American Health Lawyers Association Annual Meeting June 27-29, 2011 Boston, Massachusetts Robert L.

Coffield Flaherty Sensabaugh Bonasso PLLC

How to Use Social Media with @BobCoffield

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Social Media Introduction

Social media has changed the social fabric of the world and continues to transform the way we communicate. Similar to the impact which Gutenberg-style printing had on the availability and affordability of the printed word, social media tools, mobile-based applications, and technology are having a similar impact in today’s world. Social media has transformed the way we communicate. Social media played a significant role (or not) in the revolutions and revolts earlier this year, and as one Cairo activist stated, “We use Facebook to schedule the protests, Twitter to coordinate, and YouTube to tell the world.” Why do lawyers need to understand and use social media and its related technology tools? Answer: Social networking is what lawyers do everyday. Lawyers are communicators and we should be comfortable using social media tools that allow for more efficient and better communication. Social networking is not a new concept -- it is exchanging business cards, networking at AHLA receptions, taking clients on golf outings, sharing articles for publication, and helping people and businesses everyday. Communication is transforming from the "industrial media" age where traditional media resources such as newspapers, television, and film, which require more significant resources to create and publish controlled, to a new "social media" age. A social media age where we can instantaneously share, discuss, publish, and analyze text, photos, and video using social media tools. Social media allows anyone to create and disseminate information, ideas, and experiences and communicate quickly and efficiently using low cost and highly scalable web based technology. Traditional industrial media is not democratic and is broadcast from one to many. Social media supports a dialogue among many and transforms content consumers into content producers. Social media and user-centric technology is moving us toward another revolution. We have moved from the industrial revolution to a digital revolution and are now moving toward a “data revolution.” Each of these revolutions has been driven by innovations. Whether it is the steam power, iron making, or automobile assembly line of the industrial age or digital circuits, personal computer, or smart cellular phones of the digital revolution. Today’s social data revolution began

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with the rise of social networks and innovations such as blogging, RSS, geolocation, Craigslist, YouTube, Flickr, Facebook, and Twitter. The result has been incredible amounts of social data being created, aggregated, analyzed, visualized, and studied. This data revolution leads us to the semantic web where the web starts to understand the semantics of the vast amounts of data and information. The impact of the data revolution is no clearer than in the health care industry. The meaningful use of health data and technology has become the focal point of our future health care system. We can all debate about the intent and outcome of the new health care legislation but it has set us on a path focused on the data and using data for innovation. The social data revolution has given rise in the health care environment to health 2.0, participatory medicine, e-patients, quantifiable self, and other similar consumer focused health care technology and efforts. As a result, our health care system in the United States is being primed for a social media driven revolution brought about by millions of American consumers who want more from the health care industry hairball. Using technology, data, and social media to force behavior change, improve health through self-monitoring, and focus on health prevention and management is becoming a large part of the health care ecosystem. 2. Web 2.0, Health 2.0, and Health Care Social Media A. Web 2.0

Web 2.0 is a perceived or proposed second generation of Internet based services—such as social networking sites, wikis, RSS feeds, Facebook, Twitter, and other person to person communication tools—that emphasize online collaboration and sharing among users. Web 2.0 is a term used to reflect a social phenomenon that has grown over the past seven years centered around generating and distributing content that is characterized by open communication, decentralization of authority, freedom to share and reuse, and a market of conversation. Coined in 1999 but made popular in 2004 by Tim O'Reilly in his opening talk at the first Web 2.0 Conference. O'Reilly summarized the key principles of Web 2.0 applications as: the web as a platform, data as the driving force, network effects created by an architecture of participation, innovation in assembly of systems and sites composed by pulling together features from distributed, independent developers ("open source"), lightweight business models enabled by content and service syndication, the end of the software adoption cycle (“perpetual beta"), and leveraging the power of The Long Tail. Looking back now on these key principles we can see that many of these have been accomplished as a result of the continued technology development around Web 2.0 ideals. B. Health 2.0

The Health 2.0 movement is centered around user-generated health care content using social software and cloud based technology tools, including health search, health communities,

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and tools for health consumers to collaborate with each other and health care stakeholders. Jane Sarasohn-Kahn of THINK-health defines Health 2.0 in The Wisdom of Patients; Health Care Meets Online Social Media as the power of collective wisdom to create value and the use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health. Others define it more broadly as a new concept of health care wherein all the constituents (patients, physicians, providers, and payers) focus on health care value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care. Online health social networking and software as a service ("SaaS") models harness the power of networking and collective intelligence to generate a new level of collective knowledge. The Health 2.0 movement along with the rise of social media, more consumer focused technology products, intelligent mobile devices, and other health care technology innovations is leading to a revolution from Health 1.0 to Health 2.0 and paving the way for the consumer health driven revolution. Health 1.0 Opaque System Passive Patient Physician Authority Hospital Institution Insurance Adversary System Generated Data Health Care Health 2.0 Open and Transparent System Engaged Consumer Physician Advisor Mobile Health Health Plan Advocate User Generated Data Health and Wellness

Below is a sample of some of the developing health care and technology companies in the Health 2.0 sector utilizing social media and social networking to generate health care data and connect patients, providers, and other health care stakeholders. Currently, those involved in the Health 2.0 effort are tracking over 1,200 different companies developing technology tools or devices that either directly or indirectly incorporate social networking features or infrastructure. Also, mobile health is a growing part of the market and iTunes now has over 5,900 health related applications for the iPhone and iPad. A recent article, The Doctor is In (and Using an iPad), reported that there has been a huge jump in the number of hours that physicians spend online and that a recent Manhattan Research survey found that 30% of physicians now have an iPad. Rock Health, a new seed accelerator for web and mobile health applications, has developed a start-up program to help turn health technology ideas into products and businesses. Rock Health’s mission is to enable and empower an entrepreneurial cure for the relative lack of

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innovation in the health care sector. Rock Health recently announced its first 11 startups for its inaugural accelerator program, including BrainBot (technology to improve mental performance)
 , CellScope (at-home diagnosis of diseases)
, Genomera (personal health collaboration), 
Health In Reach (medical procedure marketplace), 
Omada Health (clinical treatment social networking)
 , Pipette (patient monitoring and education)
, Skimble (mobile fitness), 
WeSprout (connecting health data and community)
, and three additional start-ups in stealth mode

. Following is a sample list of some of the technology and health companies that represent the Health 2.0 sector: PatientsLikeMe www.patientslikeme.com PatientsLikeMe is an online health community for patients with life-changing health conditions. PatientsLikeMe allows users to share their experiences with others patients struggling with conditions such as ALS, multiple sclerosis, Parkinsons, Epilepsy, HIV/AIDS, mood disorders, and organ transplantation. Keas www.keas.com Keas is a health and wellness company co-founded by technology innovator Adam Bosworth, the architect and former head of Google Health. Keas has developed a new corporate health and wellness solution that leverages “The Power of Play” in an online social game that delivers unprecedented sustained employee health engagement rates. Organized Wisdom organizedwisdom.com Organized Wisdom aggregates, organizes, and promotes online wisdom shared across the Web by more than 5,000 vetted health experts and advocates. Sermo sermo.com/ Sermo is the largest online physician community in the US. It’s where practicing US physicians—spanning 68 specialties and all 50 states—collaborate on difficult cases and exchange observations about drugs, devices, and clinical issues. Sermo is a real-time meeting place where physicians get help with everything from patient care to practice management. DailyStrength www.dailystrength.org/ DailyStrength is a collection of safe, anonymous, online support groups focused on over 500 specific challenges to help people overcome their personal challenge or support a loved one through theirs. DailyStrength isn't just for those living with a challenge themselves - care givers, supporters and medical professionals are welcome as well.

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ZocDoc www.zocdoc.com ZocDoc is a free service that allows patients to book appointments online for Doctors in New York City, Los Angeles, Washington DC, Philadelphia, Houston, San Francisco, Chicago, and Dallas. Doximity www.doximity.com Doximity is a private communication network for physicians and other medical professionals to (re)connect and share contact information. NextRoom www.nextroomapp.com NextRoom is an iPhone application for use by doctors and nurses allowing them to view, assign, and manage patient rooms to improve work flow. US Department of Veteran Affairs - Blue Button www.va.gov/bluebutton Blue Button allows Veterans to download their personal health information from their My HealtheVet account. The Veteran Affairs developed the Blue Button in collaboration with the Centers for Medicare and Medicaid Services, and the Department of Defense, along with the Markle Foundation’s Consumer Engagement Workgroup. Massive Health massivehealth.com Massive Health is a company still in stealth mode founded by Aza Raskin, the lead developer for Mozilla Firefox. Massive Health is described as dedicated to helping you live a healthier life and developing products that bring you joy while helping you understand your body. MedPedia www.medpedia.com The Medpedia Project is a long-term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body among medical professionals and the general public. This model is founded on providing a free online technology platform that is collaborative, interdisciplinary and transparent. MyMedLabs www.mymedlab.com MyMedLab is an online medical laboratory testing marketplace. Users are able to browse a wide array of medical laboratory tests, become informed on both the tests and diseases, and can purchase the medical lab test directly on the website. BodiMojo www.bodimojo.com

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BodiMojo is a health community web site for teens created in collaboration with teens and health experts, primarily geared towards minimizing teen obesity and other such reciprocal health factors. BodiMojo website features articles by both health experts and teens, a health search and other interactive tools, games, videos, contests, social networking, and customized user pages for teens. HealthyWage www.healthywage.com HealthyWage is a provider of health and wellness incentive programs. HealthWage offers a variety of challenges with cash rewards for free, as well as supersized challenges where users can invest their own money to increase their incentive and reward. Target clients are corporations seeking to encourage healthy lifestyles among employees, physician offices and gyms. SugarStats www.sugarstats.com SugarStats is a comprehensive tracking and diabetes management system for diabetics. A webbased self-management interface allows patients to track, monitor and access glucose levels, important diabetes statistics, and graphs to spot dangerous trends and better manage diabetic health. RateADrug www.rateadrug.com RateADrug provides user generated information on prescription drugs and their real world side effects. Users can enter their current medication list, identify potential interactions and side effects and learn about other treatment options available. RateADrug is not affiliated with, and does not accept sponsorship or advertising from any pharmaceutical groups or drug companies. RateMD www.ratemds.com Patient crowd-sourced information about physicians and dentists that allow you to search, rate, and provide your opinions. Tweet What You Eat www.tweetwhatyoueat.com Tweet What You Eat is a Twitter-based food diary that allows users to track their diet and weight through their mobile phone, Twitter, or the web. Tweet What You Eat provides a crowd-sourced calorie database which auto-fills uncaloried entries in member food diaries with the correct calorie values based on community submissions. Tweet What You Eat also provides a forum for members to seek and share diet advice. Healthymagination www.healthymagination.com Healthymagination is developing a variety of mobile health applications, including Stats of the

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Union, Morsel, I’m Expecting, and Patient Shuffle. GE created Healthymagination to gather, share and discuss health ideas. Their website is a source for learning of new and past projects that have been implemented including contributing partners. WebMD www.webmd.com WebMD is one of the best known health and medical content networks on the Web. It includes WebMD for consumers, Medscape for professionals, and WebMD Health Services, which supplies consumer tools and data integration services for health plans and employers. Zinc Software www.zincsoftware.com Zinc software is currently building health tracking software linked to social networking sites such as Facebook so that individuals and groups can track their health status. Enhanced Medical Decisions www.doublecheckmd.com Enhanced Medical Decisions publishes doublecheckmd.com, an interactive website allowing patients to screen for drug-drug interactions and determine whether symptoms they are currently experiencing might result from drug side effects. iPregnancy www.ipregnancyapp.com Designed by a practicing Ob/Gyn, iPregnancy is an iPhone application for keeping track of pregnancy. MealSnap mealsnap.com Meal Snap lets you take pictures of the meal you eat, and then tells you what food was in your meal. The application also estimates how many calories. Usable Health usablehealth.com Usable Health is a web-based technology that allows users to type in their food interest (including meal choices at specific restaurants) and immediately receive a replacement option that is healthier with fewer calories. FitBit www.fitbit.com The Fitbit is a connected health device that tracks calories burned, steps taken, distance traveled, and sleep quality. CureTogether www.curetogether.com

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CureTogether helps people anonymously track and compare health data to better understand their bodies, make more informed treatment decisions and contribute data to research. Currently users have contributed patient generated data on symptoms and treatment effectiveness on over 500 disease condition. American Well www.americanwell.com American Well has created an Online Care system that allows consumers to connect with physicians immediately, whenever they have a health need, from their homes or offices. The solution uses advanced Web-based technologies and telephony to remove traditional barriers to health care access, including insurance coverage, geography, mobility and time constraints. Online Care is growing and is currently offered by Blue Cross Blue Shield of Hawaii, Blue Cross Blue Shield of Minnesota, OptumHealth (a business of UnitedHealth Group), TriWest Healthcare Alliance and Wellpoint. athenahealth www.athenahealth.com Athenahealth is a publicly-traded provider of practice-management and revenue cycle management solutions (athenacollector). It also supplies an EMR solution (athenaclinicals) and a patient communication system (athenacommunicator), all based on its web based EMR system, athenanet. Skinsight www.skinsight.com Skinsight provides information, images, and Q and A with physicians about skin diseases and other visual conditions. Zipnosis www.zipnosis.com Zipnosis is an online service that allows users to create an account, and pay a flat fee of $25 for an online Doctor’s visit for treatment of common ailments 8:00 am to 8:00 pm, 7 days a week. Users will complete an online interview and clinicians will follow up with a diagnosis and prescriptions as needed. Medical Mine www.medicalmine.com Medical Mine has developed ChARM Tracker, an innovative patient-inspired, cloud-based software platform for practitioners, researchers and patients supports the medical network necessary to improve outcomes for multi-factorial conditions, including children with autism. Navigating Cancer www.navigatingcancer.com Navigating Cancer provides comprehensive resources and tools to help patients track and manage their cancer, including patient discussions communities. Navigating Cancer partners

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with cancer clinics to provide EMR-integrated, Meaningful Use applications designed to streamline the patient intake process for new patients. BreakThrough.com www.breakthrough.com BreakThrough.com provides online counseling and psychiatry services, connecting mental health providers and clients via secure video, phone, email, and chat. SwiftMD www.swiftmd.com SwiftMD offers 24/7 access to medical services including emergency physicians, psychiatrists, and orthopedic surgeons. Subscribers request consultations by telephone and are guaranteed a telephone consult within 30 minutes. Phreesia www.phreesia.com Phreesia automates the patient check-in process through an electronic intake interview that delivers fully interactive content direct-to-patients. The Phreesia system verifies patient insurance information and safely secures entered information in within its patient portal. The system is interoperable with numerous physician practice systems. Withings Design www.withings.com Withings is a wireless health care product development and design company. Products include a wireless scale and compact wireless blood pressure monitor. Your TeleDoctor www.teladoc.com YourTeleDoctor is start-up offering video consultations with physicians over the Internet. Myca www.myca.com Myca provides web-based health care platforms including its Hello Health Platform, a primary care practice platform that helps doctors communicate, document, and transact with their patients in-person and online. ENURGI www.enurgi.com ENURGI is a web-based health care services company that connects families and patients with local caregivers across the country. ENURGI has a a database of over 1.5 million licensed caregivers across the country. Through its website, patients, family members and caregivers can independently manage the care process through on-line scheduling, instant messaging, referral and direct payment transactions.

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Epocrates www.epocrates.com Epocrates provides web-based and handheld clinical reference tools (free and premium) used by 1 out of 3 U.S. physicians. The company’s tools cover over 4,400 medications including prescription, alternatives and over-the-counter drugs. Intuit Health healthcare.intuit.com Intuit Health was formed by the recent combination of Medfusion and Intuit’s Quicken Health Group. Intuit Health provides online patient-provider communication solutions for physicians including website development, appointment scheduling, billing and patient encounter tools. Humedica www.humedica.com Humedica is a next-generation health care informatics company that provides novel SaaSbased clinical business intelligence solutions. Semantelli www.semantelli.com Semantelli embraces web 3.0 and semantic web concepts to solve real world business problems. Your Nurse Is On www.yournurseison.com YNIO (Your Nurse Is Online) is an Internet based, health care communications system that uses Internet and SMS messaging to give hospitals unprecedented access to health care staff. C. Health Care Social Media

There are various individuals and groups working to understand and further the use of social media and social networking in the health care industry. Over the past few years there has been a growing group working to quantify the health care social media resources and document the impact of social media on health care. Leading the way has been a core group of individuals who meet for a weekly chat (Sunday @ 8pm CT) on Twitter under the hashtag #HCSM. The group was started in January 2009, and is moderated by Dana Lewis, Interactive Marketing Specialist at Swedish Medical Center. The weekly chats on Twitter are a great way to stay in touch with all things happening in the world of health care social media. Ed Bennett, a web operations manager at the University of Maryland Medical Center and author of Found In Cache, has been tracking and reporting on the development of health care social media. He regularly blogs and provides a number of resources, data, and charts on the development of health care social media and its impact especially on hospitals. He maintains

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the hospital social networking list that tracks United States hospitals that use social networking tools, including YouTube, Facebook, Twitter, LinkedIn, Four Square, and blogs. Currently his lists include over 1,188 hospitals in the United States utilizing social media tools to social network. Hospitals account for at least 548 YouTube channels, 1,018 Facebook pages, 788 Twitter accounts, 913 Four Square accounts, and 137 Blogs. Creative hospitals have used social medial driven viral videos on YouTube to generate awareness of social and health issues, including promoting breast cancer awareness. The Pink Glove Dance by Providence St. Vincent Medical Center in Portland, Oregon went viral in November 2009 and has over 12 million hits. The success spawned countless videos from across the country and inspired the Pink Glove Dance Sequel in 2010 featuring more than 4,000 health care workers and breast cancer survivors from all over the United States and Canada. Watch the The Sequel and some of the videos here if you need any proof that health is social. Hospitals and health care providers are learning that it is important to monitor social media channels and capitalize or respond to content captured by their patients. There are numerous stories and cases about the failure of heath care providers to recognize or respond to the use of social media tools by their employees, patients, etc. Alternatively, there are examples of positive and proactive use of social media. For example, Mayo Clinic utilized a patient recorded video to highlight the healing power of music, which was then seen by millions. The video, Mayo Clinic atrium piano, charming older couple, was filmed by a patient and her daughter from West Virginia visiting the facility. The YouTube video has had over 7.5 million visitors since it was uploaded in September 2008. Mayo Clinic has been one of the leaders in the health care social media revolution and as a result formed the Mayo Clinic Center for Social Media to improve health globally by accelerating effective application of social media tools throughout Mayo Clinic and spurring broader and deeper engagement in social media by hospitals, medical professionals, and patients. Health care professionals, including physicians, nurses and others are blogging and using social networking tools like Facebook and Twitter to communicate and collaborate. The number of medbloggers is in the thousands. The diversity of specialty blogs runs from anesthesiology to urology. The success of the AHLA Discussion Listserves are a great example of a digital community formed around a common interest or niche area. More recently AHLA has expanded its member resources to capitalize and use social media, including the AHLA Health Law Wiki, AHLA Facebook Group, AHLA Linked In Group, and @HealthLawyers. 2. The Basics of Social Media Tools A. Blogging

Blogging was the catalyst that started the social media paradigm shift and started to blur the

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lines of traditional mainstream media. In 2004 there were less than 2 million blogs. By 2007 the number had grown to 63 million blogs and as of June 2011, there were over 163 million public blogs. Blogs began the shift from a read only web to a "world live web" driven by user generated content using tools such as blogs, wikis, podcasts, RSS, tagging, and a variety of other social networking platforms. Blogs are user generated websites where entries are made in journal style and displayed in a reverse chronological order. A typical blog contains text, images and links to other blogs and websites. The first blogs were started as online journals where people kept a running account of their personal lives. The modern blog evolved from users who went online in the 1990s to participate in digital communities. The history of blogs goes back to usenets, bulletin board systems and email listserves. The origin of blogs goes back to 1994 with Justin Hall being recognized as one of the first bloggers. The December 2004 New York Times Magazine referred to him as "the founding father of personal blogging." Examples of commonly used blogging platforms are Blogger, Posterous, Tumblr, Typepad and Wordpress. Blogs are really just an extension of websites but allow individuals (especially non-technical persons) to manually update content rather than requiring a webmaster who knows html. B. Wikis

Wikis are websites that allows the easy creation and editing of any number of web pages and creation of links using a simplified markup language or a WYSIWYG (what you see is what you get) text editor by any number of people. Wikis are typically powered by wiki software and are often used to create collaborative websites, to power community websites, in corporate intranets, and in knowledge management systems. Wikis may exist to serve a specific purpose, and in such cases, users use their editorial rights to remove material that is considered "off topic". Such is the case of the collaborative encyclopedia Wikipedia.

Physicians and health care professionals are using social media tools through online health communities, like MedHelp and AskDrWiki to provide current medical information to the public and answer questions. Knowledge about health and medicine is being crowd-sourced by dynamic wiki-based systems, like the MedPedia Project, that allows health professionals from broad disciplines to create content and collaborate. Health and medical wikis now cover almost every imaginable topic area - go here or here for a couple of aggregated lists. C. Podcasts

Podcasts are a series of digital media files (either audio or video) that are released in episodes and downloaded through web syndication. The mode of delivery differentiates podcasting from other means of accessing media files over the Internet, such as direct download, or streamed webcasting. Originally, listener or viewer employed special client application software known as a podcatcher to access and catch the web feed, check it for updates, and download any new files in the series. This process can be automated so that new files are downloaded

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automatically. Many podcasts are now accessed and made available on iTunes in the podcast library. D. Facebook

Facebook is a social networking service that was launched in February 2004. Facebook was founded by Mark Zuckerberg and his college roommates and could initially only be used by users who were in college. It was later expanded to other colleges and universities, high schools, and then opened to the general public. Facebook has impacted and disrupted many traditional institutions, including the media and politics. Facebook users create a profile with basic demographic information, can add other Facebook users as friends, post messages on a public wall for other users to read, and exchange messages. Facebook also allows you to easily create and join Facebook Groups, including businesses, schools or colleges, community groups, interests, etc. (for example, American Health Lawyers Association). As of June 2011, Facebook statistics were as follows: Facebook has over 500 million active users and of those users 50% log on every day. There are 250 million active users currently accessing Facebook through their mobile devices. The average Facebook user has 130 friends. The average Facebook user is connected to 80 community pages, groups, and events. Each Facebook user creates on average 90 pieces of content each month. Approximately 30 billion pieces of content (web links, news stories, blog posts, notes, photo albums, etc.) are shared each month. Entrepreneurs and developers from more than 190 countries build with the Facebook Platform and people on Facebook install 20 million applications every day. C. Twitter

Twitter is a social network and micro-blogging company started in 2006 that enables users to send and read messages called tweets. Tweets are text-based messages that can also include web links or links to photos that are up to 140 characters. Tweets are displayed on the users profile page and can be directed to all followers or to a specific Twitter user. Twitter is estimated to have over 200 million users as of March 2011 who generate 190 million tweets per day. Twitter handles over 1.6 billion search queries per day. If you are unfamiliar with Twitter watch Twitter in Plain English to gain a simple video/audio explanation of how it works and what it can do. Mashable provides the Twitter Guide Book, a good overview and resource for understanding how to use Twitter. Twitter also provides a variety of information in Twitter Basics to help you understand how to effectively use Twitter. Below are some of the more common Twitter tweet-terminology: # (hashtags) The # symbol, called a hashtag, is used to mark keywords or topics in a tweet. It

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was created organically by Twitter users as a way to categorize messages. @ The @ sign is used to call out usernames in tweets, like this: Hello @Twitter! When a username is preceded by the @ sign, it becomes a link to a Twitter profile. Twitter Bio A short personal description used to define who you are on Twitter. Connections The Applications tab in your Twitter settings shows all third party websites and applications to which you've granted access your public Twitter profile. Direct Messages (DM) Also called a DM and most recently called simply a "message," these Tweets are private between only the sender and recipient. Tweets become DMs when they begin with "d username" to specify who the message is for. Find People The Find People tab (to find people) is Twitter's search feature used to locate friends on the site. Follow To follow someone on Twitter means to subscribe to their tweets or updates on the site. Follow Count The numbers that reflect how many people you follow, and how many people follow you. Found on your Twitter Profile. Follower A follower is another Twitter user who has followed you. Following Your following number reflects the quantity of other Twitter users you have chosen to follow on the site. Lists Curated groups of other Twitter users. Used to tie specific individuals into a group on your Twitter account. Displayed on the right side menu of your homepage. Check out the AHLA Health Lawyers List that I created. If you are an AHLA Member and want to be added to the list send me a tweet at @BobCoffield. Mention Mentioning another user in your tweet by including the @ sign followed directly by their username is called a "mention". Also refers to tweets in which your username was included. Reply A tweet posted in reply to another user's message, usually posted by clicking the "reply" button next to their tweet in your timeline. Always begins with @username. Retweet (RT) (noun) A tweet by another user, forwarded to you by someone you follow. Often used to spread news or share valuable findings on Twitter. Retweet (RT) (verb) To retweet, retweeting, retweeted. The act of forwarding another user's tweet to all of your followers.

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Search A box on your Twitter homepage that allows you to search all public tweets for keywords, usernames, hashtags, or subject. Searches can also be performed at search.twitter.com. Third Party Applications A third-party application is a product created by a company other than Twitter and used to access tweets and other Twitter data. This includes information about how to use Twitter using your Blackberry, iPhone or Android. Also, the link includes help pages for some of the most widely used Twitter apps, including TweetDeck, Twitpic, bit.ly, etc. Trending Topics A subject algorithmically determined to be one of the most popular on Twitter at the moment. Tweet (verb) Tweet, Tweeting, Tweeted. The act of posting a message, often called a "Tweet", on Twitter. Tweet (noun) A message posted via Twitter containing 140 characters or fewer. Twitterer An account holder on Twitter who posts and reads tweets. Also known as tweeters. Unfollow To cease following another Twitter user. Their tweets no longer show up in your home timeline. D. LinkedIn

LinkedIn is a business focused social networking website used mainly for professional networking that was founded in May 2003. Registered users build out their profile, including their past employers, skills, and education. This information is then used by LinkedIn to connect individuals together. LinkedIn is a active resume which connects with others who have similar information. For example, if you list that you went to a particular college or university during certain years, LinkedIn will allow you to review data from other registered users and make connections with those who attended that college or university at the same time. As of March 2011, LinkedIn reports that it has more than 100 million members in over 200 countries with one-half of the members currently located outside of the United States. In 2010 there were nearly 2 billion people searches on LinkedIn. One of the main purposes of the website is to allow registered users to maintain a list of contact details of people with who they have some level of relationship, called Connections. Think of it as a modern Rolodex powered by social media. Users can invite anyone to become a connection. Your connection network is built up consisting of direct connections, the connections of each of their connections (referred to as “second-degree connections”) and also the connections of second-degree connections (referred to as “third-degree connections”). A user can utilize the connection structure to gain an introduction to someone through their connections to a second or third-degree connection. By comparison, imagine standing at a

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cocktail party and asking a friend to introduce you to someone who they know but you want to know. LinkedIn has built this concept into a social network via the web. LinkedIn can be used to find jobs, people, and business opportunities. Employers can list jobs and search for potential candidates. Job seekers can use LinkedIn to review profiles of those who they may be meeting with for an interview. LinkedIn also allows users to research businesses and companies statistics. A user can search for a business or company and LinkedIn will provide various statistics including, ratio of female to male employees, the percentage of most common titles/positions held in the company, the location of the company’s headquarters and officers, a list of present and former employees, information about the employees colleges or universities, other demographic information about the business or company. As LinkedIn has grown it has added other social media and social networking features. Initially LinkedIn was focused more on connecting people rather than developing a social networking community environment such as Facebook. As the social media world has matured, LinkedIn has moved in this direction of creating more social features. Building in features allowing registered members to embed application platforms within a members profile page. For example, a user can build in a Amazon Reading List, their Twitter tweets, or their latest blog posts on Wordpress or TypePad. LinkedIn also supports the formation of interest groups (for example, the AHLA LinkedIn Group). As of March 2011, there were over 850,000 LinkedIn Groups. The majority of the groups are employment related or center around professional or career interests. Within each group there is a structure that allows discussion among the group members. Group members can post questions, comments or information and others in the group can respond with comments. In 2011, LinkedIn acquired CardMunch, a mobile app maker that scans business cards and converts the information into online contact information. LinkedIn plans to integrate this functionality into their services in the near future. LinkedIn allows the groups to be private or public. The private groups require Avvo has many similarities to LinkedIn but is more of a directory of attorneys and physicians. Avvo’s states mission is to help people make the best decisions for their medical and legal needs by providing unmatched level of transparency and providing more information and better guidance. Avvo’s attorney directory now includes more than 90% of the licensed attorneys in the United States. It is the equivalent of the modern day social media driven Martindale. Avvo allows each licensed attorney to log in and claim their profile, add additional information, and confirm the accuracy of the public data that has been aggregated by Avvo to form the basis of each attorney profile. Avvo has obtained and aggregated public records provided by most state bars and other attorney licensing entities. Avvo empowers consumers by rating attorneys and physicians. Avvo profiles contain helpful

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information about attorneys and physicians, including experience, background, disciplinary history, and reviews from patients and clients. Avvo also uses a mathematical algorithm using the data provided and obtained, including years of experience, board certification, education, disciplinary history, professional achievements, and industry recognition to create an Avvo Rating. E. Other Social Media Tools and Terms

1. Tagging is assigning a keyword or term to a piece of online information, such as a Internet bookmark or digital image. The tag acts as meta-data to help other find the information based on the keyword or term. Tags are personal and chosen by the creator or viewer of the information. Tagging became popular with bloggers as a way to identify and categorize particular blog posts. Now tagging is used to associate common tweets on Twitter using a hashtag designated with the # symbol along with the word tag (for example, #AHLA or #Medicare). More information about Twitter hashtags can be found in the Twitter help, What Are Hashtags (#Symbols). Tagging has also become popularized by the growth of Facebook and the ability to tag photos with names of other Facebook users. 2. Social Bookmarking is a method for online users to organize, share, search, and manage bookmarks and favorites of web resources. Traditionally individuals bookmarked their favorites in their web browsers. Now social bookmarking systems allow individuals to save links to web pages, add comments or meta-data and tags and publicly share the bookmarks. This new bookmarking allows you and others to view the bookmarks chronologically, by category or tags or via search. Examples of social bookmarking tools are Delicious, Google Bookmarks, Digg, and AddThis. 3. RSS (Web Feed) is a term used to publish frequently updated digital content, such as blogs, news feeds, podcasts or videocasts. RSS stands for "Really Simple Syndication". Using a program called "feed reader" or "news aggregator" a user subscribes to an RSS feed. Programs known as feed readers or aggregators can check a select list of RSS feeds on behalf of a user and display any updated articles or information found. Many websites and most blogs that have ever changing content now have some type of RSS capability. Dave Winer, considered the father of RSS, describes it with a three-word answer: automated web surfing. It allows you to spend more time reading content rather than searching for content. I often explain it as “push technology" where you select the information you want and have it pushed to you rather than you having to constantly go to the information using bookmarks or favorites. RSS feeds are typically referenced on web pages with an icon stating: RSS, Atom, XML, Subscribe, or using the universal symbol . Google Reader has become one of the most popular RSS readers and can be accessed via your Google account. Incorporating the use of RSS into your daily web monitoring and research can provide you with real-time monitoring of any news coming out on the web. It is particularly useful to monitor news or legal topics of interest to lawyers, regulatory matters, or information about specific clients. Twitter has also

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replaced much of the traditional RSS monitoring and many now use Twitter as a way to monitor topic areas, specific users, etc. 4. Other Social Media Terms and Definitions. Reed Smith has produced a legal guide on social media that provides a comprehensive list of terms and definitions relevant to social media and social networking called, Network Interference: A Legal Guide to the Commercial Risks and Rewards of the Social Media Phenomenon (Second Edition). This guide is a great resource for health lawyers to better understand some of the risk/rewards of social media. A copy of these written materials and my presentation will be made available on my Health Care Law Blog a couple of days prior to the Annual Meeting. You can find them under a blog post titled, 2011 AHLA Annual Meeting: How to Use Social Media by @BobCoffield. Robert L. Coffield is a member at Flaherty Sensabaugh Bonasso PLLC in Charleston, West Virginia. Bob is co-chair of the Privacy and Security Compliance and Enforcement Affinity Group, a part of AHLA’s Health Information and Technology Practice Group. Bob is the author of the Health Care Law Blog and can be found on Twitter at @BobCoffield. Email him at RCoffield@fsblaw.com.

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