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The Evolution of Social Media

10:28 AM Posted by David Do, MD , No comments

Previously, I wrote about what an EMR built on Twitter would look like. Some readers interpreted this literally, citing concerns about security and other practical issues about storing patient data on Twitter. Social media has demonstrated a new level of awareness of events and information, and allowed conversations to take place involving participants from around the world. Meanwhile, there is a data problem in our hospitals. We are not sharing, utilizing, or predicting enough, even within the walls of a single building. Twitter is not an electronic medical record, but it has revolutionized the way we communicate information, serving as an important conceptual model for our future EMRs.

Several years ago, I awoke to my house shaking. I didn’t know what was going on, but seconds later the word earthquake was trending on Twitter, and you could see the exact geographic extent. I was amazed at how quickly this crowdsourced information emerged, ahead of all major news outlets; in fact, there are tools that news outlets use to mine Twitter for potential stories. In healthcare, how can we think of our conversations about patients in the same way, allowing for faster and more adequate responses to new data and clinical changes?

The maps below serve as a conceptual model for how social media has built on each type of electronic communication before it, and serves as a roadmap for how we can follow suit in healthcare. Each node represents a communication event and each line represents a participant in healthcare, a provider or a patient.

Map #1

In communication: This map represents letters, faxes, and emails--types of communication in which two or more participants are included in a thread and share messages back and forth.

In healthcare: Clinicians have been using this type of communication for quite some time. Hospitalists and specialists send messages, usually with primary care providers. Primary care doctors communicate results with patients in this manner. This will always be a necessary form of communication, but its usefulness depends on a primary care doctor to manage and coordinate all of a patient’s care.


  • After the last message, the thread dies. The correspondence does not persist for other providers to see.
  • Good for private communications

Map #2

In communication: This map represents forums, chatrooms, or periodicals—types of communication in which a conversation persists beyond any single participant. Participants can come and go, and newcomers have the opportunity to see and understand what happened before.

In healthcare: EMRs, and to some extent the paper charts the proceeded them, have allowed data to persist independently of the participants of the conversation. As a new doctor to a patient in many cases you have access to a body of information and it will persist for the next provider. This can be very helpful for multidisciplinary care.


  • New participants to the conversation have the opportunity to see and understand what happened before.
  • The “paper trail” makes it possible, although time consuming, to go back and process the history or to find important information

Map #3

In communication: This map represents blogs or RSS feeds—types of communication in which several content producers can broadcast news, while any reader can choose any number of feeds to subscribe to.

In healthcare: This type of communication is underdeveloped in healthcare, but is necessary to facilitate consolidation and contextual interpretation of data:

  • Consolidation - Currently, providers must manually collect and consolidate data from many sources. This occurs on the hospital level (talking to nurses, talking to the patient, getting information from EMR, testing schedules, and discussing cases with consultants) and on the EMR level (looking in “labs”, “imaging”, “flowsheets” sections).
  • Context - EMRs, to this point, have not been designed to facilitate interpretation of data. A piece of information is classically observed through an EMR’s interface, in a particular view. But the reality context is essential to accurate interpretation; the patient, the diagnosis, the perspective of the specialist. A sodium value, for example, means different things according to:
    • diagnosis: liver failure, heart failure, SIADH, DKA
    • patient: baseline sodium levels and acuity of the change
    • recent interventions: medications and fluids given

An “open data” architecture with feeds could allow development of custom interfaces that do more of this work.


  • It gives users a chance to consume more, high yield information, increasing their awareness of news
  • Allows news to come to the user rather than vice versa
  • Allows for contextual interpretation of data

Map #4

In communication: This map represents Twitter and Facebook—types of communication where users can produce and consume posts. Users have access to feeds that allow a prioritized way to see important posts, and responses.

In healthcare: This type of communication is nonexistent in healthcare. I see this as a central piece to true patient-centered care, allowing patient involvement in conversations.

  • Enhance Conversations: Imagine if clinicians could have a conversation about a particular patient, a new data point, and patients participate. Information can be “retweeted” between providers to highlight data of importance. Each communication, in the prior models, becomes a conversation.
  • Enhance Coordination of Care: imagine if multiple consultants, therapists, could coordinate care better,
  • Satisfaction: This increased awareness not only would allow clinicians to take better care of patients, but patient awareness of the conversations, the schedules, could reduce the mystery of their care and increase satisfaction.


  • Each node becomes a conversation
  • Content consumers are also content producers
  • Prioritization of nodes based on users

I imagine a time when a doctor subscribes to a patient’s “feed” and becomes aware of all the data and events. At my institution, we are designing and building a suite of tools that span these models of communication.


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