1. Social Media and Your
Practice –
Ready Or Not
Russ Cucina, MD, MS
Ryan Greysen, MD,MHS,MA
Associate Professor of Hospital Medicine
Medical Director of Information Technology,
UCSF Medical Center
Assistant Professor of Hospital Medicine
www.russcucina.org
@RussCucina
www.geripal.org
@RyanGreysen
Social Media Editor, Journal of
Hospital Medicine

2. Social Media and Your Practice – Ready or Not
Permissions
• All material is Copyright © Russ Cucina and Ryan
Greysen, 2014, except where attributed otherwise.
• You are welcomed to reuse this content with attribution
for noncommercial purposes, under the Creative
Commons Attribution-Noncommercial license.
http://creativecommons.org/licenses/by-nc/3.0/
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

3. Social Media and Your Practice – Ready or Not
Audience Response
Are You On Facebook?
1. No!
2. Only to keep an eye on the kids.
3. For my personal use.
4. For professional use.
5. For both personal and professional use.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

4. Social Media and Your Practice – Ready or Not
Facebook: The Largest Social Network
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

5. Social Media and Your Practice – Ready or Not
Facebook: It’s Not Just For Kids
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

6. Social Media and Your Practice – Ready or Not
Facebook: It’s Not Just For Kids
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

7. Social Media and Your Practice – Ready or Not
Twitter: The 2nd Largest Social Network
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

8. Social Media and Your Practice – Ready or Not
Twitter: Also Not Just For Kids
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

9. Social Media and Your Practice – Ready or Not
Twitter: Also Not Just For Kids
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

10. Social Media and Your Practice – Ready or Not
Vignette 1
Mr. Smith is a very pleasant patient you cared for
during his recent admission for DKA at your
hospital.
At discharge, he tells you that although he has
struggled to control his sugars for years, the
counseling and support you gave him has
inspired him.
He feels empowered now to turn over a new leaf.
“You believe in me Doc – that means so much to
me – I won’t let you down!”
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

11. Social Media and Your Practice – Ready or Not
Vignette 1 continued
Mr. Smith was so impressed with your care that he
decided to Google you after discharge.
He sees that you’re on Facebook so decides to
send you a “friend request.”
Do you accept?
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

12. Social Media and Your Practice – Ready or Not
Recommendation:
Decline!
Policy from the ACP and Fed of State Med Boards
“Online Medical Professionalism”
Position: The boundaries between professional and
social spheres can blur online. Physicians should
keep these spheres separate….
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

13. Social Media and Your Practice – Ready or Not
Vignette 2
You decide to call Mr. Smith to encourage him and
also explain why, regrettably, you can’t accept his
Facebook request.
He thanks you for the call and says he completely
understands and respects your position.
Relieved that you’ve handled this matter both
empathetically and professionally, you head off
for 2 weeks of medical volunteer work in Haiti.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

14. Social Media and Your Practice – Ready or Not
Vignette 2 continued
The work there is rewarding but you miss your
friends, family, and colleagues back home so you
keep up with Facebook.
To show them what can only be described with
images, you post pictures to Facebook of the dire
clinical situation as well as pictures of friends and
colleagues blowing off steam after the hard days
of working in the hospital.
What could possibly go wrong?
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

15. Social Media and Your Practice – Ready or Not
What’s wrong with these pictures?
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

16. Social Media and Your Practice – Ready or Not
Recommendations:
1. Be very cautious about what you post online
2. Adjust your privacy settings
ACP / FMB “Online Medical Professionalism”
Position: The boundaries between professional and
social spheres can blur online. Physicians should keep
these spheres separate…. and comport themselves
professionally in both.
Position: The reach of the Internet and online
communications is far and often permanent. Physicians,
should be aware that online postings may have future
implications for their professional lives.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

17. Social Media and Your Practice – Ready or Not
Vignette continued
Given your experiences with Facebook…you
begin to wonder, “is it worth it to be social?”
On the plane home, you contemplate whether
social media might be able to actually help you
and your patients…
Is there a professional role for social media in
health care and in YOUR practice?
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

18. Social Media and Your Practice – Ready or Not
Social Media Growth in Healthcare
Data courtesy of Ed Bennett, Director of Web Strategy
University of Maryland Medical System, http://ebennett.org/
Annual aggregate growth in social networks:
• 212% from 2009 to 2010
• 40% from 2010 to 2011
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

19. Social Media and Your Practice – Ready or Not
Social Media in Medicine
Brain surgery live on Twitter!
Interesting and educational, but not improving the health
of the Internal Medicine patient.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

20. Social Media and Your Practice – Ready or Not
Social Media in Real Life Medicine
Major institutions, small practices, and
individual providers are on social networks.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

21. Social Media and Your Practice – Ready or Not
Survey Says: Patients Want To Get Social
33% of U.S. adults are gravitating to social media
for discussions about health care.
Social Media Consumer Survey 2012
PwC Health Research Institute
When asked what services they would find valuable if
offered on social media:
• 72% said availability of appointments
• 71% said appointment reminders
• 70% said referral to specialists
• Patients "want social media to be something that helps
them coordinate care and navigate the health care
system, and they think physicians are the best people to
deliver it.”
Social Media Likes Healthcare
PwC Health Research Institute, 2012
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

22. Patients Are Already Med-Social
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

23. Social Media and Your Practice – Ready or Not
Audience Response
Has a patient ever mentioned you
on social media?
1. Confidently no.
2. Not to my knowledge, but you are making me
nervous.
3. Yes, but I made no response.
4. Yes, and I made a response.
5. Yes, and I encourage my patients to do so.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

24. Social Media and Your Practice – Ready or Not
Ready or Not…
• your patients are on social media
• your employees are on social media
• your competitors are on social media
• you may already be discussed on social media
with or without your knowledge
Social media is a promising new medium through
which we must engage at some level, and we
should learn to harness its power
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

25. Social Media and Your Practice – Ready or Not
Vignette 3
Your group practice decides to develop a social
media presence. The medical director says “You
use Facebook, right? Great – I’d like you to
manage our practice’s new Twitter account!” You
accept reluctantly…
In the first week, a patient in your system Tweets
the following:
How do you respond?
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

26. Social Media and Your Practice – Ready or Not
Case Study: Kaiser on Twitter
• Kaiser responds to complaints from patients
• Asks to learn more via email
• Shows concern while respecting privacy
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

27. Social Media and Your Practice – Ready or Not
Vignette 3 continued
The boss is so impressed with how you handled
problematic Tweets like this that he asks you to
further expand your practice’s outreach.
How might you build your influence on Twitter and
other social venues?
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

28. Social Media and Your Practice – Ready or Not
Case Study: Mayo Clinic on Twitter
• Mayo Clinic answers health questions
• Shares stories written by patients
• Provides thought leadership
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

29. Social Media and Your Practice – Ready or Not
Case Study: Kaiser’s Six Blogs
•
•
•
•
•
•
•
Health leadership
Global care
Patient stories
Staff stories
Health tips
Hospital legacy
Multi-media
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

30. Social Media and Your Practice – Ready or Not
Case Study: Mayo Clinic on Facebook
• Mayo promotes health through leadership and
education on Facebook
• Extends influence via mobile apps
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

31. Social Media and Your Practice – Ready or Not
Vignette 4
As you continue to develop the social media
presence for your group practice…you begin to
revisit your earlier experience with a patient’s
friend request.
You wonder, “is there some way I could use social
media to help my patients on a more direct level in
addition to our group practice Twitter and blogs?”
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

32. Social Media and Your Practice – Ready or Not
Case Study: Natasha Burgert, MD
• Dr. Burgert’s approach to social media:
– “Anticipatory guidance can be repeated,
reinforced, and repeated again”
– “I can act as a „filter‟ to promote the good
and refute the bad.”
– “I can be a source of reliable, real information.”
– “Saves me time in the long run. Questions I am
repeatedly asked […] can be answered quickly
and completely by directing them to my site.”
Source: Natasha Burgert, MD, published at www.kevinmd.com
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

33. Social Media and Your Practice – Ready or Not
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

34. Social Media and Your Practice – Ready or Not
How many phone calls
did this Facebook
conversation save?
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

35. Social Media and Your Practice – Ready or Not
Case Study:
Dr. Burgert’s Financial Return
• “I average one new patient family per week
who came because of our social media
presence”
– They tell me, “I am here to see you today
because I found you on Facebook” or “your
blog”
52 patients/year x $2700* =
$140,000 of billable income over 2 years
* average pediatric care for 0-24 months
Source: Natasha Burgert, MD, published at www.kevinmd.com
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

36. Social Media and Your Practice – Ready or Not
What You Need To Do
• Minimum level: write, communicate, and
enforce a social media policy
• Intermediate level: engage reactively
• Advanced level: engage proactively
• Master level: promote health and your practice
As the cost of investment approaches
zero, return-on-investment approaches
infinity.
Lee Aase, Mayo Clinic
(Paraphrased)
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

37. Social Media and Your Practice – Ready or Not
Vignette 5
Now that you’ve develop a highly-rated social
media outreach for your group…
and a personal yet professional Facebook and
Twitter effort using your own good name…
So the medical director comes back to your office
to make another request.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

38. Social Media and Your Practice – Ready or Not
Vignette 5 continued
He says:
“Great job! Now I need you to develop a policy to
guide social media use by everyone else who
works for us.
You know, some people just don’t know how to
use social media professionally…”
Where to start? What are some basic principles?
What about more advanced policies?
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

39. Social Media and Your Practice – Ready or Not
What To Do: Minimum Level
• Borrow and adapt a social media
policy, communicate, and enforce it
• No need to start from scratch
– UCSF Blogging and Social Media
Guidelines
– Kaiser Permanente Social Media Policy
– AMA Professionalism in the Use of Social Media
• Major Areas:
– For Staff: designated spokespeople, professionalism
and professional boundaries, privacy
– For Patients: online interactions are not individual
medical advice, hours of operation, patient/staff
boundaries
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

40. Social Media and Your Practice – Ready or Not
What To Do: Intermediate Level
• Engage reactively
– Monitor yourself and your practice on
Twitter, Facebook, Yelp, and Google+
– Google yourself and your practice to find
mentions on blogs
– Respond online or offline as appropriate
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

41. Social Media and Your Practice – Ready or Not
What To Do: Advanced Level
• Engage proactively
– Have a Facebook and Google+ page for
your practice
– Use Twitter in your practice
– Include social media channels in practice
communications
– Write a blog
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

42. Social Media and Your Practice – Ready or Not
What To Do: Master Level
• Promote health and your practice
– Make clinical announcements such as
vaccine availability
– Provide health promotion and education
– Be involved in your community
– Raise the profile of your practice
• Excellent Resource:
– CDC Social Media Toolkit
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

43. Social Media and Your Practice – Ready or Not
Is Privacy Dead? Absolutely not.
4th century BCE
All that may come to my
knowledge in the exercise of
my profession or in daily
commerce, which ought not to
be spread abroad, I will keep
secret and never reveal.
21st Century CE
No changes. Period.
Mark Zuckerberg is wrong.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

44. Social Media and Your Practice – Ready or Not
You Already Know Patient Privacy
• Keep doing it
• Make sure your staff understand
it, the risks are higher
– The baseline etiquette of social media is
farther from our professional obligation than
the world was before it.
– It is not a new problem nor is our response
any different, but it requires a higher level of
awareness and education.
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

45. Social Media and Your Practice – Ready or Not
You Already Know Patient Privacy
1. Borrow and adapt a social media policy,
educate on it, and enforce it.
2. Move any patient-specific conversations
offline
3. Get a HIPAA Business Associates agreement
with any provider of media, email, storage, or
other information services
4. Professionally secure all your computer
hardware and IT equipment
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

46. Social Media and Your Practice – Ready or Not
Social Media in Health: What’s Next?
Taking social media models into the EHR
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

47. Social Media and Your Practice – Ready or Not
Social Media in Health: What’s Next?
• Integration between EHRs and social
media
• Integration between social media and
nurse call centers
• Extension and mobility: push
information and pull data
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

48. Russ Cucina, MD, MS
Ryan Greysen, MD, MHS, MA
Blogging at www.russcucina.org
On Twitter @RussCucina
Blogging at www.geripal.org
On Twitter @RyanGreysen
Russ.Cucina@ucsf.edu
Ryan.Greysen@ucsf.edu
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License

49. Social Media and Your Practice – Ready or Not
References and Resources
• Social Media Likes Health Care,
a report by the PwC Health Research Institute
http://www.pwc.com/us/en/health-industries/publications/health-care-social-media.jhtml
• UCSF Blogging and Social Media Guidelines
http://www.ucsf.edu/about/social-media-guidelines
• Kaiser Permanente Social Media Policy
http://xnet.kp.org/newscenter/media/downloads/socialmediapolicy_091609.pdf
• AMA Professionalism in the Use of Social Media
http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml
• CDC Social Media Toolkit
http://www.cdc.gov/socialmedia/Tools/guidelines/pdf/SocialMediaToolkit_BM.pdf
Copyright © Russ Cucina and Ryan Greyson, 2014. This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License