Health SM Research

Health & Social Media: Whats A
Healthy Dose?
Avery Faehling
May 11th 2016
University of Wisconsin-Green Bay
Table of Contents
Health & Social Media: Whats A Healthy Dose?

Introduction.3
HIPAA..5
Beyond HIPAA...8
Incidents..9
ROT10
The Dark Side of Social Media..11
ROT13
Mobile Technology: Following You and Your Health..13
Wearable16
Social Judgement Theory17
Laugh Model..18
ROT.19
Healthcare Organizations and Social Media.20
Social Media Plan.23
Healthcare Physicians.25
ROT.29
Final ROTs.30
Citations..31
100 Facts37
Health: In The World of Social Media
Introduction
Its true, most of us have a heart, brain, lungs, blood, and air to breathe. It is a part of our being, and
something we rely on every single day. As time has gone on though, we have found ourselves relying on
something that is not within us. Rather we have begun to rely on social platforms where we can express who
we are, what we do, and some of our ideas or thoughts.
What is interesting, is the fact that health encompasses part of who we are, the habits by which we
live and diet by are what we do, and there are countless thoughts put forth on how to improve health and
which healthcare provider to use.
This paper explores many of the relationships formed by social media and the health field. Some of
these relationships include: HIPAA, the law, mobile technology, healthcare practices, along with
opportunities and threats for both patient and physician use. This is important because there is currently a
lack of information and implementation of social media that is tailored to the health field.
The first obstacle to make sure is eliminated when starting the talk on social media in healthcare, is to
make sure that it is something that is implemented by health organizations whether it be through a strategist,
physician, or team. According to the International Telecommunication Union in their Measuring The

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Information Society Report more than 40% of the world's population use the Internet. Social media has a
future with all brands and individuals in the health industry and is important that social media is embraced
into these settings but in the right way. Audiences, especially patients, demand a lot of their health care
providers and physicians and social media is something they demand as well with 91% of adults have their
mobile device within arms reach the full 24 hours of a day (Erbs, 2014) and 41% of people admitting that
social media would affect their choice of a specific doctor, hospital, or medical facility. (Falls, N.D.) These
statistics prove that prospective and current patients expect to have the information they demand at the palm
of their hand and available for use within seconds. These insights also prove that if a hospital is able to use
social media strategically, then they are gaining a major advantage over their competitors. For example,
qualitative analysis of posts and discussion forum topics on the 10 largest diabetes management groups on
Facebook revealed that patients, as well as family members and friends, share personal clinical information,
receive emotional support, and request diabetes management guidance from other group members. (Greene,
2010) While this example mentions Facebook groups, hospitals could create a space just like the ones
mentioned above, where patients can feel welcomed, comforted, and informed by their credible healthcare
provider.
Once a healthcare organization embraces social media as a part of what they do, they can then delve
deeper into more specific areas of social media in the health field. With that said, it is important to keep in
mind that a true strategist will always have a core of attributes to rely on throughout their health career to
keep them on a successful path. With relating to audiences, humanizing the experience as a personal
healthcare brand or independent physician will always be a useful skill in the world of medicine. As with any
professional use of social media, having a sustainable strategic plan will create a long term advantage by
assisting with the creation of innovative tactics in two fields that are evolving at a rapid pace. Finally, every
social media strategist in the health field will need to continually evaluate their insights to continuously
improve and adjust to create the greatest return on influence.
HIPAA: Does Social Media Cross a

Line?
Laws
Whether a social media post using patient information constitutes a HIPAA violation
will depend, in large part, upon the purpose of the post and to whom the post was
disclosed.
When exploring social media laws, one of the most important industry laws to examine revolve
around the health industry. In the health industry, the code to work by is called HIPAA, also known as the
Health Insurance Portability and Accountability Act. The purpose of HIPAA is to set certain guidelines to
protect an individuals rights over their health information and who can receive it. This is incredibly
important as an organization, because a persons health is who they are and as a health organization
credibility is more important to your strategy than social media is. The best health entities find a way to use
innovative social media strategies, while maintaining their credibly by adhering to HIPAA policies. To make
it clear, social media is certainly included by HIPAA and when it comes to communicating with or about

patients on social media, breaches of patient confidentiality can result in legal action against an HCP and
potentially his or her employer. (Lambert, 2012) Rather than jumping into what to specifically do to obey
HIPAA policies, it is more efficient to look at the laws themselves and examine what not to do. In many
cases, the first question to ask is what a breach is to a persons health information. A great area to begin
examining HIPAA guidelines is Section 13410(d) where HIPAA addresses civil and criminal penalties for
violations that are based on the nature of the violation, as well as resultant harm. Although the use of social
media isnt specifically referenced, these tools can certainly present risks under HIPAA and HITECH.
(Lambert, 2012) It is stated that a HIPAA violation becomes a breach, when a harm threshold has been
reached and, more specifically, when the HIPAA Privacy Rule Violation poses a significant risk of
financial, reputational, or other harm to the individual. (Rorer, N.D.) One the harm threshold has been
verified as a breach, the HITECH act details that notification must be sent to the individual affected no
later than 60 days after discovery of a breach. (Rorer, N.D.) This helps contain the damage possibly done to
patients, reevaluates ethical practices in the organization, and minimizes the chance that a breach happens in
the future. It is also important to note that while these guidelines do not specifically mention social media;
they still cover social media and create an understanding that a post should not include anything so specific
that would embarrass and harm a persons reputation. A better way of summing such a policy up is to live by
the guideline that if you wouldnt want it said about you in a public setting, then dont post it. The problem
becomes that there are many possibilities in the situation such as receiving permission from a patient to post,
or a physician not understanding that there are varying degrees of salience on certain diseases that they may
not take into account the fact that their idea of reputation harm may not be the same as their patients. When
entering the social media grey area, it is best to err on the side of not posting. As it can be seen in HIPAAs
guidelines, breaking the privacy rules of patients can levy heavy fines and potential criminal charges on the
unauthorized disclosure of individually identifiable health information by covered entities in oral, paper, or
electronic form. (Chretien, 2013) This surprisingly brings up an even greater question; how can a social

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media post de-identify a specific person? As it can be seen in HIPAAs policies, de-identification can be
accomplished by changing or omitting key patient details (e.g., names, insurance or Social Security numbers,
date of birth, and photos), by avoiding the description of rare medical problems, and by not including
specific time frames or locations without the patients consent. (Chretien, 2013) While this may seem like a
lot of information to exclude, it is the information that a health organization or physician should be
concerned about sharing, rather than the who. If a hospital were to create a bang for the buck for their social
media, they will get far more return on influence through what, why, and how rather than who when and
where. It is the who, when, and where that is described as making a patient identifiable. Often times, a
strategist may just assume that any information related to a patient is off limits, which could hinder the
spread of useful information through a social channel. Instead, it is important to note that HIPAA does not
restrict the distribution of medical information that has been de-identified. (Fogelson, 2013) It is common
to think of social media in health care as something done by a strategist, when in reality a physician has the
ability to have social interactions with people and patients as well. This is something of high importance to
consider as a physician or when hiring staff due to their ability to interact with patients on a social scale. In
fact, if social media is handled incorrectly by a physician, state medical boards have the authority to
discipline physicians, including imposing restrictions or suspending or revoking licenses. These penalties can
be meted out for unprofessional behavior, such as the inappropriate use of social media, sexual misconduct,
breaches of patient privacy, the abuse of prescribing privileges, and the misrepresentation of credentials.
(Farnan, 2013) This policy specifically states that inappropriate social media can either hamper a physicians
career or even leave a health care facility without one of its top professionals.
Beyond HIPAA
While HIPAA is significant in the medical field, especially in relation to social media, it is imperative
to examine policies beyond the act itself that may influence social behavior by medical professionals and

their organizations. For example, many of the violations that occur are through social media as previously
stated. With a deeper dive into the issue though, one can find that Facebook is the most popular form of
social media by health organizations along with their physicians. With this in mind, it is important to
understand Facebooks privacy policy, especially as it relates to the data and information that may have been
put on social media by healthcare professionals. To be exact, Facebooks policy on the use of data states,
we may access, preserve, and share your information in response to a legal request both within and outside
of U.S. jurisdiction. (Chretien, 2013) Facebooks policy only emphasizes more that healthcare professionals
should tread lightly on social media, especially in relation to patient cases. The policy that Facebook
currently has in place would allow all information on Facebook to be used against an organization or
physician in a legal movement regarding a HIPAA violation. Beyond just Facebooks clear policy, there are
constitutional rights than that can assist a healthcare organization or physician such as freedom of speech,
freedom from search and seizure, and the right to privacy. (Peck, 2014) While these rights may assist the
accused, they may also be challenged and have tended to cloudy the water between HIPAA and other rights.
Even with HIPAAs guidelines appearing strict at times, healthcare professionals can still communicate
properly with patients, even without being in the office or using social media. For example, communication
between the two parties can take place in a more private and direct setting using unencrypted email, which
are permissible, as long as other reasonable safeguards are followed. (Chretien, 2013) More specifically,
safeguards require covered entities to reasonably protect patients health information from unauthorized
disclosure by using physical, administrative, and technical safeguards. (Chretien, 2013) If these are followed,
then a healthcare professional is safe for the most part, therefore unencrypted emails would be a good choice
to follow. Healthcare professionals who assume they are safe should still assess they personal and
professional social media accounts, whether in school or at a job. This is because a Microsoft survey found
that 79% of employers view online information regarding prospective employees. This number will only
continue to increase, and with so many social accounts, a healthcare employer will be able to assess whether

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prospective or current employees are acting in a way that will either harm the company or improve it. Once
that assessment is made, regardless of a clean law record, they can decide internally whether the healthcare
professional is worth maintaining in association with their brand.
Incidents
As clear of a warning many of these policies make, a study of medical blogs written by health care
physicians found that individual patients were described in 42% of the 271 samples studied. This means that
42% of the physicians studied could have been fined, suspended, and jeopardized their license. When
examining the significance of this study, it is important to understand that if this statistic held true throughout
every medical organization, almost half of an organizations medical professionals would be acting illegally
or unethically. It is fair to point out that of these samples, 17% were found to include enough information for
patients to identify themselves or their providers, and three included recognizable photographs of the
patients. (Chretien, 2013) This means that the level of severity varied in the 42%, but none the less risked the
chance of breaking HIPAA standards. Another study done on medical schools found that 60% of medical
school deans reported incidents in which students had posted inappropriate content online, including patient
information, inappropriate language, depictions of intoxication, and sexually explicit material. (Chauhan,
2012) This is an alarming statistic that proves a miscommunication between what HIPAA expects and what
physicians assume to be acceptable on social media. A more specific case that delves beyond the numbers
happened in Rhode Island, where an emergency medicine physician was reprimanded by the Rhode Island
State Board. He was caught in violation of unprofessional conduct and was fined after making comments
on Facebook about a patient. The physician did not mention the patients name in the post; however,
sufficient information was included that allowed others within the community to identify the patient.
(Chauhan, 2012) It is specific cases such as these that show the severity and realism that comes with HIPAA
and healthcare professionals. Problem being, medical professionals not only hurt their credibility through

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patient mishaps and personal social media accounts; in fact, researchers analyzed the content of blogs written
by health professionals, with 11% containing product endorsements. (Lagu, 2008) One way to slow down the
number of professionals falling into a fragile world between patients and posts is to possibly train or educate
them in their schooling before they reach the professional world. If there is concern of a transition period
between the current physicians and incoming physicians, a more sustainable strategy would be to create a
social media training program for all incoming employees to ensure the best quality care is given to patients
not only in person but also socially.
ROT
When posting social media content, do not post on any platform if it cannot be spoken aloud in a
public setting.
If a HIPAA violation occurs, notify the legal staff and take employee back through training.
Monitor and train all employees on social media.
If a health organization wants to implement physician-patient interaction, a social media training

program should be created.
Promote local and national health initiatives by posting content that will inform a broader audience
and is not patient specific.
If a physician is posting, then they should not discuss a specific patients condition.
Implement and know how to handle social media crises into your hospitals crisis communication
plan.
Evaluate your healthcare social media policy after a set period of time to make certain that current
uses do not cross a legal line.
As a healthcare organization, a clear set of guidelines needs to be established by the marketing,

public relations, and legal team.
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The Dark Side of Social Media in

Health
While social media provides the health industry with a plethora of opportunities to enhance
healthcare, there are also many concerns that combat the full implementation of social media.
Misinformation is one of these many concerns, with social media having the ability to spread information
worldwide within minutes, whether it be accurate or not. A recent example of this is vaccines, where much
debate has gone into the scientific pros and cons of the practice. Some anti-vaccination websites and social
media pages, such as the National Vaccine Information Center, look absolutely credible and can easily trick
users into questioning vaccines safety. With these credibility issues, it becomes increasingly hard to
determine whether a source has the underlying goal of creating a healthier world, or whether they they have
the underlying goal of pushing their own initiative. It is essential to understand just how powerful
misinformation, especially in the vaccine case, where it was found there is a correlation between the
sentiments expressed in social networks towards a new vaccine and the vaccinat ion rates in a region.
(Salath, 2011) The ability to share or gain information so quickly creates fast thinking, where people absorb
data on social media at face value rather than taking a slower thinking approach that would break down
credibility issues. With this task being difficult, it is currently very hard persuade people to handle health
information on social media more carefully, because there is a strong credibility appeal to information and
testimonials that are shared by people we can associate with a face, friend, or family member.
With health initiatives, social media platforms and their users run into health campaigns that can be
both positive and negative. WHO, UNICEF, and World Bank said it best in 2010 when they stated With
ever increasing access to internet-based information, an unsubstantiated rumor about vaccines can rapidly
circle the globe and undermine immunization services, sparking outbreaks of disease and untold deaths" The

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problem is that users who are impartial to a particular campaign may be served the wrong side of information
that could either bring humor to a serious issue or promote unhealthy acts. For example, a study shows that
pro-anorexia videos are better rated and more highly favored than videos with serious informatio n about
eating disorders. Anorexia activists use the same tags as reliable health videos, and their websites sometimes
rank higher in YouTube or Google. This happens because of the way searching engine algorithms are
designed, according to researchers. (Syed-Abdul, 2013) This is an issue that cannot be easily fixed, due to
algorithms and tags, making both healthy and unhealthy initiatives have a level playing field in the social
world. The greatest hope is that unhealthy initiatives are shared by credible friends, family, organizations,
and physicians to contain the inaccuracy on the same channels from which they gained popularity. A great
example would be a study, which analyzed 172 YouTube videos about the HPV vaccine. Most videos (news
clips or consumer generated content) were negative in tone, disapproving of the vaccine. Also, negative
videos were liked more by viewers than positive ones. (Briones, 2012) While this is an issue, it provides a
great social media trail for health organizations to follow and combat with. Because many of the negative
perceptions were created through YouTube, organizations with the accurate and healthy information should
start their social media by targeting YouTube and the audience. Another example outside of YouTube would
be in regards to the recent Ebola outbreak that plagued social media and the world. The British Medical
Journal published an article that evaluated tweets regarding the outbreak emitted from African countries. The
researchers concluded that most of the messages had false information and that 'bad' tweets were more
retweeted than the ones with truthful information. (Oyeyemi, 2014) Again a proper base to a social media
strategy in this situation would be to focus health campaigns and initiatives on Twitter, even directly
targeting the misinformed tweets with comments and quoted tweets that will give realistic examples of what
not to believe in a time of panic and Ebola outbreak. In a sense, both the Ebola and anorexia strategies will
assist in creating a type of uncertainty that will force users to do further research, where accurate information
will prevail more likely than if the user had just listened to the unhealthy information put out by a third party.
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ROT
Follow the trail of negative information and take a proactive approach through verified accounts by
quoting and commenting.
The channels through which an initiative is attacked should be at the forefront of channels used to
combat negative information.
Know terrain of enemy and use it to create a form of uncertainty that encourages impartial users to
utilize your links and information
Mobile Technology: Following You

and Your Health
Social media has changed the healthcare world in drastic ways that nobody could have imagined even
5 years ago. While social media has taken healthcare by storm, social media itself has been rapidly changing
due to mobile technologies. This has created a chain reaction that has now impacted the health industry;
hopefully for the better. As mentioned before 91% of adults have their mobile device within arms reach the
full 24 hours of a day. (Erbs, 2014) On this mobile device, there are more than 100,000 mobile health apps in
app stores around the world, with more than 4 million free downloads every day. (Jahns, 2013) This number
will only grow as two of the fastest growing industries in the world, health and mobile technology, continue
to grow. In 2012 the Demi & Cooper Advertising and DC Interactive Group found that 19% of smartphone
owners have at least one health app on their phone. Exercise, diet, and weight apps are the most popular
types. (Falls, N.D.) It is fair to infer that this number has drastically escalated due to the much higher

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adoption that has occurred over the last four years in mobile technology; to be more exact the FDA predicts
that by 2018 over 1.7 billion mobile device users will have downloaded at least one medical app.
When it comes to mobile health applications, two categories of mobile health apps are used. The first
are wellness apps, which are designed for consumers and patients. The second category is medical, which are
used by physicians. Because there are more general users of mobile technology, over 85% of people use
wellness apps as opposed to medical applications, which only encompass 15% of the industry. (Jahns, 2013)
It isnt hard to see the appeal that consumers have in the mobile health industry, considering the
personalization it brings to users on the go. On Facebook, one of the most popular social media platforms,
groups frequently focus on specific medical conditions. These groups actively engage in peer-to-peer support
as well as fund-raising efforts for affiliated organizations and individuals. (Lii, 2014) Health is constantly
impacting individuals with mobile technology, whether it be something as minor as allergies, or something
far more serious such as chronic conditions. Because of this, 62% of smartphone owners have used their
phone in the past year to look up information about a health condition. (Smith, 2015) This only emphasizes
the need for credible health organizations and physicians to be highly present and top of mind on the
Internet, or else the wrong health information will misdirect users, while they are on the go and fast thinking.
In fact, the need for some sort of online characteristic could be used to distinguish the credible health sources
from the less credible ones. The World Health Organization is leading a request to the Internet Corporation
for Assigned Names and Numbers to establish a new domain suffix that would be used solely for validated
health information. These domain addresses would be prioritized by search engines when providing results in
response to health-related inquiries. (Lii, 2014) Until that domain can be established though, individuals
using mobile technology and applications will need to rely on anecdotal reports from friends and personal
research to gain collective medical knowledge. (Grindrod, 2014) When looking to friends and testimonials,
the top inquiries regarding mobile health apps include tracking nutrition (47%), receiving medication
reminders (46%), tracking symptoms (45%), and tracking physical activity (44%). (Pennic, 2015)

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When health apps are being used, many healthcare entities may be looking to data-mine the results to
better refine their services, initiatives, and campaigns. While data-mining has been a controversial topic,
especially in regards to social media, health is a unique subject that can be useful in targeting any health
related issues that may be occurring in an individual or given area. Ironically, data itself backs this up, with
88 percent of Americans willing to share their personal information for the sake of improving care and
treatment options. (Pennic, 2015) Individuals have unique health conditions and needs, therefore tailored
treatment and monitoring are the best outcomes with mobile technology. For example, 63 percent of
Americans with gastrointestinal conditions will use mobile health apps to track diet and nutrition, 50 percent
of those with pulmonary conditions would use a mobile app for medication reminders, and 52 percent of
Americans with cardiovascular issues would use a mobile app to track sleeping patterns. (Pennic, 2015) Each
condition was accepted with mobile health applications, but each condition was also accepted in a different
way that was unique to their health. Beyond what would just be accepted by users and patients, the FDA has
predicted that 80 percent of instances of diabetes, heart disease and strokes can be prevented by better selfcare, and mobile apps allowing patients to easily monitor their blood sugar, blood pressure, and weight can
be indispensable tools for high-risk patients. This means that the earlier mobile technology is adopted along
with health applications, the sooner that many preventable diseases can be combatted and contained
immediately. As it was just mentioned, individual cases can be contained if mobile technology is accepted,
but the question remains whether local communities can contain an issue through mobile technology. A
promising instance recently occurred during the Ebola outbreak, where it was first detected by HealthMap
[37], a website that delivers real-time data on infectious diseases for health institutions and governments.
Even more impressive is the fact that populations with mobile phones can get informative messages on
prevention, control, and treatment, which was a strategy used once the Ebola outbreak was confirmed by
HealthMap. If technologies such as HealthMap can continue to monitor mobile health data, the future of
local disease outbreaks will be promising. Part of these disease outbreaks could be handled by an

individuals specific physician, in fact 61 percent of patients would make use of a mobile app to
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communicate with a doctor. (Pennic, 2015) This brings up a strong question of ethics, as mentioned in
previous chapters, where it is hard to define the proper form of communication that does not become too
invasive.
Wearable Technology
Mobile technology consists of more than just a phone that can be carried in a pocket. In fact, mobile
technology is only beginning to evolve into a new market, wearable technology. An example of wearable
technology is FitBit, which has over 19 million registered users as of October 2015. (Goode, 2015) This is
actually over half of the current wearable market, which had 34.5 million unit shipments in 2015. These
numbers, while large, still have a lot of room for improveme nt due to 79% of Americans willing to use a
wearable device to manage their health. (Pennic, 2015) Of that 79%, the reasons they would invest in a
wearable device would be to track physical activity (52%), symptoms (45%), manage a personal health issue
or condition (43%), track sleep patterns (41%), and track nutrition (39%). (Pennic, 2015) These wearable
technologies have as much potential as their technologies will take them, due to the large support they have
gained from consumers and mobile technology brands. Apple is a very good example of this support, as they
have adopted a health app that can track body measurements, fitness, nutrition, reproductive health, test
results, sleep, and vital signs. This strategy can be considered a double edged sword, which targets both
mobile technology and wearable technology. Apples HealthKit app, even allows the data from something
such as your blood pressure to be shared automatically with your doctor. It will be no surprise as such
wearable technology grows in the health field and monitors patients. An extreme possibility that has been
considered is internal technology that would be implanted within a patient by a physician, who could then
receive the most direct and accurate results for any health issues that are unique to the patient. As technology
evolves with health, the main concern that will always come up is a patients privacy. As it was mentioned in

the HIPAA section, a shield in healthcare has been established to maintain the privacy of patients, their
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conditions, and their data. Social media breaches and hacks may occur if social media along with mobile
technology are used to a thorough extent between patients and their physicians. Therefore, through this
research I recommend that patients and their physicians tread lightly, but adopt the opportunities that fit their
medical needs.
Social Judgement Theory

To tie together all of the information examined above, the University of San Francisco- California
created an in-depth look at how health information has evolved from passive to active participation. This is
one of the most important and largest improvements that the health field has ever taken outside of solving
health issues. As it can be seen, the health field strategized using social judgement theory and created steps
rather than jumps that would be more widely accepted. To help engage patients more effectively, three
stepping stones are utilized: 1) wearable devices, 2) social media websites, and 3) personal health records.
(Paton, 2012) This can be seen in (Figure 1).
(Figure 1)

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As it can be seen, the first stepping stone in the process is wearable devices which can also include
mobile technologies. In this step, patients are in control of their active health and how much data is stored on
the health apps they have downloaded. Once that has been decided by the individual, the data can be used or
shared within online communities, whether it be a community of physicians or regular peers. They can also
use this self-experimentation to constantly be doing group experiments, which may be able to provide
physicians with valuable data as they vary diets and workout regimens. Once this data has been utilized
socially, the data can then be developed into the third step of personal health records. In this step, data can be
combined with other electronic health records to examine both the individua l from their past medical history
along with other patients that are in the area to find any health trends locally. From there, the data can be
implemented even farther by being shared across health systems everywhere. These two sub-steps then allow
the data to be examined on a large scale for electronic epidemiology, where health patterns and causes can be
analyzed for the betterment of public health.
ROT
Mobile technology is an expectation therefore physicians along with brands need to interact in the
mobile terrain.
Health information is now outside of just an organization, so if mobile interaction is part of strategy,
then guidelines and crisis communication need to be set in place.
Mobile should be embraced by healthcare organizations to monitor and combat local health
outbreaks.
If an organization is looking to contain health crises or misinformation, then they should embrace
social media with mobility.
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Patients under the same healthcare organization should be given a mobile social space to create peerto-peer support, bettering care.
If an organization wants to create top of mind awareness among patients, then they should be highly
present on mobile, proving quality care.
Healthcare Organizations & Social

Media
Healthcare organizations are at the heart of every medical movement that has occurred in our history.
They look to provide information, physicians, and medicine to improve the health of society. It is without
question that such establishments are looking to provide the best possible care to their patients, especially as
patients health evolves and they begin to demand new forms of care. Social media along with mobile
services are one of the new demands, with such services expected to reach $26 billion globally by 2017.
(Jahns, 2013) Patients are also being highly active in this process, with 57% of patients voicing that social
media presence would affect their choice of a specific doctor, hospital, or medical facility. (Peck, 2014) This
movement did not come unpredicted though, with nearly 95% of US hospitals on Facebook, and 50% are on
Twitter, as projected by the Journal of Medical Internet Research. (Griffis, 2014) This shows that there is a

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strong quantity of social media being utilized, but the question with all social media, especially in the health
field is whether quality care is being given to patients. For example, 81 percent of individuals stated that a
strong social media presence indicated that a hospital offers cutting-edge technologies. (Peck, 2014) While
the demand for quality social media care appears clear, the Institute for Health found that only 31% of health
care organizations have specific social media guidelines in writing. This leaves a large hole for any social
crisis that may occur under HIPAA, and proves that a true social media strategist is not being used. The 31
percent that do have social media guidelines are most likely gaining more consumers of their healthcare
practices as opposed to the organization that appears to be taking greater risks and seems more disorganized.
In fact, this is more than an inference, with studies showing that one in five internet users have consulted
online reviews and rankings of health care service providers and treatments to make an educated decision on
their care. (Pennic, 2015)
Beyond the monetary benefits that healthcare organizations can receive from patients using their
services, there are also benefits that focus on the accuracy of health information and assisting with great
causes. For example, when consumers are diagnosed with a medical condition, 41 percent research the
symptom online or socially, 26 percent research treatments, and finally 18 percent will look up specialized
doctors and care facilities (Pennic, 2015) This allows a large gap of social time to pass, where consumers
may end up using inaccurate advice on their medical condition. Therefore, healthcare organizations need to
be highly present on social media to combat these issues, especially in a social world where people are three
times more likely to look to WebMD (57%) over government-affiliated websites such as the CDC (17%) or
FDA (16%). (Pennic, 2015) This is why organizations such as the Mayo Clinic develop thorough social
media strategies, where they use more than just one or two platforms and expand themselves to other social
areas such as podcasts, where Infographics Archive examined listeners rising by 76,000 after the clinic
started using social media. This created a harmonious relationship that benefited both platforms. Beyond
their podcast and social media, they also create blog posts, conferences, and webinars to engage with their

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audiences. (The use of social media in healthcare: organizational, clinical, and patient perspectives). It is
these exact platforms that have the ability to help patients and followers manage health conditions, with
Healthcare Finance News finding that 40% of people polled stating that information found on social media
affects how they coped with a chronic condition, their view of diet and exercise and their selection of a
physician. This means that if healthcare brands truly have a mission of creating a healthier society, then they
need to make sure their sources, information, and voices are heard socially.
Healthcare organizations are tasked with not only working with their own patients, some
organizations can be a national brand that is tasked with combatting worldwide health crises. Social media is
a strong tool for these situations due to their ability to promote, educate, and analyze on a worldwide scale. A
healthcare organization that has made great use of this is the Red Cross, who tracked Twitter posts during
natural disasters, such as hurricanes and earthquakes, to gather information about where the greatest needs
were. (George, 2013) The impact that this made was more than impressive with Donate Life America finding
that the week after this feature was introduced, online state organ-donor registries experienced a 23-fold
surge in donor pledges. (George, 2013) The Red Cross is not the only one using this brilliant strategy either,
with the CDC maintaining an active presence on Twitter and Facebook to track tweets that might indicate
a flu outbreak and to share updates about such incidents. (George, 2013) The same strategies can be used in
the present and future to achieve public health goals as well. Finally, social media can even be used for
medicine specific practices such as refills. An example of this is some of the larger pharmacies and insurers
who have conducted programs that provide prescription refill and appointment reminders via social-media
messaging. (Farnan, 2013) These direct messages have the ability to provide a sense of caring and
responsibility, where the patients health is at the forefront of the brands mind.
22
Social Media Strategy for High Impact
The Laugh Model, in figure 1, was created to use cost effective and powerful strategies such as social
media to create social change for the benefit of public health. In fact, the model was tested by attempting to
change a public health initiative without a budget, which was completed successfully. This model highlights
the largest benefit for healthcare organizations, which is improving public health through cost-effective
means. Much of the focus on the model to begin with is using the proper appeals, whether it be through
entertaining, humor, or emotional appeals. Rather than making the decision to focus on reach, the Laugh
Model encourages health organizations to focus on engagement where the bang for buck will be greatest.
Collaborating through social media, when done correctly, will be more effective and efficient. Much of the
effectiveness is based on a proper audience analysis that pairs well with the core messages and platforms that
will be used. This creates unique health initiatives that cut through the clutter that other health campaigns are
plagued with. A fantastic example of tailoring this strategy is a YouTube statistic, that states within the first
three clicks regarding health initiatives on YouTube, users choose a humorous or sexually explicit video
about the health initiative. Therefore, it is good strategy to adjust to the audience and create accurate health
campaigns that fit this description.
23
Social Media Plan

It is important that if a healthcare organization is to implement social media, then they need a strategy
to use to be more precise in their initiatives. An effective social media strategy will always provide some sort
of unique value to a healthcare organization that is sustainable. With health, there are many opportunities to
misstep on information and the tactics that are presented. Therefore, a well thought out strategy will help
combat such threats, and allow a certain form of adaptation as the healthcare field evolves. This will put to
rest many of the leading concerns that healthcare marketers have when considering the implementation of
social media and its policies as it can be seen in figure 2. Here it can be seen that some concerns involve the
return on influence, regulations, the law, training, compliance, and responding to consumers. These can all
be solved with a proper social media plan.
(figure 2)
At the core of every plan should be strategic decisions regarding the coordinates, content, channels,
connections, and corrections. This will vary highly depending on the organization, their audiences, and the
goals they have set in place. Something that is unique to healthcare is that policies should be at the forefront
of every social media plan due to the risk of legal miscues. The policies should cover the strategist, laws

regarding HIPAA, the leaking of health information, brand damage, and any other policies unique to the
24
organization. Beyond the social media original to the healthcare organization, a plan needs to be provided
regarding personal social media accounts that viewers may relate to an organizations brand. When creating a
policy, building blocks to an effective strategy can be found on www.socialmediagovernance.com/policies as
well.
Either way, one thing is clear with healthcare and social media; a plan needs to be set in place.
Something that many organizations have yet to do as it can be seen in figure 3. It can be seen that over half
of all organizations have a policy that addresses employees at the very least, a large accomplishment for an
organization. Only 54 percent is not a promising number though, considering the many pitfalls that can occur
with countless employees who have healthcare of thousands of individuals at their fingertips every day.
Therefore, a policy needs to be developed at the earliest possible time by a strategist and the organizations
leadership.
(Figure 3)
25
Healthcare Physicians
The basis of all healthcare organizations are the physicians themselves, who interact with patients and
record their health information. With this type of impact in each position, the question that occurs is whether
social media has more pros or cons for professionals. To begin with it is important to hear what physicians
themselves have to say about their views on social media use in the medical field. A recent survey of more
than 4,00 physicians conducted by the social media site QuantiaMD found that 65% of physicians use social
media for professional purposes. (Ventola, 2013) To go along with physician input approximately 60% of
physicians were found to favor interacting with patients through social media for the purpose of providing
patient education and health monitoring, and for encouraging behavioral changes and drug adherence, with
the hope that these efforts will lead to better education, increased compliance, and better outcomes.
(Househ, 2013) While both studies point to great hopes for social media, there appears to be a disconnect in
genuine actions by physicians. This is because a survey of approximately 480 practicing and student
physicians, found that 68 percent felt it was ethically problematic to interact with patients on social networks
for either personal or professional reasons. (Dizon, 2012) This is interesting due to the fact that younger
physicians would be more adapted to social media, but clearly there is a concern that they may fall into
communication that is unethical.
Pros
As with all social media there are many opportunities to improve the field that an individual is in.
Part of effective practices in healthcare are communicating on a global scale with other physicians. The good
news is that this is a top use of social media in healthcare with Publicis Healthware International finding that

60% of physicians stating their most popular activity on social media is following what colleagues are
26
sharing and discussing. This helps garner the best practices from around the world into one healthcare
facility where a physician works. There is also the ability for rich communication such as video chat, which
was used to communicate with patients 7 percent of the time in 2011. (Cooper, 2011) This number has most
likely sharply rose considering the greater implementation of mobile technologies along with the popularity
in applications such as Skype and FaceTime. There is also the ability to utilize patient-targeted Googling,,
which is known in the medical field as using the wealth of information about a patient online that can be
used in a positive way to aid clinical care. (Farnan, 2013) This helps take a more unique approach to patients
and allows more tailored treatment options before a face-to-face appointment is created. An example of this
is anecdotal reports which examined using information found on social media to identify an amnesic
emergency patient or intervening when a patient is blogging about suicide. (Farnan, 2013) Those are huge
differences that are made just through the simple use of social media by an individual physician. It is
important to understand that a healthcare organization would not be in charge of such social tasks, instead it
would be at the discretion of the physicians themselves.
Cons
Since social media has been established and popularized, there have always been pitfalls to the
practice. In the carefully watched field of healthcare, physicians have a spotlight on themselves along with
their organizations brand with everything that they post. There also becomes an issue of separating personal
life from professional life when many patients, families, and friends may be looking to the physician for
health advice, even when they are off the clock. It was even proven in a recent study that patients often
extend online friend requests to their physicians on Facebook. (Farnan, 2013) There also becomes an issue
of the demands that patients demand of physicians themselves, such as a recent study stating that capabilities
patients want their doctor to have are 42 percent wanting an app to see their test results, 33 percent want

27
remote monitoring devices, and 30 percent wanting access to patient health records. (Falchuk 2012) These
are very strong ideas, but are limited by the healthcare brands that physicians are employed by, not to
mention laws that may prohibit communication that goes so in depth outside of a doctors office. Because
patients may be expecting too much out of their physicians without knowing the reasons why social media
isnt being fully applied, they may create negative perceptions of the individual physician, hurting online
ratings. This actually has a large impact with a US study finding that 37 percent of patients had consulted
physician rating sites when gathering information about a specific provider. (Keckley, 2011) This could
mean less business and credibility for certain physicians, depending on the demands that their specific
patients have.
Finally, there are also times when physicians are allowed to use social media to a great extent in their
field of study. With this power comes a responsibility that must be handled correctly, or else physicians can
hurt their reputation, get fined, or even lose their license. Specifically, in July 2012, a Chicago Daily Herald
article reported the following items: [A] physician, on his blog, called a patient lazy and ignorant
because she had made several visits to the emergency room after failing to monitor her sugar levels. In yet
another case, a medical student filmed a doctor inserting a chest tube into a patient, whose face was clearly
visible, and posted the footage on YouTube. (Being Facebook Friends and Doctors May Cross Line,)
This is very unethical and could result in a loss of license, while also hurting the healthcare organizations
credibility although they did not play a direct role. As many have been quick to point out, one of the greatest
restraints of health information found on social media and other online sources is a lack of quality and
reliability. This is because physicians are concerned of their name brand on health information that may
receive negative feedback, therefore on many social sites physicians choose to go unknown. They have also
tended to limited information, hurting the quality of information, but protecting themselves. At the end of the
day, possible costs lead to physicians to add medical information that is unreferenced, incomplete, or
informal. (Moorhead 2013)
28
Practicing Physicians
With social media becoming a part of younger lives, it is important to assess healthcare professionals
who are going to be coming into the field in the near future. Part of how physicians will use social media will
be dependent on what they are taught in their medical colleges before reaching the profession. At Auburn
University, instructors established Twitter handles so that pharmacy students could participate in class
discussions anonymously. By semesters end, 81% of students felt Twitter had let them express opinions
they wouldnt have shared otherwise. (Grindrod, 2014) To go along with this statistic, one-third of pharmacy
programs have reported using Twitter in some capacity and 38% of pharmacy faculty members use Facebook
for teaching, with half reporting that they plan to use social media in the future. (Grindrod, 2014) This is
promising when considering the need for healthcare providers to meet the social media demands of their
patients in the future as social media only becomes more popular. In fact, HealthCare Finance News found
that 49 percent of those polled expect to hear from their doctor when requesting an appointment or follow-up
discussion via social media within a few hours. This only adds to the strong stress that has been put on
physicians, between the long hours they work and the amount of patient issues that they are tasked with
solving. Sadly, this is a standard that physicians need to meet in some form, therefore it is important for
medical programs to continue utilizing social media in their discussions to improve the social quality that is
given in healthcare.
ROT
If a brand is looking to persuade patients to use their healthcare services, then they should implement
a strategic social media plan
If a brand implements a strategic social media plan, there needs to be guidelines in place.
If a brand wants to increase client care outside of the facility, they should create strong awareness and
make it clear they are a reliable source.
29
To tailor local care, healthcare brands should monitor social media of patients and community
members.
If a healthcare brand wants to be the go-to provider, then they need to implement social media trends
to enhance their refracted image.
Conclusion
Through this deep-dive analysis of social media in the healthcare field, many conclusions were
drawn. The first is that HIPAA and many other laws will help form the guidelines from which healthcare
brands and professionals should follow. It is clear that social media has benefits of improving health through
more interaction, information, accessibility, and strategic initiatives. Early adoption of social and mobile
trends is encouraged, but before they are fully implemented there needs to be a social media plan in place
that covers any new implementation. There are many abilities to misstep between physicians employed under
a brand, and even a strategist who may not be aware of specific guidelines. This makes a strategic plan
imperative to the success of a healthcare organization. A strategist with a well-thought out plan will be able
to subdue concerns of lions in the organization by proving there is a high return on influence that will give a
healthcare brand the greatest bang for buck.
Final Overarching ROTS

1. If you are representing a healthcare facility, then you need to find ways to effectively collaborate
across your departments and platforms.
2. If you want to have the most successful social media as a healthcare organization, then you need to
always be searching for ways to continuously improve your employee social media policy.
3. If you want to create a very personal experience for patients, then implement and monitor the ever
growing mobile health field.
4. If you want to create optimal content, then you need to listen to and value insights.

30
5. If you want to further a health initiative, social media if used strategically, can encourage your target
audience to spread the initiative for you.
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100 Facts On Health & Social Media

1. 31% of health care organizations have specific social media guidelines in writing. (source:
Institute for Health)
35
2. A survey of more than 4,00 physicians conducted by the social media site QuantiaMD found
that 65% of physicians use social media for professional purposes.
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/)
3. There are two categories of mobile health apps: 1) Wellness (85%), which are designed for
consumers and patients. 2) Medical (15%), which are used by physicians.
(http://research2guidance.com/2013/03/07/the-marketfor- mhealth-app-services-will-reach-26billion-by-2017/)
4. The market for mobile health services are expected to reach $26 billion globally by 2017.
(http://research2guidance.com/2013/03/07/the-marketfor- mhealth-app-services-will-reach-26billion-by-2017/)
5. There are more than 100,000 mobile health apps in app stores around the world, with more
than 4 million free downloads every day. (http://research2guidance.com/2013/03/07/the-marketfor-mhealth-app-services-will-reach-26-billion-by-2017/)
6. 91% of adults have their mobile device within arms reach the full 24 hours of a day.
(http://www.businessinsider.com/10-ways-mobile-is-transforming-health-care-2014-6)
7. If a breach has occurred, notification must be sent to the individual affected no later than 60
days after discovery of a breach.
(https://www.healthlawyers.org/Events/Programs/Materials/Documents/HHS13/Z_rorer.pdf)
8. A HIPPA use/disclosure violation becomes a breach, when a harm threshold has been
reached and, more specifically, when the HIPAA Privacy Rule Violation poses a significant
risk of financial, reputational, or other harm to the individual.
(https://www.healthlawyers.org/Events/Programs/Materials/Documents/HHS13/Z_rorer.pdf)
9. In July 2012, a Chicago Daily Herald article reported the following items: [A] physician, on his
blog, called a patient lazy and ignorant because she had made several visits to the emergency
room after failing to monitor her sugar levels. In yet another case, a medical student filmed a doctor
inserting a chest tube into a patient, whose face was clearly visible, and posted the footage on
YouTube. Being Facebook Friends and Doctors May Cross Line, Chi. Daily Herald (July 9, 2012)
published at 2012 WLNR 14380254.
10. Of more than 1,500 hospitals nationwide who have an online presence, Facebook is most
popular. (source: WHPRMS)
11. 40% of people polled said information found on social media affects how someone coped with a
chronic condition, their view of diet and exercise and their selection of a physician. (source:
HealthCare Finance News)
12. 49% of those polled expect to hear from their doctor when requesting an appointment or
follow-up discussion via social media within a few hours. (source: HealthCare Finance News)
36
13. The Mayo Clinics podcast listeners rose by 76,000 after the clinic started using social
media. (source: Infographics Archive)
14. 26% of all hospitals in the US participate in social media. (source: Demi & Cooper Advertising
and DC Interactive Group)
15. 41% of people said social media would affect their choice of a specific doctor, hospital, or
medical facility. (source: Demi & Cooper Advertising and DC Interactive Group)
16. 19% of smartphone owners have at least one health app on their phone. Exercise, diet, and
weight apps are the most popular types. (source: Demi & Cooper Advertising and DC Interactive
Group)
17. One-third of pharmacy programs have reported using Twitter in some capacity. (Pharmacy 2.0:
a scoping review of social media use in pharmacy.)
18. A 2011 survey also found that 38% of pharmacy faculty members use Facebook for teaching,
with half reporting that they plan to use social media in the future. (Pharmacy 2.0: a scoping
review of social media use in pharmacy.)
19. At Auburn University, instructors established Twitter handles so that pharmacy students could
participate in class discussions anonymously.1 By semesters end, 81% of students felt Twitter
had let them express opinions they wouldnt have shared otherwise. (Pharmacy 2.0: a scoping
review of social media use in pharmacy.)
20. It has been estimated that 70% of U.S. health care organizations use social media, with
Facebook, Twitter, and YouTube being the most popular. (The use of social media in healthcare:
organizational, clinical, and patient perspectives.)
21. 57% of consumers said that a hospitals social media presence would strongly influence their
choice regarding where to go for services. (Social media in nursing education: responsible
integration for meaningful use.)
22. A strong social media presence was also interpreted by 81% of consumers as being an
indication that a hospital offers cutting-edge technologies. (Social media in nursing education:
responsible integration for meaningful use.)
23. Mayo Clinic goes beyond typical social media and also provides a vast library of blog posts,
podcasts, conferences, and webinars to engage various community stakeholders. (The use of
social media in healthcare: organizational, clinical, and patient perspectives)
24. Several large pharmacies and insurers have piloted programs that provide prescription refill
and appointment reminders via social-media text messaging. (Online medical professionalism:
patient and public relationships: policy statement from the American College of Physicians and the
Federation of State Medical Boards.)
25. Approximately 60% of physicians were found to favor interacting with patients through social
media for the purpose of providing patient education and health monitoring, and for
encouraging behavioral changes and drug adherence, with the hope that these efforts will lead
to better education, increased compliance, and better outcomes. (The use of social media in
healthcare: organizational, clinical, and patient perspectives.)
26. In a survey of approximately 480 practicing and student physicians, 68% felt it was ethically
problematic to interact with patients on social networks for either personal or professional
reasons. (Practical guidance: the use of social media in oncology practice.)

37
27. In the U.S., eight in 10 Internet users search for health information online, and 74% of these
people use social media. (Reviewing social media use by clinicians)
28. Facebook groups also frequently focus on specific medical conditions. These groups actively
engage in peer-to-peer support as well as fund-raising efforts for affiliated organizations and
individuals. (Social media: a review and tutorial of applications in medicine and health care.)
29. Some states public health departments are using Twitte r and other social media to facilitate
greater progress towards public health goals.
30. The CDC maintains an active presence on Twitter and Facebook to track tweets that might
indicate a flu outbreak and to share updates about such incidents. (Dangers and opportunities for
social media in medicine.)
31. Red Cross track Twitter posts during natural disasters, such as hurricanes and earthquakes, to
gather information about where the greatest needs are. (Dangers and opportunities for social
media in medicine.)
32. According to Donate Life America, the week after this feature was introduced, online state
organ-donor registries experienced a 23-fold surge in donor pledges that was presumably due
to this social-networking effect. (Dangers and opportunities for social media in medicine.)
33. The main limitation of health information found on social media and other online sources is a
lack of quality and reliability. Authors of medical information found on social media sites are
often unknown or are identified by limited information In addition, the medical information
may be unreferenced, incomplete, or informal. (A new dimension of health care: systematic
review of the uses, benefits, and limitations of social media for health communication.)
34. While evidence-based medicine de-emphasizes anecdotal reports, social media tend to
emphasize them, relying on individual patient stories for collective medical knowledge.
(Pharmacy 2.0: a scoping review of social media use in pharmacy.)
35. The World Health Organization is leading a request to the Internet Corporation for Assigned
Names and Numbers to establish a new domain suffix that would be used solely for validated
health information. (Social media: a review and tutorial of applications in medicine and health
care.)
36. These domain addresses would be prioritized by search engines when providing results in
response to health-related inquiries. (Social media: a review and tutorial of applications in
medicine and health care.)
37. A Microsoft survey found that 79% of employers view online information regarding
prospective employees. (Social media revolution and blurring of professional boundaries.)
38. The HITECH act details privacy-breach notification requirements and expands various
mandates to include business associates. (Risk management and legal issues with the use of social
media in the healthcare setting.)
39. Section 13410(d) addresses civil and criminal penalties for violations that are based on the
nature of the violation, as well as resultant harm. Although the use of social media isnt
specifically referenced, these tools can certainly present risks under HIPAA and HITECH.
(Risk management and legal issues with the use of social media in the healthcare setting.)
40. Whether communicating with or about patients on social media, breaches of patient
confidentiality can result in legal action against an HCP and potentially his or her employer.
(Risk management and legal issues with the use of social media in the healthcare setting.)
41. It is important to note that HIPAA does not restrict the distribution of medical information
that has been de-identified. (Beyond likes and tweets: an in-depth look at the physician social
media landscape.)

38
42. The HIPAA Privacy Rule levies heavy fines and potential criminal charges on the unauthorized
disclosure of individually identifiable health information by covered entities in oral, paper, or
electronic form. (Social media and clinical care: ethical, professional, and social implications.)
43. The HIPAA Privacy Rule also includes a safeguards standard that requires covered entities
to reasonably protect patients health information from unauthorized disclosure by using
physical, administrative, and technical safeguards. (Social media and clinical care: ethical,
professional, and social implications.)
44. Communication between a patient and an HCP using unencrypted email might be permissible,
as long as other reasonable safeguards are followed. (Social media and clinical care: ethical,
professional, and social implications.)
45. This de-identification can be accomplished by changing or omitting key patient details (e.g.,
names, insurance or Social Security numbers, date of birth, and photos), by avoiding the
description of rare medical problems, and by not including specific time frames or locations
without the patients consent. (Social media and clinical care: ethical, professional, and social
implications.)
46. A study of medical blogs written by HCPs found that individual patients were described in
42% of the 271 samples studied. (Social media and clinical care: ethical, professional, and social
implications.)
47. Of these samples, 17% were found to include enough information for patients to identify
themselves or their providers, and three included recognizable photographs of the patients.
(Social media and clinical care: ethical, professional, and social implications.)
48. A recent study found that patients often extend online friend requests to their physicians on
Facebook. (Online medical professionalism: patient and public relationships: policy statement from
the American College of Physicians and the Federation of State Medical Boards.)
49. Patient-Targeted Googling, is known in the medical field as using the wealth of information
about a patient online that can be used in a positive way to aid clinical care. (Online medical
professionalism: patient and public relationships: policy statement from the American College of
Physicians and the Federation of State Medical Boards.)
50. Anecdotal reports have highlighted some benefits to Patient-Targeted Googling. (for example,
using information found on social media to identify an amnesic emergency patient or
intervening when a patient is blogging about suicide) (Online medical professionalism: patient and
public relationships: policy statement from the American College of Physicians and the Federation of
State Medical Boards.)
51. State medical boards have the authority to discipline physicians, including imposing
restrictions or suspending or revoking licenses. These penalties can be meted out for
unprofessional behavior, such as the inappropriate use of social media, sexual misconduct,
breaches of patient privacy, the abuse of prescribing privileges, and the misrepresentation of
credentials. (Online medical professionalism: patient and public relationships: policy statement from
the American College of Physicians and the Federation of State Medical Boards.)
52. An emergency medicine physician was reprimanded by the Rhode Island State Board for
unprofessional conduct and was fined after making comments on Facebook about a patient.
The physician did not mention the patients name in the post; however, sufficient information
was included that allowed others within the community to identify the patient. (Social media and
you: what every physician needs to know.)
53. One survey found that 60% of medical school deans reported incidents in which students had
posted inappropriate content online, including patient information, inappropriate language,

39
depictions of intoxication, and sexually explicit material. (Social media and you: what every
physician needs to know.)
54. A number of constitutional rights can be applied to the use of social media, such as freedom of
speech, freedom from search and seizure, and the right to privacy; however, these rights can be
successfully challenged. (Social media in nursing education: responsible integration for meaningful
use.)
55. The Facebook policy for the use of data informs users that we may access, preserve, and share
your information in response to a legal request both within and outside of U.S. jurisdiction.
(Social media and clinical care: ethical, professional, and social implications.)
56. 62% of smartphone owners have used their phone in the past year to look up information about
a health condition. (http://www.pewinternet.org/2015/04/01/us-smartphone- use- in-2015/)
57. There are over 19 million registered FitBit users as of October 2015.
(http://www.theverge.com/tech/2015/8/6/9110035/fitbitfitness-tracker-watch-active- users-sales)
58. The number of worldwide healthcare wearables shipments was 34.5 million units in 2015.
(http://www.statista.com/statistics/302725/healthcare-wearables-shipments-worldwide/)
59. Almost two-thirds (66%) of Americans would use a mobile app to manage health-related issues.
(http://hitconsultant.net/2015/02/24/66-of-americans-would-use-mobile- health-apps/)
60. The top interests when downloading and using mobile health apps reflect proactive desires for
informative, functional and interactive programs: Tracking diet/nutrition (47%), Medication
reminders (46%), Tracking symptoms (45%), Tracking physical activity (44%).
61. More than 6 in 10 (63%) Americans with gastrointestinal conditions will use mobile health apps
to track diet and nutrition. (http://hitconsultant.net/2015/02/24/66-of-americans-would-use- mobilehealth-apps/)
62. 61 percent would make use of a mobile app to communicate with a doctor.
63. 50% of those with pulmonary conditions would use a mobile app for medication reminders.
64. 52 percent of Americans with cardiovascular issues would use a mobile app to track sleeping
patterns. (http://hitconsultant.net/2015/02/24/66-of-americans-would-use- mobile- health-apps/)
65. 79% of Americans would be willing to use a wearable device to manage their health. With the
most important reasons being: Tracking physical activity (52%), Tracking symptoms (45%),
Managing a personal health issue or condition (43%), Tracking sleep patterns (41%), and
Tracking diet/nutrition (39%). (http://hitconsultant.net/2015/02/24/66-of-americans-would- usemobile-health-apps/)
66. 88 percent of Americans would be willing to share their personal information for the sake of
improving care and treatment options. (http://hitconsultant.net/2015/02/24/66-of-americanswould-use-mobile- health-apps/)
67. People are three times more likely to look to WebMD (57%) over government-affiliated
websites such as the CDC (17%) or FDA (16%). (http://hitconsultant.net/2015/02/24/66-ofamericans-would- use- mobile-health-apps/)
68. If consumers were diagnosed with a medical condition, they would be most likely to research
symptoms (41%), treatment options (26%), and specialized doctors and care facilities (18%).

40
69. One in five internet users have consulted online reviews and rankings of health care service
providers and treatments. (http://hitconsultant.net/2015/02/24/66-of-americans-would- use- mobilehealth-apps/)
70. By 2018, over 1.7 billion mobile device users will have downloaded at least one medical app.
(https://www.snappii.com/resource-center/future- mobile-health-apps/)
71. 80% of instances of diabetes, heart disease and strokes can be prevented by better selfcare,
and mobile apps allowing patients to easily monitor their blood sugar, blood pressure, and
weight can be indispensable tools for high-risk patients. (https://www.snappii.com/resourcecenter/future- mobile-health-apps/)
72. Mobile capabilities patients want their doctor to have: 42% want an app to see their test
results, 33% want remote monitoring devices, and 30% want access to patient health records.
(2012 Ruder Finn mHealth Report)
73. (http://search.proquest.com.ezproxy.uwgb.edu:2048/docview/1723084386/fulltextPDF/23810DC808
B04165PQ/1?accountid=14788)
74. According to the Measuring the Information Society Report 2014 by the International
Telecommunication Union [1], nearly 3,000 million people use the Internet, which is more than
40% of the world's population (7,200 million). (Measuring the Information Society Report 2014)
75. According to a study published by the Journal of Medical Internet Research [10], nearly 95%
of US hospitals are on Facebook, while only 50% have a Twitter account. (Use of social media
across US hospitals: descriptive analysis of adoption and utilization)
76. The study [27] shows that pro-anorexia videos are better rated and more highly favored than
videos with serious information about eating disorders. Anorexia activists use the same tags as
reliable health videos, and their websites sometimes rank higher in YouTube or Google. This
happens because of the way searching engine algorithms are designed, according to
researchers. (Misleading health-related information promoted through video-based social media:
anorexia on YouTube.)
77. "With ever increasing access to internet-based information, an unsubstantiated rumor about vaccines
can rapidly circle the globe and undermine immunization services, sparking outbreaks of disease and
untold deaths" stated WHO, UNICEF, and World Bank in 2010.
78. Some anti-vaccination websites, such as the National Vaccine Information Center [31], look
absolutely credible and can easily trick users into questioning vaccines safety. (National Vaccine
Information Center [Internet] Sterling (VA): National Vaccine Information Center; 2015.)
79. The study [32] analyzed 172 YouTube videos about the HPV vaccine. Most videos (news clips
or consumer generated content) were negative in tone, disapproving of the vaccine. Also,

41
negative videos were liked more by viewers than positive ones. (When vaccines go viral: an
analysis of HPV vaccine coverage on YouTube.)
80. On the other hand, the study [34] showed that there is a correlation between the sentiments
expressed in social networks towards a new vaccine and the vaccination rates in a region.
(Assessing vaccination sentiments with online social media: implications for infectious disease
dynamics and control.)
81. The Ebola outbreak was first detected by HealthMap [37], a website that delivers real-time
data on infectious diseases for health institutions and governments. (HealthMap [Internet] [place
unknown]: HealthMap; 2015.)
82. The British Medical Journal published an article [38] that evaluated tweets regarding the
outbreak emitted from African countries. The researchers concluded that most of the messages
had false information and that 'bad' tweets were more retweeted than the ones with truthful
information. (Ebola, Twitter, and misinformation: a dangerous combination?)
83. Through mobile phones, the population can get informative messages on prevention, control,
and treatment. A few initiatives of this type have already been deployed in the Ebola outbreak
[39]. (Kelion L. Ebola text-message system set to expand [Internet] London: BBC News; 2014. [2015
Apr 15].)
84.
85. Apples health app can track the following: body measurements, fitness, nutrition, reproductive
health, test results, sleep, and vital signs. (http://www.apple.com/ios/health/)
86. With Apples HealthKit app, you can allow the data from something such as your blood
pressure to be shared automatically with your doctor. (http://www.apple.com/ios/health/)
87. Consumer health informatics in the past decade has moved from passive patient education to
activities that encourage patient participation and engagement in their health care through the
use of three key innovations: 1) wearable devices, 2) social media websites, and 3) personal
health records. (Self-Tracking, Social Media and Personal Health Records for Patient Empowered
Self-Care. Contribution of the IMIA Social Media Working Group.)
42
88.
89.
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_048693.hcsp?dDocName=bok1_0486
93
43
90.
91. Qualitative analysis of posts and discussion forum topics on the 10 largest diabetes
management groups on Facebook revealed that patients, as well as family members and
friends, share personal clinical information, receive emotional support, and request diabetes
management guidance from other group members. (Greene JA, Choudhry NK, Kilabuk E, Shrank
WH. Online social networking by patients with diabetes: a qualitative evaluation of communication
with Facebook. J Gen Intern Med. 2011;26:287292.)
92. In a 2011 US survey of practicing physicians, 7% had used video chats to communicate with
patients. (Manhattan Research. Seven percent of US physicians use video chat to communicate with
patients. http://manhattanresearch.com/News-and-Events/Press-Releases/physician-patient-onlinevideo-conferencing Published May 16, 2011. Accessed June 23, 2012.)
93. In a US study, 37% had consulted physician rating sites when gathering information about a
specific provider.
(Keckley PH. Deloitte Center for Health Solutions. 2011. 2011 Survey of
Health Care Consumers in the United States: Key Findings, Strategic Implications.
http:/www.deloitte.com/assets/DcomUnitedStates/Local%20Assets/Documents/US_CHS_2011ConsumerSurveyinUS_062111.pdf
Accessed 6/23/12.)
94. When researchers analyzed the content of blogs written by health professionals, 11% contained
product endorsement. (Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written
by health professionals. J Gen Intern Med. 2008;23:16421646.)
95. A study of 271 medical blogs written by health professionals found that individual patients
were described in 42% of blogs. Of these, 17% included sufficient information for patients to
identify their providers or themselves, and 3 included recognizable photographic patient
images. (Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health
professionals. J Gen Intern Med. 2008;23:16421646.)
44
96.
97.
98. 60% of doctors say that social media improves the quality of care delivered to patients.
(http://thesparkreport.com/infographic-socialmobile- healthcare/)
99. 60% of physicians say their most popular activity on social media is following what colleagues
are sharing and discussing. (Publicis Healthware International)
100.
Health care marketers use social media less often than other marketers (Facebook:
75/82, Twitter: 70/78, LinkedIn: 56/74)
101.
45

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