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Sue Feldman and Thomas Horan have released their Kay Center study on disability claims and health information exchanges. I am proud to have been a data and interview source for this study. It highlights the importance that integrated systems can play in providing a better patient experience and increased revenue for providers. Click the image below for a PDF of the report, or view it here on SlideShare.

After a twenty year stint in the U.S. Air Force as a medical records expert, Bob Ross was destined for a life in healthcare social media. Somewhere he got sidetracked.  By some accounts it was when the Air Force stationed him at Eilson and he first saw snow-capped mountains. Destiny being the fickle force that it is took Bob’s life in another direction. Today very few of us think of Ross as an Health Information Management (HIM) guru. Instead we remember him as the the afro guy who had the painting show on PBS. But, I think, were he still with us today, Bob would confirm my suspicion that he was really just preparing us for the social web.

The Bob Ross Theory of Social Content Management is simple: Let your content live where it naturally wants to live and embed it in your own happy place.

Or, as I call it at work, the argument for having our own blog site. Social networks are by definition communities; and communities are all different. It is what makes life interesting. It is also what makes the initial entree into social networking a challenge for many healthcare organizations. Is it Facebook or Twitter? What about YouTube? Should we really be giving all that traffic away (does traffic really matter anymore)? The answer is more simple that it sounds. Let the content live where it wants to live and embed it on your blog.

Having a blog-type site is more than just having a place for long from posts. They are the blank canvas for our own social media oil painting. One of the biggest advantages of a content management system like Wordpress is the ability to aggregate all of your social web efforts. With a blog site, or “social hub” as we have started calling our site, content like videos can live on sites like YouTube. The advantage is that you can present them on a site you own and control. It also lets you showcase them alongside your other social content like photos from Flickr, audio from AudioBoo, presentations from SlideShare, etc.

There is another distinct advantage to The Bob Ross Theory. As hospital web content expert Ed Bennett often points out, YouTube is the third most visited site online, making it the second biggest search engine (after its parent, Google). Ed is also quick to share the tip that the more information you populate about your video, the more likely it is to come back as a search result. Where else would a happy little video want to live? Once uploaded, you embed that video on your blog site and share your own link via twitter or facebook, but the video still lives on YouTube. It is the best of both worlds.

The Bob Ross Theory is not limited to videos. Flickr is the 34th most visited site and second largest photo site after Facebook. Lets put a happy little photo right there. Now add some tags, a description and presto, it becomes a search result on Yahoo!. When you want to share that photo or slide show, you embed it as a blog post and share that link.

Pretty soon your blog site is not such a blank canvas, it is full of happy content. When prompted with: ‘Bob, everything in your world seems to be happy.’ Ross replied: “That’s for sure. That’s why I paint. It’s because I can create the kind of world that I want, and I can make this world as happy as I want it.” 1

For more information on getting started with a blog site, take a look at Lee Aase’s SMUG site.

1 Wikipedia http://en.wikipedia.org/wiki/Bob_Ross

On Sunday, January 17th, as a group we celebrated the one year birthday of #HCSM (pronounced “HIC-sum” by those in the know). The event was a special 2 hour chat that included a first ever live audio component. Lee Aase, Director of Syndication (and social media) for the Mayo Clinic and Dana Lewis moderated. Seven participants, I was proud to be one, spoke with Lee and Dana on the state of and future of social media in healthcare. You can listen to the event via the player below or download it as a podcast into iTunes.

Thanks to all those who participated:

• Dr. Jeff Livingston aka @macobgyn
• Christine Kraft  aka @christinekraft
• Dr. Val Jones aka @drval
  
• Jon Richman  aka @jonmrich
• Nick Dawson  aka @nickdawson
• Liza Sisler  aka @lizasisler
• Greg Matthews aka @chimoose

And a special thanks to the producers of the event:

• Meredith Gould aka @meredithgould
• Tom Stitt aka @tstitt

Finally, and to reiterate what I said at the top of my segment in the audio cast, thank you to the #HCSM community. In the last year we have laid the ground work that is changing the face of healthcare. Every day this group comes up with new ways to improve the patient experience. After all, we are all patients.

What happens when you need to get a message out to a lot of people quickly? You turn to your friends and fans.

Does anyone know the medical signs of Gout? I will say this, its going to be salads for this guy for a while….at least until lunch tomorrow. Two weeks of indulging in everything from baby octopi to Ossobuco, from martinis to zinfandel, from sour patch kids to pizza rolls (don’t ask) have caught up. As I reflect back on menus and meals from 2009 it is not with the aire of a ill-fated gym resolution but rather appreciation for a rekindled passion for food. For me 2009 was a year of many things including career building, enjoying working in the town I live in, Land Rover repairs and knee surgery. Missing from that list – food. According to my scale there was no decline in my passion for eating. But, like all things in life when time is tight somethins’ gotta give; I simply did not cook as much as in previous years. Despite that, 2009 was not without some interesting salvos across the culinary bow. What follows is a retrospective of 2009 in three parts: food trends in, my top meals, and my top kitchen endeavors.

2009 Food Trends

The end of the last decade had a clear trend, it was when we took food back. Over the last few years us foodies have been kicking to the curb the ideas of factory made, mass produced food. Reaching a crescendo in ear of the factory food manufactures in 2009, the “local movement” has taken hold. There is still a long way to go before the movement is even mainstream, but it is clearly making headway. Want to know more? Have a listen to this episode of the Splendid Table. In addition to eating locally, we are continuing to pay more attention to the quality of our food. Books like Pollan’s Omnivores Delemma (though published in 2006) helped draw our attention to what we are eating and where it comes from. As home cook and diners we are celebrating by returning to slow cooking, artisanally made foods.

• Bacon – this is probably not news to anyone who has eaten in the last year. Bacon has transcended mere breakfast food to ubiquitous ingredient.  Perhaps a symbol of our rebellion against low fat, low carb tasteless diet food, last year we embraced cured smoked pork belly with vigor.
• Slow food – We came back to crock pots, braising, and the family meal in 2009. In addition to things that cook slowly, we also returned to things that that time to prepare and eat; quite literally the antithesis of fast food. The wonderful result of slow food is often slow eating; spending more time around the table with the people we really enjoy breaking bread with.
• Traditional food merchants – Though still not widespread, many medium and smaller sized cities are seeing the return of butchers, fish mongers, bakeries and traditional purveyors. In recent years we have begun rewarding the entrepreneurial foodies who setup specialty shops in our towns. Think about this, would you take your car to a place that claimed expertise in all manor of transportation from skateboards to horses? No, we take our cars to mechanics who work on four wheeled passenger vehicles. Why are we buying our food in a place that sells everything from trash bags to meat in plastic sitting on a diaper?

My top meals of 2009

This portion of the review is regrettably challenging for me. Our travel was sparse, our time to eat out limited and our energy to sleuth out foodie finds minimal. Although a year that included sushi, Vail cannot be considered unfortunate by any means.

• 18 week aged New York strip steak at the Wildflower in Vail Co – This was one of the best steaks that I never ordered. It was my father who called for the rarely cooked (and rarely well aged) cut. To add to the improbability, those who know my cynicism for hoity-toity, resort style restaurants are undoubtedly surprised by the inclusion of the Wildflower on this list. The steak was the standout dish of the meal, but it was the service that made the experience remarkable. If the economic situation (remember, we are not supposed to say depression) of 2009 has taught us anything it is that we do live in a service economy. The businesses who are going to make it are those that understand exceptional service. The Wildflower, and our fortunately named server Nicolas (he was French, thus no ‘asssh‘ – or h) were the quintessential definition preemptive service; understanding the customer’s unexpressed wishes and seeing to them. Have I discussed my passion obsession for service before?
• Sushi at Hatsuhana - I’ve said it many times (including in 2008), Hatsuhana in New York is the best sushi that I know of. Hatsuhana is not avant garde sushi, unlike the fusion and insanely creative creations of my friend Osada (formally of Takah Sushi in Aspen which has gone donwnhill since his departure). Hatsuhana is traditional in the best sense. When I first mentioned it to Osada his comment in whimsically broken English was “[Americans] dont eat there, only Japanese”. And although not entirely true, the place is frequented by Westerners and Asians alike, it is rooted in real sushi culture. In the spring of 2009 I found myself in New York for a speaking engagement; due to schedule, I was in and out in less than 24 hours. One thing I made sure of was a meal at Hatsuhana. I walked in straight from the airport to a nearly empty sushi bar, owed entirely to my late arrival. I started with one of my guilty pleasures, ankimo – cured and steamed monkfish liver served with ponzu and chives. I’ve long held the belief that you have to gain the trust of a sushi chef and there is no better way to their heart than to request a childhood favorite. I asked for sawagani which are unctuous and umami laden fried tiny fresh water crabs. Sadly I learned they are illegal in the US thanks to a frivolous law suit. Never the less, the gauntlet was thrown and when I asked the chef to chose for me the reward was spectacular. There is benefit of arriving very late at a place that prides it self on new fish daily. In an effort to make use of the ingredients that he was most proud of, I was literally spoiled for choice. What followed was a virtually private meal of non-stop piscine creativity. For once, it paid to be late.

My Top Kitchen Endeavors of 2009

As alluded to above, 2009 did not see a lot of kitchen time from me. I would like to think it was because I was too busy, which is in part true. Also the case, some of the passion was gone. Perhaps the former led to the later, or maybe it was experiencing so few inspiring meals (only 2 on this years list above, compared to 5-1o in years past). Regardless, I just did not feel as innovative or inspired as I have in years past. Two meals in particular proved the exception.

• The New Visits charity dinner in Lynchburg – Can you say ‘over the top’? We started by mailing a very simple “comfort food” menu to guests with items like ‘tomato soup with grilled cheese’ and ’southern barbaque’. The reality, at least my hope in how it was perceived, was very different. The tomato soup, pictured above to the left, was a gazpacho aspic with jalapeno and cucumber caviar. The bbq was all day braised pork belly served under a glass filled with apple wood smoke. It did not stop there – the salad nicoise was deconstructed and the olives had a surprising twist, they were liquid inside… the bisque was an sea urchin foam…liver and onions? foie gras torchon served with apple butter on a southern biscuit and shallot salt. It was a great night, well executed with expert help (hi family!).
• New Years Eve, aka the Sous Vide Experiment -  Of all of the things I have played with recently, sous vide has to be the technique that has me the most excited about cooking again. Sous Vide, or under vacuum, involves cooking foods sealed in vacuum bags submerged in a precisely controlled water bath. Put practically, if you want a piece of beef to be perfectly medium, say 134F, then why not cook it at that temperature? When you think about it that way, it makes perfect sense. The added benefit of the vacuum bag is there is no loss of moisture of flavor from the meat. In fact, you can infuse just about any flavor you want. It does not have to be meat either. Veggies can be perfectly cooked as well. For New Years Eve we started with a take on the croque madame – fine dice of home cured bacon lardons and brioche, a scant bit of aioli with some water cress for color all topped with a butter fried quail egg. It was a perfect one bite dish! We moved on to veal cheeks which had been cooked en sous vide for 8 hours in butter and a braising liquor of squab stock and aromatics. We capped off the meal with buffalo tenderloin that was also cooked en sous vide, enveloped in duck fat with just a hint of sage. Check out the menu here for the complete details.

The end of the decade was still a resplendent one in terms of dining in the Dawson world. I would be remiss to call myself anything but lucky. The thing that I am perhaps the most excited about is becoming invigorated again about spending time in the kitchen. Here is to eating in 2010!

What takes longer, teaching a doctor to tweet or sticking a microphone in their face and asking a question? I have been thinking a lot about efficiency in the way we interact with media. Techy types often have the same thoughts about data storage – compression and decompression. What is the most efficient way to record a file to a disk and then read it back? It is not a stretch to think about our relationship with media in the same way.

As an experiment, what is the first thing that comes to mind when you see this image?

How long does it take to register “STOP” in your mind? Probably longer even than it takes to put your foot on the brake. Call it Pavlovian, but the truth is that our brains are wired to process visual stimulus very quickly. The “decompression” of the meaning of a red octagon is highly efficient.It takes very little effort for us to decode the message behind the sign.

Now examine a sonnet from Shakespeare:

There are two challenges to texts as ethereally magical as those from Shakespeare. The first is the creation of the written words. To take a simple phrase – ‘I cannot figure out if it’s my heart or eyes that love you more’ and transform it into:

Mine eye and heart are at a mortal war
How to divide the conquest of thy sight

requires a substantial amount of intellect. The effort required to “compress” the emotional sentiment associated with the text is staggering. It is probably our appreciation for that effort that causes us to always conjure mental images of poets gazing into the distance, quill in hand, always thinking more than writing. It is not just poets that have the challenge. Writing is simply hard work. Ask any good editor . To take an idea and translate it into text that, hopefully, the majority of your audience can understand is not a simple thing. Your audience, in turn, has the job of decompressing what you have written and recompiling it into a cohesive thought. Its a lot more complicated that drawing a stop sign to write about something as complex as love.

Video has emerged as pretty comfortable middle ground in the compression/decompression challenge. From a decompression standpoint, videos require fairly low “processing power”. That explains why so many of us are glued to the TV every night. The entertainment value is high compared to the effort we have to put into it decoding it. Practically speaking, the “how two” video has a lot of advantages over a text book. Julia Child understood this very well. Showing someone how to truss a chicken is easier on both parties than writing about about it. To truss a chicken you first tuck the wing tips into and under the wings themselves. Then you have a complicated procedure of wrapping one long string around the bird in a way that both closes it up and forms the perfect roasting shape. On second though, let the folks at HowCast show you how…

Video, as it turns out, is pretty efficient in both compression and decompression as a means of interacting with media. It is worth noting that audio, as in the spoken word, also fits nicely into this niche. Both require less effort than text to create and less effort for an audience to decode.

In a healthcare setting, one of the biggest challenges to the adoption of social media is time. It is fairly easy to convince people they have something worthwhile to talk about. It is another thing to get them to take the time to do it. Doctors, executives, department heads, etc all have the same excuse “who has time to blog or tweet?” I wonder if what they mean is ‘I don’t want to have to write a term paper every week!’. But what about 30 second audio blip, or 2 minute video? How hard is it to stop a doctor in a hallway, stick a camera in their face and ask for three health tips? OK, maybe it feels funny to do it, but the effort required to capture that moment is pretty low. From an audience standpoint, no one has to read a bombastic (ahh humm, you are still right this, right?) post about health tips; you get the “how to” video and nothing else.

With that in mind, I present a Phil Baumann styled list of 10 things you can try for easily compressed and decompressed social media posts (in no particular order)

1. Sign up for AudioBoo - AudioBoo is a site that allows you to record (via computer or smartphone) an audio clip and instantly post to many social media sites.
2. “Three Words” campaign – every day, stop someone in the hall and record them giving their name, job and 3 words that, to them, represent the organization. Do themes, like heart month, and nursing week… Use audiboo, an iphone, a flip camera…
3. Doc on the spot – stop a doctor, record a 30 second health tip. Make sure the doctor mentions their specialty and how to follow up for more info. “Hi, I’m Doctor Jones with a quick tip for sleeping better…. want to know more, tweet us your questions…”
4. Roving reporters – Distribute inexpensive flip video cameras everywhere. They are inexpensive. Send them around the hospital and ask people to be “roving reporters” – every week, send out a theme or question and ask for people to interview co-workers. Compile the videos and post online
5. Physician updates – Imagine a family member in surgery. Have the doctor record updates as audio clips that can be shared with family members who are not in the waiting room.
6. CEO minute – a daily update from the CEO on the most important things on his desk that day. It is a glimpse into his world (and ultimately what is important for the organization). It does not take the CEO more than a minute to record, and the staff more than a minute to view. He or she can even produce it from his phone on the way to work.
7. Show the way – record a time-compressed video of how to drive from major intersections to medical practices.
8. Share the health – allow interested patients to record doctor advice during appointments including advantages and disadvantages of treatment options. Remember that your patients have a network too, help them help their friends (and it doesn’t hurt your image either)
9. Employee recognitions – record spontaneous employee recognitions. Have someone to recognize? Take a video camera, bundle of balloons and their boss along to that person’s work area. Record the recognition and share it – tag them on appropriate networks so their friends and family see how important they are to their employer.
10. Photo of the day – ask employees and fans/friends to contribute to a flickr pool. Re-broadcast one photo a day. Again, remember themes and important weeks.

Have some more suggestions? Post them in the comments!

So you have a hospital blog, now what? The more contributions you have to your social media effort, the more engaging you will be. No one is an island, and it would be nearly imposable for one person to represent an entire hospital or health system. Fortunately, the nature of social media is that everyone can join in the fun.

A model of which I am increasingly in favor is the “Pipeline” approach. The pipeline is where many contributors funnel in various media (video, written posts, photos, etc) into the effort. Those contributions can live on which ever site is most appropriate (IE video on youtube) and be aggregated and embedded on a centralized, branded “social media hub”. Sharing.mayoclinic.org is a great example of a social hub. They then become the fodder of tweets, facebook updates, etc.

As interest in social media grows and marketing funds disappear, service lines and departments are clamoring for support. We answer that demand by asking those interested to become contributors – part of the funnel of content, the pipeline. When an department or service line is identified, we share a guideline document with them. The guide highlights the social media program and establishes expectations for time commitments and content.

The example below is not fancy or even complete (what about policies and a review process?) but it may help serve as a launching point for those creating their own pipeline of social media contributors. This is a de-identified and simplified version of the document we use internally, please forgive the generic name and branding. It can  be downloaded and used under the creative commons guidelines.

Social Sharing guidelines by Nick Dawson is licensed under a Creative Commons Attribution-Share Alike 3.0 United States License.
Based on a work at www.nickdawson.net.

There are a few truths in life – death, taxes, jackalopes, freedom and the equality of all humans. Ponder that list, study it. Notice what is missing? Bacon. Maybe its sausage, maybe its a nice pate or a pickled trotter; regardless it is time to liberate our swine. Proclaim porcine freedom!

What am I blathering on about? Let us go back more than 2 years ago to the Pownce social network (RIP). Those were the early days when we waxed on into the morning hours about the pursuit of life, liberty and the pursuit of pork. We heard the call to arms with the first Pownce Pork Project (again, RIP). The concept was simple – make bacon as a group. We voted on everything from the spiciness of the cure to the wood it was smoked over. In the end we rattled the foundations of commercial pork production by auctioning off a luscious slab of salty bacony goodness. Whomever made the biggest donation to a food related charity got to…well…take home the bacon. The winner was @surlyshirley.

It is time once again crusaders of cochon to take up arms. We must not go gently into the factory produced, chemically cured BLT. Let us stand up together and say “We demand open source pork!”

Over the coming weeks we will resurrect the hoggett mission. Follow @nickdawson – help plan the next Open Source Pork Project. I will be asking YOU what part of the pig to lop off, how to treat it and in the end, it will once again come to a food related charity auction. So spread the word – let free pork reign and don’t miss your chance to get in on the action!