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hcsm

study how teens use the web to solve #HCSM challenges

On Sunday I got plugged back into one of my favorite things - the #HCSM tweet chat. Somewhere between graduate school, career demands and whatever else life throws at us, I hadn’t spent much time with the HCSM crowd. It was great to get plugged back in to the latest in healthcare and social media thinking.

This week’s chat was full of fresh ideas, new faces and progressive thinking.

But elsewhere - blogs, articles, random tweets - I’m still seeing a lot of concerns around two specific areas: adoption and privacy.

Maybe we should take a hint from how teens think about social networking.

On this week’s episode of This Week in Tech, the panel discusses Vine, Instagram and online messaging in general. They talk about critical mass and the network effect - terms us techie types use to adoption of social media.

Host Leo Laporte points out that teens have no allegiance to one particular platform. Facebook’s done for kids," he says.

It turns out, what teens value is privacy and features, not a particular platform. They move quickly as the landscape changes, with little or no loyalty for a technology brand. What they chase are easier access to friends on a platform their parents haven’t discovered yet.

They flock to apps like Snap Chat for two reasons:

1) It lets them send pictures quickly and easily

2) The app promises the pictures will disappear in a matter of seconds. IE no record exists.

Am I suggesting Snap is HIPAA compliant? Not at all. But maybe studying teen behavior around social media, networking and mobile apps could provide some valuable insight into adoption and privacy challenges with HCSM.

Takeaways: 

  1. Try new things quickly and follow the trends. You may not send a Vine video to your doctor, but testing new apps and networks may lead to fresh thinking.  You'll at least be ready if there's a ground swell. 
  2. Be agile in your thinking. Being locked in to Facebook and Twitter narrows our thinking. A Facebook page probably won't cure cancer.
  3. Picture a different enemy. Pretend HIPAA isn't the problem, instead its a parent looking over your shoulder. Pretend we aren't worried about law suits, but instead making sure so-and-so's girlfriend shouldn't know so-and-so took whatshisface to a movie last weekend. Would that change how you think about privacy? What solutions shake out that can be applied to healthcare?

Here’s a link to the specific spot in the TWiT conversation. It starts around 0:58:00.

You can watch the full episode here:

HCSM Review - Patient Experience & Innovation Edition

It’s live!

This week’s Health Care Socil Media Review is chock full of great stories. Thanks to everyone who submitted something.

First, a little background. The #HCSM Review is what the cool kids call a blog carnival. Every two weeks, the hosting blog (that’s me this week) rotates. We ask for your submissions, and boom, just like that your awesome stories magically* appear here.

*By magically I mean with lots of wordpressy CSS technical bits which no one really understands.

Last week’s call for submissions generated exciting, thought provoking some links. I’m excited to share them here. Originally, I wanted focus on innovation-related posts, which were certainly a theme in your offerings. The big news of the week was The Walking Gallery at HealthData in Washington DC. The Wallking Gallery is the creation of the brilliant and inspiring @ReginaHolliday Read the Storify stream of the event here.

Regina's Walking Gallery is a huge innovation in patient experience. Regina has created a living, moving, growing, ever-evolving art instillation. The power of this project is in it's ability to remind any observer of the humanity at the core of medicine. Everyone wearing a painted jacket is a person, with a story and an experience - sometimes multiple - with the healthcare system. Seeing the gallery, even images via the web, is a disruptive innovation to be sure!

Another Storify post of the Walking Gallery comes from Wen Dombrowski.  According to Wen, This Storify captures the essence of The Walking Gallery at the Kaiser Permanente Center for Total Health in DC, Monday June 4. Regina Holiday paints the backs of jackets for people who agree to wear them to conferences and spread the word about patient access to health data. Regina paints on each jacket an allegorical painting explaining the wearer’s relationship to health data and its liberation, which may or may not involve a personal or family story about an encounter with the medical-industrial complex.

Everything we understand about knowledge is changing. That’s the subject of Dr V’s great post on 33 Charts. For Doctors, the World is Too Big to Know. How should accessible network information be balanced with that committed to memory? How will the doctor of 2050 process and apply information appearing faster than any traditional authority can conceptualize?

Ben Miller PsyD, offers his thoughts on why politics and SCOTUS will not interfere (too long) with healthcare innovation on the Occupy Healthcare blog. According to Ben: We will do what we must to continue to create a high performing and effective system we all deserve. Regardless of the ruling, you cannot stop the innovation in our communities. We will wake up, have our coffee, see the outcome of the decision and continue going back into the trenches working towards a comprehensive whole person system.

David Harlow, writing on his Health Care Law Blog, offered his review of Health Data and Innovation Week. Included in this post is a vlog of a random walk through the Health Datapalooza exhibit hall and lobby spaces, where I interviewed nine entrepreneurs and found that most of them could not have launched their businesses all that long a go – they are fueled by the open data movement that has turned the government into a free sharer of a tremendous amount of information. Many of these tools for health care improvement have social components to them, as well.

Jean Kelso Sandlin, EdD, shared Gatewatching: A Social Media Strategy for Hospitals. Consider how social media gatewatching can position your hospital or clinic as a trusted source for health information and help it earn a reputation for being responsive to patient and community concerns.

Matt Allen, writing at HealthWorks Collective, pins about Gamification and Government Health Care. According to Matt: The move to adopt video games for healthy living initiatives represents a huge innovation in how public health is tackling the lifestyle diseases that are such a burden on our healthcare system. Using games to promote healthier behaviors will help prevent health problems before they start.

Also on HealthWorks Collective, Barbara Duck shared her concerns about a new Facebook app touting secure patient-physician communications. It doesn’t appear to be free for the doctors; the site states that it is $69.95 a month. When you visit their free standing website the RegisterPatient has all the whistles and bells that can integrate with a medical record system, etc. so why do you need Facebook in the portal?

For something a little different, although nonetheless inspiring, Lisa Fields shared an unlikely musical remix - Mr. Rogers singing Garden of Your Mind. It's a auto-tuned mashup of a classic Fred Rogers song, stitched together with cut scenes from his iconic children's show. The lyrics, along with Rogers immutable presence, are great reminders of the power of the human mind. And, if that's not enough, the slide whistle solo is worth the watch alone.

 

That’s a wrap for this week’s HCSM Review. Remeber to follow the HCSM Review twitter account for the next round of submissions and roundups.

HCSM Review - call for submissions

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You people are voracious consumers of web content. Admit it, you’d read healthcare sites and blogs in your sleep if you could. By the flood of amazing sources in my tweeter feed every morning, I’m convinced some of you actually do. Since we know sharing is caring, we’ve established the HCSM Blog Review just for you.

Here’s how this works. Send me links to posts you’ve read recently with no more than three sentences on why the post made an impact. It’s ok if you love the post or want to disagree with it. Send it my way and, if it fits our theme, it will get included.

For this edition of the Review, I would like to focus on patient experience, design and innovation (in care models, service offerings, hcsm itself, etc). How is hcsm facilitating and improving patient experience? How can the social web impact design in healthcare?

So, what are you waiting for, make with the links already!

How to submit:

Leave a comment in the comments section of this post with your name, a link for you (twitter, web site, etc), a link to the post you what to feature and no more than three sentences on what you found compelling about the post.

If you prefer, you can also email your submissions to: nd {at] nickdawson (period) net

Then, check back here on 6/13/2012 for the official roundup.

On bridges - connecting the real world and technology through emotional bridges

20120604-125607.jpg I saw a picture online the other day. “I love my computer because all my friends live in it.” It’s funny because it’s true. I’m also pretty sure there are magic, nearly microscopic elves who live in my iPhone. Think about it, how else can you explain how an iPhone works? Don’t give me that hokum about nanotechnology. It’s elves. Now get back inside my computer, friend.

Regrettably, sites like iFixIt and Wikipedia tell attest there are not, in fact, elves in my phone. As it turns out, you don’t live inside my computer either, though I’m still suspect. The bitter truth, is these things are just metal and silicone. It turns out, according to “experts”, Facebook isn’t really a place either. For that matter, the entire Internet doesn’t really exist anywhere. There go my plans to move there one day. Come to think of it, we’re spending more and more time with things that are really pretty cold and austere; void of any emotional connection.

The real world and what we see on a screen aren’t as connected as we might think. Sure, Facebook has changed how we keep in touch. But, there’s no way to reach out and touch something on someone’s wall. We can have an emotional experience via these sites and technologies, although it’s not the result of an interaction with something real. That’s exactly what an emerging big trend is all about.

Last week I came across two examples of things which connect the real world and the physical world with a particularly enormaring emotional appeal.

DearPhotograph is a site from the same team who did Post Secret. The premise is pretty simple, take a photo of yourself holding an older photo superimposed over the scene where it was originally taken. Then write a little note to that photo.

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I know what you are thinking. Hey Nick, get on board the USS Clue, it set sail long ago and left you on the dock. Don’t you know Facebook just bought instagram for like a gagallion bucks? Why are you so amped over another photo site? The difference is in how Dear Photograph bridges the real world, with a real object (a photo) and creates and emotional tie. The site, and technology, are just a vehicle to share the emotional thing created. That’s a pretty cool.

Dear Photograph is more than instagram or flickr or faceboo. It requires you to go and actually do something. You have to find an old picture, one with an emotional draw. Then you have to go to the spot it was taken - does that place still exist? Can you get there? Now align the photo in 3D space over that real place and take another picture. Still sound like just s photo website? The result is an emotional connection with a time and place, and the technology which made it happen.

Now that we’re getting settled in our temporary apparent, I had the opportunity to play with a technology I’ve been eyeing for a long time. The Nest thermostat is…well…a thermostat. But it’s like the iPhone of thermostats. And that’s by design. The Nest was created by Tony Fadell who, during his time at Apple, launched the iPod. The nest is part of a growing class of devices which connects the real world to the digital. For starters, it’s a real thing. You mount this gizmo on your wall (and, as a excellent example of experience design, even the install is well designed).

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Once hanging on your wall, the user experience melds between your physical interaction with the thermostat and it’s online features. You can check, set and monitor your temperature and energy usage from an app or the web. And if that sounds nerdy, it’s far from it. You really connect with this thing. It does something, it bridges the real, physical world of your home environment with the online world of data and numbers, and that creates a strange emotional bridge. It makes caring about energy use and savings a meaningful act.

I’m inspired by these two examples. They are bridges. They link our physical world with the intangible, elif-infested, silicone composed digital either. Think about a real bridge, it does more than get you from one side of a bank to another. It enables you to go someplace, to see someone, to touch something and to do something. That’s the next phase of technology - creating bridges.

In healthcare, we’ve known about technology bridges longer than many other industries. We’ve had medical wonder-gizmos for years. Considere the nearly ubiquitous heart rate monitor in every inpatient room. Beep, beep, beep… That rhythmic drone isn’t just a machine making nose, it is the heart beat of some we love. Each beep represents life, someone’s beating heart. Each beep also represents a data point inside the machine’s inner workings which will inform doctors and nurses. That’s a bridge.

We’ve also got a long way to go. While the inpatient room might be strewn with wires and beeps, funneling data into a black box, virtually none of those devices are designed with user experience or emotional consideration in mind. Neither are implantable medical devices. Just ask Hugo Campos who is crusading to get access to the data from a defribulator implanted in his chest.

The Internet is evolving to become an Internet of things, all connected to our real world, which is inherently tied to our feelings, hopes, needs, excitement, etc. Healthcare devices and services need to look towards sites like Dear Photograph and gadgets like Nest. What can we learn from things and services designed around creating emotional connections between the real world and the world of 1s and 0s. Now, more than ever, with health information growing by billions of dollars and health reform pushing much needed change on an already constrained system, we need user-centered design. We need bridges which connect us, real living things, with the beeps and wires, or our doctor’s avatar on a patient portal.

From Mayo: Building a Process to Accept Feedback from your Social Media Audience

Note: I'm not writing much on this site about healthcare and social media lately. However, over on Mayo Clinic's Center for Social Media I contributed a piece on social health strategy. One of my concerns about any business which uses social media is how they will manage feedback. It's easy to setup a facebook page, but it's another thing entirely to connect all the right processess and people within the company to help address feedback from fans and friends. Yet, without that process, your social strategy can fall flat on its face if audiences don't think you can help them with anything other than marketing info.

You can download a pdf of the article here.

 

which way did he go - healthcare, meet the internet

subtitled: foreseeing a day when we will shop for and buy medical services without leaving the house. Which way did he go

Google  - (n.) first stop on the information superhighway. "I went to google to find the answer"

Google - (v.) to look for anything online "He wanted to know more about diphtheria, so he googled it"

Google - (n.) medical instrument used to aid in diagnosis and treatment "Sally wondered about the bump on her arm, so she went to google and googled the symptoms of spider bites"

Sometimes a topic is like a cloud full of metaphors waiting to rain down. The trains coming and you better get onboard. That ship has sailed. Know thy enemy. A few weeks ago I had the privilege to speak (along with a group of infinitely more qualified other folks) at a healthcare conference in Chicago. During one of the panel discussions, someone made a comment which I've been chewing on for a week. "The competition, for attention online, is sites like RatedMd and WebMD."The only thing I could think of was those Loony Tunes where the Abominable Snowman always got confused and said: "Which way did he go George, Which way did he go?". He was cutely befuddled by misdirection as abominable snowman are apparently wont to be. (The catch phrase, by the way, comes from Of Mice and Men.)

The context of that comment was in regards to reputation control and public perception. The concern is healthcare providers are being valued and rated online and without some presence of their own, their "brand" has potential to be devalued. While that point deserves some consideration, it wasn't what got me thinking.

What set the hamster on my mental wheel gasping for breath was the idea of online sites competing for patient attention in general.  This isn't a new idea and likely won't strike you as terribly profound. People go online, they google, and now they talk to each other via social media sites. Now think about this: how does that play out when those searches, sites and conversations reduce the overall need for your system's healthcare services? What happens when a patient goes online and gets a diagnosis and even a treatment rather than coming through your doors?

Think it won't happen?

I've been looking for pickle crocks. I like to pickle things. You probably know that about me. Here's the thing about pickling, when you let natural bacteria do the work, its a delicate process. Two things will kill the bacteria and render salty but unpicked veggies every time: sunlight and chlorine in municipal water. The later is easy, you buy spring water from the store. The best solution against sunlight is an earthenware ceramic pickle crock. You've seen them in your grandmother's kitchen, probably holding the wooden spoons and whisk in the corner near the stove. Once upon a time, they served a real purpose. The problem is that they are increasingly more rare. It seems no one else shares my interest in pickling - shame. So try this: go to google, type in "pickle crock".

If your results are similar to mine (and remember, a google search is in the fingers of the beholder), then the top 5 or 6 results for pickle crock are online stores or sales sites. You may even get some Google Shopping results at the top. Think I even checked a local store first? (I know, I know, its good to shop locally).

Now, google "allergies". This time the top several sites are informational sites: WebMD, MedicineNet, eMedicineHealth, and even a few nationally known hospitals.

I know what you are thinking. Yeah, you can buy a pickle crock online but its not like you can buy an allergy diagnosis on WebMD. …. yet.

Last week CMS, the Center for Medicare Services, announced it is loosening the regulations around telemedince certifications. That is a big step. The process for credentialing practitioners to treat people via Skype just got a lot easier.

Lets talk fee-for-service

This one is simple. The average net reimbursement for a family physician visit is about $60. The average patient co-pay is $25. If a patient can stay in their own home, avoid the hour wait in the waiting room, not to mention the germs and two year old copy of Highlights magazine, and see a doctor or nurse via Skype for $15, which path do you think they'll pick? You're out $60 and the patient saved $10. There is, of course, the huge downstream impact on referrals and patient loyalty as well.

Enter the ACO

With the hullabaloo around Accountable Care Organizations, there is an increased interest in technologies like telemedcine. They can save money. Here's the rundown incase you missed it. In an ACO model, a provider is given a pool of patients, lets say 5,000. They are then allotted a fixed amount of money to keep those patients well for a year. Lets say $1,000,000. If no patients come in the door at all and all of those patients are perfectly healthy you effectively pocket the cool million. However, when they do come in, you need to use your resources wisely. The healthier they are, the more you keep. So you have a mixed bag - don't order expensive tests, thats money out of your pocket. But you do need to ensure they get better. Now what happens when those patients start going online and getting treated by eVisits from other providers? The current CMS regulations do not prevent patients from seeing other doctors. However, you are still on the hook for the outcomes. If that eVisit doesn't work out, or worse, has an adverse outcome, guess who's pocket is being reached into?

Now, I'm the last one to spread FUD and start fear mongering. I'm also a big fan of the interwebz and the potential these technologies hold for patients (after all, we are all patients). What I would suggest is that health systems and providers need to be ahead of this curve, not behind it (that one counts double for buzz word bingo). We need to offer these services to our communities and patients ourselves and not let large, profit driven websites own this space. eVisits, telemedicine, social media, text messages, email, EMR … these are all doable today. There are already patient populations where this makes sense and there are revenue models which work. In a fee for service environment, what does the pro forma look like? Can you staff a nurse in a role to interact with patients and charge them just a little less than an office visit co-pay? What about doctor to doctor telemedince as a start? Lets not be the Abominable Snowman with our arms crossed and fingers pointed in opposite directions asking: "which way did he go George, which way did he go?"

Update: From the "great minds think alike department", Jen Riggle wrote a great post on the same day talking about, of all things, skyping doctors. Her research and links suggest reality is closer than we may think. In particular, take a look at Dr. Brian Goldman's advice. He suggests starting with established patients. If you already know, because you have meaningfully implemented an EMR, that someone has seasonal allergies every spring, that is one more check box in feeling secure about making that diagnosis next April via Skype.

 

By the way, Leeners sells great stoneware pickling crocks at a good price.

Meaningful Use guidelines for Social Media in Healthcare

I had the privilege recently of being asked to write a short reflection on the use of social media in healthcare. I suggested many of us are moving from our freshman year - getting familiar with campus, determining which is the cooler spot to hang out at, facebook or twitter... you get the idea - towards our sophomore and junior years. For many providers, this year is about figuring out what to do next. What will actually bring value and make using social media in healthcare, well, meaningful. What are the meaningful use guidelines for #HCSM? In late 2010, the federal government released a much anticipated set of guidelines around how healthcare providers should use electronic medical records. The guidelines, know as Meaningful Use, specifically spell out what features an EMR must contain and how doctors must use those features in order to qualify for federal stimulus dollars. For instance, the guidelines suggest providers council every smoker on smoking cessation. The software must be able to prompt doctors when someone has identified as a smoker and it must be able to capture that the physician has spoken to them about quitting.

Meaningful Use says it is not enough to simply have an electronic record. Meaningful Use says the EMR's feature set and how it is put into practice determine the impact it has on care. Today, we can say the same thing about social media in healthcare. With heartfelt thanks to the pioneers who fought the HIPAA and ROI battles, it is no longer enough to simply have a facebook page or twitter account. There are expectations around engagement, user experience, quality and value which users have come to expect through interactions with other individuals and organizations.

The good news is that there is no single correct way to use social media and digital communications as a provider. There are, however, a few basic ideas which I boldly offer as guidelines for using social media as a healthcare provider:

  • Be available - Phil Baumann said it well. You do not need to be famous online, you just need to be available. In fact, the rest breaks down if when this guideline is not followed. It has been said many times by many people, social media is less about pushing and more about pulling. If you are not open to conversations with the public, patients, other providers, etc then social media may not be for you.  As guidelines go, this one may be the most significant for meaningfully using social media. Being available is more than just replying to tweets. Availability means knowing who within the organization can answer the question authoritatively; It means having a team of on call experts. I know at least one healthcare thought leader who envisions call centers giving way to tweeting centers. Have the capacity and expertese to follow up with your tweets, comments and facebook wall.
  • Bring Value - There is an easy litmus test for this one. Think: "why would I follow or fan a company?" Most people get enough spam email and junk mail. Can you honestly say you would want to get the message you are pushing out if you didn't work for the provider pushing it out? If not, then it is probably spam. So what kinds of things bring value? Think about curation, sharing expertise, answering questions, helping someone find what they are looking for. Here is a simple way to bring value: go to search.twitter.com and select advanced search. For the search string, enter something like "doctor" and then put your zip code in the location field. Chances are someone in your area is looking for a good doctor. Reply and offer to set them up with a same day appointment. Now that's value! Another example includes hosting diagnosis specific communities and wikis with clinician participation. Imagine an online community of folks who have been and are about to go through an orthopedic joint replacement. What kind of value would they get from connecting with each other and sharing experiences in a forum moderated by a clinical expert?
  • Liberate your expertise - Most physicians go through at least 4 years of medical school and post graduate education. Many pursue fellowships and residencies. There is a significant amount of intellect and scholarship trapped in those brains of theirs. Here is the problem, until there is something wrong with me, I have no way of tapping into that knowledge. We often mistake holding onto our ideas and knowledge as power. The reality is the opposite. Those who are willing to share their expertise often find the rewards to be considerable. If you are a physician, you are a trusted expert in your field (the same can be said of provider organizations). Your use of social media must consist of sharing that expertise. Provide your opinion on the health news of the day. People would much rather get that expertise from someone local and trusted than an etherial disembodied name on the byline of a major news paper. Here are two great examples: Dr. Howard Luks and Piedmont's HealthWatchMD site.
  • Be collaborative - engage publicly with other physicians and experts (and can't patients be experts in their own conditions?). If you are an expert individually, and there is indeed benefit to liberating that expertise, imagine what happens when you team up with other experts? In medicine there is the concept of grand rounds - opportunities for physicians to present complex cases as learning experiences to other providers. Today's social tools are perfect platforms for grand rounds. The more providers are willing to interact and share, the more we all benefit. This collective knowledge becomes searchable, accessible by anyone - patient or provider - who wants to learn more about a condition or treatment. Dr. Gayle Smith does a fantastic job of collaborating with patients and colleagues.
  • Be Innovative - Innovations come in many forms; not everyone has to be the next iPod. Think about how social and digital tools are being used outside of healthcare. What applications might they have in improving health and patient experience? Over 500 million people are using facebook. According to their statistics, 250 million access the site from a mobile platform and mobile users access the site at least two times a day. What does that tell us about the role mobile platforms play in what has become the most significant communication tool of our age? Do you have a way to interact with patients via a mobile device? What about text messaging? There is an innovation which is easy to adopt. Solve problems, don't get hung up on them.

There you have it. How is that for a start? As we start to go beyond simply being online it is time to think about how to have an impact in what we are doing. What other guidelines would you propose? What about from a patient's perspective, what makes social media meaningful?

Elsewhere: Harvard Business Review's profound validation of social

The third in my elsewhere series of important content from other sources, this post highlights the entire December 2010 issue of the Harvard Business Review. Because HBR is a business and has to pay the bills, not every article is available online. I'd implore anyone reading this to find a print copy and read it, cover to cover. I'm obsessed. If we've chatted about social media recently then you know about my obsession with the December 2010 issue of Harvard Business Review. The majority of the issue focuses on social media and branding. I'll sum up my reaction simply by saying the entire issue is a profound validation of the new model for community engagement. Along similarly profound lines, Dana Lewis recently posited, "social media is more art than science." If that is the case, then the HBR outlines the form of the art, its importance and place in the world.

That later point is not to be understated. As barriers to communication disappear, the expectations on meaningful interactions rise. Today, social has to touch nearly every business line and strategy before it goes out the door.

According to the authors:

Many consumer touch points are owned-media channels, such as the company’s website, product packaging, and customer service and sales functions. Usually they are run by parts of the organization other than marketing. Recognizing the need to coordinate these channels, one of our clients, a consumer durables company, has moved its owned-media functions into the sphere of the chief marketing officer, giving him responsibility for orchestrating them. Along with traditional and digital marketing communications, he now manages customer service and market research, product literature design, and the product registration and warranty program.

Here is the take away: its not a silo. I don't agree with the quoted case study saying it has to be under marketing, in fact I'd suggest that there is a new breed of communications department, or as we call it, Community Engagement. But the salient point is regardless of what you call it, it has to be empowered and positioned to include responsibilities for customer service, market research, business development, communications, branding, outreach, sales and more.

Retail vs Healthcare - its not exactly the same

I hear a lot of heathcare organizations asking the hows and whys of using social media. This week, Ed Bennet released the latest round of hospital social media stats - 890 hospitals are now engaged in some form of two-way, modern communication. And while that figure is impressive, validating and promising, there are still some 4,200 odd hospitals and countless physician practices, vendors, professional groups, patient groups, etc which are still struggling to understand the value of how people are communicating today. That's ok. They are asking themselves important questions which those organizations need to sort out for themselves. I will offer one cautionary bit of advice:

heathcare is not like retail

Sure, there's lots of talk about consumer driven healthcare. And maybe I've gone on on and on about what healthcare can learn from consumer companies. I'm not trying to contradict those points. What I am suggesting is that looking at retail as a model for using social platforms is flawed for a few reasons.

Retail can get away with...

Selling, for starters. When you interact with a retail brand online, you expect their goal is to sell you stuff. Indeed, the savvy ones understand the importance of experience and customer service in making the sale, but it's still about the sale.

So when a company asks you to fan them on facebook for deals or retweet for a chance to win, you enter into a pact which both the consumer and the retailer understand.

In the infographic above, the idea of giving away kidneys may be a crass example. It is however not any different from a retail approach.

What healthcare organizations can do...

Is what retail has a hard time with; actually caring about (and for) individuals. Healthcare organizations have an inherent trust based on the services they provide. When a healthcare provider ventures into modern communications, there is a pulpit awaiting them with the words "first do no harm" emblazoned on the front. That credo is also a pact which patients and providers understand. Providers can further build trust by using social platforms to extend the reach of their care.

Again, in the example above, actively listening for and responding to patient needs is something retail simply can't do with any cache. Here are some other things providers can do which retail cannot:

  • Give away trusted, curated medical news and tips
  • Help people find care
  • Participate in the medical decision making process
  • Be genuinely compassionate
  • Support community efforts without bias

Rather than taking the retail approach to interacting with the digitally connected, try taking the nursing approach. Let's ask ourselves what a nurse can do that a shopkeeper cannot (are there still shopkeepers? well, you get the idea).

Its not the platform (subtitled: a note to self)

So, let me get this out in the open. I'm not a social media advocate. I'm not a social media guru, expert, thought leader, or zealot. I am not pro-twitter. I'm not really that into Facebook (please don't unfriend me!). You might be surprised to read that I'm not always looking down at my phone. Maybe I am. But still. I am an advocate for care. I am an aspiring healthcare guru, a wanna be expert, a hopeful thought leader and unabashed zealot for improving the patient experience. I am a pro human. I am really into making someone's care experience a holistic one. You might be surprised to read that I like to spend part of my day greeting people at the door of our ER.

When did social media become about, well, social media? When we we decide that talking about what we are talking on was more important than what we should really be talking about? I'm not an angry blogger, I promise. And I'm not singling out anyone or any post either. In fact, there have been some important online discussions recently about the validity of social media in healthcare.

But, isn't it really about healthcare, about care. I mean, if its not, why are we interested? I'm guilty of getting wrapped up in frenzy; and suspect we all are. This is my call to action, my reminder to myself and my sincere wish - lets keep it about advancing how we care for others. We do that in many unique ways. Doctors do it differently from nurses, who do it differently from patient advocates, who do it differently from mental health professionals who do it differently from us admin types, who …. well, you get it. Still, we are all focused on improving the experiences and outcomes of those we care for. When we start talking about the 1s and 0s that our bully pulpit is made of, we've lost some of our effectiveness.

Be health champions first. Let's be champions of care first. Let's focus on using early adopter, expert, and guru status to champion what it is we are really doing - elevating the art of healthcare.

epilogue: Now, I know what you are thinking. Wasn't my last post on this blog a hubristic, aggrandizing, self-promotional link to an article where I was quoted as being some kind form of thought leader? I see where you are going with that though and I agree. I'm talking to myself in this post. In fact, when I forget about this altruistic nonsense, I expect you (my two readers, hi mom!) to call me out. I'll also add that those kinds of articles and posts are important. They are ammo in our arsenal to promote the use of social media - we just need to remember why we are so keen to promote it in the first place.

Get your HCSM nerd on with ThinkUp

Ever go shopping and see something and think "I have no idea what I'd do with that, but I have to have it?" It happens to me all the time, and almost always in one of two areas: food and tech. Take for instance this Star Trek USS Enterprise pizza cutter- I have to have it! I'm nothing if not predictable. This week, I was blown away when I learned about what the folks at Expert Labs have come up with. They are calling it ThinkUp. In their words:

ThinkUp is a free installable web application that captures the insights and expertise of your social network by collecting and organizing replies to your conversations on Twitter, Facebook and (soon!) other networks.

I grabbed a copy of the code and installed ThinkUp on my hosted webserver - in fact, you can see it here. Like a left handed garlic peeler that doubles as a beer opener you pick up in the check out line, ThinkUp is one of those things that is both immediately full of possibility and confusion at the same time. ThinkUp connects to your twitter account(s), and Facebook account and begins backing up your conversations. Via a sleek web interface, it presents all kinds of data and analtics back to you. ThinkUp shows:

  • Your most replied-to posts
  • a breakdown of clients
  • your most re-tweeted posts
  • Threaded conversations that you have had
  • Links the people you are following have tweeted
  • photos from the people you are following

And much more. Like I said, I've just begun to scratch the surface.

What makes this Healthcare and HCSM related? Nothing special other than it is a great tool to have in your arsenal. Providers should consider installing ThinkUp for two reasons: Firstly it backs up your twitter stream. There are plenty of other great ways to do that, including Backupify, although TweetUp lets you own that data on your own server. Secondly, it helps you produce some dynamite metrics easily - replies, retweets, popular tweets, etc. It makes showing the effectiveness of your posts quite easy.

There are some not so obvious examples as well. For instance, ThinkUp shows your percentage of "conversationalist" vs "broadcaster". Maybe it is time to stop telling and start listening...and responding.

ThinkUp helps you track your conversations and replies. When you ask a question, particularly if you have an engaged set of followers, you often get answers in an asynchronous timeline. That is to say, replies may trickle in over time. ThinkUp remembers your query and presents all the replies in an easy to digest view.

Your experience with the setup process will depend on your comfort level of installing web applications. If you have ever set up a WordPress site on a hosting account, you'll have no problem. If the idea of installing software on a web server sounds daunting, then you may want to wait for hosted ThinkUp providers to pop-up - and that is sure to happen.

If you want to see the user's public dashboard, feel free to check out my install. Or, grab the code and get your HCSM nerd on!

Social Media Ambassadors - the rebel rock stars of the online world

Remember when rock bands would storm the radio station, taking over the morning zoo? They had totally free run of the place. "Dogs and cats, living together, mass hysteria." Well, at least that's how it seemed to me circa 1993. In the end, it was just one of many marketing and promotional tools used by bands to tout new records. However, there is a kernel of validity in handing over the controls from time to time. When the same idea is applied to healthcare social media programs, the result are fresh voices and perspectives, deeper explorations of topics and a group of employees who are more capable of representing the organization online. Lately, I have been inspired by the Ritz Carlton's use of "guest tweeters;" ladies and gentleman outside of their core communications team who take over the reigns on behalf of the organization. Having different members of the organization represent the company gives a chance to highlight regions and specific properties. Hospitals, even single facility systems, are not much different. Using guest tweeters, or "social media ambassadors" is a great way to add some dynamic range to what you are sharing online. Recently we tried something similar in our Richmond market. If success can be measured in sentiment, we felt energized by the pilot.

There are many reasons to consider cultivating social media ambassadors. For starters, no [person] is an island. Even with best efforts, it is difficult for any one person to represent an entire healthcare organization. The most seasoned healthcare communicators may still be clinically novice; having a nurse tweet for a day could be a detailed look at a clinical topic. Interviews and quotes from various departments or experts give a sense of a topic. Allowing those same groups to run the show for a few hours or days lets them to take a much deeper dive. Showcasing someone else's voice in the mix also keeps things fresh and interesting. The way someone talks passionately about their own work is always more stimulating that listening to someone else try and represent it for them. Finally, cultivating a group of ambassadors helps organizations develop a base of pitch hitters and trusted spokes people. (I've written before about empowering employees to speak for the organization.)

The logistics and mechanics of a social media ambassador program is fairly straight forward. Just like any successful project, coaching and a partnership will go a long way. Start with a simple, one page document. It should include an overview of the tools (twitter, Facebook, etc) and terms (retweets, direct messages, likes, etc). It should also spell out, in lay terms, the organizations communications guidelines. For example, thank everyone, even those with negative feedback, or don't engage in political banter. Finally, it should define expectations of what is on and what is off limits. For instance, you may want your ambassadors responding to general comments and you may ask them to avoid replying to anything negative. Perhaps you stay "on call" and formulate any replies together, ensuring that the organization is well represented along with the guest's voice. Regardless of the plan, spell out out.

In addition to coaching the experience for online ambassadors, it is important to make sure they understand the tools they are using. Many will already be familiar with Facebook, making it easy to turn "Wellness Wednesday" over to your wellness team. They may not have administrated a page, something that is easy to walk through in a 30 minute coaching session. The same goes for Twitter. Tools like Hootsuite can help and give some control. They can also be tedious for new users to pick up quickly.

A good policy and agreement of expectations will help the governance process. That said, turning over the controls should not mean abdicating responsibility. It is important for those responsible for social media to watch the flow of the posts and conversation. Maintain close contact with your guest posters and make yourself available to answer any questions they have along the way.

Take a page from the Ritz Carlton's play book and find some social media ambassadors. Hold their hands through the process and you'll be well rewarded. Your social media stream will get a fresh voice, some deeper perspectives and you'll be training a whole team of spokespeople in the process.

someone build this: put my tweets in my health record

There is a great deal of attention these days to the concept of electronic medical records (EMR). Sometimes we refer to them as electronic health records (EHR) or even personal health records (PHR). While there are semantic differences between each, the idea is the same: a complete, portable electronic snapshot of your health. At least that is the idea. In practice today we are really talking about an electronic record of your medical history. (notice I left out portable, complete and health). Enter the idea of accountable care. Many industry experts are already envisioning a near future when providers will move from reaction to proaction. Rather than being paid to treat the symptoms that walk in the door, doctors may get paid for keeping you out of the office. A practical example is obesity. Instead of being reimbursed to treat the side effects of obesity (asthma, diabetes, joint pain, etc), a doctor may get paid for helping a patient achieve a healthy lifestyle and losing weight.

There is still something missing from this equation. And that is where your social graph comes in. A lot of us do healthy things all the time. According to Foursquare, the geolocation based social network, I have "checked in" to my gym 57 times since early March. I have gone to the farmer's market 15 times this year. I have attended four medical education seminars (ok, those were work-related, but I still learned something). Here's the rub, my doctor doesn't know any of that. If he is going to be responsible for my complete health, shouldn't those things factor in?

So, continuing my "someone please build this" series of blog posts, here is my latest plea: someone please build a conduit between my social graph and my health record. Let me opt in and chose which things I share online which should also go into my EMR to become available for anyone treating me. Tools like Foursquare come to mind as an obvious choice. Since it is based on location, it takes some of the effort out of participating; it just knows where you are. So when I check in to the gym, wouldn't it be great if my health record was updated too?

My good friend and HCSM guru, Dana Lewis pointed out the power of twitter hashtags. What if we were able to define a specific, personal tag, say #NicksHealth. Every time I want to include a twitter update in my health record, I tag it with #NicksHealth. Last week, I had surgery on my knee to repair an ACL injury. Every day for the first week, I took a picture and loaded it into Flickr, the social photo sharing site and posted a link to the picture to Twitter. If I were able to tag it with #NicksHealth then my doctor would have a series of images showing the progression of my range of motion, wound healing, etc. When I update my Facebook page with details from physical therapy, that information could populate my medical record, along with my Foursquare checkins - my doctor would see just how compliant I have been with his rehab orders.

It doesn't all have to be healthy. Providers need a complete snapshot of our lifestyles if they are going to suggest a course of care. Perhaps through incentives, competition or other means, patients may be encouraged to also share things that are less healthy. "I ate a burger tonight, with fries…and bacon…lots of it. #NicksHealth" - My doctor should probably know how often that happens in relation to my trips to the gym.

There are, of course, some challenges to this idea; including the burden of combing through all the data. Physicians may already feel like they have information overload. Without an accountable care model in place today, there is not much to entice them to pour over patients' social graphs. In time, we will also need software that can automatically sift through the updates and present them in a meaningful way to physicians. However, the first step remains building the connection.

Every major social network has an API, or Application Programer's Interface. APIs are a way to move data into and out of systems. If you use a twitter client like Tweetdeck or Twitter on your iPhone, you are using the Twitter API. Health providers, when considering their online offerings, would be wise to build in API functionality to online health portals.

Let people chose which data they want to share with their medical record. Providers can incentivize participation through reduced co-pays, social competition, etc. In return they get a rich flow of lifestyle information. When accountable care, meaningful use, EMRs and social graphs come together it will be a win for us all.

someone build this: Foursquare for Doctors

The genesis of this idea came out of the Healthcare track of the C2C US/Russia Civil Summit that I participated in in June 2010. During a discussion around the use of social games, Dr. O Marion Burton had a lightbulb moment. He piped up with, "oh wow! how cool would it be to show off that I used a cheaper med and had better results!" I have been taken with the idea since that conversation. Since I am not a coder, here is my plea: someone help build this. Imagine a social site, a game of sorts, that rewards doctors and clinicians for improving outcomes, reducing costs and improving a patient's experience. Docs are a competitive lot, they worked hard to get where they are and that kind of drive doesn't end at graduation from medical school. "Dr. Smith just prescribed a less expensive alternative." Oh yeah? "Well, my patient just got out of the hospital a day under the national average length of stay." Can you see the peer pressure building?

Unfortunately this site doesn't exist...yet. Imitation is the sincerest form of flattery right?

Have you checked out the Foursquare social network? It is a social game, you (or rather your GPS equipped mobile phone) tells Foursquare where you are and Foursquare tells your friends. If you are out on the town and want everyone to get together at your favorite watering hole, you log into Foursquare, update your location and blast a note to your friends.

The game part comes into play in two ways. First, if you check into a place multiple times you may become its "Mayor". Savvy restaurants and businesses are rewarding mayors. In early 2010, Starbucks began offering Mayors a $1 discount off Frappuchinos. The second part of the game are the badges. You get badges for anything from checking in after 3:00AM (School Night) to checking in near the water (On a Boat). Think of them like Girl or Boy Scout merit badges, only, well, internetier.

Back to our medical example

Patient care is not a game and to create a social site that does not trivialize it takes tact. However, there is nothing wrong with a little healthy competition. The Federal Government's CMS website offers good data on how one hospital stacks up against another; and it is fairly easy to read….if you work in healthcare and spend your time digesting these kinds of things. I am not convinced that the average consumer wants to suss out the percentage difference between two providers (although the site does a nice job of using plain language).

What I am suggesting - no - begging someone to build is a site that is relevant to both clinicians and the public. Think: Foursquare for doctors. Write a script for a generic med three times, get a badge. Have a better than average outcome, get a badge. Become the mayor of wherever you attend CME courses. Doctors could follow each other and would see what their peers are up to. When Dr. Jones writes a generic script three times, Dr. Smith might ask him which med it was, what the differences are, why Dr. Jones prefers it, etc. The professional interaction does not have to happen on the site. The site is simply a way for docs to encourage each other to improve care. Patients can follow along too. You could visit your doctor's page and see what badges they have. Looking for the best surgeon? Find the one with the "10 complication free surgeries" badge.

I'm not much of a coder and don't have an ability to produce great design (although I did the fancy syringe badge for this post, pretty good huh?). So please… someone build this!

Code Lavender - making the patient experience a strategic goal

"Most patients want the high tech and a great quality outcome, but they can't judge the quality of the [treatment] they can judge the quality of the experience..." - Bridget Duffy, MD This inspiring video came to my attention by way of Dr. Howard Luks. Every time I watch it - I have done so several times - I become more inspired. Dr. Bridget Duffy, the Chief Patient Experience Officer for the Cleveland Clinic (how great is that title!) presented this talk at the Gel Conference. Dr. Duffy makes the case for elevating the patient experience to the same level of importance as clinical outcomes.

There are two concepts in particular that resonate with me from this talk. The first occurs around 21:45 when Dr. Duffy talks about "Code Lavender". In her words, TV medical dramas have made us all familiar with a Code Blue, a patient in cardiac and/or respiratory arrest. A Code Lavender is when someone is emotional arrest - a patient, visitor, doctor, nurse, anyone in the hospital. Calling a code Lavender means that "everyone in the hospital stops and sends healing intention or prayer..." It is a powerful concept.

The second point that I find especially apt is an overall theme of the talk: creating a meaningful, positive, healing patient experience is the most important strategic goal a provider can have. "If you focus on that, [hand washing, clinical outcomes, quality, performance improvement] will come."

At the end of her talk, Dr. Duffy slips in a key part of this plan, "listening to their needs." I recently had cause to say to someone "I'm working with a patient to resolve a concern they have, this is the best part of my job, social media is just a way to get there." Using these real time tools to connect with patients and improve their experience is truly what #HCSM is about to me. I am fortunate to work for an organization that has made experience a strategic goal. I get to see every day the impact it has.

Bridget Duffy at Gel Health 2009 from Gel Conference on Vimeo.

Daws.in, its close enough. Using Bitly.pro for custom short links

Bit.ly is becoming more liberal with invites into their Pro service. One of the things Bitly.Pro provides is the use of a custom domain for shortening links. Most hospitals refer to themselves, internally, with initials. Some State Regional Hospital is probably SSRH internally. There's a good chance you can register those initials or a close variant. It makes a nice way to keep your tweeted links aligned with your brand.

Bit.ly, and Bitly.pro also allow you to create custom short names. When you combine a custom domain and short name, some even neater things happen. Rather than saying "find us on facebook" you can use a link like ssrh.biz/ssrhfb . It makes a nice way to send links internally as well.

The waiting time for a bitly.pro invite seems to be less than a week. In addition to the custom domain, they also provide some enhanced, detailed reporting tools. Check it out at the Bitly.Pro site.

As for me, I'll be posting links via Daws.in (because .on isn't a valid suffix and I was all out clever).

Power to the People [Part 2] – Exposure Therapy

Part 2 of a 34-part seriesThe next level of growth for healthcare social media, must come from within the organization and involve all employees in the effort.

The previous post in this series reviewed the first year of healthcare social media and noted the correlation between engaged employees and customer service. I’ve predicted that in the coming year we’ll see progressive organizations extending the use of social tools to their employees; thereby creating a culture of information exchange and online service. Achieving a socially connected employee base at a healthcare provider is not without challenges, although it may be easier than some would suggest.

Action conquers fear

We have no reluctance about hiring someone to register a patient or letting nurses tend to patients. Healthcare providers, as Lee Aase of the Mayo Clinic has quipped, are accustomed to embracing cutting edge advances in medicine but ironically slow to adopt new business practices. And so, it should come as no surprise that many hospital systems balk at the idea of allowing a nurse or registrar represent their brand online. Many concerns can be easily relieved by exposure to social media tools and education about their use.

Compliance and regulatory issues usually top the list of concerns and rightfully so. A well-intentioned caregiver posting a patient’s picture could unwittingly generate serious legal problems for a provider. Similarly, I would not suggest completely dismissing issues relative to branding. Again, a well-intentioned employee could post offensive or misleading information.

But there are also concerns that rest on a much less solid foundation. Here, I’m referring to the red herrings of productivity, viruses (or other technological malfeasance), and inflammatory discourse. I suggest these concerns can be allayed by  what psychologists call exposure therapy.

The tools that organizations are scared to give their employees  can, in fact, be the way to overcome fears – real and imagined. It is time to begin using social media internally, within provider organizations. Doing so will help assuage naysayers and allow organizations to cultivate online ambassadors.

Connecting the dots by connecting employees

Out-of-the-gate it may not make sense to extend Twitter to 5,000 employees. However, a simple forum site, accessible only internally, may be a gentle introduction for both the organization and its employees. Consider augmenting the intranet site with a forum. Make the rules clear and accessible -- no foul language, no insults, and no patient information. This is not a unique idea.

Paul Levy, the widely-read CEO blogger from Beth Israel Deaconess Medical Center in Boston set up forums when facing a difficult financial position last year. He explained that layoffs seemed inevitable, but offered an online, intranet for employees to discuss other options. It worked. Employees collaborated openly and created ways to reduce costs and save jobs. Concerns about inflammatory language proved unfounded, the conversation was civil and professional. Levy is a seasoned leader who knows criticism is often a suggestion in disguise; he’s fearless about letting employees speak freely.

If forums are the first steps, a more feature-rich social platform may follow. Multi-user content management systems like open source Word Press MU or commercial Microsoft SharePoint can be used to build powerful internal social networks. As a colleague puts it: "I can log into Facebook and see what everyone I know is up to in broad strokes, and it only takes minutes a day. Why can't we do that across our organization?"

Imagine logging into an intranet and discovering what’s going on in finance, surgical services, registration, administration, and infection control,-- all from short status updates. Wouldn’t knowing where the company as a team was headed be useful?

These kinds of controlled, internal social efforts also help employees better understand what leadership looks like. Leaders,  coached by those who understand social networks and organizational development, can model leadership by their participation in online communities. Most companies already have online training tools, so including Social Media Communications 101 is an easy drop-in that will lead to an internally connected and engaged workforce.

Next time, a deeper look at the the tools to build an internal social network...

Power to the People [Part 1] - HCSM turns 1

Part 1 of a 3 part series The next level of growth In healthcare’s use of social media, must come from    the within the organization by involving all employees in the effort. Preface

For many healthcare provider organizations, social media has become an extension of external marketing efforts.  And while  big external wins, like viral videos or news coverage of tweets can help create internal momentum, too often these actions are little more than glorified sales pitches. To truly be successful in the use of social media, providers need to begin thinking about engaging their employees in the social conversation and. creating a team of online ambassadors who serve each other and their customers more effectively. In the case of healthcare, it means engaging the  entire staff of caregivers in the conversation about bettering the patient experience.

The story so far If seven human years equal a dog year, how would we calculate an internet year?

Only twelve to sixteen months have passed since early adopters got serious about social media in the healthcare industry. A lot has happened during that short period of time. Just recently the #HCSM twitter chat celebrated its first birthday. According to Ed Bennett’s Found in Cache, over 500 hospitals now have some kind of social web presence.  We’ve seen surgeries tweeted, the Pink Glove Dance go viral, doctors tweeting, and iPhone applications for hospitals. So what does the coming year look like for healthcare social media?

Most, if not all,  healthcare providers  share the collective goal of improving patient experience. Sometimes, this is expressed as clinical excellence; sometimes as increased efficiency. Regardless of wording, having an entire organization discussing this type of improvement can strengthen a provider’s ability to deliver care. Just as there is a correlation between engaged employees and good service, so too is there a connection between connected employees and empowerment.

During the past two years at the hospital where I am employed, we have seen how increased employee engagement has  improved everything from patient satisfaction to clinical outcomes.

Well cared for, happy employees serve customers with an exuberance that comes from a sense of pride that cannot be induced by coaching alone. The exuberance and best in class service I have observed  across multiple service industries is a result of establishing and sustaining a company’ culture of serving customers with pride, anticipating patient needs, and caring about positive outcomes. This type of culture is rooted in engaged employees who believe in the organization’s mission. And just as service emerges from a culture of engaged employees, social media must emerge from engaged participants.

Prediction This next year for healthcare social media will be an opportunity for progressive providers to grow in amazing ways. I say this is the year that organizations that truly embrace openness and transparency will move to the forefront. Social tools have a role inside of organizations. When they’re used to help flatten the org chart and promote discourse, the entire enterprise benefits and convey an important ethic that branding alone cannot match. The path has been paved in this last year. The very social tools that we have been using externally have an immense power when they are applied internally. More on that thought soon...

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This post is shared with much gratitude to Meredith Gould for her editorial guidance

The Bob Ross Theory of Social Content Management

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