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Physical Therapist 2.0Considerations for an Evolving Marketplace
2009 AAOMPT Annual Conference
Washington, DC
Eric Robertson, PT, DPT, OCS
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Does Anyone Have the Hog?
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Twitter.com/EricRobertson
Eric Robertson, PT, DPT, OCSAssistant Professor
Texas State University, San Marcos, TX
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DISCLAIMERS
1.I’m not an official geek.
2.I don’t endorse any of the products or applications that I will show you.
3.I appreciate interruptions and discussion!
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OBJECTIVES
1. Define the terms Health 2.0 and Medicine 2.0, and understand the role of the physical therapist in this changing healthcare realm.
2. Understand the role of social media in physical therapist branding and marketing
3. Develop a strategy to respond appropriately to a changing consumer marketplace using Web 2.0 and social media tools.
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QUESTIONS
1. We are hands on. How do we deliver care through a computer?
2. What are the opportunities and limitations to delivering physical therapy services in the evolving world of Health 2.0?
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HEALTHCARE IS CHANGING
Beyond payment policy reform, delivery is about to dramatically evolve.
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Something’s Happening…
Patients
Providers
Health IT
• 80% of internet users want to use it for learning about their health
• This is 66% of all adults!
• 54% of physicians use smart phones
• Exponential Growth in HER in last 10 years
• $14B in mergers and acquisitions in SV in last 3 months alone
• Health IT is leading the economic recovery!
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Patient-Centered Healthcare
Health 2.0 = (Me + MD)Us
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Health 2.0 - Defined
“The use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health"
Source: Adapted from Jane Sarasohn-Kahn's "Wisdom of Patients" report, by Matthew Holt, Last updated June 6, 2008
http://health20.org/wiki/Main_Page
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Web 1.0• Pull Information• One -way• Stand alone / Firewalls• E-mail Alerts & Listservs
Web 2.0• Open Source• Collaboration• Syndicate / Push Information• Liberation of Information
Web 2.0 in a Nutshell• Make Sites Sticky• Notification of updated content (feeds)
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Web 2.0The Past… Now…
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Characteristics:
Web 2.0 …•Applications without software…it lives on the web
•Users add value
•Social networking aspect
•User-friendly interface
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Disruptive InnovationsDevelopment of new technologies can cause a reduction in performance.
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DISRUPTIVE INNOVATIONS…
“...it is often entirely rational for incumbent companies to ignore disruptive innovations, since they compare so badly with existing technologies or products, and the deceptively small market available for a disruptive innovation is often very small compared to the market for the established technology.”
http://en.wikipedia.org/wiki/Disruptive_technology
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Vic Gundotra, Google VP of Engineering at Google I/O, 2009
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3.0And we’re always moving forward….
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THE SEMANTIC WEB
•Web 1.0 is like buying a can of Campbell's Soup
•Web 2.0 is like making homemade soup and inviting your soup-loving friends over
•The semantic web is like having a dinner party, knowing that Tom is allergic to gluten, Sally is away til next Thursday and Bob is vegetarian.
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Health 2.0 – Let’s Look Deeper
Health 2.0:“Health 2.0 defines the combination of health data and health information with (patient) experience through the use of ICT, enabling the citizen to become an active and responsible partner in his/her own health and care pathway.”
Medicine 2.0: "Medicine 2.0 applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate … openness within and between these user groups. ”
http://www.icmcc.org/pdf/ICMCCSWWS08.pdfhttp://gunther-eysenbach.blogspot.com/2008/03/medicine-20-congress-website-launched.html
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HEALTH 2.0 USE EXAMPLES
What does the utilization of these tools look like?
Health 2.0 Acceleratorwww.h2anetwork.org
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Adapted from Wikipedia.com: http://en.wikipedia.org/wiki/Health_2.0
Use of Web 2.0 Tools in Healthcare
Use Role Example Users
Gathering Information
Stay up to date on latest developments in a field, managing a condition
RSS, Podcasts, Search Tools, Networks
Health Professionals, Public
Education Delivery of professional and continuing education
E-Learning, Web Seminars, Distance-based, podcasts
Health Professionals
Collaboration and Practice, Care Delivery
Decision making in daily practice, collaborative research
Wikis, literature searches, shared documents, distance-based interactions, videos, etc…..
Health Professionals, Consumers
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GATHERING INFORMATION
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•44% say the information changed the way they think about diet, exercise, or stress mngt.
•39% say the info changed the way they cope with a chronic condition or manage pain.
•35% say the information affected a decision about whether to see a doctor.
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Wikipedia!
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Caudate Nucleus on WikipediaHow sweet is this?!
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Wikipedia and the NIH• Wikipedia Academy – July, 2009
– “The next time you read a health-related article on Wikipedia, it might have been improved through a new collaboration between the National Institutes of Health and the Wikimedia Foundation.”
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RSS: Really Simple Syndication
►Requires an AGGREGATOR to display the Feeds
…like an inbox for the web.
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Google Reader!
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www.healthline.com/
www.healthline.com/
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http://www.myhealthexperience.com/
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Apomediation
• Intermediation • Stands in between the consumer and information
• Disintermediation• Remove the middle man entirely
• Apomediation (latin: separated, detached)• Networked Collaborative “Authorities”• Positioned to Guide users to information solutions• Usually Web 2.0 solutions
– Consumer ratings on Amazon, Digg, Twitter
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gling.com – Free meal planning via social networking. The dietician has been apomediated!
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Twitter.com/EricRobertson
Just WHAT, will we use Twitter for?
•Microblogging•On-the-go communication•Crowdsourcing•Patient interactions?
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Using Twitter
Best used with Twitter Apps, like Tweetdeck•Create Searches•Use Hash Tags•Create Lists
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Using Twitter
Things I’ve done on Twitter:•Gotten directions through a hospital•Located a developer for iPhone apps•Met friends•Found a community of individuals interested in Health 2.0•Found new physical therapist friends online•Participated in debates of various topics•Became a mentor to PT students•Discovered new restaurants and coffee shops•Posted reviews of businesses•Linked to my web content
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Quality of Tweets• Analysis of Tweets during H1N1 Outbreak
• Pre- and Post-pandemic, 2009• Analyzed 1800 tweets per day• Coded for analysis (high-level, personal exp, etc)
– 21% Personal experience– 16% Personal opinion– Of remainder, only 5% were unreferenced
–<1% categorized as giving Mis-Information!
• Caveat: Government and Public Health sites were not the main source of linked references.
Cynthia Chew, Medicine 2.0 Congress Proceedings, 9/2009 www.infovigil.com
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EDUCATION
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The Student•Students have changed radically
•They are no longer the people our educational system was designed to teach
•Have grown up in a digital age
•Digital immigrant teachers speak a different language
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The Educator
Regis Faculty comment:
“I just visit the Internet, my students live there”
Barriers:
•Prioritization – Update content or add technology?
•Lack of knowledge
•Lack of support
•Effectiveness of technology?
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•Learning a new language
•Accent still evident
Digital Immigrants
•Early innovators
•Early adopters
Digital Settlers
•The only world they ever knew…
Digital Natives
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Web 2.0 CME/CPD
• This medium has largely remained unchanged
• Question:– Is listening to a webinar of a recorded lecture Web
2.0?
• Many regulatory barriers here in the U.S. that do not exist in Europe
• Ripe for innovation
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Example: Regis University
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Physio-pedia.com
•World-wide Evidence-based Encyclopedia written by, and for Physical Therapists
•Can serve as a turn key wiki for PT educators
•An evidence-based FREE resource for the profession
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A resource for clinicians, instructors and students!
• Where have all the textbooks gone?
• Student-generated content • Instructor-generated Content
Currently being utilized by instructors and students from:• Medical College of Georgia, School of Allied Health Science• Evidence In Motion, Orthopaedic Residency• Royal College of Surgeons in Ireland, School of Physiotherapy• University of Hertfordshire, School of Health and Emergency Professions
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Educator’s Portfolio•Professional Branding
•Links to Dynamic Web Content
•Exposure for your institution
•Links to your Physiopedia Contributions, or your student’s contributions
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CARE DELIVERY & COLLABORATION
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E-PATIENTS
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Participatory Healthcare via the e-patient
• Group of consumers who have used the web to help manage or learn about a condition.• Some individuals, like e-patient Dave, have chosen to make their experiences in healthcare public.
• This is a very powerful individual!!
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Jay ParkinsonI started a practice in NYC on September 24, 2007:
•patients would visit my website•see my Google calendar•choose a time and input their symptoms•my iphone would alert me•I would make a house call•they’d pay me via paypal
This concept evolved into Hello Health.
I design elegantly smart products, processes, and services that meet the needs of patients, doctors, and the public health.
I’ve been called the Doctor of the Future and one of the top 10 most creative people in health care.
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Hello HealthWe’ve built Hello Health from the ground up to help you do what you do best— form relationships and practice real medicine. It’s practicing medicine using today’s technology and today’s
communication – and getting paid for communicating with your patients whether it’s in your office or using email, IM, or video chats within hellohealth.com.
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Smart Phones as Medical Devices
64% of U.S. physicians are using smart phones.Oct 9, 2009, WSJ
“Stanford Hospital & Clinics, in Palo Alto, Calif., started a trial with Apple and Epic Systems Corp., a provider of health-care information systems, to test software that will let medical staff access patient charts on Apple's iPhone.”
ImageVis3D Mobile for example
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Smart Phones as Clinical Tools
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Electronic Health Records•Get the data to the cloud!
•Interoperability
•Standards•HHS Certified•Certification Commission for Health Information Technology (CCHIT)
•Stimulus $$? •Not so much.
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Keas (pronounced KEE-ahs), Incwww.keas.com
“The Obama administration has drafted its guidelines for producing electronic health records — patient records held by doctors and hospitals — with applications like Keas in mind. To qualify for government subsidies, the electronic records must be able to generate patient education materials that help guide care, and eventually share information with personally controlled health records of the sort offered by Google Health and Microsoft Health Vault.” NYT, 10/6/09
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• 3 month intervention for Dutch office workers
• Utilized a Physical Activity Monitor (PAM)
• No significant effect observed in physical activity after 8 months, however:
• “More attention should have been given to the quality and appropriateness of the tailored advice.”
Online Physical Activity Advice
Sander M Slootmaker et al., “Feasibility and Effectiveness of Online Physical Activity Advice Based on a Personal Activity Monitor: Randomized Controlled Trial,” Journal of Medical Internet Research 11, no. 3 (7, 2009), http://www.jmir.org/2009/3/e27/HTML.
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Virtual Fibromyalgia Gym
• Part of Project OneSelf, an effort to improve patient interaction/lifestyle for people with fibromyalgia
• http://www.slideshare.net/Smirne/learning-onlinea-tool-to-improveselfmanagement-in-patients-suffering-from-fibromyalgia
• 2 Components to System– Assessment
• Patient Questionnaires, health ratings
– Feedback• Customized exercise advice and monitoring
• Used Rheumatologists to form exercise guidelines
• An example of how Physical Therapists might interact with patients from a distance
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INFLUENCE ON MARKETING AND BRAND
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Changing Patient Behaviors
Injury
Diagnosis from the Physician
Referral to PT
Injury
Apomediation
Self-Diagnosis
Seek out correct provider
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New MarketingConventional
Bagels at the referral source
Advertisement in local paper
Yellow Pages
More bagels at the referral source
Word of mouth
Health 2.o
Word of Mouth
Online presence
• Website• Blog• Social Media• Value-added products and services for
patients
Collaborative partnership with referral source
Maybe some bagels
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Online Presence
Website
SEO Interactivity Value-Added Content
Social Media
Which one?
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Google Local / Google Business
• You must list your business with Google Local– Provides a local result for individuals
searching– Needs to be linked to your website– Improves the SEO for your site–Make sure information is current– Pay careful attention to keyword listings– You can even give specials for people
who find you via Google Local
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Social Media Strategy
• Determine your client preferences
• Be transparent and approachable, but not “too friendly”
• Learn to use each tool in depth…– Example: Learn how to search make a Facebook fan page,
learn how to use hash tags in Twitter or Digg an article
• Deliver value with every posting– Physical therapy links, research reviews, links to podcasts
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Social Media Strategy
• Accept that you can’t measure ROI
• But you can measure web activity– Alerts for your content– Google Analytics
• Social media is about building a brand, not selling something!
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Interactive Features
Social Media
Brand
Community Building
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Posterous.com: A Simple Solution
• Establish a web presence in 1 quick step!
• Blog solution + more• Post via email• Post simultaneously to
blogs and social media• Post from anywhere• Easy to set-up
• Customize your designhttp://www.openforum.com/idea-hub/topics/the-world/article/twelve-tips-and-tricks-to-get-the-most-out-of-posterous-guy-kawasaki
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Thanks, but no thanks, WebMD!
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Dangers of Social Media and Web Apps?
Some fears reflect personal comfort, some reflect misinformation, others…just need to be accepted.
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Managing Your Online Identity
1. Have a Message
2. Spread the Message
3. Be Consistent
!!!Who do you really want to see this pic?
http://lifehacker.com/357460/manage-your-online-reputation
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5 Fool-Proof Ways to Stay Out of Trouble for Your Posts
1. Get Permission
2. Be Nice
3. Manage the Permissions of Your Medium
4. “Will I Offend Anyone?”
5. Create Alerts for Your Stuff
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A MUCH RICHER HEALTHCARE EXPERIENCE…
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THE PATIENT IS EMPOWERED
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THE PROVIDERS MUST BE PREPARED…
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PT Hacker Educational Focus SeriesUsing Technology to Make You a Better PT
Upcoming: 2010 Annual APTA Conference
Washington, DC
Eric RobertsonTim NoteboomRussel SmithRachael Lowe