth start-ups add value to Health Systems? |

Redditch MP Karen Lumley discusses the challenges of balancing online NHS services with face-to-face treatment


Almost all of us have at some point, used information technology to improve the health service we receive. Possibly the most dramatic change to our health service related to information technology was the introduction of the telephone to book appointments and, more recently, hold direct telephone appointments...


"Of course, we must remember that the internet is not a means to replace or reduce the need to visit a medical professional when necessary. We must also remember that there are still many people, particularly the elderly, who have no access to the internet. It is therefore, essential that technology should be used to aid face-to-face health services rather than replace them. The internet and other communication applications must meet the criteria of allowing services to run more quickly and more effectively. When this criterion is met, as with the creation of the NHS Direct then we must not fear change, but embrace it. Through utilising technology, we can also free up more time for face-to-face care when it is really needed." (...)

Via David Foord
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A Social Media Guide for Authors of Medical Resources

A Social Media Guide for Authors of Medical Resources | How do eHealth start-ups add value to Health Systems? | just published a list of tips and pieces of advice about improving a medical social media channel. You can read the guide here or download it in PDF. (

Via Lionel Reichardt / le Pharmageek
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Evaluación de la utilización de las Tecnologías de la Información y...

Esquema del trabajo sobre "Evaluación de la utilización de las Tecnologías de la Información y la Comunicación en Salud Pública" presentado por Francisco...

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Who has the power? Impact, analytics and the ethics of social health

Who has the power? Impact, analytics and the ethics of social health | How do eHealth start-ups add value to Health Systems? |

Reflecting on a recent #hcsmca chat that she moderated on the subject of the utility of the analysis of healthcare hashtag conversations and contributors in order to aid in patients in disease awareness, Ashley Weinhandl (@ashleyweinhandl) writes:


Utilizing top influencers is definitely a valuable first step for patients looking to gather information and support when feeling alone with their disease or health concern. However, it is not the only resource that should be used. Like any information on the Internet, patients need to be aware of the source and the validity of the information provided.


It was stated that users have the option to make their tweets private, thus many saw no problem with mining their data – it’s already public. Don’t tweet publicly if you want to remain private.


Data collection through tweets should be handled in a way that will not reveal true identities. It was also suggested the line should be drawn to what the Federal Government allows for university research. Ideally, data collected should be transparent and open to the public. The power of the data is in its reliability, validity, generalizability and aggregation. All in all, who is analyzing this data and for what purpose really determines the ethics of the analytics.


Social impact, analytics and ethics made for a lively, informative and dynamic hour with #hcsmca. There were a variety of diverse opinions allowing us to expand our minds and consider ideas we hadn’t thought of before.

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Am I a cyborg now? Achieving a sixth sense through tech

Am I a cyborg now? Achieving a sixth sense through tech | How do eHealth start-ups add value to Health Systems? |

Marek Majkowski writes:


Some time ago I’ve read about a guy that had a magnet implanted in the pinky finger.


Having a sixth sense sounds exciting, but implanting a piece of metal in your body is quite invasive. Even ignoring such details like finding a surgeon willing to perform the operation, the prospects of a possible magnet corrosion and not being able to get an MRI scan are major downsides.


Deciding that an implant may not be for me I started to wonder: why not to try “emulate” the thing? Of course, any kind of “emulation” is inferior to real sensation in your finger, but at least I will be able to figure out if the whole idea is worthwhile without cutting myself.


[Majkowski describes how he designed and build the device, then moves on to his experience of using it]


I wore the device for some time and it actually works.


I quickly found out that the buzzer needs to be directly touching the skin to be felt.


When wearing the device I could feel “stuff”, mostly electrical devices. Friends were laughing at me when during a walk I was stopping suddenly and doing few steps back to identify the source of the magnetic field (it was usually a utility box). There were also places where I couldn’t identify the source of the field.


After all that, I agree that being able to feel the magnetic field is a great fun.


[AS: This is, of course, more about the concept than the device in question, and I feel that scanners are more likely to adapt to us than we are likely to become comfortable with real rather than emulated invasive devices, but a fascinating article nevertheless.]

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If you think telemedicine is about technology, think again

If you think telemedicine is about technology, think again | How do eHealth start-ups add value to Health Systems? |

Telemedicine isn't about technology. It's about people figuring out how to use technology. Read how lawmakers and healthcare providers are catching on.

"“It’s about what you do with technology,” much of which has existed for years, American Telemedicine Association CEO Jon Linkous said at the Health Policy Institute of Ohio’s telehealth event last week. “It’s not health IT — it’s about people.”

Which is why it’s important not only to get healthcare stakeholders on board, but to have people in the right places to make regulatory changes that will enable telemedicine to break through challenges with licensure and the regulation of Internet prescribing." (...)

"Standardization and globalization. Hospitals are outsourcing entire components of what they do, Linkous said, and need to use telecommunications to bridge geographical gaps.

Telemedicine shouldn’t be considered a specialty area in healthcare, several of the event’s speakers insisted, but rather a tool that’s used under the surface to improve care. Many people don’t even know they’re using it, Linkous noted, which demonstrates that it eventually can be seamlessly integrated into care."(...)

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The Future Of Health Care Is You

The Future Of Health Care Is You | How do eHealth start-ups add value to Health Systems? |
Let’s pretend you don’t know how to swim. Now let’s imagine I take you to the middle of a lake, drop you in and tell you to find your way to shore. Every day, that’s how society approaches the challenge of improving people’s health.

(...) "Devices like smartphones, Fuelbands, and Fitbits are capturing increasingly insightful data, giving us instant feedback on our health, from how we eat, sleep, and exercise, to our heart rates, blood pressure, and stress levels. For those seeking more complex data about themselves, companies like Wellness FX, 23&Me, and Sano Intelligence are offering the chance to look at our own individual blood chemistry and DNA and make healthier choices based on that info.

People are putting the power not just in the hands of the consumer, but in the hands of their network.

On top of those data capturing devices, companies are building software to help interpret this new wave of information and make it relevant to the end user. While most consumer health companies offer a dashboard of some kind, companies like Massive Health and Nike are leading the way in user experience.

Finally, people are adding a human layer on top of these applications, putting the power not just in the hands of the consumer, but in the hands of their network. This provides an incredible resource to doctors, trainers, and others who help people achieve their health goals. (...)"

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Tweeting the meeting: an in-depth analysis of Twitter activity at #KidneyWk11

Tweeting the meeting: an in-depth analysis of Twitter activity at #KidneyWk11 | How do eHealth start-ups add value to Health Systems? |

From the conclusion of the discussion:


There are an additional 6 notable points of this investigation.


First, tweets that were not deposited in the #kidneywk11 timeline were not analyzed in this investigation. However, this deficiency is unlikely to significantly alter our results because #kidneywk11 was the official Twitter timeline for Kidney Week 2011.


Second, we calculated sentiment scores through a lexicon-based linguistic analysis of each tweet. While this method is well accepted and validated, it may not encompass the full range of emotions that a “bag of words” model could capture [18]–[21]. Moreover, the lexicon used was comprised of English words only, and thus non-English tweets (76 out of 993) were excluded from the analyses. We did not translate the non-English tweets; doing so could have resulted in an unintended change of tone and thereby skew the results.


Third, we correlated the number of sessions and posters with the number of informative tweets. A more meaningful correlation might be the time exposed to each learning pathway with the number of informative tweets, but the former could not be accurately measured or calculated.


Fourth, we did not compare tweets from similarly sized nephrology or other medical conferences. Our comparison was limited between tweets from Kidney Week 2011 and the 2011 ADA meetings because conference officials for both had documented an interest in using Twitter to increase public awareness [1], [6]. A comparison with other nephrology or medical conferences would have been more meaningful had those respective conference officials/organizers documented a similar intention.


Fifth, we analyzed 917 tweets from 172 unique tweeters. While these numbers might be considered small, they represent the entire population of 1) English-worded tweets and 2) tweeters from the meeting. In addition, this study had an 80% power to detect statistically significant differences.


Finally, a large percentage of tweets were advertisements. This finding makes the use of Twitter as a communication tool challenging as advertisers can misuse it under the disguise of education.

The tweets analyzed are part of the public domain. Neither the ASN, Twitter, nor the individual tweeter own any or all tweets deposited in #kidneywk11 [23]–[24]. Tweets, by definition, are short expressions and are not protected under Section 102 of the US Copyright Act [25]. To the best of our knowledge, this report conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [26].


Our investigation highlights significant areas of promise when using Twitter to share kidney-specific educational information with the public. In fact, our analyses are pertinent to any medical conference in which the organizers or healthcare providers wish to disseminate information to the general public. Dissemination of information is needed in order for the nephrology community to increase public awareness of kidney disease. This investigation focuses on how well Twitter was used to disseminate educational information from a scientific conference. In the future, investigations are needed to determine if greater dissemination of educational information will lead to greater public awareness.

Via Howard Luks
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What happened to the doctor-patient relationship? | BMJ

NotesCite this as: BMJ 2012;344:e4349 (What happened to the doctor-patient relationship?

An old maxim of general practice says that doctors get the patients they deserve, because patients actively seek out like-minded doctors who share their own health beliefs. The health-anxious seek health-anxious doctors; both value so called thoroughness, and referral, and refuse to accept any uncertainty. Likewise, some doctors and patients are bound together by a degree of fatalism. Both are happy to accept risk; happy not to treat, refer, or investigate. What passes as denial to some seems like only common sense to others. Once upon a time doctors understood that medicine was more opinion than science, so were tolerant, supportive, and respectful of differing perspectives. But this balance in the doctor-patient relationship is under threat, with any, even realistic, fatalism increasingly deemed unacceptable.⇑

Despite modern medicine’s supposed so called patient centredness, the medical model (that all symptoms have a pathological cause, to investigate, treat, and cure) is absolutely still the prevailing mindset within medicine. This is despite most contact with patients being driven by abnormal health seeking behaviours, cultural aspects of care, or medically unexplained symptoms—facts lost to the educators. And the medical model is ever more powerful; opinion is usurped by the perceived infallibility of so called evidence. Despite the glaring weaknesses and naked commercial interests found within much research, “you can’t go against the evidence.” The rise of the superspecialist means absolutism is now the norm not the exception. The paradox is that medicine is supposedly more enlightened, but it has never been more tyrannical, hierarchical, controlled, intolerant, and dogmatic. Working doctors who dissent are cowed because failure to comply with the medical orthodoxy threatens livelihood and registration. Much of modern medicine is an intellectual void.

The current situation is far worse for medically sceptical patients, who are denied the opportunity to consult doctors who share their health beliefs. Changes in working patterns mean continuity is broken and doctors are less available and less experienced. Doctors’ consultations have been reduced to some universal unit of medical time, not a long term relationship of the like-minded. In every consultation, onscreen pop-ups prompt us to record blood pressure, weight, screening, and the rest. Payments provide incentive for this intrusion, making refusal difficult. Everyone is made into a patient; there is no opt-out clause, no choice. Patients complain that they are “pushed onto pills”; captive to constant computer generated recall, yet no one listens. Medicine shows no respect for any fatalism, openly scolding patients if they have different health beliefs. This is all set to get worse, more pervasive, more paternalistic, and less persuasive. Are patients really getting the doctors they deserve?

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Video Fitness Startup Founders Shake Up the Act of Shaping Up

Video Fitness Startup Founders Shake Up the Act of Shaping Up | How do eHealth start-ups add value to Health Systems? |
They created their startup, Wello, to eliminate all possible excuses for not working out.

(...) "The website,, helps certified fitness professionals deliver high-quality personal training online, over live, two-way video. The company, incorporated as Knowplicity, has five employees in San Francisco now, and just raised a $1 million seed financing round to grow this platform.

Making real-time, online help available to customers via video chats is nothing new. Many online education providers do this—including, among many others, Preply, a test prep tutoring site, and Idroo, a digital whiteboard with Skype video chat features.

More importantly in the founders’ view, Wello carefully screens and then teaches personal trainers how to use online tools and video to do their work, before they start coaching on the site.

The startup employs proprietary processes and technology to test trainers and match them to appropriate clients. Scott explained, “We don’t want a weight-loss specialist to train someone who is about to have a baby, and needs that prenatal knowledge.”

Currently about 150 trainers are using, which launched in July. All trainers give their first, online video lesson to a Wello employee." (...)

CE: Pfff. Most probably will just save money and time for people who are already involved in working out and fitness activities. Increased access to people that want-but-can't: unlikely.

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10 Ways Telemedicine is Changing Healthcare IT

10 Ways Telemedicine is Changing Healthcare IT | How do eHealth start-ups add value to Health Systems? |
Telemedicine mixes teleconferencing, document-sharing and mobile technology in order to improve healthcare quality, largely for those who lack access to care.

(...) "Here's a look at 10 ways that telemedicine technology is changing the delivery of healthcare—along with a note of caution for organizations that are taking advantage of relaxed regulations to expand their use of telemedicine services.

1. Diagnose and Treat Strokes Faster (...)

2. Provide ICU Physicians, Nurses a Second Set of Eyes (...)

3. Let Patients Undergo Rehab at Home

"When patients are discharged from the ER or the ICU, the care process is often just beginning. This is especially true for patients who are recovering from a stroke or suffering from other neurological disease such as multiple sclerosis, Parkinson's or dementia. In many cases, these patients find it difficult to travel to a health care facility regardless of whether they are in an urban or rural setting.

The use of telemedicine technology in rehabilitation addresses these issues in several ways— conducting cognitive or psychiatric assessment, leading group therapy sessions (hosted at a clinic or senior citizens' center, for example), providing patients with online resources and remotely monitoring a patients' pedometer readings to ensure that an exercise regimen is up to par.

Telemedicine can also assist in recovering from lung disease, as it lets patients participate in online education sessions and attend supervised physical rehabilitation at a nearby satellite location."

4. Help Patients Reduce Their Risk of Heart Disease (...)

5. Encourage Diabetics to Embrace Healthier Behavior (...)

6. Empower Patients to Manage Chronic Conditions

(...) "...patients can describe symptoms to physicians over email, perform a number of self-tests and participate in step-by-step educational programs related to their particular disease. In both cases, mobile health technology eases chronic disease management by literally putting care management applications and devices in patients' hands."

7. Improve Oral Health With Store-and-Forward Telemedicine (...)

8. Link Patients, General Practitioners to Dermatologists (...)

9. Provide Mental Health Consultations to Children (...)

10. Improve Rural Healthcare Around the World (...)

Don't Neglect Telemedicine's Risk Management Needs

"The use of telemedicine technology is not without its risks. Both patients and physicians must have appropriate hardware and software security in place to ensure the safe transmission of PHI and PII such as a Social Security Numbers and detailed medical records." (...)

"In addition, your organization should draft a detailed set of telemedicine guidelines that lists all partner facilities, addresses which types of healthcare providers (nurses, radiology techs and physician assistants, to name three) can participate and clearly states how the information gathered during telemedicine treatment will enter a patient's electronic health record.

Taking such steps will help protect your facility from telemedicine fraud, which can target loopholes in prescriptions, insurance reimbursements and the anti-kickback statute.

Rising healthcare costs and the demand for improved care are driving many facilities to explore the benefits of telemedicine. While technological barriers and skeptics remain, many studies have shown that telemedicine can complement, and in some cases improve, the overall patient experience.

Expect more even use cases for telemedicine technology to emerge."

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There is no app for patient engagement

There is no app for patient engagement | How do eHealth start-ups add value to Health Systems? |
Physicians, hospitals and other providers are being misled by industry pundits claiming that more health information technology (as in EMRs, PHRs, smartphone apps, and web portals) is the key to greater patient engagement. It’s not.

"If health information technology were all that was needed to “engage” patients then patient and member adoption rates of provider and payer web portals offering personal health records (PHRs) and electronic health records (EHRs) would not still be hovering around a disappointing 7% (with several notable exceptions Kaiser, Group Health and the VA).

Part of the misunderstanding concerning the role of HIT comes from how the discussion about patient engagement is being framed. According to the pundits, patient engagement is the physician or hospital’s responsibility. And like everything else these days, we can fix it if we just throw more technology at the problem. Can anyone say Stage 2 Meaningful Use requirements?

Here’s why HIT will not solve the patient engagement challenge

The role of physicians, hospitals and other providers is not so much one of needing to engage patients in their care. Rather, providers need to “be more engaging” to patients who are already actively engaged in their health.

Take the simple act of a trip to the doctor’s office. Before a person shows up at the doctor’s office they have to 1) have a reason or need (symptoms, a concern, chronic condition), 2) believe that the need or reason merits seeing the doctor vs. taking care of it at home themselves – this generally implies cognition and doing research, i.e., talking with friends, going on line, etc., 3) make the appointment (by calling or going online), 4) show up for the appointment, and 5) think about what they want to say to the doctor. The point here is that by definition, people who show up for a doctor’s appointment are already engaged.

Now providers tend to not consider the patient’s perspective when it comes to engagement. For most providers engagement means getting patients to do what providers say is in their best interest. But that approach totally dismisses the fact that patients are already engaged, just not in the same way that providers expect." (...)

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The Case for New Physician Literacies in the Digital Age

The Case for New Physician Literacies in the Digital Age | How do eHealth start-ups add value to Health Systems? |

Doctor Vartabedian is part of the Doctors 2.0 & You movement.


(...)" The paper in mama’s bag

Not long ago I was treating a boy with ulcerative colitis who developed a complication of UC called sclerosing cholangitis. This is a condition where there’s autoimmune activity against the duct structures leaving the liver.

During one of his clinic visits the mother brought with her a paper that had just been published on the use of a particular antibiotic for the treatment of sclerosing cholangitis. It had been found to potentially stall the progression of the condition. The paper had been under discussion on a patient network and she wanted to know if this was an option for her son.

I looked at the paper and immediately recognized that this was in the latest edition of a journal that happened to be sitting on my desk. Mom had found the article before I had a chance to read it.

Those of you who read my blog, 33 charts, know that I’ve made a habit out of taking some of my everyday experiences and breaking them down as a means of illustrating how medicine is changing. I’d like to use this brief encounter as a jumping off point.

Breakdown | Mom beats doc

What can we learn from this?

Physicians no longer control information. While the idea of a patient bringing new research to her doctor isn’t a new phenomenon, in the broader historical context it’s huge. For the better part of civilization our role as physician has centered around privileged access to information and knowledge. But the web has created a type of disintermediation. The face-to-face encounter with a physician is evolving as a more narrowly defined element in an individual’s quest to understand their condition and get better. Access to information is the bedrock of the health 2.0 movement.

There’s too much to know. There was once a time when physicians could get their hands around what they needed to know. You’d go to the mailbox and pick up that 200 page journal and you were all set. Not so much anymore.

And honestly, a part of me felt bad. I’m a pediatric subspecialist – I’m supposed to be on top of this stuff. But had I read that that paper, there would have been another patient with with a newly released paper. There’s simply too much to know.

Information will find us. While we used to be dependent upon search in order to get the information we need, information now finds us through our social networks just as this mother did. And going forward, information will find us based on our context. The right information will find us on our smart phones depending upon where we are, what we’re doing, or what clinic we happen to be in. Social media visionary Shel Israel has suggested the last decade was about conversation, this coming decade will be about context.

We’re facing a crisis of medical knowledge. (...)

CE. As with anything written by Dr. Vartebendian: make it mandatory reading, NOW!


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Consumers Use Social Media For Health Information - The Holmes Report

Consumers Use Social Media For Health InformationThe Holmes ReportThe research investigates consumers' overall engagement with online healthcare information, and reveals specific consumer preferences for online publishing sources, channels and even...

"The research investigates consumers’ overall engagement with online healthcare information, and reveals specific consumer preferences for online publishing sources, channels and even devices, and finds that consumers rate government agencies such as the Centers for Disease Control and Prevention or the Food and Drug Administration and advocacy organizations among the most credible.

“Whether they want guidance for an informed conversation with their doctor, or the support of a larger community coping with the same illness, consumers seek trusted sources for health information,” says Gil Bashe, executive vice president and Practice director, Makovsky Health.

“These new survey results enhance our understanding of how and with whom consumers connect online, and help ensure that credible, useful information is readily accessible to the patients who need it.” (...)

Via Dean Berg
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As the Web Goes Mobile, Healthcare Stands Still

As the Web Goes Mobile, Healthcare Stands Still | How do eHealth start-ups add value to Health Systems? |

NEW YORK–(BUSINESS WIRE)–U.S. consumers seeking health information online are more likely to visit Wikipedia than health magazine websites or Facebook, connect through a PC rather than a mobile device, and be swayed by word of mouth over direct-to-consumer advertising, according to results from a new national consumer survey conducted by Makovsky Health and Kelton. The Makovsky-Kelton research investigates consumers’ overall engagement with online healthcare information, and reveals specific consumer preferences for online publishing sources, channels and even devices. Data pinpoint trust in content sources, with consumers rating government agencies such as the Centers for Disease Control and Prevention (CDC) or the Food and Drug Administration (FDA) and advocacy organizations among the most credible.

“These survey data shed light on where companies should invest to engage consumers in cost-efficient, yet effectively engaging ways.”

“Whether they want guidance for an informed conversation with their doctor, or the support of a larger community coping with the same illness, consumers seek trusted sources for health information,” said Gil Bashe, executive vice president and practice director, Makovsky Health. “With new and evolving access points, understanding the consumer mindset is critical to supporting improved health outcomes. These new survey results enhance our understanding of how and with whom consumers connect online, and help ensure that credible, useful information is readily accessible to the patients who need it.”


When and How Do Consumers Search?

People are still most likely to use a personal computer (90%) – and not a smartphone (7%) or tablet (4%) – to search for health information online. Further, these PC-reliant consumers are more likely than smartphone/tablet-reliant consumers to visit a pharma website after receiving a diagnosis from their doctor (52% vs. 31%), whereas smartphone/tablet users are far more likely than PC users (43% vs. 24%) to visit a pharma website after they experience a few symptoms.

Who Do Consumers Trust?

If seeking information about their own medical condition(s), consumers trust advocacy group and government agency websites (e.g., CDC or FDA) nearly as much (33%) as they trust websites with medical information, such as WebMD (35%). Further, a personal recommendation from a friend, family member or colleague (33%) is a stronger motivator to visit a pharma website than TV advertisements (27%), magazine advertisements (14%), digital advertisements (13%), or discounts (16%). Consumers also report an overall preference for externally-sourced information, though user-generated content on Wikipedia is gaining high levels of trust:

56% of Americans use WebMD for healthcare information31% visit Wikipedia, which has emerged as a trusted source of credible information, an increase of 13% from Makovsky Health’s 2011 survey29% visit health magazine websites online (e.g., Prevention, Women’s Health)Social networking sites are utilized by far fewer Americans for healthcare information: Facebook (17%), YouTube (15%), blogs (13%), and Twitter feeds with links to other resources (6%). (...)


Via Tracy Parish, Lionel Reichardt / le Pharmageek, dbtmobile
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MappyHealth - A #NowTrending2012 Entry - Following disease trends, 140 characters at a time

MappyHealth - A #NowTrending2012 Entry - Following disease trends, 140 characters at a time | How do eHealth start-ups add value to Health Systems? |
Mappy Health is tracking disease trends and terms on twitter 140 characters at a time. A NowTrending 2012 ASPR app competition entry.

Via ChemaCepeda
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Civil rights in the era of digital health

Civil rights in the era of digital health | How do eHealth start-ups add value to Health Systems? |

William F. Pewen writes:


Despite the hazards posed by both actual and surrogate health data, an examination of what has been said about not only health IT, but information sharing more generally, yields an overwhelmingly positive view.


An on-line inquiry will generate results dominated by tech luminaries who lead firms that have created such products as search engines, social networks, and marketing and communications applications -- but relatively few from legal or ethical authorities.


It is significant that those search results ranked highest reflect glowing depictions of a world with an unimpeded flow of data -- yet these typically emanate from those who profit by the sale of personal data, including many uses that may not be in an individual's best interest. Ironically, many such luminaries are themselves not so trusting in terms of sharing their own information.


This brings to mind the answer of Mark Zuckerberg of Facebook, to the question of why users would entrust their private data to him. His reply characterized his view of those who would do so: "Dumb f***s."


That underscores the problem.


As many seek to mine the health data [of patients], either directly or via surrogate measures -- it has become the Wild West out there. And millions are just beginning to recognize that they are not the customers in such endeavors, but the product. Should we fail to better address the use of medical information and its surrogates, millions may find themselves not only product, but victim as well.


It may be time for the second civil rights bill of the 21st century.

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Is there hope for clinicians in the digital age?

Is there hope for clinicians in the digital age? | How do eHealth start-ups add value to Health Systems? |
Getting the majority of doctors to go beyond spreadsheets is a daunting task, says the patient from hell...

"the beginning of this year I bemoaned that GPs no longer understood IT. Five months later, however, I cheered because the NHS Hackday showed that a lot of clinicians do in fact want clunky NHS IT systems to be improved and are prepared, if only for a weekend, to get down in the mud with loads of geeks and get their hands dirty writing innovative medical Apps (and I am delighted to hear that one of these Apps, Patient List, is to be released as open source).

But, sadly, in an increasingly digitalised NHS, geeky clinicians are a rare breed. What about the majority of doctors – how much do they understand? And, more importantly, what are they taught about IT in medical school?

Not a lot from what I've seen in Learning to manage health information, a 56-page document produced by the Department of Health's embedding informatics in clinical education (eICE) team. It sums this up by admitting that "many healthcare professionals continue to have limited or no education in informatics and yet the expectations of them to manage information effectively is a current and increasing requirement."

I get the impression that although the eICE team was set up in 1999 and has been bashing away relentlessly, it has not made much progress in educating the lumpen mass of clinicians to make them ready for the digital age.

Many of them still seem not to have got their heads around relatively simple national stand-alone systems, some of which have been around for years, like Choose and Book, e-prescribing and Summary Care records. My GP surgery seems to have had no difficulty with implementing these systems so it can be done.

Assuming that most clinicians have achieved some keyboard skills over the years and can write emails and manipulate spreadsheets, doesn't mean they have a real understanding of what they ought to know about IT or how it can improve the care they provide to patients and make their own lives easier. What is scary is how much there is for them to learn.

Just look at what they have to get their heads around right now; electronic health records, for a start, are changing the relationships between clinicians and healthcare teams, but security problems need solving by clinicians as well as by IT experts.

Telehealth and telecare require them to master all types of physical and psychological measurements and remote monitoring, and throw away the conventional way of treating patients. Public health education and information requires them to use different media channels to inform citizens, both healthy individuals and patients, about medical and health topics and to increase self-help. They also have to deal with patients, who diagnose themselves on the internet and just visit the doctor for confirmation of the research they have done.

Then they need to get a grasp of what is involved in giving patients access to their records – and even make changes. Medical Research Using eHealth Grids means learning to control powerful computing and data management capabilities to handle large amounts of heterogeneous data.

The mind boggles. There are also clinical coding systems, like Read Codes and Snomed, and more generally, they need to understand the need to standardise procedures and data, and the importance and limitations of interoperability.

Now there is also the new mobile world, which will revolutionise the life of doctors on the wards. And social networking, useful for campaigns and for patients to communicate with each other, but can have pitfalls for healthcare professionals. And who knows, they may get around some day to using email as a bog-standard way of contacting their patients.

And finally, there is the ability to suss out technological snake-oil salesmen.

Will they catch up? I doubt it. The eICE report ends by saying: "It is recommended that commissioners and providers consider the need for catch up or consolidation programmes, based on the guidance in this framework." So we are back in the hands of the GP commissioners, who have too much on their plate already, and who have not shown much inclination in the past to improve their IT knowledge, or initiate IT systems for the benefit of their patients.

To suddenly realise the importance of the digital revolution and be ready to commit resources to educating their clinical colleagues would be out of character. I don't hold out much hope."

via @jranck

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Putting people first » Social media’s neoliberal world view (and how it affects us all)

Putting people first » Social media’s neoliberal world view (and how it affects us all) | How do eHealth start-ups add value to Health Systems? |

Recently I have embarked on trying to understand better the underlying ideology and world view of the Silicon Valley tech scene, and how this is impacting our daily lives through the products and services they create.

My mission is still far from complete and reading suggestions are more than welcome. On Twitter, Brian Schroer guided me to a few books and to this inspiring 2010 NYU doctoral dissertation by Alice E. Marwick, currently an Assistant Professor in Fordham University’s Department of Communication and Media Studies. Previously she was a postdoctoral researcher at Microsoft Research New England in the Social Media Collective (and therefore a frequent co-author with danah boyd), and a visiting researcher at the Berkman Center for Internet and Society at Harvard Law School.

Marwick’s 511 page dissertation, which she is now reworking into a book for Yale Press, is based on ethnographic research of the San Francisco technology scene and explains how social media’s technologies are based on status-seeking techniques that encourage people to apply free-market principles to the organization of social life.

Rather than re-publishing the abstract, I want to cite a few paragraphs (on pages 11-13) from her introduction:

“David Harvey defines neoliberalism as “a theory of political economic practices that proposes that human well-being can best be advanced by liberating individual entrepreneurial freedoms and skills within an institutional framework characterized by strong private property rights, free markets, and free trade” (Harvey 2007, 2). Neoliberal policies emphasize “trade openness, a stable, low-inflation macroeconomic environment, and strong contract enforcement that protects the rights of private property holders” (Ferguson 2006). [...] Neoliberalism is also an ideology of the integration of these principles into daily life; neoliberal discourse reproduces by encouraging people to regulate themselves ―according to the market principles of discipline, efficiency, and competitiveness‖ (Ong 2006, 4). Aihwa Ong identifies “technologies of subjectivity,” which use knowledge and expertise to inculcate this expertise in individual subjects. Exploring such technologies reveals how neoliberalism is experienced, and how these subjectivities are formed.

I argue that social media is a technology of subjectivity which educates users on proper self-regulating behavior. Internet and mobile technologies create the expectation that white-collar professionals should always be on the job, decreasing personal agency and creating conflicts between the often-contradictory demands of work and home life (Middleton 2007). Social media encourages status-seeking practices that interiorize the values of Silicon Valley, which is a model of neoliberal, free-market social organization. In the technology scene, market-based principles are used to judge successful social behavior in oneself and others, extended through social media. Status increases up to a point with the ability to attract and attain attention online. The ability to position oneself successfully in a competitive attention economy becomes a marker of reputation and standing. Web 2.0 discourse is a conduit for the materialization of neoliberal ideology. I isolate three self-presentation techniques rooted in advertising and marketing to show how social media encourages a neoliberal subject position among high-tech San Francisco workers: micro-celebrity, self-branding, and lifestreaming.”

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Facebook is for bonding, Twitter is for bridging: Contextualizing social media involvement as help-seeking behavior

Facebook is for bonding, Twitter is for bridging: Contextualizing social media involvement as help-seeking behavior | How do eHealth start-ups add value to Health Systems? |

A working paper by Annie Feighery 


Around the turn of the Twenty-first century, the internet transitioned from a unidirectional source of information to an interactive platform for sharing information. This paradigmatic shift, referred to as Web 2.0, spread beyond the confines of the internet, resulting in increased sharing (porousness) beyond previous institutional or cultural boundaries and flattened layers of hierarchy between those in power and those overseen by power structures (Rogers, 2011). 

Previous to Web 2.0, academic institutions were strongest for their role in society as trans-generational keepers and generators of knowledge, resilient to trends of cultural change. In the new paradigm, change itself is a commodity and academic institutions' inability to quickly adapt is a liability for their long-term survival. The revolution through which the institution of journalism is just emerging is just beginning to impact academia. In the coming years, the shape of knowledge-generating sectors of society, once simply known as universities, will depend on leaders that can integrate the historic cannon with the porous and flattened structure of a post-Web 2.0 world. 

The technology-enabled, socially-integrated world offers public health researchers and practitioners many advantages, especially since mobile connectivity expanded to handheld mobile phones. The financial costs of reaching populations is greatly reduced by overcoming geographic distances with mobile penetration. Sub-Saharan Africa, for example, now has a majority of countries with populations whose mobile phone market is at the level of virtual total penetration. Virtual total penetration is reached when more than half of potential mobile phone owners have a mobile phone. The remaining 0-50% can access a phone through family or neighbors--an act made more feasible by cultural perceptions of collective, as opposed to individual ownership. In Rwanda, for exmaple, each village--on average, 200 people, is assigned a mobile phone-carrying health worker whose job it is to ensure everyone has access to a mobile phone. 

Predating networks in their now-online ussage, social network theory offers a foundation for cannonical integration between traditional best practices and emerging opportunities for engagement and intervention. The foundational behavioral attribute of public health, help-seeking behavior, can be understood in social network theory as interactions between types of connections people represent in an increasingly integrated, flatter, porous social fabric. 


Help-seeking behavior in social network theory 

Within social network theory, the connections between people are categorized by the types of social capital exchanged in each pairing, or dyad that unites a person to another. Connections marked by homophily, or likeness are called bonds. Connections marked by heterophily, or differences like geographic backgrounds, beliefs and values, or socioeconomic indicators are called bridges. They can also be thought of as low energy and high energy connections. The title stems from the idea that a social bridge of sorts is implied when you make a connection to a heterophilous person, for example, one who is no relation and did not grow up near you. School can be an excellent bridging mechanism if the student body is from a diverse enough catchment. Meeting other students and teachers from different backgrounds is one theorized causative agent in the health bump girls get just from attending a few years of school (Lindstrom, 2008). Before the field developed the categories of bonding and bridging, Granovetter's (1973) terminology of strong (now bonding) and weak (now bridging) ties were the usual way of explaining dyads. In the late-nineties, the new terminology of bridging and bonding were formalized and a third kind of connection was termed linking, which is used to categorize a dyad between a person and an authority or institution, ie, you and the police (Gitell & Vidal, 1998). 

At the most basic level, being social and having more dyadic connections--greater network size--is beneficial, regardless of the types of connections in the network. Birkman and Syme (1979) demonstrated this with the now-infamous study in Alameda County, in which people who scored low on their index of social connections had as much as 4.6 times higher risk of all-cause mortality compared with those who scored low. More recently, Klinenberg (2002) found that individuals who were socially isolated were the most likely to die during the 1995 Chicago heat wave. 

There is a strong tendency in the US to romanticize bonding connections. From advertising to elections, bonding themes can be seen when people refer to small town values, old fashioned neighborhoods where a person is born and dies on the same street, or, my personal favorite for health outcomes, a person can succeed by pulling themselves up by their bootstraps--turning down formal means of support like welfare or Medicaid. Contrary to the cultural perceptions, of the three main types of social connections people make, bridging is associated with the best outcomes in health and well being. As far back as the 1920s, Ryan and Gross (1945) showed that farmers in Iowa who visited the city more often, meeting different people and encountering different ideas (termed cosmopolitanism), were the most likely to introduce seed and technology innovations on their farms back home, resulting in more successful farms (Rogers, 2003). Granovetter (1973) first showed that weak, or bridging ties were more useful than strong, or bonding ties when individuals were looking for a job because their social network had a greater surface area, making them more likely to encounter a person with an open position. Rogers explained that more diverse connections also results in more information--a necessity for making better and more economic choices (Rogers, 2003). 

Help-seeking behavior differs greatly between bonding and bridging dyads. A hypothetical situation among bonding and bridging neighbors that can explain the impacts of different help-seeking behaviors is a common situation many women face worldwide: what to do with a sick child who cannot go to school on a workday. When asked for help, a neighbor in a bonding dyad would likely respond by offering to watch the child herself, whereas a neighbor in a bridging relationship to the woman would likely respond by offering an additional bridge--giving the woman the phone number to a babysitter. Using the economics tactic of mapping winners and losers in an outcome with a net gain or loss in each aspect, you can graph the health and well-being outcomes of each dyad. Considering consequences of each means of helping, the bonding context is a net loss, whereas the bridging context is a net gain. Taken to a community level, it becomes apparent why bonding tends to bankrupt community resources, while bridging strengthens ties without depleting resources.

In addition to exhausting resources, bonding behavior has another attribute that can be detrimental to health and well-being. First identified as amoral familism by Banfield (1958), Gans (1965) conducted an ethnographic study of a Boston slum inhabited mostly by Italian immigrants, and found that the group behavior self-regulated against new innovations with subtle and overt tactics like ridicule and exclusion. Even when the innovations were clearly in the best interest of the individuals, such as organizing to block the impending razing of the neighborhood, the group behavior shunned change. Bonding groups tend to make bridging behaviors into a taboo, or an outgroup behavior for fear of losing the cohesion and exclusiveness that marks the bonding group. The health outcomes of this tendency are more clearly visible in the Hurricane Andrew case study conducted by Hurlbert et al (2001). The authors followed individuals' help-seeking behavior in response to the devastation of the hurricane and found that people in tightly-knit bonding groups were least likely to seek or accept formal means of support, such as food vouchers. Instead, they turned to each other for support. This finding was reinforced in a social capital study of Hurricane Katrina's aftermath, which showed the bonding behavior quickly bankrupted groups' resources, resulting in increasing their vulnerability (Hawkins, 2010).  


Social media and social networks

Worldwide, the most populated social media platform is Facebook. With over 500 million active users, Facebook is easily the largest community in the world. Developers in 190 countries have used the Facebook platform to create applications and tools that further the social media conversation. Facebook members have an average of 130 friended connections and half of all users log on to interact with those friends every day (Facebook Statistics, 2011). In one of the few studies to look at users beyond college age, Burke (2010) found most Facebook users' friended connections tend to be bonding in nature. As bonders, the information shared amongst those 130 average friends reinforces homophily and strong ties. Through Facebook, childhood friends are reconnected and otherwise-bridged dyads are drawn closer toward bonds by reinforcing homophilous values between them, such as religion or political parties.

In contrast, Twitter users tend to connect with heterophilous dyads and messages are more often sharing inforamtion, such as links to websites, than values or emotions. Twitter, the world's second largest social network, limits messages, called tweets, to 140 characters. As a result, tweets tend to be more densely packed with information and fewer characters are available for ephemora. Since a connection, or follow on Twitter does not require reciprocity, the social network term dyad is often not applicable at all. The overwhelming majority of Twitter users employ the site to lurk rather than interact--lurking indicates following feeds or conversations without actively engaging in them. 75% of individuals with a Twitter account have written ten or fewer tweets (RJ Metrics, 2011). As a result, the functionality of Twitter in social networks is not geared toward strengthening homophily, but rather the bridging and linking communications of sending and receiving information (Jave, 2007; Zhao, 2009).

Facebook membership continues to outpace Twitter membership worldwide, but features of Twitter make it more easily adaptable to low-resource areas. Largely because of its integration with SMS and mobile texting, growth in Twitter users is less dependent on available internet connections. 8% of South Africans were recently found to use Twitter and, of those, the majority connected via their mobile phone (Mobility, 2011). Its independence of a centralized network made Twitter the engine of choice for the historical series of political revolutions in Spring 2011, termed Arab Spring, in which citizens coordinated their efforts via social media with others who shared their cause, regardless of whether they shared a social network. 


Implications of dyad types in social networks

Given the health and well-being outcomes associated with bridging versus bonding predominant netwokrs, isolated geographic areas with a history of bonding behaviors are at especially high risk for becoming social media deserts, losing out on the access to markets and social interventions available in online bridges. Interconnectedness with individuals from diverse backgrounds online is, health-wise, among the most rewarding aspects of participating in social media by increasing one's surface area to innovations, ideas, and opportunities. Although social media penetration is low in the African continent (2.7% penetration for Facebook), the broader derivative for growth is steep: overall internet user growth on the continent has expanded by 2,527% in the past decade (Internet World Stats, 2011). New efforts to lay cables under the oceans surrounding the African continent are increasing connectivity speed and network size. Current disparities in connectivity within the continent are wide. 30-50% of individuals are online in Middle East and North African countries, while Sub-Saharan African countries generally fall below 30%. Nigeria has 44 million people online, while Ethiopia has only 445,000, or 0.5% (InternetWorld, 2011). 

Beyond acquiring connectivity, for researchers in health and development, the key emerging question is how to be sure connectivity translates to the health and well-being benefits seen in other parts of the world. In an animation representing tweets around the world following the earthquake in Japan, it is obvious that individuals in African countries were not involved in the otherwise-global conversations represented by tweet flows (Twitter blog, 2011). In terms of development, cultural patterns of bonding equate to a lack of bridging in valauble bridging conversations on a global scale. 

Used with permission, created by @miguelrios with Twitter via 
In the post Web 2.0 world, Twitter alone offers an inroad for help-seeking behavior in one of the most vulnerable human conditions: natural disasters. Recall Banfield's (1958) amoral familism, the taboo bonders feel about accepting linking means of support and integrating with outside bridges into their homophilous communities--even when doing so is in one's own best interest. In Hurlbert's (2001) case study of bonded communities hit by a natural disaster, ussage of formal (linking) means of support, such as Medicaid and FEMA vouchers did not significantly go up, despite the severity of the impact on the community--showing the taboo at work. However, in more recent natural disasters hitting bonded communities in this same Southern US geographical region, Twitter-based support systems have flourished (Williams et al, 2012). Birkmann (2006) has documented that over 90% of natural disaster response is provided by lay members of the community--precicely why bonded communities take such a hit exhausting their resources. However, through Twitter, the taboo against outside help seems to be lifted. In the constructs of social network theory, contributing information about the disaster system on Twitter allows bonders to safely become bridgers, whereas the traditional, hierarchical response system forced bonders to accept outside linking interaction to get assistance. 

Bonding and bridging behaviors are fluencies that can compete with each other in terms of norms and values. An individual from a bonding network, when given a tool for bridging, still requires the fluency to use it to form heterophilous connections. Technology-enabled, community-based health interventions that select for diversity, as opposed to heterophily, ie, poverty, offer a promising strategy for increasing bridging networks. This tactic attracts participation in groups for a common goal, for example, skills workshops, and creates relationships as a positive externality. George Rupp of IRC has often spoken about the seemingly magical benefit group-based program design can have for health and well-being outcomes. Creating a new fluency in bridging relationships may be the mystical cause Rupp was observing. A predominance of bridging in one's social network has until now been associated with cosmopolitanism, higher education, and younger age. Online social interction itself effects a fluency in bridging.

In itself, the intervention of teaching people how to bridge, or creating fluency in bridging is a fundamental capacity-building objective that can stretch far beyond more standard, vertical interventions. 

Via bacigalupe
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Social Networks in Health Care | JAMA: The Journal of the American Medical Association | Social Networks in Health CareSo Much to LearnSocial Networks in Health Care

Social Networks in Health Care | JAMA: The Journal of the American Medical Association | Social Networks in Health CareSo Much to LearnSocial Networks in Health Care | How do eHealth start-ups add value to Health Systems? |

Because many of the policy changes now under way in the US health care system are intended to foster collaboration and improve coordination among physicians, understanding physician social networks will be important. In this editorial, JAMA provides a brief overview of the report by Landon et al, explain its relationship to other work, and discuss the potential importance of deepening the understanding of social networks in health care.


The study by Landon and colleagues uses data on the connections—intentional and unintentional—created by shared patients to describe the structure of the networks that connect physicians in a diverse sample of US hospital referral regions (HRRs). The authors suggested knowledge of these natural social networks may be useful to those striving to improve coordination, such as payers forming accountable care organizations (ACOs) or hospitals worried about readmissions.


Many of the policy reforms now under way—episode payments, the patient-centered medical home (with its emphasis on care coordination), and ACOs—are intended to address these problems. At their core, these reforms are social innovations. The explicit intent is to encourage collaboration among physicians, other clinicians, and hospitals to improve care not only for individual patients (by coordinating the care delivered by multiple clinicians across space and time) but also for populations (by developing shared clinical pathways that ensure the best possible care for patients with specific health problems).

Via Joel Selzer
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