In a 4-day span, Farris K. Timimi, MD, penned… err, typed… well, actually, he tapped almost 300 tweets. People who followed the short messages he posted on his Twitter account (@FarrisTimimi), could read the happenings at the ACC's annual meeting in Chicago in real time. And Dr. Timimi did more than use the popular social media tool to inform; he also engaged, explained, and even entertained: "Not sure which is in more need of a recharge—me or my iPhone #acc."

"Many people who couldn't attend were tweeting back to me from Belgium or California," Dr. Timimi told CardioSource WorldNews. Often those following his ACC posts from afar sent him follow-up questions. Dr. Timimi, a cardiologist and medical director of Mayo Clinic's Center for Social Media, relayed researchers those questions face-to-face and then tweeted the responses for all to see.

For example, he tweeted a panel discussion question: "Would you turn down a HF patient for CABG who refuses to quit smoking?" After receiving several responses, Dr. Timimi polled the panelists himself—three said yes, two replied no.

The interest in Dr. Timimi's ACC updates underscores the overall convergence of health care and social media. More doctors and health institutions are using these popular sites to interact with potential patients, stay abreast of new data, and keep in touch with colleagues.

140 Characters in Search of an Author
Dr. Timimi isn't alone. A Frost & Sullivan poll found that 84% of doctors use social media for personal relationships—that's more than the 65% of the general population that connect using sites like Facebook, Twitter, YouTube, and LinkedIn, according to the Pew Internet & American Life Project.

This type of online interaction in essence gives patients and cardiologists access to each other, as well as to far-flung, constantly evolving medical information, like the more than 22 million publications in PubMed or the more than 400 heart failure and transplant guidelines, Dr. Timimi pointed out.

"The doctor is no longer the only expert in the room," Dr. Timimi said. "Patients have access to the same data."

Many health care professionals have turned to social media sites online as a way:

• to stay updated by reading posts from colleagues;
• to share their own research and to share other data of interest in their field;
• to promote their practice or hospital system's services;
• to answer common questions, so valuable office time can be spent more effectively; and
• of course, to share cool photos and videos.

Ready for My Close-up, Mr. DeMille
A perfect example, Dr. Timimi noted, is his children's pediatrician and her annual 3-minute "bike helmet" spiel. "She probably does it at least five times a week," he said. "Imagine if she put it on YouTube." Those same 3 minutes, with the aid of a $50 or $100 video camera can be online for everyone to see—even those who weren't scheduled for a springtime appointment and those who simply couldn't afford a checkup. "It's scalable, leveraged content that meets the patients physically where they are."

Content is king when it comes to imparting information, and Dr. Timimi noted that Hollywood glitz and glam doesn't matter. Most who are actively sharing data online said that physicians and health care institutions shouldn't let fear of production values prevent them from joining their colleagues, friends, and patients on these social sites.

Actually, institutions shouldn't fear social media at all, but many don't know how to handle the tools and haven't established guidelines, so they block Facebook. "The employees are already there. Facebook is the third largest country in the world," Dr. Timimi said. "The key is to develop guidelines: do you want to take advantage of the human bandwidth? It's an incredibly powerful tool to improve health care." Beyond all the pros for playing online, Dr. Timimi could think of only one con: "Not participating."

#Hail to the Chief
Apparently, William Zoghbi, MD, agrees. As the first tweeting president of the ACC, he also shares ideas from the College, updates from his meetings worldwide, links to important papers, posts photos from local ACC chapter meetings, and he even shared his excitement at being an Olympic torchbearer. Dr. Zoghbi's Twitter handle: @WilliamZoghbi.

"I started tweeting just a few months ago," Dr. Zoghbi said. "I think, in my position, it's important to relay either events, ideas, thoughts, or reflections on what goes on in the cardiovascular field to people who are very interested in what we're doing. It's a phenomenal means of reaching so many people so quickly."

"It's amazing how wide a net you can reach with these various modes of communication. This makes the world so small," Dr. Zoghbi said. As he noted, one could be in China and be talking to the entire world, using the speed, proximity, and widespread availability of these new tools.

Because different members might have a particular preference for how they receive information, Dr. Zoghbi said, the College uses as many outlets as possible, in addition to email alerts, to spread the word. Visit the URLs below to access the ACC's social media sites:

• the ACC in Touch blog (blog.cardiosource.org)
• tweeting (twitter.com/ACCinTouch)
• CardioSource Video News (cardiosource.org/News-Media/Cardiosource-Video-News)
• Facebook (facebook.com/AmericanCollegeofCardiology)

But does the world listen? Does all of this interaction lead to more patient satisfaction, or, more importantly, does it enhance care?

Early Adopter
Howard Luks, MD, likes to say he "entered the intersection of social media and medicine before the pavement was dry." Chief of sports medicine and arthroscopy at University Orthopedics PC and West Chester Medical Center in Hawthorne, New York, Dr. Luks has been using Twitter since 2008 and has kept a blog for a decade. At press time, Dr. Luks's Twitter feed, @hjluks, had more than 7,500 followers. His website dubs him "Howard J. Luks 2.0, digital strategist, chief medical officer," and his Twitter page declares, "Medicine can be social."

Dr. Luks has found that being active online benefits both him and patients. "It's very useful and relevant to extending my experience and knowledge base beyond the four walls of my practice," he said. "There is a global audience that is thirsty. Most of what's available is commercialized nonsense. We need non-commercialized, knowledgeable information about disease processes. I want to be able to fill that need." Social media, Dr. Luks said, has enabled him to do so.

His website contains plain-language descriptions of common injuries, along with images and even video of him providing more background. He's also served as a sounding board for remote, rural physicians in the United States and abroad who don't have a nearby colleague "to bounce ideas off of." Being separated from colleagues, patients, and data by space and time no longer has the same impact on quality of care.

When asked if social media allows more people to have information, therefore making high-level health care more accessible, Dr. Luks didn't hesitate to answer, "No question."

One example of social media saving the day: a Twitter follower located in a mountainous region of the world contacted Dr. Luks about a problem that his surgeon wasn't able to solve after four separate procedures. After he received relevant studies from the patient, Dr. Luks collaborated with the surgeon online on a surgical plan that solved the patient's problem. This is not an isolated incident, he noted. Hypochondriacs have always been fans of using the internet to research potential diseases, but now even more doctors are engaging each other and sharing information with the public.

The Social Media Toolbox
"Hundreds of papers are published every single day in my area," Dr. Luks added. Social media keeps him abreast on the recent developments and connects him with others in his field. "It's patients, patient advocates, and physicians all collaborating together to help solve problems. We as physicians need to embrace patients who might bring a study into the office that might prove relevant to their care," he said. "Patients can benefit enormously based on who they follow."

Social media not only lets physicians get involved in the virtual conversation, but also to secure themselves as thought leaders and credible online sources. "Patients are looking for information on health care," Dr. Timimi said. "Our opportunity and moral obligation is to meet our patients wherever they are and to walk with them from illness to health. And where they are is online."

Dr. Luks sees this expanded dissemination of health care information as a boon for those on the receiving end of care. "This has the potential to speed the health care delivery process, to facilitate open dialogue and communication" that will cut down the lack of adherence or the misunderstanding of a discussion," said Dr. Luks. "Seventy percent of what is said to a patient is forgotten by the time they leave the door and 30-50% of what the patient remembers is wrong. Social media can be used to clear that windshield of doubt about post-hospital protocol. It's very important that these tools exist."

"Because [social media] is instantaneous and connects people worldwide, I think it will improve health care," Dr. Zoghbi said. Social media allows practitioners to "virtually" give patients information they need, when and where they need it. Although the information can be tailored for a specific person's conditions, it doesn't have to be disseminated individually. For instance, it's one thing to urge a long-time smoker to quit while he's sitting in your exam room, it's another to activate the ACC's CardioSmart patient education initiative, so reminders and tips flow right to the person's phone. Those who sign up receive free text messages reminding them to stop smoking, take their medications, or exercise.

Christopher Cannon, MD, editor-in-chief of CardioSource WorldNews, spends about 20 minutes each day posting links to articles on Facebook and Twitter. "The kind of things on my Twitter are mostly news, medical news, the ACC, theheart.org, CNN, and the like, plus the US Women's Soccer Team," said Dr. Cannon (@cpcannon), associate physician at Brigham and Women's Hospital and professor of medicine at Harvard Medical School.

Dr. Cannon has been using these online services for a couple of years. He also created a Facebook page to let people know about his book, The New Heart Disease Handbook. A couple of years ago, he participated in an online author's forum on Amazon.com. The virtual author chat, or book club meeting, allowed readers or those interested to ask him questions or comment about the book to get his responses.

When Dr. Cannon's patients receive a new heart disease diagnosis, he points them to CardioSmart.org so they can get reputable, easy-to-understand information about their disease. According to Dr. Cannon, 5 to 15 minutes can be spent debunking things patients have read. "I try to give them reliable information before they start reading the wacky stuff. It's critical. I also encourage them to send the information to family members as well."

Dr. Cannon also directs patients to check out his hospital's site, www.brighamandwomens.org, which allows patients to ask non-urgent questions of a cardiologist, nephrologist, neurologist, obstetrician, or rheumatologist. The site also keeps an archive of past questions and answers.

Social Media and Medicine 3.0?
In the future, Dr. Cannon envisions doctors using these tools more to relay information to their existing patients. For example, Brigham and Women's Hospital uses a system that allows patients to pull up their lab results online and to send secure messages to their health care team. "It's a growing way to interact and it's terrific that you can send the actual data."

Just as doctors can team up online, so can patients. A group of patients with a rare heart disease convinced Mayo Clinic to study them after they connected online. This type of patient-level connection extends beyond the clinical. Patients work together in many ways using social media tools. By using the internet or smartphone apps to find people with similar health goals, such as weight loss, smoking cessation, or increased physical activity, individuals can motivate each other. "There's a running app. You can tweet whatever your jog was," Dr. Cannon said. "It builds a competitive advantage to your exercise. You get encouragement from other people. It's a very positive way to use social media that will likely grow in use."

Dr. Cannon predicts that electronic patient-to-doctor communication will grow tremendously in the near future. "I see that as a very good thing. Hopefully all of the different avenues for getting information will improve health literacy of all patients and families so they'll know what's important and what's not. The downside: too much information that is often conflicting."

Another drawback is that bad news is often sexier than good. The old newspaper adage "if it bleeds it leads" spills over into the online world as well. News that is contrary to medical practice or controversial seems to get more attention.

Lee Aase, a colleague of Dr. Timimi's and the director of the Mayo Clinic Center for Social Media, urges reputable sources, doctors, and other experts to get involved so that misleading information can be disputed online. "One of the reasons for vaccine hesitancy is that the activists have the field all to themselves. We need to be there and participate in the discussion, make resources available, share the scientific perspective, and share the best evidence."

"This is a way to leverage the knowledge our experts have," said Mr. Aase, whose name on Twitter is @LeeAase. "This isn't the place for directly treating your patients."

Mr. Aase urges hospitals to appoint or hire someone to develop the organization's social media plan and guidelines—even if they only work as point person part-time. "Having a go-to person to navigate on behalf of the organization makes a lot of sense."

What doesn't make sense is ignoring social media.

"If you look at the 900 million people on Facebook and the 500 million people on Twitter, this is becoming the most significant way people are communicating. Many colleges aren't even giving out email addresses to students anymore because they use Facebook," Mr. Aase said. "If you're not in this space, it's a self-inflicted wound. You're hindering and hampering yourself because the reality is people are out there talking about medical providers and hospitals. If you're not out there with them, then it's people talking about you instead of you talking with them." —by Otesa Miles

Keywords: Patient Care Team, Social Media, Health Literacy, Delivery of Health Care, Electronic Mail, Communication, Smoking, Moral Obligations

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