Social media and healthcare quality improvement: a nascent field.

To cite: Ranney ML, Genes N. BMJ Qual Saf Published Online First: [please include Day Month Year] doi:10.1136/bmjqs-2015004827 Two articles 2 describe the use of social media to describe or potentiate healthcare quality improvement. Taken together, these articles point to an exciting—but still nascent—trend. We hope that these two pilot studies will be taken as a call to future research rather than as definitive reports. The first article describes the proportion of emergency department (ED) patients who consent for researchers to download their Facebook and Twitter data. The novelty of this study lies in its underlying premise: accessing patients’ social media data could, in theory, permit better awareness of patients’ health status and risks, and thereby permit real-time interventions and improved patient engagement. To our knowledge, this study is the first to show the acceptability, feasibility and limitations of accessing patients’ social media data. It thereby gives hope that incorporating social feeds into healthcare may be possible. This study had three important, and surprising, findings. First, the authors report that 52% of ED patients reported using Twitter or Facebook. This fraction is much lower than found in other urban EDs (eg, 67% of ED patients in a 2012 manuscript) or in national surveys (62% of all US adults, according to recent Pew data). Second, of those patients using social media, 53% agreed to participate in the study, and approximately two-thirds of those agreed to have data downloaded. These statistics could be interpreted as encouraging—representing a higher-than-expected proportion of ED patients who are willing to share their social media feeds with researchers. It could also reflect a limitation to the applicability of this method for healthcare in general: it would be difficult to argue for implementation on a large scale, if only 37% of those with social media feeds agree to sharing their data. Finally, those participating in the study were less likely to be injured or have psychiatric complaints compared with the general ED population; these categories of patients seem most likely to benefit from insights gleaned by integrating social feeds into health records. These results, in toto, lead us to wonder: why did 50% of social media users refuse to even participate, and why was there differential participation according to chief complaint? What could be done to increase participation in the future? To what degree would these findings translate to other EDs, and to non-research applications? Future work should better characterise the refusers, and should be sure to capture the full range of online social networking platforms, to minimise the inherent bias in this strategy. The second article, ‘Measuring patientperceived quality of care in U.S. hospitals using Twitter’ extends others’ work using social media to measure or evaluate healthcare. Twitter has previously been shown to provide real-time monitoring of conditions such as viral and foodborne illness, mental illness and substance use. 8 The study by Hawkins et al, showing a correlation between patient sentiment and readmission rates, has findings that are similar to Kilaru et al’s recent article in this journal that analysed Yelp reviews. While these methods provide insight into a variety of patient characteristics and behaviours, they are nonetheless limited and subject to misinterpretation. Analysing Twitter and other forms of social media for real-time feedback on care may be faster and cheaper than traditional surveys or US Hospital Consumer Assessment of Healthcare Providers and Systems scores, allowing administrators and researchers to quickly gauge the impact of new quality improvement initiatives. However, Twitter is but one data stream, and is currently the least used form of social media (behind Facebook, LinkedIn, Pinterest and EDITORIAL