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Could Facebook Be Your Platform for Care Coordination?

My guess is you’ve probably never asked yourself this question. A quick preview:

  1. Technical barriers aren’t the limiting factors to Facebook becoming a care coordination platform.
  2. Facebook’s company DNA won’t play well in health care.
  3. Could Facebook become the care coordination platform of the future? If not Facebook, then what?

1) Technical barriers aren’t the limiting factors to Facebook as a care coordination platform.

Can you imagine Facebook as a care coordination platform? I don’t think it’s much of a stretch. Facebook already has 650 million people on its network with a myriad of tools that allow for one-to-one or group interactions.

What would it take to make Facebook a viable care coordination platform?

  • More servers to handle the volume — not a problem
  • Specialized applications suited for health care conditions — not a problem
  • Privacy settings that made people comfortable — more on this later
  • A mechanism to identify and connect the members of YOUR care team — really tough, BUT this is NOT a technological problem, but a health system one

Suppose you are a 55–year-old woman who is a brittle diabetic. Your care team might include a family physician, an endocrinologist, a registered dietitian, a diabetic nurse, a ophthalmologist, a podiatrist, a psychologist, and others. Ideally you’d have one care plan that coordinates the care among members of the team, including you.

What’s the reality of today’s health care non-system?

  • There is no formal designation of “your team.”
  • There is no mechanism to designate one “plan” that coordinates the plays among your team members.
  • It’s possible that multiple quarterbacks are calling the plays for your care.
  • It’s possible that members of your team have no knowledge THAT you are being treated by others and HOW you are being treated by others.

Care coordination today is in the stone ages — there is no system for care coordination.

Supplying a modern Facebook-type technology platform doesn’t change this. The major limiting factors in Facebook’s becoming a care coordination platform aren’t technological.

Let’s look a bit deeper.

2) Facebook’s company DNA won’t play well in health care.

Facebook CEO Mark Zuckerberg’s definition of an open social graph doesn’t fit well with people’s expectations of privacy in health care. Here’s how Zuckerberg described his views:

“You have one identity,” he emphasized three times in a single interview with David Kirkpatrick in his book, ‘The Facebook Effect.’ “The days of you having a different image for your work friends or co-workers and for the other people you know are probably coming to an end pretty quickly.” He adds: “Having two identities for yourself is an example of a lack of integrity.”

IMHO, Zuckerberg’s notion of a single identity isn’t going to fly with people’s private health care information. Sharing everything about yourself might be an idealistic goal for a 26 year old gazillionaire, but when it comes to most medical information, people will want to share information with their care team, not with the world. Zuckerberg doesn’t recognize that the default for medical information for almost everyone is “don’t share,” not “share”.

In contrast, LinkedIn is a platform built for business networking. It assumes that people will want to share different types of information with business colleagues than with their friends. This strikes me as a much more realistic notion of identity, but you can certainly disagree.

Here’s another example of how Facebook’s company DNA would violate trust. Facebook has a reputation for pushing privacy boundaries, and then falling back only if/when people complain (and they must complain loudly).

Since its founding, Facebook has done a 180 degree turn on its business model. The company started with the premise that default for your information was “private” unless you specified otherwise. By May 2010, the default had become “public” unless you specifically modified privacy settings. Why? …because they realized that the valuation of the company was driven by the quantity and quality of data about YOU.

So how would this work in health care? “Oops, we changed privacy settings on you and revealed your HIV status…won’t happen again, sorry.” Disaster!

3) Could Facebook become the care coordination platform of the future? If not Facebook, then what?

Let’s circle back to the original question “Could Facebook be a platform for care coordination?”

My answer is NO!

What are alternatives?

Its pretty much wide open. Here are some possibilities:

  • A new specialized company will become a dominant player in care coordination
  • The market could fragment — companies might specialize based on patient conditions, geographic concentration, other factors.
  • Existing healthcare technology companies, e.g. EHR (electronic health record) companies, could extend their care coordination functionality
  • Your local ACO or integrated delivery system could position itself as YOUR platform for care coordination
  • An existing social platform (e.g., Facebook, LinkedIn) MIGHT turn the corner and add care coordination functionality
  • or ??

Hope you’ve enjoyed going through the thought process. Let’s continue the conversation.

Article Series - Social Networks and Care Coordination

  1. Could Facebook Be Your Platform for Care Coordination?
  2. Could Google+ Be Your Platform for Care Coordination?
  3. Google+ Shines the Light on the Value of Data Portability

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Discussion

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Comments

1.
On April 9th, 2011 at 7:09 pm, Alan Gilbert said:

Care collaboration solutions have been around for many years in other countries than the United States. Managed Clinical Networks (MCN) have been around in Scotland since 1999. In Scotland, there have been examples of Care Collaboration and MCN in such areas as Diabetes, COPD, Cancer Care, Cleft Lip and Palate and Sexual Health.

2.
On April 10th, 2011 at 2:12 pm, David Doherty said:

Hi Vincent,

Thanks for the interesting article.

I thought you might like to check out the work being done at Patients Know Best.

They’ve created a patient-controlled medical records system that’s integrated into the NHS’s secure network enabling patients to meet online with their care team in a secure private environment.

http://www.PatientsKnowBest.com

3.
On April 10th, 2011 at 4:10 pm, Vince Kuraitis said:

Alan, Yes…seems it would be easier to simply adopt a uniform platform in countries where government role in health care is more direct than U.S.

David, thnx for sharing NHS perspective.

4.
On April 11th, 2011 at 12:59 pm, Frank Avignone said:

As Alan and David have stated there are similar platforms that could be implemented for health care collaboration however the issue is far more involved than just the social networking component. HealthyCircles a product currently available to patients and physicians at no charge provides at the health system level an extremely rish social networking feature with all access and security controlled by the Patient/Member. In addition this platform adds care management, disease management, health campaigns, forms, professional portal and even a mobile component. If we are to make any real progress in health care and the lack of connectivity between patients, physicians and the required services platforms such as HealthyCircles will be one of the key parts of the solution.

Thank you

5.
On April 12th, 2011 at 11:59 pm, LINH C. NGUYEN, MD, MMM said:

Vince, as you can see i follow your blogs very closely. You got me again on this one. Here is another possibility: A virtual ACO for one sector (i.e. frail elderly), managed by physician executives for physicians, who also manage a scalable and customizable EHR with API interface through FACEBOOK (650 M potential globally), Linkedin, and healthvault with mission to create values for patients and strategic partners. Why would you limit yourself locally when Medicare is reimbursing Telemedicine and supporting patient-centered managed care:-).

6.
On April 15th, 2011 at 12:15 am, Steve Hards said:

Hi Vince, thanks for raising the issue. I think there is also a technical point you missed – Facebook could unplug your access to the data on a whim, or a change of policy, and who’d want to be dependent on a company that could that?

7.
On April 22nd, 2011 at 7:36 pm, Patrick Vega said:

This may not be the reach it seems to be. My world is strategy and service line development in spine, neurosciences and orthopedics. Typical care coordination in spine is dismal- long waits for initial consult (often with a surgeon) only to be told surgery is not indicated. Compared to orthopedics, where the evaluation and treatment is linear, spine is complex.

There are a few models of care coordination and navigation that are making an impact in quality, patient experience and cost effectiveness.

The facebook model might work and integrates with the zeitgeist of social media.

8.
On April 28th, 2011 at 10:11 am, Steve Hards said:

Just reinforcing my earlier point that no one should trust Facebook to keep a coordination process running, see this article from ZDNet today: Neowin’s Facebook Page Downed by Bogus Complaints – Again.
http://www.zdnet.com/blog/violetblue/neowin-8217s-facebook-page-downed-by-bogus-complaints-again/317

9.
On April 28th, 2011 at 10:49 am, Vince Kuraitis said:

Steve, yes…you make an important point. Facebook is driven by proprietary interests which might or might not be compatible with optimal care coordination for patients.

The spirit of my post is much more to raise questions and possibilities than to suggest specific answers.

Thus, let’s consider two similar but DIFFERENT questions:

1) Could Facebook be a platform for care coordination?

2) Could a “Facebook-like” platform be useful for care coordination?

10.
On June 8th, 2011 at 11:36 pm, Ajay K Singla said:

I have been thinking similarly and that is what led me to this blog. I believe this is doable and should be done. Use will be more for chronic ailments requiring multispecilaty consulations, conflictiong opinions, alternative systems, research by patients, sharing between patients etc

Mentions on other sites...

  1. Vince Kuraitis on April 9th, 2011 at 5:21 pm
  2. Jill Kuraitis on April 9th, 2011 at 5:25 pm
  3. Netspective Health on April 9th, 2011 at 6:08 pm
  4. Aparna M K on April 9th, 2011 at 6:12 pm
  5. Ed Butler on April 9th, 2011 at 7:33 pm
  6. Eastern Ranges GP on April 9th, 2011 at 7:36 pm
  7. Stonetree on April 9th, 2011 at 7:38 pm
  8. Toni van Hamond on April 9th, 2011 at 8:15 pm
  9. CGCollaborative on April 9th, 2011 at 9:18 pm
  10. journal des reseaux on April 9th, 2011 at 9:20 pm
  11. Charles Webster, MD on April 10th, 2011 at 1:16 am
  12. Lyall Furphy RN on April 10th, 2011 at 3:05 am
  13. Maria Jose on April 10th, 2011 at 3:18 am
  14. Robert Nauman on April 10th, 2011 at 6:43 am
  15. Les Morgan on April 10th, 2011 at 11:41 am
  16. Joel Selzer on April 10th, 2011 at 1:50 pm
  17. Robert Nadler on April 10th, 2011 at 3:46 pm
  18. P L Mudd on April 10th, 2011 at 11:14 pm
  19. Perficient Health IT on April 11th, 2011 at 12:19 pm
  20. Bob Coffield on April 12th, 2011 at 10:34 am
  21. Health Is Social on April 12th, 2011 at 6:41 pm
  22. MD CHAT on April 12th, 2011 at 6:41 pm
  23. WaitingRoomSolutions on April 13th, 2011 at 2:58 pm
  24. John Worth on April 15th, 2011 at 4:22 pm
  25. Samuel Gallegos on April 30th, 2011 at 7:45 pm
  26. Heather Leslie on May 5th, 2011 at 10:34 pm
  27. Peter Borden on May 23rd, 2011 at 7:34 pm
  28. Vince Kuraitis on July 4th, 2011 at 4:10 pm