Hello. My name is Christopher Koh, and I'm the program chair for the social media session at the liver meeting. Today, we have a great program for you. We're going to start off with Dr. Nancy Riau presenting her topic, For the Hepatology Healthcare Professional, How to Make Twitter a Part of Your Digital Diet. Next, we'll have Stephen Belipo presenting on how to use social media as a networking, mentoring, or advocacy tool. Then we'll have Brett Fortune presenting his topic on best practices for communicating with your patients via the electronic medical record system. And finally, we'll end our session with an academic debate in social media. The moderators for this session will be Atusa Rabi and Niral Shah. The topic to be debated today will be personal and professional social media accounts. Do you need separate accounts? And the speakers on this topic will be Elizabeth or Lizzie Abbey and Bilal Asif. Hello, I'm Nancy Rau from Rush University Medical Center. And today, I'm going to talk to you about how to make Twitter a part of your digital diet. This is me. I joined Twitter in 2018. I have currently 792 that I'm following and 1,469 followers. I've sent 871 tweets. This by no means makes me an influencer. These are my disclosures. I am also the editor of CLD or Clinical Liver Disease. CLD also has its own Twitter account. It joined October 2011. I get help with both of these Twitter accounts. With CLD, we have a group of individuals that are our social media reps under the hashtag CLDSOMIreps, and they make a lot of noise. We'll come back to the importance of this. In my personal account, I do also have some help, and we'll come back to this too. I do want to point out that CLD is not the only AASLD journal that has a Twitter following. Hepatology joined in 2014 and liver transplantation in 2016. The most important question is why? Why would you want to make Twitter a part of your digital diet? Well, Twitter is a microblogging and social networking platform, so that doesn't always seem like it gels well with medicine. Users engage by following others and sending tweets. Tweets are a maximum of 280 characters, a lot of space there. Then you either like or you can retweet this information. It's important to use a hashtag, which is a phrase that is unbroken, preceded by that little cross hatch, otherwise something like hashtag liver Twitter. Tweets contain identical hashtags are then automatically linked. You can see that they're all linked together, how that really makes a lot of noise. In Q2 2021 or quarter two, Twitter had 206 million monetizable daily activities worldwide. Now, that doesn't mean that I'm encouraging you to join Twitter so that you can make money, but you can see how impactful Twitter is. This is where your colleagues and your patients are. Now, that's going to vary by country. You can see on the right-hand graphic here, these are the leading countries that engage or use Twitter as a platform as of July of 2021. Here, the top five are the US, followed by Japan, followed by India, the UK, and Brazil. Let's go through just a little bit of data. At the start of 2021, the world's population stood at 7.8 trillion. Let's go through a little bit of data. At the start of 2021, the world's population stood at 7.83 billion people. It's growing by 1% per year or 80 million people. That's a lot of young people. 5.22 billion use a mobile device or 66.6% of the population. 4.66 billion use the internet or nearly 60% of the population. That's up 7.3% from 2020. Thank you, pandemic. When we look at social media, there are now 4.2 billion social media users around the world. This figure has grown by 490 million people over the last 12 months. The number of social media users is now equivalent to more than 53% of the world's total population. Social media users jumped significantly, up 13% over the past year, with nearly half a billion new users taking to the global total to 4.2 billion by the start of 2021. That's a lot of Twitter users and social media users. On average, more than 1.3 million new users joined social media every day during 2020, equating to roughly 15.5 new users every single second. That's pretty staggering. Nearly all use their mobile device to engage with social media. The average social media user now spends two hours and 25 minutes on social media every day. This is roughly one waking day of their life per every week. And the reasons vary. 63% use the internet to find information. That kind of makes sense. And 36.3% are specifically looking for healthcare-related information. You can also see very striking differences in the demographics on how people use this. So you can see that in the younger demographics, social media search engines are more common than traditional search engines like Google search, whereas in our older demographics, that's flipped. They use typical search engines much more than social networks in order to find information. So Twitter and healthcare. Really? Why would anyone in healthcare want to consider using Twitter? Well, medical professionals are going to use this in multiple different ways. You can highlight academic achievements, including recent publications. You can provide real-time media updates. AASLD is doing that right now. You can highlight articles of interest. You can use this for networking. You can discuss controversies, otherwise known as Twitter debates. Some also will use this to engage with their patient population, either through education or even for marketing. And as I earlier outlined, the AASLD journal platform is also engaged in Twitter. And this is increasingly common among both organizations, such as institutions, as well as other journals. I'd like to discuss this pretty complicated journal article that was published recently in Gastroenterology. Here, they sought to understand who was posting the most widely read information on Twitter in the field of GI. They also studied the association between an individual's status as a social media influencer and then parameters of conventional academic success, as well as social media's reach of GI journals, and if that's related back to their impact factor. You can see from this network graph of the top and the lower 50 Twitter accounts in GI, where the lines between nodes intersect, this represents mutual following. This publication also found that influencers were typically older and in academic medicine, predominantly male. They also had higher age indices, which is a very nicely used metric to look at academic success. So in other words, social media influence was associated with traditional academic success. Journals also in the top quintile of influencer scores had higher impact factors, suggesting that both from an academic as well as a journal association, that the more visible you are on Twitter, the more this is likely to be linked to academic success and impact. So is it perfect? Well, absolutely not. It is a younger demographic. So if you're an older academic male, you need to understand who your message is going to. Half of the users are under the age of 35. Misinformation, here I really don't need to say more, but it's easy to see how people can pick up something that's not necessarily well vetted. And that's really important when we talk about transparency. You need to let individuals know where the information that you're getting is coming from. So how now do you make Twitter part of your digital diet? So the first thing is to understand why you want to engage in Twitter. Is this so that you can work towards education, for advertisement, to increase dialogue, networking? Well, how can you use Twitter for healthcare? The first thing, which is universal for Twitter, is you have to build a quality bio. This is important to get Twitter off the ground. And your bio has to have a good picture. Your profile picture is usually the first thing people notice on Twitter. After that, follow smartly. You want to make sure you're following individuals that are influencers, have quality information, things that you agree with. And then you want to share original content. I didn't do this when I first joined. I was more of a Twitter voyeur. I liked things. I retweeted things. But it's really important to share your own content. That's obviously easy for CLD. But it wasn't necessarily as easy for me on my personal Twitter. But now we share all kinds of original things. You also want to take advantage of social listening. What does that mean? It means that you're going to monitor the social media channels for mentions of you, your brand, your competitors, your product, and you can see where that information is going. Please respond not just to the positive feedback, but also the negative feedback, respectfully. It's important to know that there are going to be Twitter debates out there. You can use some of that negative feedback to generate discussion and to increase your networking and then engage with influencers. This kind of goes back to following smartly. All of this really is going to help humanize healthcare. And your patients really like to see us as real people and feel that connection to their position. So how do you get started? Well, luckily, there's a lot of great resources. So there's a great primer from Johns Hopkins called Twitter Best Practices and Tips for Physicians. And I put the link here. Thank you, Johns Hopkins. I was a fellow there and they've always been leaders in digital format. And this is a very useful document. AASLD also has a great resource in their social media essentials. They have a toolkit to help you get started. And then there was a recent publication in American Journal of Gastroenterology where they specifically talk about the impact of Twitter, why you should get involved and give you some tricks to get you started. So Twitter elements. So again, shine. Think about that bio. This is the time to highlight your achievements. You're not going to be shy here. But the other things that are helpful are finding a buddy. There's a huge learning curve, not just in coming up with hashtags, but kind of how to feature information, who to follow. Get attached to someone who's already done that. They're usually really excited to help someone enter the Twitter world. And if you're busy, as many of us are, automate. I personally use Hootsuite. This is a service that allows me to line up content to go out at a regular interval. That's not the only way of doing that. But if you line up things that you want to release ahead of time, it means that you can keep your Twitter account a little more fresh, even if you're not actively in and out of it every single day. So let's talk a little bit about what a Twitter influencer is. Well, first of all, there's no magic number of followers. They can be between a few hundred to 20,000 plus. And influencers with huge numbers can then drive really serious traffic, which then delivers results. Now that you often think of that as a product delivering a brand, but that can also be product of medicine, whether it's your own institution or something that you're doing uniquely, or maybe even an article you've just published. There's really a lot of ways to kind of circulate that across this platform very rapidly. There are some tricks to becoming an influencer. So number one, go back to that bio. Your bio needs to be eye-catching. You also then want to be unique and stylish. Maybe you're a little bit funny, maybe featuring things that are a little more artistic, but you want to make sure you distinguish yourself outside of all the other many Twitter people out there. Also respond to followers. Again, this goes back to that good and bad. You always want to recognize that someone has followed you or is responding to something, you know, circulating something that you've posted. Be up to date. It's really important to take down or to not circulate information that's It's really important to take down or to not circulate information that's out of date, and that goes back to that unique information. You want to use the right hashtags. This is really, really important. Remember, if you put a hashtag out there, any liked or similar hashtag, they're all going to be linked. And that's why as the liver community, we try to use the hashtag liver Twitter so that we can, you know, link all of that noise together so that people who are interested in the liver information are going to be able to see it. You want to keep your content short. You know, that seems kind of obvious that you're only given 280 characters, but this is where graphics, pictures, these things are much more powerful than 280 words. And then you want to use viral words and phrases, so not just COVID-19, but you want to use things that are going to highlight something so that someone takes a look at it. I'm going to leave you with an example of how impactful Twitter can be. So I told you that CLD had been part of the Twitter world for a long time, but liver transplantation joined in 2016. And it's easy to see from these graphics where on the left, you have the number of tweets, and on the right, you have page visits. You can see that from 2016, when the Twitter account was established, all the way till 2019, when liver transplant started to actually tweet their own articles. What really moved the dial most impactfully was in July of 2020, when liver transplantation engaged social media editors. These editors tweeted all of the articles at least once. They included that hashtag liver Twitter so that they were all connected. They tagged active account users, so they tagged those social influencers when they could. And then they wanted to include things that were noticeable, which were really figures and graphics. Much easier to do if you're developing content around a recently released article, but not all articles have great graphics to use as a tweet. And so they really were making their message very visual. Well, I hope I've convinced you that Twitter can really be a very powerful tool in medicine, not just from a personal information gathering, but also to circulate your academic credit, to make sure you engage with your journal, your society, your patients. But you want to make sure that you go into Twitter understanding how you want to use it, and then develop that platform along those lines. Thank you again so much for joining me. Hello, everyone. Thank you, ASLE, for this opportunity to present this talk in the social media session. And I wish I was there in California live presenting this to you, but I guess we're all used to these Zoom meetings now. And I'll try to make it as entertaining and interactive as possible within the limitation of Zoom, I suppose. For those of you who don't know me, I work in John Hunter Hospital in Newcastle in Australia, which is not far from Sydney. I'm also a lecturer at the University of Newcastle. And I'm also actively involved in policy and advocacy through the Royal Oscillation College of Physicians. And for those of you who haven't been on Twitter, please find me on Twitter as at Stephen Bullock. Now, I have no financial, commercial interests to declare. Now, coming to this talk about social media, I'll be focusing mostly on Twitter because that's my favourite medium at the moment, because I think that's the best one for professional networking in gastroenterology, at least. But I'm going to touch briefly on other forms of social media. So you all know Twitter, Facebook, Instagram, TikTok, YouTube, WhatsApp, and also LinkedIn and other kind of social media are there as well, where you can share things. Each of them have their own flavour and what their purpose is. So I'll touch on them briefly as we go. Now, there's been a lot of talk about social media and what doctors can do, can't do, and risks and benefits like with anything. But I think the risks are often so exaggerated and you hear horror stories about someone posted something and they lost their job or they got into so much trouble and so on. So most doctors that I speak to, at least in Australia, are horrified about actively engaging in social media at a professional level. And many organisations have come up with various rules and guidelines. It's often mainly about patient privacy because it's not just about de-identifying something. If you just came and posted something saying, oh, that was a horrible day of ERCPs, someone who's just had an ERCP that day, when they find that post on the internet will know that they're talking about them. So you have to be really careful about patient privacy. But because of that, the risks are often so exaggerated in all these guidelines, so much that people are put off by engaging in social media. So I'll try and keep this as positive as possible. Now, there's obviously a risk of oversharing, not knowing the etiquette of that particular medium. Something is good for TikTok may not be good for Twitter and so on. And also how you can come across as unprofessional. Again, I put that in quotes because that's a definition like, for example, if I'm enjoying a beer and I say cheers and I hold a beer and take a photo, some people who don't drink alcohol might consider that as unprofessional, that a doctor, a liver specialist is holding a glass of beer. So what people consider as unprofessional continues to be a debate. So that's another risk when you're doing things. Then trolling and online bullying, and also it can really waste a lot of time. So those are the risks. But benefits, I think it's a relaxing thing to be on social media. It's entertaining, interacting, you can make new friends. And if you're lucky, you might even publish a few papers with people that you've never met. You can also come up with large, collaborative, multi-centred clinical trials and research just by getting to know people on social media. You can also be mentoring, teaching, learning. And if you have a particular issue that you really want to be out there and advocate for, there's nothing better than being on social media because you're not preaching to a couple of people, you're preaching to millions. So these are all the benefits. And also there's, you can also counter misinformation. Now, these are just some examples of collaboration and research that I was particularly involved in, at least the three of them, all of them actually. You can see many of these people, the co-authors, I've never met in real life. In fact, all of them, I haven't met in real life, but we published in major high impact journals in the recent times. And I'm also actively involved in tutorials and all those kinds of things, Scoping Sundays. So it's become something that you could actually put on your CV. But this talk is actually about how to use social media. So I'll tell you a few tips. Step one, you've got to choose the right medium based on what your purpose is. So you've got to reflect on it. Why am I here? And say, for example, if you're trying to reach millions of people and advocate about vaccination or something, you might want to be on Facebook or Instagram or TikTok. And who is your target audience? Is your target audience fellow professionals? Or is your target audience patients? Let's say if you're trying to reach out to patients about, say, fatty liver disease and what you can do, you might want to actually go into mediums like Facebook and Instagram. And whereas if you're trying to reach out to young people, you might want to be on more recent media like TikTok with short attention span. So it all depends on how much time you've got and what your purpose is. And depending on if you have multiple purposes, you might even choose more than one medium, like Twitter for professional networking, Facebook for reaching out to patients, TikTok for reaching out to your young clientele and so on. But it takes time and consistency and to choose a medium that you enjoy. Next thing is you need to build a personal brand. So it's easier to be yourself than maintain some sort of a fake persona that your friends in real life actually look at your social media profile and say, that's not Steven, that kind of thing. So it's much better to be authentic and be yourself. And if you're actually needing to create a fake persona on the internet, that means that your real persona might need work. And also be authentic and have a real name, have a real photo, have a work profile, a link to your bio on your hospital website and that kind of thing, so that people who want to follow you know that you are a real person and also know how much to share. I mean, work-life separation is very artificial. Some people talk about having a very professional profile and a personal profile and try to separate them, but that's risky. I think that separation of what's work, what's life is a gray zone. So it's okay to share some interests, some hobbies, so people actually get to know you as a real person rather than a bot on the internet. Sometimes you might want to share photos, videos, your achievements, announcing that, hey, I'll become the associate professor or something like that. Something that you're sharing your life, almost like you're sharing on Facebook for your social media friends and family, but you could also do it professionally. Now, don't underestimate the importance of followers. I mean, if you just got 10 followers and whatever you say is just going to be falling on deaf ears. So it is important to actually have a certain number of followers in whatever medium that you're choosing. For example, I think people say on Twitter, you should get at least a thousand or 2,000 followers as a scientist to be able to have an impact and I don't have the reference right here, but there is a reference for that. Now, so it is important to build your following and unless you have followers, you're not going to make any difference. That means that you need to follow the right people and then eventually they follow you back, interact with people, comment, quote, retweet, occasionally even direct message them. Once you get comfortable, post regularly and maintain a variety of posts so that people are interested in following you and have some original content. Initially, you might be just sharing, retweeting that kind of thing until you get to know the medium, but at some stage, you've got to do more than just retweeting other people's tweets. You've got to come up with something original, which means that not just sharing your knowledge or just some pictures from journals and that kind of thing, but actually share your opinion, your wisdom, which is what makes it unique. Otherwise, people could just follow a journal website and then follow the journalist publishing. Be creative, put some effort and explain why you're sharing a particular thing. Hey, this is a nice article or something like that, and try and tag a few people in and create a discussion. So original content is important. Now, lastly, don't be negative. Don't be a perpetual critic. Be humble, appreciate others, encourage others, and yeah, be an occasional critic, but don't make that a habit. You will get followers. There are negative people out there, so if you are a negative person, you can have a few thousand negative people who follow you and you will be in your echo chamber of constantly criticizing others, but that's not the way to enjoy social media. And, you know, so self-awareness of when you're trolling. You might be thinking, oh, I'm having a bit of fun by poking a stick at everyone, but you're actually trolling. So understand when you're doing that. So no one can be positive all the time, but be a critic, but not to the point of trying to bully others or hating others. You know, sometimes if it's an article, then don't go there and actually completely bash an article, you know, something that someone might have put years of research into it. So you might want to write a proper letter to the editor rather than a troll by social media. Now, so the key takeaways about how to use social media is know your purpose, understand the etiquette of the medium that you've chosen, bring your personal brand, bring your personal qualities to your profile, be authentic. Takes a lot of your personal time, so whatever you're doing, actually you're enjoying it. Don't do it as a chore to try and build up something, but as a way of enjoying, as a way of relaxing, but have some benefit from it in the end. Choose the right medium, build your profile, you know, get a decent number of followers, not just random followers, but followers in your field, create some original content, post regularly and a variety of things, be nice to people, and most importantly, don't forget to have fun. You know, this is a group of people, you know, we were, as you can see from the photos, we were all in different time zones, and we were discussing on a Zoom call about an article, I think this was when we were getting our article on GI endoscopy, where we did an international survey, and we actually got a thousand responses from around the world of gastroenterology trainees, and all through this group of people, and then using their connections with the local societies. So, but it was fun. It was a lot of hard work, but we really enjoyed doing it, and we now have a lot of real friends that one day when the travels open, one day we can all meet and, you know, give each other a hug, but until then, you know, we're still meeting each other online quite regularly, and occasionally on Zoom meetings and having fun. So, social media is not all about yet another way of actually trying to improve your CV, but a way of relaxing in these times, but at the same time benefiting from it, so that all that screen time you're spending is not wasted. And I hope that's been of some use to you, and please don't forget to follow me on Twitter, because one more follow is all I need. Thank you. Well, hello, everyone. Thank you. I'm excited to be joining this excellent session here at this year's AASLD liver meeting. My name is Brett Fortune. I am a hepatologist and associate professor of medicine at Weill Cornell at New York Presbyterian Hospital in New York City, and very excited to discuss best practices for communicating with our patients via the electronic medical record system. I have no financial conflicts and no disclosures. So, when we talk about best practices, I wanted to discuss three major themes. The first one being education and establishment of a chain of communication, basically educating and informing patients and their caregivers, and showing a demonstration of how to use the communication tools in the EMR, as well as establishing rules of engagement, setting the bar so that upfront, we can make sure that we have proper chain of communication. The next theme is optimization of patient portal utilization. Therefore, making sure that the patient is taking full use of the patient portal access in the EMR and making sure that the care team is able to both discuss with the patient or caregiver through the portal messaging or establish other activities such as standing orders or scheduling follow-up appointments or procedures. And finally, our third theme will be creating care workflows, where we'll be establishing telehealth or virtual visit options, as well as using reminder activity function or health maintenance tools and establishing a standardized approach so that any care team member can perform a spontaneous, seamless communication with patients even in the absence of their original provider. So let's first start with the first theme, educate and establish chain of communication. So basically telling patients how it works. So when you talk about educate and establish chain of communication, there are three major steps. One, inform the patient and caregiver. Seems easy enough, but unfortunately is forgotten quite often. And it's really important to set this up at the first visit because I have found in my experience, once you set this up, it really saves you a lot of time down the road, especially as you manage patients for long periods of time. So first at the initial visit is first discussing with the patient or caregiver or both, the presence of the access of a patient portal in your electronic medical record or EMR. And with that, you also need to make sure that they know how to access and verify that they have the proper login information, and are successful in logging in. Believe it or not, these are two of the hardest steps in order to initiate. And if you're able to verify this, especially in person in the office, whether it's with a staff member helping you at the front desk or an IT person that's on the phone, it's very critical to get this set up upfront so that you can have proper communication and proper utilization of the portal throughout your time with the patient. Next step is demonstration. And this kind of goes along, follow through with the information is obviously walking them through step-by-step, sort of like a YouTube video, where basically we provide step-by-step instruction, whether it's screenshots or actually having lifetime help on how to log in properly, make sure they successfully log in, as well as review all the portal functions, including how to use the messenger system, refills, scheduling appointments, et cetera. You go through this, it's worth the time upfront because once you do it, they're very successful, this will really help you in the end. And then finally, we need to set the rules. And this is especially important upfront because you wanna make sure, although there's always that small font language within the portal, which no one reads, it's very important to verbally or in writing express how the portal and communication chain should work and how to use it appropriately. So basically discuss what topics are inappropriate or appropriate. For example, if you need something that's an emergency, that's where 911 is better than a portal message, and it's okay to call that first. And so you wanna ensure that any questions or communications that they're setting is you wanna set the bar, that it's okay that the answer can be within one to two business days and not overnight and not weekends. And this is especially important because trying to call having chest pain on a Saturday using the portal system is not appropriate. In addition, it's important to make sure that they follow up on refill timing to avoid any medication interruptions, especially important when you have a transplant patient with immunosuppression or in a patient with hepatic encephalopathy that needs their lactulose. It's very important that they feel comfortable using the refill function and making sure that this has been walked out for them. Second thing, optimization on how patients use the portal. And there's a lot of functions depending on your EMR system, whether it's scheduling, messaging, reviewing their medications and modifying any changes as they get new prescriptions, reviewing test results, setting up telehealth visits or even paying their health bills. There's a lot of abilities, whether it's on your mobile device or on your computer. And so it's really important to walk through that and make sure they're familiar and comfortable because this will increase their ability to utilize it in the ideal fashion. So again, confirming that portal messaging is a primary avenue for communication. Therefore, you wanna make sure upfront, do you feel comfortable using this portal? Or is this something where you don't feel tech savvy and would rather use the old traditional phone call? And it's important to determine that because one, you wanna make sure they're comfortable in communicating because you don't wanna create a barrier that way. You don't wanna lead to disparities in those that aren't tech savvy. And you wanna make sure that it's documented in the record so we know how to properly communicate with those patients. And in addition, I always recommend sending test messages, even if it's a simple, hey, it was great seeing you in the office today, just to make sure that when they reply, you've confirmed that they've been able to adequately use the messenger function and log in. Next, you wanna train them to invest in their personal healthcare. I think one of the benefits of having access to their EMR portal is having the ability to be independently reviewing their test results, their studies, and allowing the opportunity to converse after review with their doctors or other care team providers to make sure that they have a better understanding. And this really helps, especially on the visual side, when they're able to kind of follow trends and thresholds and whatnot. In addition, being comfortable making appointments and making, as I stated earlier, having those successful refills because this will really invest in their own healthcare and help them manage their chronic disease more ideally than without having the portal. And then finally, really using order functions or other activity functions, including setting up standing labs, especially if it's a local lab, setting up scheduling with imaging studies or elastography or procedures such as endoscopy, colonoscopy. So there's definitely some care pathways that can be established and having your patient and caregiver savvy with those functions is really important because it will help you as a reminder as they've invested in their own care. But more importantly, you need to be comfortable yourself. So a lot of providers I have found aren't always comfortable with their EMR systems or the portal themselves. Obviously, it's great if you're able to create your own account in your system so that it gives you kind of a sense of firsthand of how it works so that when you experience issues, you can also see what patients are talking about, but you really wanna make sure to explore the portal function or talk to an IT or someone that's savvy in order to make sure you yourself feel comfortable because it'll help troubleshoot if you ever come across problems expressed by your patients. And keep in mind, there's also inpatient options too. When you are rounding in the hospital and your patients have access to their portal, it's quite easy for them to review their labs. And while you come in, you get to talk lifetime while they're reviewing their labs, explain any questions that they may have. And this allows them to be really involved in the medical decision-making on a daily basis during rounds. So keep it in mind, it's not just ambulatory settings. It also can be in the inpatient setting. So lastly, we'll be talking about creating care flows. And this is important, especially when you expand the platform to a virtual telehealth setting, as well as the reminder function and creating standardized workflows that work in case you're not available, but your team is able to fit in nicely, seamlessly, so that the patient gets the interaction that they expect. And so really when you're going A to B, you wanna pick the most efficient and seamless pathway and avoid redundant pathways, which also might be much less efficient. So what am I talking about here? When you create care workflows, it's really important to implement both telehealth options. And obviously during the viral pandemic, there's been obviously a great expansion in telehealth, but obviously recognizing that there's still limitations, might've magnified disparities in people that may not have access to technology or don't feel comfortable using it. But regardless, it's definitely been an advantage in expansion. And although there's been some restrictions reinstated as the pandemic has changed over time, it's still important to explore these options in telehealth, whether it's a virtual visit or a billable telephone encounter or offering other platforms in case the platform your system and your EMR uses, the patient's not comfortable, having the flexibility to offer other platforms, just as an example, Doximity or Zoom, where you can actually have, where the patient might feel more comfortable using and allow that and still integrate it with your EMR encounter. The reminders function is really important. And this is a great tool to really incorporate ways to make sure the patient is staying on top of their appointments, whether it's a screening procedures, such as ultrasound for HCC screening in our cirrhosis patients, scheduling their colonoscopies for screening or endoscopies, elastographies, or even more recently, focusing on their vaccination status and obtaining labs. And then you wanna create a workflow that works for everybody. So in case you're on vacation or out of the office, you wanna make sure that a team member that's filling in does the same standardized approach. So you wanna have efficient inbox use with other team members. So you need to create those kind of rules of engagement amongst your team members to make sure that everything's seamless because you wanna avoid repetitive actions and especially discrepancies. If you say one thing, another person says the other, at the same time, the patient gets kind of a miscommunication and this can lead to problems. So you wanna make sure you have that workflow worked out. And then you wanna make sure rules for each team member has been established, especially when you're using a shared inbox to communicate with patients. And again, you wanna really standardize among all the team members to make sure that it's seamless and not leading to discrepancies or repetitive inefficient actions. So finally, I wanted to conclude that again, there are three things to really focus on when trying to have best practices for patient communication using the EMR. One is to educate and establish a chain of communication with both the patient and I would reiterate caregiver as this will really help you long-term of having that time focused on getting the setup upfront. And I find it especially effective when doing it in the office so that you can make sure everything is in working order before they leave the office. Next, you wanna make sure you optimize patient portal utilization. You wanna make sure they understand all the functions of the portal and the ability to know how to communicate and when to communicate and also any of the other activities such as scheduling appointments, labs, procedures as well as medication refills. And then lastly, you wanna make sure this is a standardized workflow approach with all your team members, whether it's on the virtual platform using the reminder function or health maintenance function to make sure that patients are being in compliance as well as making sure that you have efficient workflows amongst your team members so you avoid redundancy or discrepancies in communication. And then I will conclude in the last few seconds, the future directions are very exciting. Improved patient to portal integration includes incorporating patient reported outcomes. This includes disease specific quality of life questionnaires or surveys, linkage to biometric monitoring, whether it's through a watch or some other scale system where you can link to the EMR, any measurements that might be helpful and help providers and caregivers capture possibly negative trends. In addition, create a disease-specific dashboard so it allows caregivers and patients and providers to interact and have thresholds to aim for. And then lastly, decision-making functions to allow the patient to be involved in their medical care. And with that, I hope you were able to understand some of the best practices that I've experienced while trying to communicate with my patients through the EMR, and I appreciate your time. Thank you very much. Welcome to Communications and Technology Academic Debate. In this part of the session, our presenters will be debating if personal and professional social media accounts should be separate. My name is Atusa Rabi, and I'm a transplant hepatologist at Washington, D.C. VA Medical Center, along with Dr. Niral Shah from University of Virginia, who will be moderating this session. Our first presenter is Dr. Elizabeth Abbey, a gastroenterology fellow from University of Minnesota, arguing that separate accounts are not needed, which will be then followed by Dr. Bilal Asif, a gastroenterology fellow from University of Maryland, arguing in favor of separate accounts. Now, Lizzie, please take it away. Well, thank you. You've already introduced me. My credentials on this topic are really that I'm a Twitter user and have been an active part of the medical Twitter community for over four years. As a part of this session, as Atusa has nicely sort of laid out, we'll be debating professional and personal social media accounts and whether we need separate accounts, and I'll be arguing that separate and personal professional accounts are not needed. I have no financial disclosures or conflicts of interest with the presented material in this presentation. The opinions expressed are solely my own and do not express the views or opinions of my employer. So, I think it's useful to start off this discussion with sort of defining what social media is. And the Merriam-Webster definition of social media is forms of electronic communication, such as websites for social media and microblogging, through which users create online communities to share information, ideas, personal messages, and other content, such as videos. There are several different types of social media platforms and networks, from social media networks, such as Facebook, photo-sharing platforms, such as Instagram, video-sharing platforms, such as YouTube and TikTok, and microblogging platforms, such as Twitter. Given the rapidly…next slide…given the rapidly evolving nature of social media and the reports of misconduct among clinicians online, several institutions, medical boards, and physician organizations worldwide have created recommendations for physician use of social media. Here are a few of the social media guidelines published by different professional organizations in the U.S., including the American Medical Association, the American Medical Student Association, and the American College of Physicians. The recurrent theme throughout these guidelines is to maintain separation, but the definitions of separation differ between groups. So, for instance, if we take the American Medical Association, they state…they recommend to maintain appropriate and professional boundaries that physicians should consider separating professional and personal content online, whereas the American Medical Student Association states maintain separation, avoid interacting with current or past patients through social media, and avoid requests to give medical advice through social media. Next slide. Now that we understand the current definitions and guidelines, I would like to argue that social media accounts do not need to be separated because physicians must always maintain standards of ethics and professionalism, no matter if they are posting as a part of their professional or their personal accounts. Next slide. As we discussed before, a common theme among professional medical organizations around social media is that professional and personal accounts should be separated. However, this is operationally not feasible. Many prominent and successful physicians share narratives in public online platforms around their personal views, such as what sports teams they support, what music they listen to. These posts, when made thoughtfully, do not cause harm and may enhance the views of the profession by showing an individual's authentic self and thus can potentially allow for others to feel more connected to that individual. While there are common themes within the guidelines around social media, there is a lack of consensus regarding the definition of separation, from not engaging with patients on social media to two different accounts on each social media platform. And not only do professional organizations have differing recommendations, but these recommendations might also differ from a physician's employer, making following these recommendations for separation even more challenging. I would also like to argue that physicians are held to a higher standard than the general public. Physicians must adhere to their professional responsibilities, including in situations that are outside the traditional clinical sphere, such as social media. And while different platforms can offer varying degrees of privacy, with some allowing for only authorized individuals to see a person's posted content, it's unlikely that true online privacy exists. Posts made on supposedly private accounts can be captured, screenshotted, leaked, and thus made public through friends, acquaintances, or friends of friends. In addition, combining personal and professional accounts can be helpful when done appropriately. In a study looking at physician biographies in the United States, patient anxiety around communicating with their physician had a greater reduction, those who had anxiety with their physician, had a greater reduction in communication apprehension when in the personal biography of that physician there was personal information provided. And then how can we ask for vulnerability from our patients when we cannot be vulnerable ourselves? Furthermore, doctors speaking out on public health issues or advocating for social justice on social media can be beneficial to patients and the profession. Here are some notable gastro…next slide. Here are some notable gastroenterologists in the field, from Russell Rosenblatt to David Goldberg to Austin Chang. These are leaders in the field that navigate a combined personal and professional account with grace. As you can see here on the screenshot of Austin Chang's has over 70,000 followers. He is using his credibility as a physician and his platform to correct misinformation about COVID-19 vaccinations, among other things. Given professional and personal accounts can be combined successfully and with benefit, it's important to remind ourselves of the general guidelines around social media use with combined accounts. Users must be professional and respectful. Those who choose to use social media must follow standards of patient privacy and confidentiality outlined in HIPAA and the Family Educational Rights and Privacy Act. Users should be transparent about what they post. Appropriate disclaimers are needed, making sure you reveal your conflicts of interest and being honest about your credentials. And finally, users must assume that nothing is private. Next slide. So, in conclusion, I hope that I've shown that rather than trying to create distinct personas, physicians should focus on ensuring that they adhere to ethical and professional standards on all social media platforms, no matter what format. Separation of identities online is operationally impossible. Nothing is truly private, and social media can be a valuable tool in a physician's toolbox, such as correcting misinformation or advocating for public health policies. Thank you very much for your time. I look forward to your questions. Thank you all for the opportunity to speak today, and thank you, Dr. Abbey, for a wonderful, thought-provoking presentation. Today, I will argue for the separation of personal and professional accounts. Listed on the slide are my credentials. Similar to Dr. Abbey, I am active on Twitter, though not as much of a Twitter celebrity as she may be. Next slide, please. So, again, I will argue that separate accounts are needed for healthcare professionals from a personal and professional standpoint. Next slide. I have no conflicts of interest and disclose for today's presentation. Next slide. So, what's the deal with social media? I'll briefly take a walk through social media, physician use of social media, and then we'll go into the benefits of separating your personal and professional accounts. Next slide. So, no doubt we're all aware that social media, as a concept and as an entity, has evolved significantly over the past decade. There are new platforms emerging. They're leveraging a user base that transcends any kind of boundary. It's regional, national, political, and ideological. The recognition of its global scope is truly staggering. As an example, Facebook has 2.8 billion monthly active users. That's more than a third of the world's population. Twitter, which is a microblogging service, has grown its base to over 200 million daily active users, which is a population bigger than most countries. And beyond personal social media use, professional social media use is rampant in user and organization-generated content during major political events, including elections, sporting events, and, of course, major academic medical conferences. This has become more clear during the COVID-19 pandemic as our collective virtual presence has grown. And with that, so has medical misinformation, groundbreaking research on vaccinations, and additionally, how the pandemic continues to affect us on a daily basis. So, clearly, social media has become a fabric of our society. And while its uses may differ from person to person, it will likely become a part of what we do personally and professionally going forward. Next slide. So, why should healthcare professionals use social media and how should they use it? There's so many reasons. You can promote healthy behaviors, which allows healthcare professionals to use a larger venue than their own personal office to deliver public health messaging. It can be a means of patient advocacy for online collaboration with organizations around the world to push for better patient care. It allows early dissemination of research that can help our patients now and in the future. And finally, it allows us to crowdsource difficult clinical cases and address practice management challenges that we may be personally stymied by but can overcome with help from our colleagues. So, while some social media platforms do exist in silos, much like LinkedIn, which is a professional networking site, individuals can also choose to have different types of accounts. Traditionally, professional accounts are linked to an individual's occupation, their institution, and their field of study. Personal accounts tend to be linked to an individual's hobbies, interests, their families or friends, and other excursions. Next slide. So, why should we have separate accounts? We'll go through a few points in the next few slides. Next slide, please. Content consumption. So, we consume what we curate and we curate what we consume. Social media exists for many reasons and one of those is to show us what we want. And it follows then that algorithmically driven content curation has become a very common feature of social media platforms. Interactions on social media at their very core are recursive. They feed on what you put into it and you see more of what you put out. Along those lines, no individual is an island. We're a wonderful amalgamation of our personal and professional lives. An advantage to that end of separate social media accounts is to carefully separate our many multi-hyphenated identities to take advantage of each portion of ourselves. Going onto your Twitter feed and seeing content related to occupation, for example, the latest update on vaccine boosters and pre-print, can be confusing and potentially promote unnecessary context switching when it's followed by your sister's new cute puppy, as shown here on the right side. The concept of homophily is also particularly germane to this discussion, which is the idea that we have a tendency to surround ourselves with others who share our perspectives and opinions about the world. This is a part of human nature and truly an organizing principle underpinning many of our digital social media networks. Being overtly cognizant of this and trying to compartmentalize different facets of our life can perhaps help us avoid echo chambers and help improve ourselves. Next slide. More often than not, our social media accounts and particularly professional identities often have an intended audience in mind, which is distinct from our personal accounts where we generally know our audience because we know them in person. I'd like to highlight two examples here. In 2017, social media metrics published by the Mayo Clinic showed nearly a million social media referrals to its website in the first quarter. Between 2015 and 16, social media referrals led to over a hundred percent increase in patient appointment requests, with Facebook being the top social media referrer. This experience shows that increasing patient appointments plays a vital role when tied to brand marketing by improving the patient care experience and enhancing this health consumer education by connecting patients, not just with providers, but with patients with similar diseases to facilitate peer-to-peer support. A second example is in 2016, Massachusetts General Hospital launched a lung cancer screening digital awareness campaign that targeted patients greater than 55 years old, and they used Facebook and Twitter to target those patients. They saw a phenomenal increase in page visits as well as cancer screening protocols. Because of that, the professional identities of their individuals were paramount in trying to figure out what is the best way to help our patients. Whatever your brand may be, I feel it's important to understand that promoting yourself and your professional identity will help in that regard. Next slide, please. Focusing on a preeminent gastroenterology social media user, Dr. Arsene Chang, we can see that brand awareness plays an important part in developing your professional identity. This is a screenshot of Dr. Chang's personal website, which helps drive awareness for the causes that he's interested in. Next slide, please. Privacy concerns are always something that we think about when it comes to social media. Social media users may have overlapping networks of families and friends and colleagues, and we must keep in mind that potentially unprofessional content can reflect unfavorably on trainees, programs, and institutions. As mentioned in the prior presentation, multiple professional societies, including the American Medical Association, have brought out recommendations on privacy settings and social media use for physicians. Next slide, please. One good way to approach social media from a personal and professional perspective may be to use the dual citizenship approach, which was first described almost a decade ago now when social media was at its advent in academic medicine. This approach helps providers manage a professional image online separate from their private identity. In the professional context, providers can manage their audience, deflect patient questions from a personal page and direct it instead to a professional account, as well as manage their content to carefully tailor their posts and online dialogues to really focus on their self-identified professional image and avoid sharing too many personal images if they choose to. In addition to separating the accounts, it's important to understand the limits of social media as a whole to make sure you have routine electronic self-audits, maximize privacy settings with the understanding that there is truly nothing private on the internet, developing a professional biography that may help you for your career down the road, understand whatever you post may be public, and avoiding direct communication with patients via third-party platforms. Next slide, please. So, as an overall takeaway when evaluating your online presence, it's important to keep in mind your content consumption, brand awareness, privacy concerns, and considering using the dual citizen approach to manage your social media accounts. Next slide. Thank you all, and I welcome any questions. Lizzie, question for you. In your presentation, you stress to keep professional views and keep your views professional on your social media accounts. Just a question for you as an avid Twitter user, what is your litmus test for what you post on your account? Like, how do you decide that this is okay or this is not okay? I actually think my litmus test is if I had a patient that came into me in clinic, would they be comfortable with what I had posted? Because part of it is I've had patients who have come into me in clinic who have seen my Twitter, and anything that I post on Twitter, I should assume that my attendings, my colleagues, all of them see that, and if I'm uncomfortable with that being in a public space, I choose not to post it. Great. I have a question for you. So, you argue, and I do agree with that, that we should be held to a higher standard and just remain professional and ethical, whether it is a private account or professional account. Now, in this day and age that clinical information has kind of a little bit, we have had a little bit of a gap, and there is some overlap with religion and politics. What do you feel about those subjects? Should politics and religion just never be subjects that physicians touch on any platform of social media? It's interesting because I had a great discussion with David Goldberg when I was asking him if I could use his screenshot for this presentation, and I think part of the political aspect of things of physicians have sometimes been told to stay in their lane regarding sort of quote-unquote political topics, and I think there are a lot of political topics that sort of bridge a public health perspective, and I think given the disinformation that we both spoke to and the fact that many people are using different platforms to get their news, that we as physicians with credit, like disclosing appropriately, have the credibility to sort of speak to certain public health issues, whether it's gun control, COVID vaccination, that people will listen to us, and we have the responsibility to engage in this space, so yeah. Bilal, I have a question for you. You stress the importance of two accounts, but a lot of my identity is tied to my institution and my professional sphere, and how do you decide which account to post something in, like because so much of my identity is tied in both places? That's a really great question, you know, and it's something I often struggle with as well. Similar to what Lizzie mentioned about a litmus test, I feel like there are certain categories that could be posted on both kinds of accounts, but some may be better suited for others. You know, for example, professional accounts tend to and may be better suited for things that are very much occupational-based, research-based, patient care advocacy-based, whereas personal accounts may be better suited for anything that happens in your personal life, so whether it's, you know, your latest woodworking workshop that you're kind of working on or, you know, building boats inside big glass bottles, which I definitely don't do, you know, all of those things are definitely, they can be compartmentalized, and I feel like the great part of social media is that the nuance is really left up to the individual, and people may have different parameters for what they consider acceptable, but I think that personal decision is really what really makes it fun to share and engage in. I also have a question for you, so I guess the bottom line of the presentation is that there is really, we all agree that there is no such a thing as private on social media, whether it is you're sharing it or somebody taking a screenshot and sharing it for you, so should physicians just consider themselves exposed and carry themselves always at that higher standard, and even though you are sharing private information on your woodwork, still think that, well, somebody is watching, so that sort of gauge your post or your sharing of information, whether it's your private account or public account, to that standard? I think so, you know, I think whether you use personal accounts, private accounts, or use one for both, I think privacy concerns are ubiquitous, and I think the underlying assumption should be that whatever you post at some point will be saved someplace and may be disseminated in the future, and with that kind of caveat or veil in mind, everything you post should kind of pass through that filter, and, you know, what you end up posting, obviously, is going to be up to you, but with the understanding that whatever you post may become public, as long as I think we start with that and keep ourselves to the higher standard that Lizzie had mentioned, that's a great place to start off with. Well, I want to take a moment to thank both of you for joining us today in this academic debate and all the people watching. On behalf of the Communication and Technology Committee, I want to give a big thank you to Lizzie Abbey and Bilal Asif, along with my co-moderator, Atusa Raby. We hope this has been an interesting topic and helped you learn something, but also helped raise some questions about certain things. Thank you again for joining us, and we hope you enjoy the rest of the Liver Meeting digital experience. On behalf of the Communication and Technology Committee, I'd like to thank you for joining us for the Communications and Social Media and Hepatology. I'd also like to thank all the people that participated in this session, along with those that participated in the academic debates and social media. Specifically, I'd like to thank our presenters Lizzie Abbey, Brett Fortune, Stephen Bolipo, Bilal Asif, and Nancy Rowe. I'd also like to thank my co-moderator, Christopher Ko, for joining us and helping organize this session.

Liver Meeting

social media in healthcare

Twitter

personal and professional accounts

Dr. Abbey

Dr. Asif

authenticity

ethical standards

privacy concerns

healthcare professionals