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Tag: Social Media

The Bar Has Gotten Higher

When I first entered the venture capital business 10 years ago after being an entrepereneur, my partners warned me that “my bar” for new investments would get higher over time.  In other words, the criteria to make a new investment – clearing “the bar” – would get more strict with time as I developed more experience and saw more things.  I found this to be very true, and the notion that investors get wiser and more selective over time has become common wisdom in the industry.

But there’s something very new going on in the last few years – something very striking.  Simply put, the collective bar of the investment community to fund young companies has recently gotten higher – much higher.

The entrepreneurs I speak to are feeling it every day.  When they pitch their new idea to investors, they are told to build a prototype first.  When they build the prototype, they go get customers.  When they get customers, they are told to show engagement metrics.  When they show engagement metrics, they are told to run some monetization experiments.  When they run monetization experiments, they are challenged to prove scalability.  Maybe I have Passover on the brain this week, but it’s like investors are putting entrepreneurs through a nightmarish version of Dayeinu, where no matter what they achieve, it’s never enough (speaking of Passover, if you haven’t seen this Jon Stewart clip of Passover vs. Easter, it’s a must.  I’ll wait.).

Why is the new investment bar so high today?  Isn’t there plenty of euphoria and “animal spirits” to go around with the IPO market returning, marquee acquisitions (e.g., Instagram at $1 billion) and the impending, earth-shattering Facebook IPO?

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The Right to Be Forgotten

At the end of January, the European Commissioner for Justice, Fundamental Rights, and Citizenship, Viviane Reding, announced the European Commission’s proposal to create a sweeping new privacy right—the “right to be forgotten.” The right, which has been hotly debated in Europe for the past few years, has finally been codified as part of a broad new proposed data protection regulation. Although Reding depicted the new right as a modest expansion of existing data privacy rights, in fact it represents the biggest threat to free speech on the Internet in the coming decade. The right to be forgotten could make Facebook and Google, for example, liable for up to two percent of their global income if they fail to remove photos that people post about themselves and later regret, even if the photos have been widely distributed already. Unless the right is defined more precisely when it is promulgated over the next year or so, it could precipitate a dramatic clash between European and American conceptions of the proper balance between privacy and free speech, leading to a far less open Internet.

In theory, the right to be forgotten addresses an urgent problem in the digital age: it is very hard to escape your past on the Internet now that every photo, status update, and tweet lives forever in the cloud. But Europeans and Americans have diametrically opposed approaches to the problem. In Europe, the intellectual roots of the right to be forgotten can be found in French law, which recognizes le droit à l’oubli—or the “right of oblivion”—a right that allows a convicted criminal who has served his time and been rehabilitated to object to the publication of the facts of his conviction and incarceration. In America, by contrast, publication of someone’s criminal history is protected by the First Amendment, leading Wikipedia to resist the efforts by two Germans convicted of murdering a famous actor to remove their criminal history from the actor’s Wikipedia page.[1]

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Digital Diet

It’s been said that losing weight is much harder than kicking cigarettes or alcohol. After all, because one doesn’t need to smoke or drink, the offending substances can simply be kept out of sight (if not out of mind). Dieting, on the other hands, involves changing the way a person does something we all must do everyday.

It’s no surprise, then, that reports of problematic doctor interactions with social media are popping up with metronomic regularity. When it comes to the smorgasbord of information coursing through those Internet tubes, increasingly, we all have to eat. And that makes drawing boundaries a challenge.

While most early reports on the perils of social media concerned inappropriate postings by physicians, a new hazard has emerged recently: digital distraction. On WebM&M, the AHRQ-sponsored online patient safety journal that I edit, we recently presented a case in which a resident was asked by her attending to discontinue a patient’s Coumadin. As she turned to her smart phone to enter the order, she was pinged with an invitation to a party. By the time she had RSVPed, she had forgotten about the blood thinner – and neglected to stop it. The patient suffered a near-fatal pericardial hemorrhage.

In a commentary accompanying the case, the impossibly energetic John Halamka, ED doctor and Harvard’s Chief Information Officer, described all of the things that his hospital, Beth Israel Deaconess Medical Center, is considering to address this issue. It’s not easy: whereas the hospital owns the Electronic Health Record and can manage access to it, the vast majority of mobile devices in the hospital today – at BI and everywhere else – are the personal property of the users. So Halamka is testing various policies to place some digital distance between the personal and professional, including blocking personal email and certain social networking sites while on duty. He’s even investigating the possibility of issuing docs and nurses hospital-owned mobile devices at the start of shifts, collecting them at the end.

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Pharma, Social Media & Common Sense


By the numbers, pharma’s usage of the social media to drive corporate, brand and disease management objectives has never been greater. But how robust are pharma’s channels and programs on Facebook, YouTube, Twitter and other networks?

Consider a few table stakes for digital communication generally:

  • Tell the whole truth and nothing but
  • If applicable, open comments but police spam and abuse (a concept FB now enforces for all unbranded health pages).
  • Support the brand you have while you build the one you want.
  • Stratify messages, channels and audiences to support that strategy.
  • Develop and monitor KPIs, some qualitative. It’s not just about the money.

Now consider a few typical characteristics of pharma social media content these days:

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Health Reform: Still the Best-Covered Social Policy Story, Ever.


Two years ago, I put myself in hot water by making the simple (admittedly somewhat hyperbolic) claim:

Because it is so easy to find bad reporting and public stupidity, it is easy to overlook something. Press coverage of health care reform was the most careful, most thorough, and most effective reporting of any major story, ever.

This column appeared on April Fools’ Day. Some readers didn’t quite believe that I was serious. I was. Others were simply horrified. Allison Kilkenny, writing in the Huffington Post, typified the reaction among frustrated left-of-center commentators who had just witnessed the “death panels” debacle, the demise of the public option, and similar depressing episodes: “Harold Pollack went out on a limb, and unfortunately fell off the edge.” Andrew Sullivan said something similar.

The Columbia Journalism Review’s Trudy Lieberman was more brutal:

Last week, The New Republic turned over its health care blog “The Treatment” to an odd commenter on media coverage—University of Chicago professor Harold Pollack, who runs the university’s Center for Health Administration Studies. I thought I knew most of those who dabble in these waters, but Pollack’s name took me by surprise. Pollack, a special correspondent for The Treatment, may know something about welfare programs and substance abuse, but we on Campaign Desk take issue with his credentials as a press critic and dispute his central point….

Better coverage than the Vietnam War; the civil rights movement; the consumer movement? Really? In the case of the civil rights struggle, the press helped change the discourse; Americans began to view race in a new way, which led to the eventual passage of the Civil Rights Act. During the Vietnam War, the media effectively changed the public dialogue from a war we couldn’t lose to one we could not win. In the early days of the consumer movement, media coverage of Ralph Nader led Congress to enact significant consumer protections. Coverage of health reform has hardly risen to that level.

Losing one’s credentials as a “press critic” is a particularly low blow. The only thing worse would be to lose the moniker “Democratic strategist” on the cable talk circuit. I appreciate where Lieberman is coming from, but I think she missed my point, which was actually intended to be sobering.
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The Risk of Avoiding Social Media: Others Get to Say Who You Are

If you want to let others say who you are, don’t dive into social media.  If you are too shy about the prospect, then don’t complain when surveys like this are published:

Cardiologists, for the most part, drive Japanese cars, believe in a higher power, and are moderately savvy when it comes to social media. Those are just some of the pearls from a lifestyle survey of physicians conducted by Medscape and published online today.

Asked to rank their level of happiness outside of their work on a scale of 1 to 5, the 762 cardiologists who replied to the survey provided an average happiness score of 3.92. That puts them 15th out of the 25 specialties surveyed, where rheumatologists, dermatologists, and urologists were the happiest, with scores of 4.04 to 4.09, and neurologists were, it seems, the glummest about their nonworking lives, with scores of 3.88.

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Who Is Biz Stone and What Is Twitter?

Yesterday, one of the founders of Twitter, Biz Stone, gave the opening keynote at HIMSS.

This is probably going to be the best keynote at HIMSS, followed by a speech from Dr. Farzad Mostashari, which will also be excellent. It goes downhill after that: there will be a talk about politics and another talk from an “explorer.” I am sure those will be great talks, but when I go to HIMSS, I want to hear about health information technology. Want to know what @biz actually said? As usual, Twitter itself provides an instant summary.

HIMSS stands for Healthcare Information and Management Systems Society. The annual HIMSS conference is the largest Health IT gathering on the planet. Almost 40,000 people will show up to discuss healthcare information systems. Many of them will be individuals sent by their hospitals to try and find out what solutions they will need to purchase in order to meet meaningful use requirements. But many of the attendees are old school health IT experts, many of whom have spent entire careers trying to bring technology into a healthcare system that has resisted computerization tooth and nail. This year will likely break all kind of attendance records for HIMSS. Rightly so: The value of connecting thousands of health IT experts with tens of thousands who are seeking health IT experts has never been higher.

It is ironic that Biz Stone is keynoting this year’s talk, because Twitter has changed the health IT game so substantially. I say Twitter specifically, and not “social media” generally. I do not think Facebook or Google+ or your social media of choice has had nearly the impact that Twitter has had on healthcare communications.

HIMSS, and in many cases traditional health IT along with it, is experiencing something of a whirlwind. One force adding wind has been the fact that President Obama has funded EHR systems with meaningful use, and made it clear that the future of healthcare funding will take place at Accountable Care Organizations (ACO) that are paid to keep people healthy rather than to cover procedures when they are sick. It is hard to understate the importance of this. Meaningful Use and ACOs will do more to computerize medicine in five years than the previous 50 years without these incentive changes.Continue reading…

Live from HIMSS12: ICD-10, Meaningful Use & Social Media

There has been a lot of buzz around two pieces of news –in one case, lack of news—in the past week. Last Thursday, HHS Secretary Kathleen Sebelius responded to heavy pressure from the American Medical Association and announced a delay to the ICD-10 implementation deadline, currently set for October 2013.

Meanwhile, the health IT universe continues to wait with baited breath for Sebelius and/or leadership at CMS or ONC to publish the proposed regulations for Stage 2 of the “meaningful use” EHR incentive program. The proposal was supposed to have been out before 35,000 or so health IT industry types descended on Las Vegas for HIMSS12, but it was not to be. As with any major federal rule-making, the White House’s Office of Management and Budget has to vet every word, so it is out of Sebelius’ hands for the moment.

Rumors spreading through the Sands Expo Center and the adjacent Venetian and Palazzo hotels have pegged Wednesday or Thursday for the release date, since national health IT coordinator Dr. Farzad Mostashari is leading a session on Stage 2 meaningful use with other ONC and CMS representatives Wednesday morning, then delivering a keynote address the following day.

In the wake of the ICD-10 bombshell last week, HIMSS itself and other IT-related groups are telling their membership and anyone else who will listen not to slack off when it comes to ICD-10 preparedness. HIMSS CEO Steve Lieber noted in his annual press conference Tuesday that the official HHS statement said the department would “initiate a process to postpone the date by which certain healthcare entities” must meet the requirements. That, to Lieber, suggests the possibility of a delay for physician practices or perhaps small hospitals, but not for larger organizations.Continue reading…

Using Twitter to Deliver Health Improvement Messages

I have decided to spam for public health.

Phone calls, text messaging, and even apps have been shown to help improve health and sustain behavior change, even in people suffering from profound mental illness. But when it comes to using these tools for public health, there are two problems. The first is that each message (whether via phone call or text) costs money. The second is that it’s quite hard to use those platforms for blasting messages to a whole population.

That’s how I ended up in what is probably a community of spammers. I registered at Black Hat World in order to get access to its forum on uploading bulk tweets, and didn’t realize what company I was keeping until I saw user names like popzzz and images of a neon green skull and crossbones and rolling lines of HTML.

I am now poised at the unique intersection of spamming and homelessness. Suffice it to say, there aren’t a lot of people stampeding to spam the homeless.

So how did I, a suburban soccer mom, former Shoney’s-waitress-turned-Harvard-trained-doc, end up in this precarious position?

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The Emperor’s New Social Network

You can’t get much cooler than HealthTap: slick Silicon Valley start-up, social media darlingsavvy and successful backers. But when you closely examine the service HealthTap actually provides, the money and good looks fall away. Like in the fable about “the emperor’s new clothes,” behind the buzz, there’s nothing there.

OK, maybe one thing: a really risky way to get medical advice.

Here’s how a Feb. 4 New York Times article described the company’s website:

[U]sers post questions and doctors post brief answers. The service is free, and the doctors aren’t paid. Instead, they engage in gamelike competitions, earning points and climbing numbered levels. They can also receive nonmonetary awards — many of them whimsically named, like the “It’s Not Brain Surgery” prize, earned for answering 21 questions at the site.

Fellow physicians can show that they concur with the advice offered by clicking “Agree,” and users can show their appreciation with a “Thank” button.

So far, so good. But there’s more. The professional credentials of the physician answering your question, such as a board-certified specialty, are not available on the site. Instead, you get a crowdsourced “reputation level” built up by accumulating HealthTap awards, by  clicks of approval from other doctors and by other measurable activities at the site.

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