And Its Confluence with Integrative Medicine, Outcomes and the American Recovery & Reinvestment Act

SM_logosIn the last 24 months, the rapid of adoption of social media elements by organizations of all kinds has started to gather up hospitals, where Twitter, Facebook, LinkedIn, YouTube and flickr are becoming the engagement tools of choice.

Apart from reaching hospitals via those social media paragons, consumers have long been using web-based online support groups or patient communities, some designed for mutual support (“Pregnancy & Parenting Support”), others organized around research or clinical trials (“The Children’s Inn at NIH”), all of them completely patient-centric.

The rationale for these actions is by now simple to understand: the number of people using social media sites is huge and growing. The children of Baby Boomers will outnumber their parents by 2010; and 96% of them use social media (which no doubt explains why the fastest-adopting segment in Facebook is women over 55).

Institutions in the integrative health and medicine community are slowly adding themselves to this matrix. NCCAM added its Twitter account in September (and is currently being bombarded there by skeptics as a result of posting its request for public input for its new Five Year Plan).

Twit_IM-List

 

 

A few integrative organizations and people with a Twitter presence:

@OregonCIM
@Deepak_Chopra
@DeanOrnishMD
@BrianBermanMD
@SpeakHealth
@Bastyr
@DrOz
@FMJournal
@AZCim
@UCSFOsher
@CDC_eHealth
@MarkHymanMD
@NIMHgov
@NCCAM

(I have added these and others to a couple of Twitter-based lists; see the links below.)

While the integrative community is just stepping into social media, the medium’s value in health care is being reinforced every day. Recently, Rohit Bhargava, at Ogilvy, 360 Digital Influence wrote a good summary of hospital use, “How Hospitals are Leading the Way.” He points out several instances in which social media have connected staff and the patient community, to the benefit of the institution. For instance:

  • Doctors at Henry Ford Hospital used Twitter to connect with more than 1,900 people to answer tweeted questions during actual brain surgery.
  • A cancer surgery patient at Nebraska Medical Center shared her experience via YouTube generating so many requests for the surgery that NMC opened a monthly clinic in response to demand.

mayo_pianoThe exemplar for hospital social media has to be the Mayo Clinic, where Lee Aase, manager of media relations, is thoughtfully and aggressively (and inexpensively) setting a no-going-back standard.  (If you view his presentation,  link below, you’ll see how social media took the gentle, serendipitous moment in a facility lobby and created the granddaddy of “marketing that money can’t buy” examples for Mayo.)

Trend One, Meet Trend Two

This adoption of social media by hospitals is likely to have more far-reaching consequences than improving communications with and among the primary stake holders in a hospital’s serving area. That trend is now blending with another one that is becoming part of care for many hospitals:

The integration of complementary integrative therapies like acupuncture, therapeutic massage and yoga, among other approaches (i.e.: healing gardens).

The critical factor behind the emergence and convergence of these trends:

They are being driven by a single common force: consumer decisions.

In the age of patient-centered health care, self-healing, behavior-centric health plans, individualized health care and posting your DNA on the web, social media moves the individual closer to the center of the conversation, where, coincidentally, he or she already resides in the minds and practices of integrative care practitioners.

The convergence of these trends is only just starting to be observed:

  • The American Hospital Association reported in the fall of 2008 that 38% of its surveyed hospitals were providing some form of integrative therapy.
  • Ed Bennett’s Hospital Social Network List stood at 410 institutions as of Oct. 27 (up from 0 in the fall of 2006).

(Where do those overlap?  We’re building the list, which we’ll post here. If you are with a hospital on Ed Bennett’s list and are also providing CAM/IM services, please let us know!)

The primary effect of adopting these social media elements for the hospital is to bring consumers deeper inside the confines of the institution, and thus closer to the care conversations that affect their decision making. Their experiences, expectations and demands are coming with them, including those from outside the hospital campus and the offices of their primary physicians.  Today, the reluctance of MD and patient to discuss alternative choices may remain, but given these trends, and other non-digital efforts to encourage openness, it is hard to see how that barrier can stay in place.

All this and Comparative Effectiveness Research too?

What’s in an Outcome?

The potential of these trends to reinforce each other is not trivial. Those hundreds of thousands (millions?) of Americans who have taken their illnesses and unresolved pain to non-conventional CAM and holistic practitioners in the last 20 years, and who have found relief if not resolution that had been unavailable from conventional care, have established a deep and tangible history of beneficial outcomes, at least as determined by themselves and their practitioners.

As a matter of rigorously established evidence, that experience may be easily dismissed as a kind of placebo backwater. But another factor is emerging from the murk of the health care reform debate that could change the molecular structure (so to speak) of Outcome. The integrative medicine research community is moving into into a more active role in defining how CAM and IM approaches should be treated in forthcoming Comparative Effectiveness Research (CER) assessments. The objective is to create the justification for the inclusion of specific practices in the care remuneration regime.  And so: to cover their patients.

They would establish long established, well understood and commonly experienced integrative care outcomes as evidentiary factors as valuable for defining efficacy,  and thus a place in health plans, as positive results are for RCTs.  One could hardly ask for a higher hurdle.   But we’re not running on a cinder track any more.

CER_coverThe Committee on Comparative Effectiveness Research Prioritization organized by the Institute of Medicine formulated the priorities for the CER program and appears to have left a door ajar.  At a recent gathering of integrative researchers and CER professionals, the co-chair of the IOM’s priorities committee pointed to one unique element of the CER program :

      • A focus on patient-centered decision-making.  Tailor the test or treatment to the specific characteristics of the patient.

(For the IOM’s CER report, click here.)

The CER program description acknowledges the problems, but also the value of “prospective observational studies,” an imperfect option compared to random controlled trials (RCTs) that historically define medical research.  “Although RCTs are considered the gold standard of evidence,” the committee wrote, “they have shortcomings.”  Of the 100 primary CER research priorities selected by the IOM committee in June, 49 are RCTs.

For CAM practitioners who apply whole-person approaches that don’t fit neatly into RCT constructs, and for whom positive, efficacious outcomes can be described and, more importantly, experienced by their patients, this accommodation of non-RCT evidence shines a light on a seriously long list of outcome-based CAM encounters.

Those encounters can be drawn from almost every community in the nation, where the word-of-mouth that still drives consumer CAM use is now amplified by Facebook fan pages, tweets about patient meetups, and videos of patient testimonials, all becoming part of local health and wellness communities, where you may find, perhaps surprisingly, your local hospital.  And if it is providing CAM services, it may be adding its own record of such encounters and their outcomes.


While the forgoing might be described as a collection of barely connected dots bouncing around the healthcare landscape, and they may never really connect, I’m sure I’ve seen this before.

In the early 1990’s, Internet adherents often explained the extraordinary growth of the net (even before there was a World Wide Web) by saying simply: “It’s the network effect:”

“The more there are, the more there are.”

In health care, the net effect is running at full force.

And the more there will be.


Resource Links

Online Support Groups mentioned (at http://www.inspire.com; there are many others)

If You Use Twitter

Some hashtags (topics) to follow:

#hcsm – health care social marketing
#hcmktg – health care marketing
#integrativemedicine
#wellness
#prevention
#alternativehealth

A General Social Media Overview

qualman_GenY

Click the image for Erik Qualman’s impressive, and musical, assembly of social media growth stats.

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