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Patient Compliance Reminders and Social Media

By January 6, 2011Professional, Strategy

Ensuring that patients adhere to their specialty-drug therapy program is a manual, time intensive and sometimes ineffective task. The traditional methods of telephone calls and direct mail letters no longer apply to today’s social patient. The social patient needs to be connected within the communications medium they are most comfortable: social media. My idea reaches out and improves communication to the social patient: deliver program compliance reminders in a secure way (protect ePHI for HIPPA compliance) to the patient via a medium where they are most likely to consume the content.

Who is the social patient?
Most healthcare and social media professionals consider a “social patient” to be a patient who uses social media either to research health-related content, engage with peers on social issues, or reach out to healthcare providers and systems via social platforms. I challenge you to instead think of a social patient as a normal consumer of social media who just so happens to be a patient (and for the purposes of this posting is also enrolled in a specialty-drug therapy program).

In 2010 Facebook overtook Google as the number one destination on the internet, a distinction Google had held for several years prior. Within the same year the top 10 most visited sites — including Facebook, Google properties (search, mail, YouTube), Yahoo and Bing properties (search, mail) — accounted for 33% of all U.S. internet traffic, up 12% from 2009. The simple analysis: people are spending more time on Facebook than any other social site; those same people, including social patients, are spending more time at their top 10 websites than ever before with a focus on search, email and social interaction.

Drug therapy programs
Specialty-drug therapy programs (oncology and nephrology, amongst others) require that patients stay on a defined treatment program — for their own health and wellness — outlined by their healthcare provider. These programs often involve therapy compliance reminders in the form of telephone calls and standard mail letters that remind patients to take their initial drug dose, follow-up on their first dosing, remind them to continue the dosing schedule, ensure accurate reimbursement details, place drug re-orders and interact with a nurse or other healthcare provider for questions.

Oftentimes pharmaceutical manufacturers and healthcare providers contract with companies to make these interactions on their behalf. These companies typically offer a myriad of services including nursing (onsite, clinical and remote), reimbursement services, order fulfillment, adverse event reporting and more; they are highly qualified to handle these interactions.

Why the traditional method needs to change
Ask any therapy program worker which obstacles hamper the process of distributing compliance reminders and one of the most oft-cited reasons is the inability to reach a patient to give a reminder or confirm receipt of one. Keeping patients on specialty-drug therapy is a serious matter; often the staff (typically nurses) will make phone call after phone call to multiple numbers day-after-day with hopes of reaching the patient. The problem? The social patient does not communicate via voice/telephone as a primary method any longer; they communicate via the social medium. Think about your own personal preferences for communications and where you consume knowledge. Do you want someone to call your phone to give an update? Or are you more likely to receive and respond to that content if it is delivered as a tweet, a secured inbox message on Facebook (or via a Facebook app) or alternately a text message or email? If you are reading this blog, your likely choice is the latter of the two options.

How can we do this? (And why Salesforce?)
For this example we will assume that Salesforce.com is the CRM system, that we are targeting the social patient specifically and that we have already received the patient’s express permission to connect with them via the social mediums described below. As with any idea I encourage you to discuss this in greater detail with your team of professionals before implementing.

Let us assume that Patient 123A4B has a compliance reminder for their specialty-drug program to reorder product for continuation of therapy. This patient has a complete CRM profile including reimbursement information and product history, and has no flags to discontinue therapy. As this patient has opted-in to receive messages sent to their Facebook inbox we can have Salesforce.com publish a document via Content (a Salesforce.com product) that is specific to this patient and secure this document on Salesforce.com’s servers with a password. We can then utilize either a Facebook application, API connection or page association to deliver a message to this specific patient’s inbox containing a link and (predefined or randomly generated) password for accessing the content. Having consumed the generic reminder on their preferred social site the patient then moves on to the secure site to read the message and take the appropriate action; in this case placing a product re-order.

In this example we were able to reach the social patient via their preferred communications medium without exposing any personal details and mitigating HIPAA concerns. This interaction was also more effective and cost-efficient than having a nurse or healthcare provider make several telephone calls to the patient — either finally reaching them or not reaching them at all. Here we have an audit trail that shows us when the patient consumed the content, how it was accessed and the direct actions taken as a result of message consumption.

The same idea holds true for distribution via a Twitter direct message (which is private unlike an @mention), a patient’s email address, or via a message sent to them via an iPhone, BB or Android application. While an ordering scenario was used in this example the same would hold true for a follow-up message or other communication that could be handled without direct real-time interaction with a nurse or other provider. In the event of a patient-reported adverse event the patient would still be advised to call the provider directly in order to report the event and receive the appropriate advice on program continuation.

Once we move past the initial roadblocks of uncertainty, nervousness and doubt I believe that — rather than focusing on how we want to define the social patient — we can use social media to open up a world for the social patient that truly becomes a benefit.

Your comments and feedback are welcome!

Corey Rawdon

Corey Rawdon

About Corey Rawdon

Prolific stick-figure artist ideating methods and mechanisms to change the world—or at least make a small dent.

5 Comments

  • This sounds great in theory, but leaves a lot of questions regarding the details of setting it all up. Because it’s SFDC, I’m sure this can all be automated and personalized, yes? What app lets you send messages to people on Facebook from SFDC?

    • Corey Rawdon says:

      Hi Phillip-
      To answer your first question: Yes. Using SFDC all of this could be automated and personalized. If this idea were implemented I’d love to see the patient be able to select a password of their own choosing and have SFDC content be generated and password protected automatically with the selected phrase. SFDC could then send the content link as a customized outbound message to the patient who would then need to validate their password on SFDC’s servers to view the content.

      The second question is a little more difficult. There is currently no app (to my knowledge) that allows a direct connection to Facebook from SFDC. At Dreamforce this year I attended a developer session where someone created an app in realtime that did this (and also linked to Foursquare); however, I have not personally seen this done. WIth that being said I know it is possible and would take some development (and advanced APEX coding) to bring the app to life.

      You could of course have the app exist on the patient’s FB page itself and have the app remind the patient that way versus using a direct message; however, now that everyone has the new Facebook profile (and as such a Facebook email address) why not skip the app and just have the outbound message go to the patient’s FB email?

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  • A former client, http://www.assistmed.com/adherence/ actually has an application that uses text and email to provide reminders and patient self-reporting on chronic-care treatment plans. I doubt that you would ever see a physician interested in “going social” with this type of information. The legal liabilities are too large and for the patient the insurance / employer implications are too complicated and risky. Who is going to hire someone with a chronic illness? No one. If that information is public knowledge then you might as well admit that you are not interested in ever being contracted or employed again.

    While, I understand that you are all for privacy, the involvement of entities like FB and Twitter may not be that simple to accomplish. They would have their own liability to consider with regard to their processes and data. Their services are meant to be public, co-opting them for delivery of legally protected messages may not work with their business model.

  • Corey Rawdon says:

    hi terry,
    please forgive my late reply to your comment.

    i understand your concern over the PII mentioned in this post; however, consider that i am only recommending that a message be sent to you via social media sites indicating that there is a reminder waiting for you that must be accessed behind a secure wall/service. this would be no different than the messages currently received and left on voicemails today.

    i feel that there is a place for social media to help patients remain compliant with their therapy programs and believe that physicians and nurses need to embrace these mediums in order to assist patients on these sites; after all, if they do not assist them someone else will

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