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Report From The Field
Take Two Aspirin And Tweet Me In The Morning:How Twitter, Facebook, And Other Social MediaAre Reshaping Health Care
Patients and pioneering medical practices show it can be done.
by Carleen Hawn
ABSTRACT:
If you want a glimpse of what health care could look like a few years from now,consider “Hello Health,” the Brooklyn-based primary care practice that is fast becoming anemblem of modern medicine. A paperless, concierge practice that eschews the limitationsof insurance-based medicine, Hello Health is popular and successful, largely because of  the powerful and cost-effective communication tools it employs: Web-based social media.Indeed, across the health care industry, from large hospital networks to patient supportgroups, new media tools like weblogs, instant messaging platforms, video chat, and socialnetworks are reengineering the way doctors and patients interact. [
Health Affairs
28, no. 2(2009): 361–368; 10.1377/hlthaff.28.2.361]
I
f you want to get a
glimpse of whathigh-tech health care could look like onedayintheU.S.,sayhelloto“HelloHealth.”Or better still, e-mail Dr. JayParkinson,32,orone of his three clinical associates who runthis small primary care medical practice outof sleek offices in Brooklyn, New York. Oreven better, you can instant message (IM) orvideochat with Dr. Parkinson online throughHello Health’s slick Web site.
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It’s a privateandsecuresocialnetworkthatisthecoreme-dium through which this new-age medicalpractice manages itself and stays in touchwith its patients.Want to know more about your HelloHealth doctor? Read about the personal inter-ests of the practice’s partners on theirFacebook-inspired profile pages. Dr. DevlynCorrigan, Hello Health’s emergency medicinespecialist, does a little comedy improvisationon the side. One of his favorite movies is
CoolHandLuke.
Dr.SeanKhozin,aninternist,enjoys“downtempo” jazz and mountain biking.
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Now let’s say you’re one of the 300 patientswho’ve so far signed up to be part of HelloHealth’spractice,forabasic“enrollment”feeof $35 a month. You’ve also developed a fever and wheezing that haven’t gone away for severaldays. You could send Dr. Khozin an IM overthe Hello Health network describing yoursymptoms and asking him for advice. A quicke-mail from Dr. Khozin would be free, but if a“cyber-visit” like this takes longer, that will be$50 to $100, please. If you need to come in tothe office for a consultation, you’re guaranteed one within twenty-four hours. For as little as
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DOI 10.1377/hlthaff.28.2.361
©2009 Project HOPE–The People-to-People Health Foundation, Inc.
CarleenHawn(carleen@carleenhawn.com)isabusinesswriterbasedinSanFrancisco,California.Herworkhasappearedin
Forbes,Fast Company,Business2.0,Outside,SanFrancisco,
and
Ode
magazines,among othertraditionalandnewmediapublications.ReportfromtheFieldistheproductofapartnershipbetween
HealthAffairs
andKaiserHealthNews,aprojectoftheKaiserFamilyFoundation.
 
$150, a doctor will even come and see you atyour home. Generic medications for acuteproblems, as well as lab tests that can be donein the clinic’s offices, are free.Ineffect,HelloHealthisoperatingasakind of “concierge” practice. Health insurers typi-cally don’t pay for “visits” over the Internet,which is just one reason the practice does notaccept health insurance (although patients arefree to submit bills to their insurers on theirown). Opened in August 2008, Hello Health isless than a year old, so there’sno guarantee that this busi-ness model of a primary carepractice will succeed. Butclearly many patients and doctors alike are betting thatthis type of practice is theway to practice medicine.More than 300 patients havealready enrolled, and demand has been so brisk that thepracticeopeneditssecondof-fice,inManhattan’sGreenwichVillage,inFeb-ruary 2009.A privately funded venture owned by a Ca-nadian holding company called Myca, HelloHealthiscurrentlymakingmoneythroughpa-tients’ monthly and per visit office fees and byselling customized versions of its communica-tion platform to corporate clients. Later thisspring it will add a third revenue stream. Thepractice will open its network platform toother physicians operating at private practicesor hospitals across the country. Doctors willbe able to join the network for free, and thenuse the same scheduling and patient commu-nicationtechnologythatHelloHealthhaspio-neered in its Brooklyn practice. In exchange,Hello Health will collect a small percentage of their office visit fees. Hello Health will add asocialnetworkingfeaturetothenewplatform,too, so doctors can “friend” each other, add totheir arsensal of referrals, or just communicatetohelponeanotherout.“ThinkofitasanEHR[electronic health record] linked with a socialnetwork,” says Dr. Parkinson.
An ‘Evangelist’ For A New Model
Dr. Parkinson, who no longer actively seespatients, describes his role at Hello Health as“more like the company evangelist.” Onemight say he is trying to do for the health careprofessionwhatSteveJobsdidforthepersonalcomputing industry throughout the 1980s and 1990s: trying to convince his peers that theycanbuilda“bettermousetrap,”onethatissim-pler and more elegant and, above all, one thatfacilitates a better experience for users—if they would only “thinkdifferent.”Onhispersonalweblog, ininterviews, or in conferencespeeches—to anyone withinearshot who will listen, re-ally—Dr. Parkinson passion-ately argues his case thathealth care, too, can be a sim-pler, more elegant, and morefulfilling experience for phy-sicians and for patients.
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“Our profession, at its core, is fundamen-tally flawed relative to how today’s world communicates and functions,” he says. “Theinfrastructure of health care needs a total re-pair from the ground up. It needs to beFacebook-ed [and] wiki-ed.”
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After all, at theheartofhealthcareiscommunicationbetweencliniciansandpatients,somethingmostofU.S.health care is still conducting with the tech-nologies of the twentieth century at best. Bycontrast, he says, Hello Health is using today’stools,“enablingthecommunityofpatientsand doctors to communicate better.”
Transformation Of MedicalPractice
Although health care may be one of Amer-ica’s leading industries in terms of size and scope, it’s been among the slowest to embraceadvances in communications and informationtechnology (IT). But along with EHRs and other IT systems, so-called social media toolsare becoming a presence in health care atlast—and transforming it in the process, saysfamilyphysicianTedEytan.BasedinWashing-
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“Dr. Parkinsonpassionately arguesthat health care canbe a simpler, moreelegant, and morefulfilling experiencefor physicians and forpatients.”
 
ton, D.C., Dr. Eytan works with the CaliforniaHealthCare Foundation and serves part timeasmedicaldirectorfordeliverysystemsopera-tions improvement for the Permanente Feder-ation, which exists to provide support to thePermanente Medical Groups across the coun-try.Heisaleadingnationalexpertintheuseof technology to promote patient-centered care.
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Acrossthecountry,atlargeintegratedsystemslike Kaiser Permanente or the Palo Alto(California) Medical Group, Facebook-likephysician profiles and securee-mail messaging are increas-ingly the norm. Members of Kaiser’s EHR, My HealthManager, can even read phy-sician-authored blogs. Else-where, disease sufferers cancompare care options and outcomes through social me-dia platforms such asPatientsLikeMe; physicianscanshareinsightsaboutmedicineandspecificcases at Sermo, an online community oftencalled the online equivalent of a doctors’lounge.
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Investors’ reactions.
Even in these be-leagueredeconomictimes,investorsaretakingnotice. According to DowJones Venture One,which tracks venture capital investments intechnology startups, nearly $900 million wasinvested in software and technology servicesfocused on health care in 2007, the latest yearfor which data are available.Asmuchasthesetechnologiesexciteinves-tors, however, they plainly trouble others.There are growing concerns about guardingthe privacy of patients’ health information,since social networks, by definition, facilitatecommunication among many parties simulta-neously. In addition, social networks depend largely upon user-generated content. So asmore “members” join social networks, com-munication channels grow exponentiallymore diffuse, and the possibility of spreadinginaccurate or problematic information, or in-formation that should remain private, growsright along withthat. Just as theability to col-lect and disseminate information quicklyamong large numbers of people simulta-neously gives social networks their power, itrenders “command and control” of that infor-mation far more challenging.
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Legal issues.
Already the first lawsuitshave been filed against physicians whom pa-tientsaccusedofviolatingtheprivacyofmedi-cal information, notes attorney RobertCoffield, a West Virginia–based specialist inhealth care compliance and regulatory law.Others, including some physicians, worry thatInternet-based communica-tion can never adequatelysubstitute for the in-personexam—and point out thatstandards have not yet beendeveloped to govern this typeof “care.” What’s more, manyindependent practitioners orsmall group practices don’tappear to have the time or themoney to adapt to the use of social media. Unless and until this changes—and it becomes demonstrable that moderniz-ingphysicians’practiceswithsocialmediaand other e-health tools is in their financial inter-est—the lack of protocols and insurance reim-bursements will be a clear barrier to thesetechnologies’ growth.
Sorting Through The Terminology
Still,theuseofsocialmediaisclearlyontherise and is likely to become an increasing factoflifeformillionsofAmericans.AccordingtoaDecember 2008 survey by the Pew Internetand American Life Project, the share of adultInternet users who have a profile on an onlinesocial network has more than quadrupled inthe past four years—from 8 percent in 2005 to35 percent in 2008.
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Drs. Eytan and Parkinsonand other advocates of social media in healthcare use a variety of social media routinely—and, in the process, draw on a technologicallexicon that would leave most modern-dayLuddites thoroughly befuddled.Naturally, all of them “blog” on a personalweblog,adigitaldiaryforchroniclingpersonalor professional experiences or for sharingnews and commentary. Often embellished 
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“Many independentpractitioners or smallgroup practices don’tappear to have thetime or the money toadapt to the use ofsocial media.”
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