Facebook, Meet Health Care: The Potential Benefits of Online Social Networking in the Health Care Marketplace

July 2009Newsletters Staying Well within the Law

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Using technology to improve patient care and communication related to patient care is not an entirely new concept; however, it has recently picked up significant momentum. More and more health information exchange (HIE) networks are popping up at the community and statewide levels. Nowadays, a health care provider may participate in a regional health information organization (RHIO), and Internet-based personal health record (PHR) repositories, such as Microsoft’s HealthVault and Google’s GoogleHealth, have become familiar household names. Soon, it is expected and hoped that health information will be exchanged across the nation in an organized, coordinated and easily-accessible manner. But even this trend is not catching on at the same speed as social networking sites.

The sharing of health care information, whether through a RHIO or other HIE networks, is often thought of as the linear sending or receipt of information related to medical care that has been or will be rendered to a patient. For example, we would send an electronic health record to another provider or request a test result to be sent from the diagnostic facility to the primary doctor for follow-up or send a claim to the payer for reimbursement.

Now imagine if such information could be shared in present “real time” directions. And what if that could be achieved with less administrative burden and lower costs than is needed for other HIE network models? Enter the “Facebook” social Internet network model, and the question of what if it could be modified, secured and assimilated with the HIE network model? Can the software technology that makes social networking so fluid and seemingly straightforward be adapted for use in the health care context?

It’s a concept that deserves a closer look.

The Age of the iPhone

As the health care IT community wrestles with connectivity challenges, privacy barriers and other issues, the up-and-coming generation networks electronically without a second thought and as simply and easily as Generation X used to call childhood friends on the phone. More simply and easily, in fact, since they can essentially “call” multiple friends and groups of friends simultaneously and without the usual impediments of chronological time. Users can post an “away” message to act as a more specific type of “busy” signal but can also jump in and out of conversations at any time and pause or speed up the communications. They can hold one conversation or many, connect into other conversations, personal web pages or pools of communication, and they generally view the fluid, spherical nature of these communications as more natural than (and perhaps preferable to) the structured, linear nature of communication via a standard landline telephone.

With the recent prevalence of social networking sites such as Facebook and LinkedIn, information can be shared widely, selectively, in overlapping concentric circles, in broad orbits and in nearly as many ways as there are people accessing the sites. Clearly, these social networkers don’t need a 400-plus page document to guide their information-sharing, but there are also clear differences between social networking and health information networking, aren’t there?

Sharing in Real Time

Most patients would not want Facebook, LinkedIn or any other proprietary social networking web site to have the ability to access their personal health information. Nor would most patients want these companies to see their personal, online network of “friends” (in the health care context case, physicians, or other health care providers and payers) and communications grids, not to mention the advertisements. But there are some perquisites to sharing personal information in real time and in a flexible, individualized format.

For example, if a patient wanted to share a surgeon’s report from his 2002 knee surgery with his sports medicine physician in 2009 and wanted to allow side-by-side access to both his 2002 and 2009 MRIs, then realtime sharing through social networking technology could be as easy as posting recent vacation photos for friends and family online. If the patient controls the input and flow of his own information, perhaps the need for 400 or more pages of contract provisions dissipates. Or, if a patient wanted to share information with a specific group of female friends about a terrific ob/gyn, social networking technology would make it easy for those friends to connect with the ob/gyn (perhaps by simply as adding the ob/gyn as a “friend” to the group). This would be a way to open the door and invite interested people into the store, rather than keeping them outside at the Internet-equivalent of window-shopping. While the patient’s female friends may not see the fabulousness of the ob/gyn simply by peering at the physician’s web site from the outside in, they can more quickly decide whether the ob/gyn is a potential match for their needs when they are greeted at the web site or personal profile of the ob/gyn by an open door, and are invited to walk in and begin communicating with the physician directly.

Moving Forward While Protecting Privacy

Adapting the power of social networking to the health care information world requires an understanding of how the information will be shared and how and when it must be protected. For example, a managed care organization that contracts with New Jersey Medicaid (a Medicaid HMO) may recognize the need to access claims information from a new member’s previous Medicaid HMO. Unlike individuals enrolled in commercial HMOs or health insurance plans, Medicaid HMO members can move from one HMO to another on a frequent basis, so the new Medicaid HMO may have very little medical information about the member. If the new Medicaid HMO member requires a diagnostic test or help in managing a chronic health care condition such as asthma or heart disease, the Medicaid HMO that has access to the past several months or years of claims information can more quickly and efficiently determine or address the patient’s needs. The Medicaid HMO does not need information related to the dollar amounts of these claims, but having ready access to the codes associated with the claims will give the HMO a valuable snapshot of the patient’s health history and current or future health care needs.

If all of this communication takes place under the umbrella of the Medicaid HMO (whether on its own server or on secure space on an outside server), the Medicaid HMO can ensure the privacy and security of personal health information, just as it does with members’ personal health information now, and can develop tools specific to the needs of the members and providers.

Similarly, a hospital or physician group that imports the social networking tools for use in health information sharing can set the parameters and protections necessary for efficient, effective communication. Lines and spheres of communication can be opened and closed, as appropriate. Because the information being communicated resides in one place (similar to the manner in which a Facebook user’s page resides on the Facebook web site) but can be accessed and shared via software applications tailored to the users’ needs, the bulk, weight and associated friction of moving information from one place to another nearly evaporates. The painstakingly created pathway would no longer be needed, since the Internet allows movement in any direction and in real time. A medical record can be accessed electronically, but it does not necessarily need to be transmitted from point A to point B along a specific pathway.

The ability to adapt social networking into health information sharing will evolve as software develops and as the use and refinement of electronic networking tools increases. In the meantime, standards panels, along with many others interested in virtual health information networking, will keep their linear focus on the legal and operational barriers of health information sharing, one connection at a time.

For more information about this topic, contact Elizabeth G. Litten at 609.895.3320 or [email protected].

This article first appeared in Advance for Health Information Executives and is reprinted here with permission.