How social media will merge with electronic medical records

Bryan Vartabedian, MD blogs at 33 Charts about the convergence of medicine and social media.  A post last year gives a vision of how current social media concepts will merge with existing electronic medical record (EMR) technologies to produce a fully integrated communications system for health professionals.

The picture Dr. Vartabedian paints is a dream for those of us who extensively use technology in other parts of our lives (which I think would include nearly all current medical students).  Social media technologies such as Facebook and Twitter have fundamentally changed the way the world communicates.  Texting and email have also altered our communication habits.  These technologies have brought added speed and functionality to many types of communication.

Yet, the medical world is still stuck using 1980s communication technologies.  Many clinicians still rely on pagers and telephones as their primary means of communicating with care teams.  Email systems within medical centers are secure and often used extensively, but violate HIPAA regulations if communicating with another health care professional outside the medical center.  Many offices (probably the majority of private practices) still fax progress notes.

Although I dream of the day when we have a system like Dr. Vartabedian’s vision, I am not very optimistic such a system will come to fruition anytime soon.  The biggest barrier is the general fragmentation of our health care system.  Academic medical centers, hospitals, private practices, and ancillary facilities (imaging and laboratory centers) exist in silos.  No form of integrated communication currently occurs between these pieces of the health care system.  More importantly, each of these players is adopting their own EMR systems, few of which are interoperable.

I have tempered my expectations of what future systems will look like.  Integration of audio clips into the EMR or speech recognition software to automatically include communication seems like a stretch for now.  Also, automatic linking to relevant medical literature based on entering a diagnosis into the EMR would be fantastic but not practical at this point (put something like “ulcerative colitis” into PubMed or Google Scholar or even UpToDate and see all the irrelevant crap you come up with).  I would be satisfied with truly interconnected EMR systems (i.e.–I can pull up any patient’s chart from any hospital or clinic and see their entire recorded medical history), the elimination of pagers and subsequent replacement with secure smartphone communication systems, widespread use of tablets at the bedside that update the record in real-time so I can finish notes at a workstation, and some level of integration of Facebook/Twitter-like communication within care teams (i.e.–during a hospitalization, I can see a feed of everything that has happened to my patient with links within the feed to notes/imaging/labs as they are updated in real-time and be able to leave short messages for other team members).

Health information technology seems to be steadily progressing towards this type of system.  However, the speed is pedestrian at best.  We need an increased pace of innovation and adoption to ensure health information technology keeps up with technological innovations outside the medical world.  Ideally, the medical world could become a place where such technological innovations are pioneered, and it’s the rest of the world trying to keep up.  Keeping pace would be good for now.

Josh Herigon is a medical student who blogs a Number Needed to Treat.

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  • Lori

    As a cancer survivor with treatments spanning two medical centers and subsequent consultations with a few others, the concept of improved communication between providers is intriguing. The fact is that today the exchange of information is only as good as the least-thorough doctors’ notes, and an open dialogue between providers is a very good thing. Not every patient can adequately translate what is happening with one doctor when seeing the next. The full integration and easy exchange of EMRs benefits patient care, but I would argue we need a system that also ensures caring about the patient.

    As a coach and advocate, I know many patients who still feel left out of the communication loop. (Remember the episode of Seinfeld when Elaine looked in her chart?) We need to be clear about things like: Who owns the records? Who controls the exchange of information? How do we protect both the privacy of the patient, as well as the patient’s trust in confidentiality? What about access by health insurance companies companies? Will a persistent headache today reappear as a “preexisting” exclusion to a brain tumor in 10 years? With compromises in the security of systems at major banks and other companies, how do we ensure the confidential of patient records as they move between institutions? And how do we help patients trust this system?

  • Margalit Gur-Arie

    Actually, you can do quite a few of those things today. You can use a tablet “at the bedside that update[s] the record in real-time so [you] can finish notes at a workstation” and you can integrate video clips and voice recognition into an EHR and you can send messages back and forth to both staff and patients (securely).
    As to “fragmentation” and “silos”, I don’t see what this has to do with facebook and twitter type communications.

    But let’s try this: bring up tweetdeck, add several columns of popular hashtags that you want to follow, in addition to your “friends” tweets; open facebook as well and hopefully you have enough “friends” there too that can see your online presence and engage in real time; be sure to have your speakers on, so in addition to seeing the little popups flashing on the top right of the screen, you can hear the beeps every few seconds; now bring up some work you need to do – read a medical journal, write a paper, study for a test, see a patient – let us know how it goes….

    • pcp

      And all done while you’re behind the wheel of a car!

  • Twitter @medmarketingcoe

    Good post Josh. Connection of EMR, PHR, and websites is already in the works at multiple health care organizations. Funny enough, independent physicians were the first ones to plant the seed.

    EMR & Social media… at a time when doctors don’t even believe in having a website of their own, we need to take some baby steps. The lack of understanding of how to leverage the internet to bridge the gap between patients and doctors should be addressed first. That is priority #1.

    Learning WHAT IS social media should be priority #2.

  • Justin

    Give all docs use of the VA VistaEMR for free. Problem sort of solved. Private EMR companies would never let the government give away their cash cow however.

  • Rheum doc

    Great post. As a tech nut and a soon to be graduating fellow I share your same frustrations. For example, I’m typing this on my iPad, where I can also acess my dropbox account and virtualized my home desktop. Yet in my university hospital clinic, we have old paper charts busting at the seams, and I rely on faxed labs that only make it into the chart 50% of the time. What’s worse is when I get a call from a patient after hours, there is no way to access their information to give them an informed right answer, other than “go to the ER” because I don’t know you and it may be life threatening.

    Personal iPad adoption amongst physicians is twice that of the normal population, yet at a systems level our profession moves at a snails pace in tech adoption (windows XP and IE 6 still everywhere).

    Since no top agency will dictate a clear EHR standard (think like USB or HDMI for your gadget standards), we will live in fragmented data systems. Real innovation will have to be in HIE systems. Cloud based systems that require little or no client side software will suceed the most IMHO.

  • Richard Hom OD MPA


    I see social media with even more deeper interconnect with ambulatory medical care.

    With the rise in both chronic illness and of the aged, the family structure can plau a significant part in assisting the patient and physician.

    Imagine a patient whose extended family is involved in a care plan that results on better compliance of their condition. Zoe conversely a physician who can understand the patient’s family network and how it might change a treatment plan.

    All of this possible with an appropriate set of technology tools and open mindness.

  • Howard

    EMR’s are a disaster. They have failed miserably and continue do so. Hospitals have to employ an army of computer professionals to keep their systems up, inidvidual physicians are spending more time staring and typing into their laptops and iPads. We can’t even make computers and software that runs efficliently to browse the internet and do simple thngs like shop. I have interviewed doszens of health care providers and almost all of them have said that EMR’s have failed. Sorry to rain on your excitement but those are the facts. Ask your doctor next time what he/she thinks of EMR.

  • Richard Hom OD MPA


    There is an element of truth to what you say. EMRs in general are only marginally during a physician encounter. The real value is proceeding the encounter.

    It is the processes after the encounter for which most providers have little knowledge. But the value depends upon data input and only the provider can input data.

    The value, therefore, of a physician is reliable input. It is the task of the computer professional to make the job for the physician input as pleasant as possible.

  • Joseph A. Ekman

    What happens when a Natural Disaster strikes and all the networks are down?

    Google and others missed the point, it’s not about having information on-line, it’s about getting information within seconds instead of minutes that can save someone…’s life. What’s needed my friends is something called The Emergency Standard, The Emergency Standard Card and The Emergency Standard Card SMART Phone Application. By the time a First Time Responder’s, EMT, Police Officer or Fireman logs on to a network to read your medical record, your “DEAD”!!

    However if the First Time Responder looked for your Emergency Standard Card and saw your medical status, which is a 3 color coded process, you still might be around to read my post.

    It’s very simple, The Emergency Standard Card is, a wallet size card that includes a 3 color-coded process which provides instant status of a person’s up-to-date medical information, emergency and medical contacts, insurance details, blood type, power of attorney or healthcare directive, and photo verification.

    Also, The Emergency Standard Card offers a color-coded system to help first responders effectively use the cards to act quickly: Red (Stop: Special Medical Condition), Yellow (Caution: Medications) and Green (Good to Go). The Emergency Standard Card includes an individual’s name and age, with a photo for clear and immediate verification.

    The last resort is the SMART Phone, today the FREE iPhone App called ICE Standard is the most downloaded Emergency Contact App and it works.

    Google can still turn this around by creating an Alliance with other companies and just focusing in the United States first. With over 310,000,000 million people in the United States in 2010, which 114 million people visited the Emergency Room and 16.2 million took an ambulance or medivac to the ER. This number isn’t going to get lower in the upcoming years, it’s only going to increase.

    What can you do, you can support In Case of Emergency Standard, a division of About The Kids Foundation We don’t want money, just tell your friends, family, and work associates about our FREE iPhone App called ICE Standard and support The Emergency Standard. My 25 cents!! :) JoeySee More

  • izaaceyes

    I fully agree with you. I have already started integrating social media in my optometry practice. Patients can already get onto my Facebook page to schedule their appointments.

    • MM

      That is so great. I am with kaiser right now & I can email \ doctors. It is so very very convenient!
      Thank you,

  • John

    Interesting article but essentially it is news about non news, since Josh doesn’t believe it will happen any time soon, which is most often the case in the medical profession. So what did I learn? I do think integrated systems that can not easily be hacked would be of great benefit but again, with the way the medical system works, it will happen when the next “new” way to communicate does. Just my experience over the years.

  • Caroline Miriam Batchelor

    This worries me – the reason being that Patients may not know the whole story!
    For instance, their records will be shared with others such as Private Health Companies who are as we write and read, preparing to enter via the backdoor of the NHS. This should be worded as such and made known to all Patients prior to Patients being asked for consent.
    At present the wording states ‘ and any others’ I submit this is not good enough!

  • Shelley

    Speaking of physicians documenting in an EHR: I spent the last 15 years supporting an EMR teaching and supporting ED physician clinical documentation systems. Why don’t they work? Because when as few as 6 ED physicians refuse to agree on a simple list of discharge dispositions, no programming or speed of system will help them. They each wanted their own incongruous list. But, of course, they need to be able to report out statistics across their ED’s. And how does that work Doc’s? Standardized language is required for EHR’s or you might as well just write it all on paper and fax it into a text blob. There is no discrete data for QA/QM, and no “cloud technology” or fancy “iGear” will make them agree on how to clinically document on their patient’s. Not to mention, they refuse to document real time, but later, like tomorrow – from home, when it’s not pertinent any longer.

  • Lory Wood

    Caroline, the standards say that the patient should have access to the audit trail of who has seen their data, when and for what reason. Whether entities follow the standards will require verification and validation which is labor intensive in itself.
    Great article and I agree that it is a desire of most hands-on providers to share data and improve care, unfortunately the “administrators” of our healthcare facilities look at the data as a $valuable$ asset that they are not willing to share.

  • James

    you are exactly there….the concept you need is of an “online medical record OMR”. We have already completed this as “Medrecord Online”. Furthermore we have already integrated voice messaging (GMS) so a clinician can leave a voice message in the online medical record. We have already integrated and give away a PACS system, which means a voice report for an x-ray or CT scan for example can be listened to when viewing the image with annotations… to use…and working now….oh and we put the whole integrated HIMS in the cloud and charge per use…..

  • Anette

    I agree with Lori, what about confidentiality? To build trust with a patient, there is a need to save from harm what is written. For example, if a patient is being treated for a mental disease, and the patient does not want this information to be easily shared with other care takers. Is the patient informed and can it be assured that this information is kept out of reach for those care takers that does not need the information? It happens from time to time that medical staff reads information more out of curiosity than the need to give care. This brings it back to who owns the patient record information? In Sweden we are currently working with these questions, and the difficulty is, what information should be available on the screen when you log on to the system, and what information do I need to have the patients permission to read?

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