Physical Therapist 2.0Considerations for an Evolving Marketplace

2009 AAOMPT Annual Conference

Washington, DC

Eric Robertson, PT, DPT, OCS

Does Anyone Have the Hog?

Twitter.com/EricRobertson

Eric Robertson, PT, DPT, OCSAssistant Professor

Texas State University, San Marcos, TX

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!

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.

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?

HEALTHCARE IS CHANGING

Beyond payment policy reform, delivery is about to dramatically evolve.

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!

Patient-Centered Healthcare

Health 2.0 = (Me + MD)Us

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

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)

Web 2.0The Past… Now…

Characteristics:

Web 2.0 …•Applications without software…it lives on the web

•Users add value

•Social networking aspect

•User-friendly interface

Disruptive InnovationsDevelopment of new technologies can cause a reduction in performance.

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

Vic Gundotra, Google VP of Engineering at Google I/O, 2009

3.0And we’re always moving forward….

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.

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

HEALTH 2.0 USE EXAMPLES

What does the utilization of these tools look like?

Health 2.0 Acceleratorwww.h2anetwork.org

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

GATHERING INFORMATION

•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.

Wikipedia!

Caudate Nucleus on WikipediaHow sweet is this?!

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.”

RSS: Really Simple Syndication

►Requires an AGGREGATOR to display the Feeds

…like an inbox for the web.

Google Reader!

www.healthline.com/

www.healthline.com/

http://www.myhealthexperience.com/

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

gling.com – Free meal planning via social networking. The dietician has been apomediated!

Twitter.com/EricRobertson

Just WHAT, will we use Twitter for?

•Microblogging•On-the-go communication•Crowdsourcing•Patient interactions?

Using Twitter

Best used with Twitter Apps, like Tweetdeck•Create Searches•Use Hash Tags•Create Lists

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

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

EDUCATION

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

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?

•Learning a new language

•Accent still evident

Digital Immigrants

•Early innovators

•Early adopters

Digital Settlers

•The only world they ever knew…

Digital Natives

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

Example: Regis University

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

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

Educator’s Portfolio•Professional Branding

•Links to Dynamic Web Content

•Exposure for your institution

•Links to your Physiopedia Contributions, or your student’s contributions

CARE DELIVERY & COLLABORATION

E-PATIENTS

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!!

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.

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.

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

Smart Phones as Clinical Tools

Electronic Health Records•Get the data to the cloud!

•Interoperability

•Standards•HHS Certified•Certification Commission for Health Information Technology (CCHIT)

•Stimulus $$? •Not so much.

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

• 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.

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

INFLUENCE ON MARKETING AND BRAND

Changing Patient Behaviors

Injury

Diagnosis from the Physician

Referral to PT

Injury

Apomediation

Self-Diagnosis

Seek out correct provider

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

Online Presence

Website

SEO Interactivity Value-Added Content

Social Media

Which one?

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

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

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!

Interactive Features

Social Media

Brand

Community Building

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

Thanks, but no thanks, WebMD!

Dangers of Social Media and Web Apps?

Some fears reflect personal comfort, some reflect misinformation, others…just need to be accepted.

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

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

A MUCH RICHER HEALTHCARE EXPERIENCE…

THE PATIENT IS EMPOWERED

THE PROVIDERS MUST BE PREPARED…

PT Hacker Educational Focus SeriesUsing Technology to Make You a Better PT

Upcoming: 2010 Annual APTA Conference

Washington, DC

Eric RobertsonTim NoteboomRussel SmithRachael Lowe