mdigitallife: understanding physicians online

#MayoRagan | @chimooseContents are proprietary and confidential.

1

Understanding Physicians OnlineGreg MatthewsOctober 18, 2012

#MayoRagan | @chimoose

Contents are proprietary and confidential.

2

““

Fundamentally, Twitter allows for medical content curation in

easily consumable bites with rapid visual access. Truly the

popcorn version of medical news (and yes, with movie butter!).

Farris TimimiMedical Director, Mayo Clinic Center for Social Media

twitter.com/farristimimi



3

““

With over 18,000 followers from medical communities, with

the right strategy and communication, I can leverage the real

power of my networks by using crowdsourcing very difficult

questions and issues. Twitter is the fastest and most

interactive social media channels in my work.”

Dr. Bertalan Mesko

twitter.com/berci

linkedin.com/in/bertalanmesko

Scienceroll.com


They’re here…


5

A benchmark

[

In 2010, Dr. Katherine Chretien of the VA Medical Center in Washington led a team in producing the first known scholarly study of physicians’ use of twitter

New, automated tools have enabled us to broaden the scope of our study

[


on the

shoulders …Standing

The power of automation

1,397US Physicians

validated against CMS’ National Provider Identifier database

403,553tweets

generated between May 1, 2012 and September 30, 2012

Data Collected and Analyzed

between October 3 and October 15, 2012

Study

The Chretien Study

260US Physicians

5,156tweets

from 260 physicans – the most recent 20 from each

Data Collected and Analyzed between May 1st

and May 31st, 2010.

6 Contents are proprietary and confidential.


Study Demographics




8

““

Connection promotes health, and twitter proves the model that

simple digital tools can vastly increase connection.

Aaron Stupple Resident, Beth Israel Deaconness Medical Center

twitter.com/astupple

http://adjacentpossiblemed.blogspot.com/


… indexed within

of the total count

%+/- 3

Reflecting the Population

1,397US Physicians* 99.5%

Of Specialties…


Plastic Surgery

%3

Residents

%-6


Reflecting geographic distribution

49 states

indexed within of the total count

%+/- 4


overindexes

underindexes


Reflecting gender distribution

Underindexon twitter

by

8%

Overindex on twitter

by

8%



Accounts Created per Year

28

532

216

301

154

281

165

2006 2007 2008 2009 2010 2011 2012



Early Adopters ’06 -‘08

Emergency Medicine

Pathology

Preventive Medicine



Rate of Adoption by Specialty

Neurological Surgery

Dermatology

Orthopedic surgery

Ophthalmology

Plastic Surgery

Obstetrics & Gynecology

Surgery

Radiology

Otolaryngology

Allergy & Immunology

Internal Medicine

All MD

Anethesiology

Psychiatry & Neurology

Urology

Family Medicine

Org. Health Care Ed/Training Student

Pediatrics

Preventive Medicine

Pathology

Emergency Medicine



Physician Profiles

contain a URL in their

bio

80%

identify themselves

clearly as such in their

twitter bio

78%

32%

link to a personal blog or website



How are MDs using their accounts?

6.90%

1.90%

31.90%

37.70%

Bio URL Distribution

Business Medical Resource Personal Blog/Website Practice

of all Plastic Surgery URLs are links to their

practice

93%



Twitter Activity – Time and Frequency




18

““

I use Twitter not to apologize but as an apoligist. I introduce

the view from the other side of the stethoscope.

Jordan Grumet, Internal Medicine

twitter.com/ordangrumet

http://jordan-inmyhumbleopinion.blogspot.com/


Tweets Over Time

Trending steadily upward

1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 1011051091131171211251291331371411451490

500

1000

1500

2000

2500

3000

3500

4000

4500



Tweets per day over Account Lifetime

Pediatrics

Ophthalmology

Radiology

Otolaryngology

Emergency Medicine

All MD Average



Anesthesiology

Radiology

Ophthalmology

Family Medicine

Pediatrics

All MD

Tweets per day over 5 months

Jun’12 Jul’12 Aug’12 Sep’12


May’12





34%tweet at least 1 time per day

May’12 42%

are increasing frequency

50%

are decreasing in frequency

9% are maintaining frequency





Anesthesiology

Neurological Surgery

MOST ACTIVE

LEAST ACTIVE

May’12


When can I find MDs on Twitter?

Morning Workday Work PM Evening Overnight

18% 22% 32% 12% 17%

Morning (0500 - 0800 Workday (0801 - 1200) Work PM (1201 - 1800) Evening (1801-2300) Overnight (2301-0459)

18%22%

32%

12%

17%

(0500 – 0800) (0801 - 1200) (1201 - 1800) (1801-2300) (2301-0459)

0500-0800 0801-1200 1201-1800 1801-2300 2301-0459

Eastern time



Twitter and the MD Workflow

Morning Workday Work PM Evening Overnight

18% 21% 31% 8% 22%

(0500 – 0800) (0801 - 1200) (1201 - 1800) (1801-2300) (2301-0459)

Localized time

18%21%

31%

8%

22%

0500-0800 0801-1200 1201-1800 1801-2300 2301-0459



The Connected Physician




27

““

I think using Twitter and other social media outlets has

benefited me by letting me know where the patients are. I

learn from their stories and I have a chance to truly hear

them. In addition, I find social media beneficial as a learning

source to interact with other physicians and med students I

never would have met if I were confined by the walls of my

own hospital. Danielle Jones,Medical Student

twitter.com/daniellenjones

Mindonmed.com



28

““My use of twitter allows me to expand the diversity of my

network, and therefore my knowledge in my areas of interest :

prevention, diversity/equity, integrated care, and Washington,

DC (the #epicenter!).

It also allows me to model open leadership as a physician,

and promote this approach among my medical and nursing

colleagues.

Ted EytanFamily Medicine, Kaiser Permanente

twitter.com/tedeytan

linkedin.com/in/tedeytan

tedeytan.com


How Many People do MDs Follow?


0 to 10 11 to 50 51 to 100 101 to 300 301 to 1000 1001 to 3000 3000+

8.2%

13.4% 13.5%

23.9%21.3%

15%

4.8%

Number of Following


How Many People Follow MDs?

0 to 10 11 to 60 61 to 150 151 to 700 701 to 2000 2001 to 10000 10001 +

6%

14.4% 16%

30.8%

16.7%14%

3.9%

Number of Followers



Ratio of following to followers

Ratio of Following to Followers

0.- .1:1 .11-.2:1 .31-.7:1 .71-1.5:1 1.51-3.0:1 3.1-11.0:1 11.1-100.0:1 100.1-2808:1

2.80%4.90%

21.50%

32.40%

16.20%14.00%

6.70%

1.60%

Median Ratio 1.1 : 1



MDs Most likely to be followed by peers*

53%

40%34%

27%

25%

Personal Blog/Website

Business/ Organization

All_Doctors

No Bio URL

practice


*Percentages measure MDs followed by at least 20 others in the data set


How connected are online physicians?

of all MDs are followed

by at least 20 MDs 34%

Pediatrics

Emergency Medicine

Family Medicine

Specialties who are followed by

other MDs



Who are MDs talking to?

@kevinmd

@drdubrow

@hrana

@ryanmadanickmd

@drmikesevilla

@drghaheri

@healthcarewen

@kentbottles

@drjengunter

@hjluks

TOP @ MENTIONS



Connected MDs – Nearly half follow Kevin Pho

43%25% 22% 21% 20%

kevinmd Atul_Gawande MtnMD Doctor_V SeattleMamaDoc


KreinMD

41%

DrJenGuntermedicalaxiomsdocpreneurDrScottPearlman

37% 26%27%27%

Most followed by other MDs in the database

Follow the most other MDs in the database


Topics




37

“ “The biggest advantage to tweeting for me has been learning

what people I admire are reading, using, watching, listening

to, both within social media and outside of it. Even better have

been the IRL connections, and the DM possibilities: it's great

to be able to meet someone at a conference whose thought

processes, links or research I admire and have discovered

thru a tweeted link. I don't think I've had any new patients

because of a tweet, but my relationships with existing patients

are probably better because I'm better informed about what

they're reading and watching.

John La PumaInternal Medicine; Author

twitter.com/johnlapuma

linkedin.com/in/johnlapuma


Top Hashtag used by MDs

healthmeded

hcsm

mhealth

fmrevolution

ff

bcsm

hpm

fb

healthcare

jobs

cancerasco12

ipodteletrauma

med2

aca

healthit

plasticsurgery

hitsm

homebased

medicine

hcr

tcot

s4pm

aafpncsc

parenting

obesity

ehr

aafpnc

aafp

30s4health

ags12myeloma

palliative

futuremed

hcsmny

p2

medsm

hrs2012

pediatrics

medx

scotus diabetes obamacare

breastcancer

cdom

healthtap

primarycare

aafpalf

hiv

amee2012

tedx

socialmedia

teamfollowback

dr4aolympics

mccsm

digitalhealth

hcmktg

orthopedics

ilovebreasts

quote

familydoc

diet

cnn

leadership

abcdrbchat

healthdata

telemedicine

gop

science

meditation

eyes

gopfail

testosterone

flavorwire

vision

ipadh20chi

nutrition

dnc2012

womenshealth

ncsc12

phm2012

music

topprog

medicare

melanoma

meded fmrevolution

mhealth


hcsm


What are MDs Talking About?

TOP HASHTAGS

#health(8,215)

#meded (4,547)

#hcsm (4,532)

#mhealth (3,412)

#fmrevolution (2,721)

Family Medicine

Residents

Most used by

Most used by



#hcsm

Health Care Social Media –

Socially Savvy MDs

#hcsm

63%

of all classifications

mention #hcsm

73%

of #hcsm mentions were

from MDs with a personal blog or

website

13%Of all #hcsm hashtags are

from Anesthesiologists

.



A closer look at conversations…

Top Hashtags for Family Medicine

#health (3,349)

#fmrevolution (2,223)

#hcsm (728)

#aca (621)

#30s4health (597)

Top Hashtags for MDs with Business URLs

#jobs (12,634)

#homebased (1,562)

#mhealth (816)

#healthIT (815)

#ff (490)

Top Hashtags for Pediatrics

#meded (1,307)

#hcsm (596)

#med2 (521)

#pediatrics (450)

#health (437)



42

Mining the Data

• Breast Cancer: (breast AND (cancer OR carcinoma)) OR (inflammatory AND breast) OR (inflammation AND breast) OR (breast AND (metastasis OR metastic)) OR (duct AND (carcinoma OR cancer)) OR (lobe AND (carcinoma OR cancer)) OR "DCIS" OR "LCIS" OR (estrogen AND receptor AND positive) OR "HER2" OR (breast AND MRI) OR (breast AND biopsy) OR (breast AND ultrasound) OR "mammogram" OR "mammography" OR "tamoxifen" OR (aromatase AND inhibitor) OR "exemestane" OR "trastuzumab" OR "Herceptin" OR "lumpectomy" OR "mastectomy" OR "komen" OR "BRCA1" OR "BRCA2”

• Diabetes: "Diabetes" OR "Mellitus" OR "Insipidus" OR "Diabetic" OR "Gestational" OR "blood glucose" OR "Blood Sugar" OR "NIDDM" OR "IDDM" OR "LADA" OR ("Antiduretic Hormone" OR "ADH") OR ("Arginine Vasopressin" OR "AVP") OR "oral glucose tolerance" OR "fasting plasma glucose" OR "glycated hemoglobin OR HbA1c OR A1c" OR "insulin" OR "SMBG" OR "hyperglycemia OR hyperglycemic" OR "biguanides" OR "Sulfonylureas" OR "Meglitinides" OR "thiazolidinediones" OR "alpha glucosidase inhibitor" OR "GLP-1 agonist" OR "DPP-IV inhibitors" OR "DKA" OR "HHS"

A sample



All Text CloudsHashtag Clouds

Diabetes & Breast Cancer – Sample Search

43


Disease Conversation Volume Over Time

04/3

0/08

05/0

5/08

05/1

0/08

05/1

5/08

05/2

0/08

05/2

5/08

05/3

0/08

06/0

4/08

06/0

9/08

06/1

4/08

06/1

9/08

06/2

4/08

06/2

9/08

07/0

4/08

07/0

9/08

07/1

4/08

07/1

9/08

07/2

4/08

07/2

9/08

08/0

3/08

08/0

8/08

08/1

3/08

08/1

8/08

08/2

3/08

08/2

8/08

09/0

2/08

09/0

7/08

09/1

2/08

09/1

7/08

09/2

2/08

09/2

7/08

0

10

20

30

40

50

60

70

80

90

100

Diabetes Breast Cancer Prostate Cancer



Disease Conversation Volume Over Time

(Minus 1 “Zealous” Physician)

04/3

0/08

05/0

5/08

05/1

0/08

05/1

5/08

05/2

0/08

05/2

5/08

05/3

0/08

06/0

4/08

06/0

9/08

06/1

4/08

06/1

9/08

06/2

4/08

06/2

9/08

07/0

4/08

07/0

9/08

07/1

4/08

07/1

9/08

07/2

4/08

07/2

9/08

08/0

3/08

08/0

8/08

08/1

3/08

08/1

8/08

08/2

3/08

08/2

8/08

09/0

2/08

09/0

7/08

09/1

2/08

09/1

7/08

09/2

2/08

09/2

7/08

0

10

20

30

40

50

60

70

80

90

100

Diabetes Breast Cancer Prostate Cancer



The PSA Controversy

117

182

36

Negative Neutral Positive

Doctors who state an opinion are

more than 3:1 against the USPSTF’s

ruling on PSA Tests



Talking About DIABETES

Top Diabetes Tweeters

• Internal Medicine• Family Medicine• Pediatrics


mention diabetes keywords

at least 1 time in their tweets.

83%



Talking About BREAST CANCER

Top Breast Cancer Tweeters

• Internal Medicine• Surgery• Radiology


mention breast cancer 1 or more

times in their tweets

77%



Talking About PROSTATE CANCER


mention prostate cancer keywords

1 or more times in their tweets.

70%

Top Prostate Cancer Tweeters

• Urology• Internal Medicine• Family Medicine



Top Links

OVERALL TOP HOSTS

yourhealthchoice.net

www.handsontelehealth.com

hchlitss.blogspot.com

www.drken.us

online.wsj.com

TOP HOSTS WITH CROSS-CLASSIFICATION LINKS

online.wsj.com

www.usatoday.com

www.nytimes.com

www.nhlbi.nih.gov

www.cnn.com




51

““

Twitter primarily helps me remain amazingly current in topics

of my interest. I also reciprocate and share much of this with

my followers.

Steven TuckerMedical Oncology

twitter.com/drsteventucker

linkedin.com/pub/steven-tucker/13/6b/235



52

“ “Twitter has been very helpful in helping me crowd source

information from my community of practice of 7200 twitter

followers. For example, when I was asked to give a presentation

to a medical school about how social media could be used in

undergraduate medical education, I posted on twitter: "Help,

need best practices examples of how to use social media in med

school education" I received dozens of response with concrete

examples I was able to use in my presentation.

Kent Bottles

twitter.com/kentbottles

http://www.kentbottles.blogspot.com//


Thank you


Acknowledgements

Physician Advisor – Bryan Vartabedian (@doctor_v)

R&D Lead – Matthew Hager (@iSmashew)

Research Analyst – Kayla Rodriguez (@Kaylarodrigue11)

Designer – Nidhi Raina (@NidhiRaina)

Visualizations – Ryan Ebanks (@ebanksre)


Appendix


Appendix – Classification Count

Row Labels Count of classificationInternal Medicine 314Family Medicine 168Pediatrics 116Psychiatry & Neurology 100Student in an Organized Health Care Education/Training Program 83Obstetrics & Gynecology 76Surgery 74Orthopaedic Surgery 74Dermatology 55Emergency Medicine 53Plastic Surgery 46Otolaryngology 42Anesthesiology 28Radiology 27Opthalmology 26Urology 24Allergy & Immunology 16Pathology 14Neurological Surgery 10Preventive Medicine 10


Appendix – Classification Count

Thoracic Surgery (Cardiothoracic Vascular Surgery) 9Physical Medicine & Rehabilitation 9General Practice 8Pain Medicine 4Colon & Rectal Surgery 3Hospitalist 2Nuclear Medicine 2Neuromusculoskeletal Medicine & OMM 2Medical Genetics 1Phlebology 1(blank)Grand Total 1397


Appendix – Specialty countAllergy & Immunology 16Allergy 7Allergy & Immunology 8Clinical & Laboratory Immunology 1

Anesthesiology 28Anesthesiology 21Pain Medicine 6Pediatric Anesthesiology 1

Colon & Rectal Surgery 3Colon & Rectal Surgery 3

Dermatology 55Clinical & Laboratory Dermatological Immunology 1Dermatology 36Dermatopathology 2MOHS-Micrographic Surgery 5Procedural Dermatology 11

Emergency Medicine 53Emergency Medical Services 2Emergency Medicine 51

Family Medicine 168Addiction Medicine 3Adolescent Medicine 1Adult Medicine 5Family Medicine 151Geriatric Medicine 2Sports Medicine 6

General Practice 8General Practice 8

Hospitalist 2Hospitalist 2


Appendix – Specialty CountInternal Medicine 314Adolescent Medicine 1Allergy & Immunology 2Bariatric Medicine 1Cardiovascular Disease 39Clinical Cardiac Electrophysiology 5Critical Care Medicine 2Endocrinology, Diabetes & Metabolism 10Gastroenterology 18Geriatric Medicine 19Hematology 2Hematology & Oncology 17Hospice and Palliative Medicine 5Hospice Care & Palliative Medicine 2Hospitalist 1Infectious Disease 9Internal Medicine 135Interventional Cardiology 7Medical Oncology 9Nephrology 14Nuclear Cardiology 1Nutrition 1Pulminary disease 1Pulmonary Disease 3Rheumatology 7Sleep Medicine 3

Medical Genetics 1Clinical Genetics (M.D.) 1

Neurological Surgery 10Neurological Surgery 10


Appendix – Specialty CountNeuromusculoskeletal Medicine & OMM 2Neuromusculoskeletal Medicine & OMM 2

Nuclear Medicine 2Nuclear Cardiology 1Nuclear Medicine 1

Obstetrics & Gynecology 76Gynecologic Oncology 5Gynecology 6Maternal & Fetal Medicine 2Obstetrics 1Obstetrics & Gynecology 57Reproductive Endocrinology 5

Opthalmology 26Opthalmology 26

Orthopaedic Surgery 74Foot and Ankle Surgery 5Hand Surgery 6Orthopaedic Surgery 48Orthopaedic Surgery of the Spine 5Orthopaedic Trauma 2Orthopedic Surgery 1Sports Medicine 7

Otolaryngology 42Facial Plastic Surgery 9Otolaryngology 23Otolaryngology/Facial Plastic Surgery 6Pediatric Otolaryngology 2Plastic Surgery within the Head & Neck 1Sleep Medicine 1


Appendix – Specialty countPain Medicine 4

Interventional Pain Medicine 3

Pain Medicine 1

Pathology 14

Anatomic Pathology & Clinical Pathology 13

Blood Banking & Transfusion Medicine 1

Pediatrics 116

Adolescent Medicine 4

Developmental Behavioral Pediatrics 1

Neonatal-Perinatal Medicine 1

Pediatric Allergy/Immunology 3

Pediatric Cardiology 3

Pediatric Critical Care Medicine 1

Pediatric Emergency Medicine 2

Pediatric Endocrinology 4

Pediatric Gastroenterology 2

Pediatric Hematology-Oncology 3

Pediatric Infectious Diseases 3

Pediatrics 89

Phlebology 1

Phlebology 1

Physical Medicine & Rehabilitation 9

Pain Medicine 4

Physical Medicine & Rehabilitation 5

Plastic Surgery 46

Plastic Surgery 42

Plastic Surgery Within the Head and Neck 2

Surgery of the Hand 2


Appendix – Specialty Count

Preventive Medicine 10Occupational Medicine 2Preventive Medicine/Occupational Environmental Medicine 3Public Health & General Preventive Medicine 5

Psychiatry & Neurology 100Addiction Psychiatry 1Child & Adolescent Psychiatry 10Clinical Neurophysiology 3Forensic Psychiatry 2Geriatric Psychiatry 1Neurodevelopmental Disabilities 1Neurology 25Psychiatry 56Psychosomatic Medicine 1

Radiology 27Body Imaging 1Diagnostic Radiology 17Diagnostic Ultrasound 1Radiation Oncology 6Vascular & Interventional Radiology 2

Student in an Organized Health Care Education/Training Program 83Resident 83


Appendix – Specialty Count

Surgery 74Pediatric Surgery 7Plastic and Reconstructive Surgery 22Surgery 32Surgery of the Hand 1Surgical Critical Care 2Surgical Oncology 4Trauma Surgery 4Vascular Surgery 2

Thoracic Surgery (Cardiothoracic Vascular Surgery) 9Cardiothoracic Vascular Surgery 8Surgery 1

Urology 24Urology 24

(blank)(blank)

Grand Total 1397

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