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Social Media in Anesthesia Practice Thomas S. Davis, CRNA Chief CRNA, Scott & White Medical Center Main OR [email protected] I think that email will explode in the future Bill Gates, 1992 Agenda

Types of Social Media Current use Future use Dangers Developing a policy Developing your own personal social media. What is Social Media? Social media refers to the means of interactions among people in which they create, share, and exchange information and ideas in virtual communities and

networks. Internet based applications Allow creation and exchange of user generated content Use mobile and web based platforms Allows real time exchanges of information within and between individuals and groups Importance of Social Media 51% of people aged 2534 used social networking in the

office, more than any other age group People continue to spend more time on social networks than any other category of sites20% of their time spent on PCs and 30% of their mobile time As of 2012, Facebook has 152,226,000 unique PC visitors and 78,388,000 unique mobile app visitors. Twitter reported 37,033,000 unique PC visitors and 22,620,000 unique mobile app visitors. Total time spent on social media in the U.S. across PCs and mobile devices increased 37 percent to 121 billion minutes in July 2012, compared to 88 billion in July 2011 Social Media Report, 2012, Nielsen, http://blog.nielsen.com/nielsenwire/social/

2012/ Comparison Published Media Social Media Quality standards by Quality determined by publisher

Subscription / Mailing Production is complex Time lag between creating and publishing Once printed can not be altered individual Available world wide Can be posted immediately Can be altered instantly

Web Based Traditional Web Sites URL identifies the type of site .com / .edu / .net / .gov /.org Share information with a public or private group Marketing

Product information Sales Social Mobile Devices Devices that connect to the internet or to each other using traditional internet technology or mobile apps. Phones Pads

Notebooks Wireless laptops Allow real time access to information in any location Twitter was created in March 2006 by Jack Dorsey and by July, the social networking site was launched. Over 500 million registered users as of 2012 Generates over 340 million tweets daily Handles over 1.6 billion search queries per

day Gossip or Useful Tool? Twitter may either be the greatest prank ever played on the internet community or it may be the best thing since sliced bread Phil Baumann, 140 Health Care Uses for Twitter http://philbaumann.com/2009/01/16/140-health-care-usesfor-twitter/ Health Care Uses for Twitter Epidemiological survey

Disaster alerting and response Emergency response team management Supportive care for patients and family members Alarming silent codes (psychiatric emergencies, security incidents) Biomedical device data capture and reporting Medical service collaboration in the clinical setting Triage management in emergency rooms Publishing health-related news Health Care Uses for Twitter

Reporting hospital staff injuries Reporting medical device malfunctions Product safety alerts Pain management Patient-sharing of health-related experiences Post-discharge patient consultations and follow-up care Discussing HIPAA reform in the age of microsharing Recruitment of health care staff Monitoring of Social Trends

We analyzed over 500 million Twitter messages from an eight month period and find that tracking a small number of flurelated keywords allows us to forecast future influenza rates with high accuracy, obtaining a 95% correlation with national health statistics. Aron Coulotta, Columbia University Library West, Texas

Facebook Launched in 2004 As of September 2012, over 1 Billion users Over half use mobile devices User must register and create a profile May join user groups A National Cross-sectional survey of social networking practices of U.S. Anesthesiology Residency Program

Directors A. Barker et al, Journal of Clinical Anesthesia 2012 Social media is a staple of American culture especially among younger generations. Users are able to generate content Professional and personal lives can become blurred Patient confidentiality can be compromised Only 30.3% of Residency Programs have Social Media Policies

The Intersection of Online Social Networking with Medical Professionalism Thompson, LA et al, J Gen Intern Med 2008 Among Medical Residents 44.5% Frequently use Facebook 83% of accounts had personally identifiable information 70% of accounts describe alcohol use or excessive drinking.

NEJM August 13, 2009 In confirming this patient as my friend on Facebook, I was merging my professional and personal lives. From my Facebook page, Ms. Baxter could identify and reach anyone in my network of friends, view an extensive collection of personal photographs, read my personal blog, and review notations that others had left on my wall.

Facebook in Medicine Communication Colleagues Patients Education Pre/Post-Op Instruction DOS Informaton Marketing Services

Billing Caution: HIPAA Violations Must protect patient information and dignity Revealing Personal Information Becoming a distracted Healthcare worker. Violating Institutional policies and trademarks

Common Sense Dont discuss patients, even in general terms; its not that hard for John Does friends to figure out who it is. Do talk about conditions, treatments, research and best practices without identifying patients. Identify yourself. Anonymity breeds bad behavior. Dont post online anything you would not say in the elevator.

Use separate accounts for your personal and professional lives. Dave Ekrem , The manager of web development and social media for MassGeneral Hospital for Children When Your Fingers do the Walking, Where do they Walk? Education The more we use social media the

more we understand it Youtube can be a very valuable classroom aid. Pre-recording the key points and references allows students to prepare for class USA Today 3/14/12 PreOp.com

503 YouTube videos All aspects of Surgery are presented Pre-op anesthesia teaching Interview General Spinal / Epidural OB

Patient Education The main reason I wanted to do this was for the educational possibilities. I spend a lot of my time with patients on what to expect and what the steps are, Kim said. A lot of anxious patients want to know exactly

what happens. With this they will be able to see what happens. http://www.huffingtonpost.com/2012/05/08/houston-hospital-live-tweet-brainsurgery_n_1500751.html Visalia California Hospital District District ordered 100 iPads for employees X-Ray images ECG Patient monitoring "This is going to make my day easier and

patient safety better," Roger Haley, a kidney specialist at the hospital, said in an interview with a local ABC News station. "Now, I don't have to find a workstation to do what I need to do; I do it right there, right then, right now." http://mashable.com/2010/04/21/hospital-purchases-100-ipads/ Steps You Can Take to Secure Your Mobile Devices Draft a Mobile device policy Who may access Which information may be

accessed Which devices may be used Follow organization's policy List specific security requirements Know your IT security officer Steps You Can Take to Secure Your Mobile Devices

Physical security mobile" devices are mobile Guard laptops, pads, phones Protect screen in public area Passwords Password protect your device Use unique password Protect your passwords Steps You Can Take to Secure Your Mobile Devices

Auto logoff or timeout will lock the device after a set time of no activity Information storage Need higher level of protection if on device Information tends to be more current when NOT stored on device Stored information requires

backup on a server Remote wipe Enables erasing of hard drive if device is stolen In The Operating Room Books Specialty apps Pediatric Cardiac Pharmacology

Patient education Patient information Mobile Books Millers Anesthesia ipad app Textbook of Regional Anestehsia Kindle app Anesthesia Comprehensive Review iPhone App Unbound Medicine

About 20 books / apps related to anesthesiology Favorite Anesthesia apps Epocrates Drug reference Anatomy Drug reference Cardiology Dosage Anatomy flash

Interactions cards Mobile Resource Center Pregnancy and Diseases Baby Alerts development Medical spanish Epocrates Drug Information

Drug Interactions Mobile Sample Closet Pill ID Tables/ Calculators Extras Favorite Anesthesia apps Pedi Safe Color coded

Weight based drug dosage Anesthesia tube sizes Emergency drugs Pedi Safe Favorite Anesthesia apps Draw MD Common templates Draw with your

fingers Save or email DrawMD ABEO Coder Search by Keyword Type procedure names, words or phrases to find associated codes. Search by Category Choose to search by category under CPT, ASA and ICD codes.

Save Favorites Save your favorite codes so you can access them conveniently without searching again. Code Identifiers Identifier icons appear to indicate the code attributes. (i.e. male specific, female specific, maternity, starred, unlisted) Average Billable Time View average billable time for each procedure. Whats the Risk?

Patient Privacy Distracted Workers Infection Control Infection Control Devices go room to room with worker Common Organisms MRSA

Klebsiella E. Coli Stapy Aureus Seth Kankel Anesthesiology News June 2011 http://www.anesthesiologynews.com/ViewArticle.aspx? d=PRN&d_id=21&i=June+2011&i_id=737&a_id=17422 Distracted Workers You justify carrying devices around the hospital to do medical

records, he said. But you can surf the Internet or do Facebook, and sometimes, for whatever reason, Facebook is more tempting. Matt Richtel, NY Times Dec 14, 2011 http://www.nytimes.com/2011/12/15/health/as-doctors-use-moredevices-potential-for-distraction-grows.html?pagewanted=all&_r=0 Distracted Workers The proliferation of

portable electronic devices, smart phones, tablets, and the like, are driving the attention of health professionals away from patients. KEVIN PHO, MD | KEVIN'S TAKE | DECEMBER 15, 2011 http://www.kevinmd.com/blog/2011/12/solving-distracted-doctoringsmartphones-tablets.html? utm_medium=twitter&utm_source=twitterfeed&goback= %2Egde_3996488_member_85860152

55 percent of technicians who monitor bypass machines acknowledged to researchers that they had talked on cellphones during heart surgery. Half said they had texted while in surgery. Were encouraging more doctors to use point of care apps, which, in theory, should benefit patients. But unaccounted for is the fact that smartphones and tablets carry many other functions that are non-clinical like Facebook

Distracted Healthcare Workers The neurosurgeon made at least 10 personal calls on his cell phone during the operation. Half of heart-monitor technicians say they've texted during surgery. Hospitals that employ distracted doctors could also face lawsuits.

Lawyers Know Your Distractions From Lawyers.com Why does anyone carry a cell phone into an operating room? The patient on the table deserves the undivided attention of everyone in that room. Were dismayed by reports that say doctors, nurses, technicians and others providing medical care are spending too

much time focused on smartphones, computer screens and other devices when they should be paying attention to their patients. From Lawyers.com Were not against the use of electronic devices for delivery of medical records or even personal communication, but it is absolutely crucial that a focus on the patient is not dropped from the accepted

standards of medical care, Will future malpractice policies include restrictions on use of mobile devices while providing patient care? Social media Internet email Facebook / Twitter Texting Social media is fertile ground for

employment / credential background checks!! Social Intelligence Corporation Background checks Internet presence Social Media activity Follow pre-defined criteria Report negative

material Racist comments Explicit pictures / videos Illegal activity Should I be Invisible on the Internet? Most people can be found Being invisible makes you odd

A large internet footprint with positive information is the best option. Patients Employers I Flunked My Social Media Background Check. Will You? Google recently purchased PittPatt (Pittsburgh Pattern Recognition) a

facial recognition technology company. Now no one knows what they will do with this technology, but if Google employs it to the levels in which they normally embark on projects (think Google Earth, Google Maps, the largest online library, etc.) one can envision a future where Google can search the Internet looking for pictures and not text. Article Source: http://EzineArticles.com/7053576

Rules are emerging Labor laws protect employee rights water cooler talk is allowed in the workplace Discrimination is NOT allowed in the workplace Age Gender Religion Sexual preference Physical conditions

Social Networking Is an Extension of You - Why What You Post Can Haunt You for a Long, Long Time! Have a non decision maker screen the social media and present ONLY the material that is legal and pertinent. Your patients dont have to follow any rules related to media searches!! Protect your Internet Reputation

Clean up your social media. Have a large Internet footprint Professional Personal A National Cross-sectional survey of social networking practices of U.S. Anesthesiology Residency Program Directors A. Barker et al, Journal of Clinical Anesthesia 2012

Departments should have a written policy related to social media use Leaders should become familiar with professionalism issues related to social media Anesthetists should be mentored in the ethics of social media Social Media Policy Why you need a Social Media Policy Sets standards for developing social media

Institutional trademarks, copyrights, policies Establishes guidelines for social media use Who, when, where Ensures patient privacy Compliance with HIPAA regulations Protects healthcare workers from legal

claims Your practice must follow institutional policies AANA Position Statement Number 2.18 Mobile Device Use Advocates of mobile handheld devices cite enhanced productivity and mobility, improved information access and

communication, higher quality care, and reduced medical errors. User friendly tools that improve mentorship through increased communication, provide easy access to medical references and guidelines, and increase accessibility to medical apps that can guide clinicians during direct patient care. AANA Position Statement Number 2.18 Mobile Device Use

Certified Registered Nurse Anesthetists (CRNAs) have an ethical responsibility to provide safe patient care by avoiding nonessential distractions. The AANA supports the use of mobile devices as established by institutional policy for patient-related communication among members of a patient care team CRNAs should avoid the unnecessary use of these tools when delivering anesthesia care services.

AANA Position Statement Number 2.18 Mobile Device Use concerns related to mobile device use in the OR are bacterial contamination and interference with medical equipment. little data is known about the prevalence of smartphone use for nonclinical purposes and its impact on clinician vigilance and patient care AANA Position Statement Number 2.18

Mobile Device Use Inappropriate use of social media, such as posting patient protected health information or photographs/videos on social media sites, blogs, or discussion boards, can violate federal and state laws Healthcare employees should be aware that breaches in confidentiality may result in civil liability to patients, job loss, disciplinary action by state licensing boards, and even criminal investigations and sanctions.

Creating Social Media Individualize for user preferences Involve the user by engaging conversation Integrate your content into the users life Initiate user generated content If you love something, let it go mobile: Mobile marketing and mobile social media 4x4, Andreas Kaplan, ESCP Europe, 79 Avenue de la Rpublique, F-75011 Paris, France

Social Media? Patients Expect it! Patient Driven Healthcare Email clinicians Review patient instructions Review lab reports Request appointments Receive personalized health reminders Review current medications Request prescription renewals Review health history

Should You be Using Social Media? How much time do you have available? Creating your own site takes time and skill Personal web site Facebook account / page Participate in discussions on existing sites Use format in existance Participate in dialogue

Anesthesia Business Consultants http://webicina.com/anesthesiology/%20#hcsm Who do You Want to Communicate With? Different messages and formats for different groups General public Your work group Colleagues Patients and Families

Your target audience will help select the best format. What Do You Want to Tell Them? Basic information about services Building your brand and/or image Patient education Pre-op instructions General information about anesthesia

Staff information Schedules / meetings Policies/procedures Equipment Do You Want them to Answer? Two way interaction increases interest Survey Blog Current topic with comments welcome

Open format versus monitored comments. Can You Ensure Privacy? HIPAA compliance is essential Always get consent before posting patient information Patients may submit their own posts which reveal protected health information January 2013 HIPAA regulations include stiff penalties for violation of patient rights to privacy.

HHS office of Civil Rights enforces HIPAA regulations. Embrace and Use Social Media to Your Advantage Vast amount of information in your hand Enhance communication Within your group With your patients Always put patient needs first Safety

Privacy Follow established rules for the use of your device Social Media in Anesthesia Practice Thomas S. Davis, CRNA Chief CRNA, Scott & White Medical Center Main OR [email protected] www.procrna.com

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