The Optimized Doctor

Medical imaging was the first taste of digital health technology for physicians and most health care providers. The technology provides prompt high-quality information which improves efficiency and is mobile. Then came electronic health records (EHRs). EHRs were mandated as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The goals of EHRs are to improve patient safety, decrease costs, and allow for the seamless exchange of information among providers and providing entities. As a proponent of digital health technologies, I submit that they are patient advocacy tools. The debate over the "effectiveness"of EHRs continues. It is too early to evaluate the true impact of EHRs on patient care at this juncture. Stage 1 of Meaningful Use (MU) of EHRs pertains solely to data capture. It is with Stages 2 and 3 that patient engagement and clinical decision support tools are incorporated in processes around the EHR. These stages have not been fully implemented and won’t be for a few years to come. Therefore those attributes of MU potentially having the most impact on patients are not in use today. What we do know is that: A) Physicians are spending more time looking at computer screens than into the faces of the people they are treating. B) That much of the data entered is to satisfy regulations of the HITECH Act and not directly related to patient care. C) That EHRs were designed for billing and regulatory purposes and do not in any way reflect clinical work flow. D) EHRs do not integrate well with medical devices or disparate digital health technology systems. However some excellent progress has been made in developing true interoperability among systems.

The EHR does not represent the face of digital technology in health care. Mobile health technologies, wearable sensor technologies, aging at home technologies, and ingestible medication sensor technology populate today’s digital health landscape. These are developments which will contribute directly to more efficient and improved patient care. They will address gaps in care. Having a mother who is ill and requiring significant help at home has taken me on a journey riddled with frustration and pain that is also experienced by my patients and their caregivers daily. It has made me a better physician, who realizes that the most important aspect of care is empathy. Most people view technology as a something that creates a divide between provider and patient. Effective technology can actually bring them closer. It can deliver trending data (which must be accurate, filtered, and actionable in order to be useful), drastically altering care recommendations and preventing hospitalizations and medical emergencies. While there remains much to be proven with regards to digital technologies, I expect them to become a backbone of the health care landscape.

Another digital health technology sector making its way into advanced health care enterprises is analytics. These tools take health care "big data" and make it relevant to treating individual patients as well as populations. Use cases for health care analytics demonstrate that EHRs, while being innately clumsy can be transformed into powerful sources of useful information.

Patients as consumers are demanding mobile tools long utilized in the retail and finance sectors . Examples can be seen in patient-physician video conferencing, mobile appointment schedulers, and even a smartphone ECG rhythm monitor. Digital health also involves social media. Patients are now finding themselves in online patient support groups. There are significant advantages of online versus real life support groups. On the provider side, digital tools such as Doximity and Epocratesare widely used.

In summary, the digital health landscape is much broader and friendlier than the EHR of today. I look forward to EHRs becoming more user friendly and clinically rewarding.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Medical imaging was the first taste of digital health technology for physicians and most health care providers. The technology provides prompt high-quality information which improves efficiency and is mobile. Then came electronic health records (EHRs). EHRs were mandated as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The goals of EHRs are to improve patient safety, decrease costs, and allow for the seamless exchange of information among providers and providing entities. As a proponent of digital health technologies, I submit that they are patient advocacy tools. The debate over the "effectiveness"of EHRs continues. It is too early to evaluate the true impact of EHRs on patient care at this juncture. Stage 1 of Meaningful Use (MU) of EHRs pertains solely to data capture. It is with Stages 2 and 3 that patient engagement and clinical decision support tools are incorporated in processes around the EHR. These stages have not been fully implemented and won’t be for a few years to come. Therefore those attributes of MU potentially having the most impact on patients are not in use today. What we do know is that: A) Physicians are spending more time looking at computer screens than into the faces of the people they are treating. B) That much of the data entered is to satisfy regulations of the HITECH Act and not directly related to patient care. C) That EHRs were designed for billing and regulatory purposes and do not in any way reflect clinical work flow. D) EHRs do not integrate well with medical devices or disparate digital health technology systems. However some excellent progress has been made in developing true interoperability among systems.

The EHR does not represent the face of digital technology in health care. Mobile health technologies, wearable sensor technologies, aging at home technologies, and ingestible medication sensor technology populate today’s digital health landscape. These are developments which will contribute directly to more efficient and improved patient care. They will address gaps in care. Having a mother who is ill and requiring significant help at home has taken me on a journey riddled with frustration and pain that is also experienced by my patients and their caregivers daily. It has made me a better physician, who realizes that the most important aspect of care is empathy. Most people view technology as a something that creates a divide between provider and patient. Effective technology can actually bring them closer. It can deliver trending data (which must be accurate, filtered, and actionable in order to be useful), drastically altering care recommendations and preventing hospitalizations and medical emergencies. While there remains much to be proven with regards to digital technologies, I expect them to become a backbone of the health care landscape.

Another digital health technology sector making its way into advanced health care enterprises is analytics. These tools take health care "big data" and make it relevant to treating individual patients as well as populations. Use cases for health care analytics demonstrate that EHRs, while being innately clumsy can be transformed into powerful sources of useful information.

Patients as consumers are demanding mobile tools long utilized in the retail and finance sectors . Examples can be seen in patient-physician video conferencing, mobile appointment schedulers, and even a smartphone ECG rhythm monitor. Digital health also involves social media. Patients are now finding themselves in online patient support groups. There are significant advantages of online versus real life support groups. On the provider side, digital tools such as Doximity and Epocratesare widely used.

In summary, the digital health landscape is much broader and friendlier than the EHR of today. I look forward to EHRs becoming more user friendly and clinically rewarding.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Medical imaging was the first taste of digital health technology for physicians and most health care providers. The technology provides prompt high-quality information which improves efficiency and is mobile. Then came electronic health records (EHRs). EHRs were mandated as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The goals of EHRs are to improve patient safety, decrease costs, and allow for the seamless exchange of information among providers and providing entities. As a proponent of digital health technologies, I submit that they are patient advocacy tools. The debate over the "effectiveness"of EHRs continues. It is too early to evaluate the true impact of EHRs on patient care at this juncture. Stage 1 of Meaningful Use (MU) of EHRs pertains solely to data capture. It is with Stages 2 and 3 that patient engagement and clinical decision support tools are incorporated in processes around the EHR. These stages have not been fully implemented and won’t be for a few years to come. Therefore those attributes of MU potentially having the most impact on patients are not in use today. What we do know is that: A) Physicians are spending more time looking at computer screens than into the faces of the people they are treating. B) That much of the data entered is to satisfy regulations of the HITECH Act and not directly related to patient care. C) That EHRs were designed for billing and regulatory purposes and do not in any way reflect clinical work flow. D) EHRs do not integrate well with medical devices or disparate digital health technology systems. However some excellent progress has been made in developing true interoperability among systems.

The EHR does not represent the face of digital technology in health care. Mobile health technologies, wearable sensor technologies, aging at home technologies, and ingestible medication sensor technology populate today’s digital health landscape. These are developments which will contribute directly to more efficient and improved patient care. They will address gaps in care. Having a mother who is ill and requiring significant help at home has taken me on a journey riddled with frustration and pain that is also experienced by my patients and their caregivers daily. It has made me a better physician, who realizes that the most important aspect of care is empathy. Most people view technology as a something that creates a divide between provider and patient. Effective technology can actually bring them closer. It can deliver trending data (which must be accurate, filtered, and actionable in order to be useful), drastically altering care recommendations and preventing hospitalizations and medical emergencies. While there remains much to be proven with regards to digital technologies, I expect them to become a backbone of the health care landscape.

Another digital health technology sector making its way into advanced health care enterprises is analytics. These tools take health care "big data" and make it relevant to treating individual patients as well as populations. Use cases for health care analytics demonstrate that EHRs, while being innately clumsy can be transformed into powerful sources of useful information.

Patients as consumers are demanding mobile tools long utilized in the retail and finance sectors . Examples can be seen in patient-physician video conferencing, mobile appointment schedulers, and even a smartphone ECG rhythm monitor. Digital health also involves social media. Patients are now finding themselves in online patient support groups. There are significant advantages of online versus real life support groups. On the provider side, digital tools such as Doximity and Epocratesare widely used.

In summary, the digital health landscape is much broader and friendlier than the EHR of today. I look forward to EHRs becoming more user friendly and clinically rewarding.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

The use of mobile or wireless devices in health care continues to challenge the regulatory landscape. States increasingly are playing a role in either advancing or retracing steps previously taken at the federal level. In the spirit of Ferris Bueller, "isms" have provided a number of opportunities for discussion surrounding mobile health technologies. Federalism remains a key criterion upon which our country creates health care policy – which could serve as a double-edged sword.

On the one hand, it might encourage innovation and provide policy that satisfies the needs of specific constituents. On the other hand, it may create more complexity or even contradict previous policy. The result is often a legal quagmire of wasted time, energy, and money. While policy will never keep pace with technology and innovation, a number of stakeholders are working to bridge the gap.

HIMSS – the Health Information Management System Society – has provided an overview of contemporary issues focused on the state level to advance the use of mobile and wireless devices in health care. Their paper titled "Mobile Health IT in the States: A Policy Perspective"sheds light on a number of potential redundancies in the regulatory system and offers some guidance on other issues.

One major issue gaining plenty of interest among physicians and lawmakers is the ability for mobile devices to facilitate the delivery of health care in a more meaningful, cost effective way. However, whenever disruptive technology begins to upset vested interests, one can expect a robust discussion.

The licensure of physicians and other providers and establishing telehealth standards of care remain substantial obstacles to overcome in the regulatory space. Federal licensure would permit physicians to care for patients across state lines via telehealth delivery systems. Some medical boards of states bordering large metropolitan areas such as Washington, D.C., have entered into reciprocal provider licensing agreements to allow for telehealth encounters.

Reimbursement represents another major obstacle to widespread adoption by providers. Telehealth is primarily a technology approved in certain rural areas under Medicaid. Enter a new age of consumerism in health care, and for a small fee, providers can engage in consultations using your mobile device.

A number of studies have examined the desire for patients to receive care on a mobile device, and not surprisingly, convenience wins out. However, a number of discordant state polices increasingly prohibit the ability to scale many of these innovative and cost-saving approaches to care delivery. The HIMSS paper encourages states to consider health IT, electronic health record (EHR) adoption, telehealth, and mobile health (mHealth) when resourcing and determining coverage for publicly funded health programs such as Medicaid, public health initiatives, and state employee health benefits programs.

Unfortunately, reimbursement for telehealth services for Medicare patients as well is also limited to rural settings defined as "originating sites."

"An originating site is the location of an eligible Medicare beneficiary at the time the service being furnished via a telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in a rural Health Professional Shortage Area, either located outside of a Metropolitan Statistical Area (MSA) or in a rural census tract, as determined by the Office of Rural Health Policy within the Health Resources and Services Administration (HRSA) or [from] a county outside of an MSA."

Telehealth reimbursement only covers certain specialties and services. Telehealth has been in existence for decades and has been the focus of many outcomes-based studies.

Extending this to mobile technologies such as medical apps remains a challenge due to the lack of evidence. However, I foresee the critical need for such applications, the rapid development of state-of-the-art sensor technologies, and the emergence of analytics to converge and make the success of mobile health technologies a welcome and accepted reality.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

The use of mobile or wireless devices in health care continues to challenge the regulatory landscape. States increasingly are playing a role in either advancing or retracing steps previously taken at the federal level. In the spirit of Ferris Bueller, "isms" have provided a number of opportunities for discussion surrounding mobile health technologies. Federalism remains a key criterion upon which our country creates health care policy – which could serve as a double-edged sword.

On the one hand, it might encourage innovation and provide policy that satisfies the needs of specific constituents. On the other hand, it may create more complexity or even contradict previous policy. The result is often a legal quagmire of wasted time, energy, and money. While policy will never keep pace with technology and innovation, a number of stakeholders are working to bridge the gap.

HIMSS – the Health Information Management System Society – has provided an overview of contemporary issues focused on the state level to advance the use of mobile and wireless devices in health care. Their paper titled "Mobile Health IT in the States: A Policy Perspective"sheds light on a number of potential redundancies in the regulatory system and offers some guidance on other issues.

One major issue gaining plenty of interest among physicians and lawmakers is the ability for mobile devices to facilitate the delivery of health care in a more meaningful, cost effective way. However, whenever disruptive technology begins to upset vested interests, one can expect a robust discussion.

The licensure of physicians and other providers and establishing telehealth standards of care remain substantial obstacles to overcome in the regulatory space. Federal licensure would permit physicians to care for patients across state lines via telehealth delivery systems. Some medical boards of states bordering large metropolitan areas such as Washington, D.C., have entered into reciprocal provider licensing agreements to allow for telehealth encounters.

Reimbursement represents another major obstacle to widespread adoption by providers. Telehealth is primarily a technology approved in certain rural areas under Medicaid. Enter a new age of consumerism in health care, and for a small fee, providers can engage in consultations using your mobile device.

A number of studies have examined the desire for patients to receive care on a mobile device, and not surprisingly, convenience wins out. However, a number of discordant state polices increasingly prohibit the ability to scale many of these innovative and cost-saving approaches to care delivery. The HIMSS paper encourages states to consider health IT, electronic health record (EHR) adoption, telehealth, and mobile health (mHealth) when resourcing and determining coverage for publicly funded health programs such as Medicaid, public health initiatives, and state employee health benefits programs.

Unfortunately, reimbursement for telehealth services for Medicare patients as well is also limited to rural settings defined as "originating sites."

"An originating site is the location of an eligible Medicare beneficiary at the time the service being furnished via a telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in a rural Health Professional Shortage Area, either located outside of a Metropolitan Statistical Area (MSA) or in a rural census tract, as determined by the Office of Rural Health Policy within the Health Resources and Services Administration (HRSA) or [from] a county outside of an MSA."

Telehealth reimbursement only covers certain specialties and services. Telehealth has been in existence for decades and has been the focus of many outcomes-based studies.

Extending this to mobile technologies such as medical apps remains a challenge due to the lack of evidence. However, I foresee the critical need for such applications, the rapid development of state-of-the-art sensor technologies, and the emergence of analytics to converge and make the success of mobile health technologies a welcome and accepted reality.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

The use of mobile or wireless devices in health care continues to challenge the regulatory landscape. States increasingly are playing a role in either advancing or retracing steps previously taken at the federal level. In the spirit of Ferris Bueller, "isms" have provided a number of opportunities for discussion surrounding mobile health technologies. Federalism remains a key criterion upon which our country creates health care policy – which could serve as a double-edged sword.

On the one hand, it might encourage innovation and provide policy that satisfies the needs of specific constituents. On the other hand, it may create more complexity or even contradict previous policy. The result is often a legal quagmire of wasted time, energy, and money. While policy will never keep pace with technology and innovation, a number of stakeholders are working to bridge the gap.

HIMSS – the Health Information Management System Society – has provided an overview of contemporary issues focused on the state level to advance the use of mobile and wireless devices in health care. Their paper titled "Mobile Health IT in the States: A Policy Perspective"sheds light on a number of potential redundancies in the regulatory system and offers some guidance on other issues.

One major issue gaining plenty of interest among physicians and lawmakers is the ability for mobile devices to facilitate the delivery of health care in a more meaningful, cost effective way. However, whenever disruptive technology begins to upset vested interests, one can expect a robust discussion.

The licensure of physicians and other providers and establishing telehealth standards of care remain substantial obstacles to overcome in the regulatory space. Federal licensure would permit physicians to care for patients across state lines via telehealth delivery systems. Some medical boards of states bordering large metropolitan areas such as Washington, D.C., have entered into reciprocal provider licensing agreements to allow for telehealth encounters.

Reimbursement represents another major obstacle to widespread adoption by providers. Telehealth is primarily a technology approved in certain rural areas under Medicaid. Enter a new age of consumerism in health care, and for a small fee, providers can engage in consultations using your mobile device.

A number of studies have examined the desire for patients to receive care on a mobile device, and not surprisingly, convenience wins out. However, a number of discordant state polices increasingly prohibit the ability to scale many of these innovative and cost-saving approaches to care delivery. The HIMSS paper encourages states to consider health IT, electronic health record (EHR) adoption, telehealth, and mobile health (mHealth) when resourcing and determining coverage for publicly funded health programs such as Medicaid, public health initiatives, and state employee health benefits programs.

Unfortunately, reimbursement for telehealth services for Medicare patients as well is also limited to rural settings defined as "originating sites."

"An originating site is the location of an eligible Medicare beneficiary at the time the service being furnished via a telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in a rural Health Professional Shortage Area, either located outside of a Metropolitan Statistical Area (MSA) or in a rural census tract, as determined by the Office of Rural Health Policy within the Health Resources and Services Administration (HRSA) or [from] a county outside of an MSA."

Telehealth reimbursement only covers certain specialties and services. Telehealth has been in existence for decades and has been the focus of many outcomes-based studies.

Extending this to mobile technologies such as medical apps remains a challenge due to the lack of evidence. However, I foresee the critical need for such applications, the rapid development of state-of-the-art sensor technologies, and the emergence of analytics to converge and make the success of mobile health technologies a welcome and accepted reality.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

Over the last few years, I have spoken with hundreds of physicians who tell me that they want to be engaged on social media, but they just don’t have the time or resources. I understand. If this sounds like you, then it’s time to consider hiring a social media consultant.

Hiring the right social media consultant or agency for your medical practice can provide many benefits, including:

• Shaping and marketing your brand.

• Handling daily social media updates and tasks.

• Devising a strategic plan to engage with social media influencers in your specialty.

• Developing a strategic plan to engage with your desired audience. Do you want new patients? More traffic to your practice website?

• Directing you to the best social media platforms for your specific goals, such as Facebook, YouTube, or Pinterest.

• If applicable, developing a plan to promote and market your products and unique services.

• Coaching you and your staff to become better and more efficient at social media.

• Helping you navigate social media analytics.

• Taking the stress off doing it all yourself.

There is no foolproof formula for choosing the best social media consultant for your practice, but here are some key points to keep in mind when considering candidates:

• Do they have experience? How long have they been consulting? How many clients have they had? How many do they currently have? Have they been published online or in print magazines? Do they teach any courses, either online or in person? Do they have success stories they can share?

• Check out their website. It is modern? User friendly? Does it include bios of the employees and client testimonials?

• Check out their social media involvement. Are they actively engaged on social media sites that they suggest you use? Look at their Facebook, Twitter, LinkedIn, and Pinterest accounts, as well as any other sites they may use.

• Are they willing to create unique content for your practice? Some agencies create boilerplate content that they use on multiple client sites. You want to be certain that the content they create for your practice aligns with your marketing and branding goals.

• Do you like them? This is a critical question because social media is, by nature, social. Do the staff members of your potential agency have likable personalities? Are they good listeners? Do they respond promptly to e-mails and phone calls? Do they seem confident or perpetually stressed?

• Do they understand your business? If the firm you hire has only restaurants as clients, then you might be at a disadvantage. Make certain that whomever you hire understands your area of medicine and has a track record of success with medical practices.

• Do they have clearly defined costs? Many firms will offer pricing based on 1- to 3-month intervals. Will they be creating and posting new content daily, weekly, biweekly? Will they work weekends and off-hours? How frequently will they meet with you in person? All of these factors will affect price. Of course, the more hands-on your social media consultants are, the higher the price is likely to be.

Outsourcing your social media is a decision that you and staff must consider carefully. As with most important decisions, it’s advisable to interview several different firms before choosing one. As for price, it ranges dramatically. Some agencies might charge $300 a month, while others might charge $3,000. It’s up to you and your office staff to determine which agency is best suited for your practice’s budget, needs, and goals.

In my next column, I’ll address pitfalls to avoid when choosing a social media consultant or agency.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is on Twitter @Dermdoc.

Over the last few years, I have spoken with hundreds of physicians who tell me that they want to be engaged on social media, but they just don’t have the time or resources. I understand. If this sounds like you, then it’s time to consider hiring a social media consultant.

Hiring the right social media consultant or agency for your medical practice can provide many benefits, including:

• Shaping and marketing your brand.

• Handling daily social media updates and tasks.

• Devising a strategic plan to engage with social media influencers in your specialty.

• Developing a strategic plan to engage with your desired audience. Do you want new patients? More traffic to your practice website?

• Directing you to the best social media platforms for your specific goals, such as Facebook, YouTube, or Pinterest.

• If applicable, developing a plan to promote and market your products and unique services.

• Coaching you and your staff to become better and more efficient at social media.

• Helping you navigate social media analytics.

• Taking the stress off doing it all yourself.

There is no foolproof formula for choosing the best social media consultant for your practice, but here are some key points to keep in mind when considering candidates:

• Do they have experience? How long have they been consulting? How many clients have they had? How many do they currently have? Have they been published online or in print magazines? Do they teach any courses, either online or in person? Do they have success stories they can share?

• Check out their website. It is modern? User friendly? Does it include bios of the employees and client testimonials?

• Check out their social media involvement. Are they actively engaged on social media sites that they suggest you use? Look at their Facebook, Twitter, LinkedIn, and Pinterest accounts, as well as any other sites they may use.

• Are they willing to create unique content for your practice? Some agencies create boilerplate content that they use on multiple client sites. You want to be certain that the content they create for your practice aligns with your marketing and branding goals.

• Do you like them? This is a critical question because social media is, by nature, social. Do the staff members of your potential agency have likable personalities? Are they good listeners? Do they respond promptly to e-mails and phone calls? Do they seem confident or perpetually stressed?

• Do they understand your business? If the firm you hire has only restaurants as clients, then you might be at a disadvantage. Make certain that whomever you hire understands your area of medicine and has a track record of success with medical practices.

• Do they have clearly defined costs? Many firms will offer pricing based on 1- to 3-month intervals. Will they be creating and posting new content daily, weekly, biweekly? Will they work weekends and off-hours? How frequently will they meet with you in person? All of these factors will affect price. Of course, the more hands-on your social media consultants are, the higher the price is likely to be.

Outsourcing your social media is a decision that you and staff must consider carefully. As with most important decisions, it’s advisable to interview several different firms before choosing one. As for price, it ranges dramatically. Some agencies might charge $300 a month, while others might charge $3,000. It’s up to you and your office staff to determine which agency is best suited for your practice’s budget, needs, and goals.

In my next column, I’ll address pitfalls to avoid when choosing a social media consultant or agency.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is on Twitter @Dermdoc.

Over the last few years, I have spoken with hundreds of physicians who tell me that they want to be engaged on social media, but they just don’t have the time or resources. I understand. If this sounds like you, then it’s time to consider hiring a social media consultant.

Hiring the right social media consultant or agency for your medical practice can provide many benefits, including:

• Shaping and marketing your brand.

• Handling daily social media updates and tasks.

• Devising a strategic plan to engage with social media influencers in your specialty.

• Developing a strategic plan to engage with your desired audience. Do you want new patients? More traffic to your practice website?

• Directing you to the best social media platforms for your specific goals, such as Facebook, YouTube, or Pinterest.

• If applicable, developing a plan to promote and market your products and unique services.

• Coaching you and your staff to become better and more efficient at social media.

• Helping you navigate social media analytics.

• Taking the stress off doing it all yourself.

There is no foolproof formula for choosing the best social media consultant for your practice, but here are some key points to keep in mind when considering candidates:

• Do they have experience? How long have they been consulting? How many clients have they had? How many do they currently have? Have they been published online or in print magazines? Do they teach any courses, either online or in person? Do they have success stories they can share?

• Check out their website. It is modern? User friendly? Does it include bios of the employees and client testimonials?

• Check out their social media involvement. Are they actively engaged on social media sites that they suggest you use? Look at their Facebook, Twitter, LinkedIn, and Pinterest accounts, as well as any other sites they may use.

• Are they willing to create unique content for your practice? Some agencies create boilerplate content that they use on multiple client sites. You want to be certain that the content they create for your practice aligns with your marketing and branding goals.

• Do you like them? This is a critical question because social media is, by nature, social. Do the staff members of your potential agency have likable personalities? Are they good listeners? Do they respond promptly to e-mails and phone calls? Do they seem confident or perpetually stressed?

• Do they understand your business? If the firm you hire has only restaurants as clients, then you might be at a disadvantage. Make certain that whomever you hire understands your area of medicine and has a track record of success with medical practices.

• Do they have clearly defined costs? Many firms will offer pricing based on 1- to 3-month intervals. Will they be creating and posting new content daily, weekly, biweekly? Will they work weekends and off-hours? How frequently will they meet with you in person? All of these factors will affect price. Of course, the more hands-on your social media consultants are, the higher the price is likely to be.

Outsourcing your social media is a decision that you and staff must consider carefully. As with most important decisions, it’s advisable to interview several different firms before choosing one. As for price, it ranges dramatically. Some agencies might charge $300 a month, while others might charge $3,000. It’s up to you and your office staff to determine which agency is best suited for your practice’s budget, needs, and goals.

In my next column, I’ll address pitfalls to avoid when choosing a social media consultant or agency.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is on Twitter @Dermdoc.

While being discharged from the hospital even after a minor procedure is not simple, the process for a patient with comorbidities after a prolonged stay is daunting.

Physicians from multiple specialties, various nonphysician providers, the social worker, and the case manager all address different discharge-related issues. It is frustrating for both a provider and patient to experience the "I really can’t answer that question" moment. Lack of interdisciplinary communication may lead to medical errors and either premature or delayed discharges.

The date of discharge is estimated soon after admission. Some hospitals have a focus on the clock when planning discharges. If planning occurs too early, it does not account for changes in patient needs and wrong instructions might be given. Transportation and home-aide needs are time sensitive.

In contrast, some planning does need to be considered early in the admission when discharge to a non-acute care facility is obvious due to the diagnosis and/or social situation of the patient.

One study from the Brigham and Women’s Hospital identified seven clinical factors predicting hospital readmission: a hemoglobin less than 12 g/dL on discharge, discharge from an oncology service, low serum sodium level on discharge, a procedure (via ICD-9 standards) during admission, nonelective admission, length of stay greater than 4 days, and number of admissions during the previous year (JAMA Intern. Med. 2013;173:632-8).

Another study examined many predictive models found in the literature.

The researchers found that "of 7,843 citations reviewed, 30 studies of 26 unique models met the inclusion criteria. The most common outcome used was 30-day readmission; only 1 model specifically addressed preventable readmissions. Fourteen models that relied on retrospective administrative data could be potentially used to risk-adjust readmission rates for hospital comparison; of these, 9 were tested in large U.S. populations and had poor discriminative ability. ... Seven models could potentially be used to identify high-risk patients for intervention early during a hospitalization, ... and 5 could be used at hospital discharge" (JAMA 2011;306:1688-98).

The authors concluded that most prediction models perform poorly or require improvement. Perhaps one reason for this result lies in the fact that these models traditionally are either clinical or administrative. I believe a better approach is to combine administrative and clinical predictive models. Better analytics programs applied real-time in the electronic health record (EHR) will facilitate integration of these perspectives.

The topic of transitional care has received attention because a poor discharge process results in higher readmission rates, a new benchmark focus of Medicare (Am. J. Nurs. 2008;108:58-63). Hospitals might be very good at meeting regulatory requirements, but the patient’s understanding of diagnoses and instructions is often unclear. Though required by regulations, the caregiver may not even be included in the process. Technology can help in this situation. Some of possibilities mentioned below might not be available in the context described.

• Durable equipment needs. The care coordinator is generally the point person regarding the patient’s durable equipment needs upon discharge. Ordering the equipment (specifications as well as date, time, and place of delivery) might be the job of someone else, such as a therapist or physician. Digital tools can expedite equipment procurement. Analytics from the EHR (mining diagnoses, equipment in use at the end of the hospitalization, expected place of transition, etc.) might determine the individual’s ambulation, oxygen, bed, or other equipment requirements. This can act as a preliminary checklist for the coordinator, doing away with the need to personally go through the EHR or surveying providers. A digital ordering program can directly interact with the distributor to check product availability and verify delivery. Another useful tool would aggregate equipment distributors, which are stratified according to certification (Medicare bidding approval status), lowest price, and best-rated service.

• Visiting nurses. Often the home-needs assessment for visiting nurses is done once the patient is discharged. This can be expedited with the help of a caregiver, with the assessment completed in the hospital. Consider a tool into which the physician’s orders or recommendations for home nursing are placed and shared with the visiting nurse entity, the patient, and the caregiver. It would include the nursing assessment as well as a video of the home environment (a factor in the assessment itself). This would obviate the need for a dedicated assessment visit. Visiting nurses themselves should be equipped with mobile technology to document their time schedule for billing, to record interventions, and to record and transmit vital signs (measured via digital remote monitors) and orders; the technology also should contain a digital messaging program.

• Scheduling of outpatient provider appointments. Evidence suggests that in a general medical population, early follow-up appointments do not affect readmission rates (Arch. Intern. Med. 2010;170:955-60). However, some patients, including those with heart failure have been shown to benefit from early follow-up (JAMA 2010;303:1716-22). The success of a growing number of commercially available mobile apps intended to streamline scheduling of physician appointments is testimony to this need in the nonacute setting. Patient portal use is a requirement of Meaningful Use Stage 2. One way of encouraging patient participation in portal use would be activating it by utilizing a discharge planning scheduling application of the portal at the time of discharge. This also fits into an overall strategy of point of engagement implementation of technology.

These are only a few highlights of the complexity of the discharge process. All physicians have dealt with the many questions, complications, and frustration experienced by patients after discharge. A failed process creates unnecessary work, expense, and bad outcomes.

To many physicians, digital health technology is represented by the EHR in its present form, which is not what the doctor ordered. It is not intuitive, it is cumbersome, and it encourages impersonal encounters with patients. I will explore in future posts how digital technologies other than the EHR will change medicine in ways that physicians will appreciate.

Dr. Scher, a practicing cardiac electrophysiologist in Lancaster, Pa., is director at DLS Healthcare Consulting, advising technology companies and health care enterprises on development and adoption of mobile health technologies.

While being discharged from the hospital even after a minor procedure is not simple, the process for a patient with comorbidities after a prolonged stay is daunting.

Physicians from multiple specialties, various nonphysician providers, the social worker, and the case manager all address different discharge-related issues. It is frustrating for both a provider and patient to experience the "I really can’t answer that question" moment. Lack of interdisciplinary communication may lead to medical errors and either premature or delayed discharges.

The date of discharge is estimated soon after admission. Some hospitals have a focus on the clock when planning discharges. If planning occurs too early, it does not account for changes in patient needs and wrong instructions might be given. Transportation and home-aide needs are time sensitive.

In contrast, some planning does need to be considered early in the admission when discharge to a non-acute care facility is obvious due to the diagnosis and/or social situation of the patient.

One study from the Brigham and Women’s Hospital identified seven clinical factors predicting hospital readmission: a hemoglobin less than 12 g/dL on discharge, discharge from an oncology service, low serum sodium level on discharge, a procedure (via ICD-9 standards) during admission, nonelective admission, length of stay greater than 4 days, and number of admissions during the previous year (JAMA Intern. Med. 2013;173:632-8).

Another study examined many predictive models found in the literature.

The researchers found that "of 7,843 citations reviewed, 30 studies of 26 unique models met the inclusion criteria. The most common outcome used was 30-day readmission; only 1 model specifically addressed preventable readmissions. Fourteen models that relied on retrospective administrative data could be potentially used to risk-adjust readmission rates for hospital comparison; of these, 9 were tested in large U.S. populations and had poor discriminative ability. ... Seven models could potentially be used to identify high-risk patients for intervention early during a hospitalization, ... and 5 could be used at hospital discharge" (JAMA 2011;306:1688-98).

The authors concluded that most prediction models perform poorly or require improvement. Perhaps one reason for this result lies in the fact that these models traditionally are either clinical or administrative. I believe a better approach is to combine administrative and clinical predictive models. Better analytics programs applied real-time in the electronic health record (EHR) will facilitate integration of these perspectives.

The topic of transitional care has received attention because a poor discharge process results in higher readmission rates, a new benchmark focus of Medicare (Am. J. Nurs. 2008;108:58-63). Hospitals might be very good at meeting regulatory requirements, but the patient’s understanding of diagnoses and instructions is often unclear. Though required by regulations, the caregiver may not even be included in the process. Technology can help in this situation. Some of possibilities mentioned below might not be available in the context described.

• Durable equipment needs. The care coordinator is generally the point person regarding the patient’s durable equipment needs upon discharge. Ordering the equipment (specifications as well as date, time, and place of delivery) might be the job of someone else, such as a therapist or physician. Digital tools can expedite equipment procurement. Analytics from the EHR (mining diagnoses, equipment in use at the end of the hospitalization, expected place of transition, etc.) might determine the individual’s ambulation, oxygen, bed, or other equipment requirements. This can act as a preliminary checklist for the coordinator, doing away with the need to personally go through the EHR or surveying providers. A digital ordering program can directly interact with the distributor to check product availability and verify delivery. Another useful tool would aggregate equipment distributors, which are stratified according to certification (Medicare bidding approval status), lowest price, and best-rated service.

• Visiting nurses. Often the home-needs assessment for visiting nurses is done once the patient is discharged. This can be expedited with the help of a caregiver, with the assessment completed in the hospital. Consider a tool into which the physician’s orders or recommendations for home nursing are placed and shared with the visiting nurse entity, the patient, and the caregiver. It would include the nursing assessment as well as a video of the home environment (a factor in the assessment itself). This would obviate the need for a dedicated assessment visit. Visiting nurses themselves should be equipped with mobile technology to document their time schedule for billing, to record interventions, and to record and transmit vital signs (measured via digital remote monitors) and orders; the technology also should contain a digital messaging program.

• Scheduling of outpatient provider appointments. Evidence suggests that in a general medical population, early follow-up appointments do not affect readmission rates (Arch. Intern. Med. 2010;170:955-60). However, some patients, including those with heart failure have been shown to benefit from early follow-up (JAMA 2010;303:1716-22). The success of a growing number of commercially available mobile apps intended to streamline scheduling of physician appointments is testimony to this need in the nonacute setting. Patient portal use is a requirement of Meaningful Use Stage 2. One way of encouraging patient participation in portal use would be activating it by utilizing a discharge planning scheduling application of the portal at the time of discharge. This also fits into an overall strategy of point of engagement implementation of technology.

These are only a few highlights of the complexity of the discharge process. All physicians have dealt with the many questions, complications, and frustration experienced by patients after discharge. A failed process creates unnecessary work, expense, and bad outcomes.

To many physicians, digital health technology is represented by the EHR in its present form, which is not what the doctor ordered. It is not intuitive, it is cumbersome, and it encourages impersonal encounters with patients. I will explore in future posts how digital technologies other than the EHR will change medicine in ways that physicians will appreciate.

Dr. Scher, a practicing cardiac electrophysiologist in Lancaster, Pa., is director at DLS Healthcare Consulting, advising technology companies and health care enterprises on development and adoption of mobile health technologies.

While being discharged from the hospital even after a minor procedure is not simple, the process for a patient with comorbidities after a prolonged stay is daunting.

Physicians from multiple specialties, various nonphysician providers, the social worker, and the case manager all address different discharge-related issues. It is frustrating for both a provider and patient to experience the "I really can’t answer that question" moment. Lack of interdisciplinary communication may lead to medical errors and either premature or delayed discharges.

The date of discharge is estimated soon after admission. Some hospitals have a focus on the clock when planning discharges. If planning occurs too early, it does not account for changes in patient needs and wrong instructions might be given. Transportation and home-aide needs are time sensitive.

In contrast, some planning does need to be considered early in the admission when discharge to a non-acute care facility is obvious due to the diagnosis and/or social situation of the patient.

One study from the Brigham and Women’s Hospital identified seven clinical factors predicting hospital readmission: a hemoglobin less than 12 g/dL on discharge, discharge from an oncology service, low serum sodium level on discharge, a procedure (via ICD-9 standards) during admission, nonelective admission, length of stay greater than 4 days, and number of admissions during the previous year (JAMA Intern. Med. 2013;173:632-8).

Another study examined many predictive models found in the literature.

The researchers found that "of 7,843 citations reviewed, 30 studies of 26 unique models met the inclusion criteria. The most common outcome used was 30-day readmission; only 1 model specifically addressed preventable readmissions. Fourteen models that relied on retrospective administrative data could be potentially used to risk-adjust readmission rates for hospital comparison; of these, 9 were tested in large U.S. populations and had poor discriminative ability. ... Seven models could potentially be used to identify high-risk patients for intervention early during a hospitalization, ... and 5 could be used at hospital discharge" (JAMA 2011;306:1688-98).

The authors concluded that most prediction models perform poorly or require improvement. Perhaps one reason for this result lies in the fact that these models traditionally are either clinical or administrative. I believe a better approach is to combine administrative and clinical predictive models. Better analytics programs applied real-time in the electronic health record (EHR) will facilitate integration of these perspectives.

The topic of transitional care has received attention because a poor discharge process results in higher readmission rates, a new benchmark focus of Medicare (Am. J. Nurs. 2008;108:58-63). Hospitals might be very good at meeting regulatory requirements, but the patient’s understanding of diagnoses and instructions is often unclear. Though required by regulations, the caregiver may not even be included in the process. Technology can help in this situation. Some of possibilities mentioned below might not be available in the context described.

• Durable equipment needs. The care coordinator is generally the point person regarding the patient’s durable equipment needs upon discharge. Ordering the equipment (specifications as well as date, time, and place of delivery) might be the job of someone else, such as a therapist or physician. Digital tools can expedite equipment procurement. Analytics from the EHR (mining diagnoses, equipment in use at the end of the hospitalization, expected place of transition, etc.) might determine the individual’s ambulation, oxygen, bed, or other equipment requirements. This can act as a preliminary checklist for the coordinator, doing away with the need to personally go through the EHR or surveying providers. A digital ordering program can directly interact with the distributor to check product availability and verify delivery. Another useful tool would aggregate equipment distributors, which are stratified according to certification (Medicare bidding approval status), lowest price, and best-rated service.

• Visiting nurses. Often the home-needs assessment for visiting nurses is done once the patient is discharged. This can be expedited with the help of a caregiver, with the assessment completed in the hospital. Consider a tool into which the physician’s orders or recommendations for home nursing are placed and shared with the visiting nurse entity, the patient, and the caregiver. It would include the nursing assessment as well as a video of the home environment (a factor in the assessment itself). This would obviate the need for a dedicated assessment visit. Visiting nurses themselves should be equipped with mobile technology to document their time schedule for billing, to record interventions, and to record and transmit vital signs (measured via digital remote monitors) and orders; the technology also should contain a digital messaging program.

• Scheduling of outpatient provider appointments. Evidence suggests that in a general medical population, early follow-up appointments do not affect readmission rates (Arch. Intern. Med. 2010;170:955-60). However, some patients, including those with heart failure have been shown to benefit from early follow-up (JAMA 2010;303:1716-22). The success of a growing number of commercially available mobile apps intended to streamline scheduling of physician appointments is testimony to this need in the nonacute setting. Patient portal use is a requirement of Meaningful Use Stage 2. One way of encouraging patient participation in portal use would be activating it by utilizing a discharge planning scheduling application of the portal at the time of discharge. This also fits into an overall strategy of point of engagement implementation of technology.

These are only a few highlights of the complexity of the discharge process. All physicians have dealt with the many questions, complications, and frustration experienced by patients after discharge. A failed process creates unnecessary work, expense, and bad outcomes.

To many physicians, digital health technology is represented by the EHR in its present form, which is not what the doctor ordered. It is not intuitive, it is cumbersome, and it encourages impersonal encounters with patients. I will explore in future posts how digital technologies other than the EHR will change medicine in ways that physicians will appreciate.

Dr. Scher, a practicing cardiac electrophysiologist in Lancaster, Pa., is director at DLS Healthcare Consulting, advising technology companies and health care enterprises on development and adoption of mobile health technologies.

If you have patients who express interest in cosmetic procedures, and especially if you are a cosmetic dermatologist or a plastic surgeon, you might want to familiarize yourself with RealSelf.com. Founded in 2006, RealSelf is an online community for learning and sharing information about cosmetic surgery, dermatology, dentistry, and other elective treatments. In 2013, the site had 36 million unique visitors, and it is expected to grow.

Why might RealSelf be relevant for you? Simply put, it’s another channel to market you and your practice. It works by allowing physicians to answer users’ questions about cosmetic procedures ranging from rhinoplasty and liposuction to tattoo removal and Botox. Over time, your participation can lead to new consultations at your practice.

To ensure credibility, physicians must be board-certified in order to join RealSelf’s physician community. There is an element of game mechanics: The more active the physician, the more exposure his or her profile and practice receives. Similarly, paid subscriptions lead to more exposure than free subscriptions (more on this later.) Although this model does not appeal to some physicians, many of them do like the platform, and see it as a way to build a reputation as an expert and to market their practices.

Unlike doctor review sites that focus on the physician, RealSelf focuses on the procedure. For each procedure, users will find actual patient reviews and before and after photos, as well as Q&A’s with board-certified physicians. Users will also find licensed physicians in their area as well as the average cost for the procedure. RealSelf believes that patients value transparency, and including prices creates transparency.

Since most patients genuinely want to help other patients make informed medical decisions, the reviews tend to be thoughtful and thorough, and many of them contain multiple before-and-after photos. As a physician perusing the patient reviews, you’ll start to notice that most of them are reasonable. For example, customer satisfaction with laser treatment for melasma was 51%, whereas satisfaction for laser treatment for rosacea was 80%.

Patients and prospective patients are flocking to the site because it allows them to share their experiences, interact with other patients, and gain access to physician experts in the field. Many patients have difficulty making decisions about cosmetic procedures; RealSelf aims to alleviate their fears and help them "make confident health and beauty decisions." If a prospective patient wants to see a video of tattoo removal or Botox injections, he or she can. If a patient wants to ask physicians their opinions, he or she can. According to RealSelf, physicians have answered over 500,000 questions on the site.

Of course, all this isn’t free for physicians. RealSelf is a business. They have a tiered membership – free, pro, and spotlight. To obtain free membership, you simply visit the site and follow the prompts to "claim your profile." Once your profile is completed, you will have access to a "doctor advisor" who can help you "optimize your visibility on the site." Both "pro" and "spotlight" offer additional benefits, such as integrating patient reviews on your practice website, promotions on Facebook and Twitter, extended directory listings, and exposure in your local area. RealSelf does not discuss costs of membership until you have claimed your profile.

Only you can determine if RealSelf is beneficial to you and your practice. If, for example, you’re not looking for new patients, then you might find it unnecessary. But at the very least, you’ll know what RealSelf is the next time a fellow cosmetic physician brings it up at a conference. And it’s never a bad idea to be familiar with current social technologies that may affect your livelihood.

If you’ve used RealSelf, let us know what you think. For more information, visit RealSelf.com.

Disclaimer: I have no financial interest in RealSelf and am not an active member.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @Dermdoc on Twitter.

If you have patients who express interest in cosmetic procedures, and especially if you are a cosmetic dermatologist or a plastic surgeon, you might want to familiarize yourself with RealSelf.com. Founded in 2006, RealSelf is an online community for learning and sharing information about cosmetic surgery, dermatology, dentistry, and other elective treatments. In 2013, the site had 36 million unique visitors, and it is expected to grow.

Why might RealSelf be relevant for you? Simply put, it’s another channel to market you and your practice. It works by allowing physicians to answer users’ questions about cosmetic procedures ranging from rhinoplasty and liposuction to tattoo removal and Botox. Over time, your participation can lead to new consultations at your practice.

To ensure credibility, physicians must be board-certified in order to join RealSelf’s physician community. There is an element of game mechanics: The more active the physician, the more exposure his or her profile and practice receives. Similarly, paid subscriptions lead to more exposure than free subscriptions (more on this later.) Although this model does not appeal to some physicians, many of them do like the platform, and see it as a way to build a reputation as an expert and to market their practices.

Unlike doctor review sites that focus on the physician, RealSelf focuses on the procedure. For each procedure, users will find actual patient reviews and before and after photos, as well as Q&A’s with board-certified physicians. Users will also find licensed physicians in their area as well as the average cost for the procedure. RealSelf believes that patients value transparency, and including prices creates transparency.

Since most patients genuinely want to help other patients make informed medical decisions, the reviews tend to be thoughtful and thorough, and many of them contain multiple before-and-after photos. As a physician perusing the patient reviews, you’ll start to notice that most of them are reasonable. For example, customer satisfaction with laser treatment for melasma was 51%, whereas satisfaction for laser treatment for rosacea was 80%.

Patients and prospective patients are flocking to the site because it allows them to share their experiences, interact with other patients, and gain access to physician experts in the field. Many patients have difficulty making decisions about cosmetic procedures; RealSelf aims to alleviate their fears and help them "make confident health and beauty decisions." If a prospective patient wants to see a video of tattoo removal or Botox injections, he or she can. If a patient wants to ask physicians their opinions, he or she can. According to RealSelf, physicians have answered over 500,000 questions on the site.

Of course, all this isn’t free for physicians. RealSelf is a business. They have a tiered membership – free, pro, and spotlight. To obtain free membership, you simply visit the site and follow the prompts to "claim your profile." Once your profile is completed, you will have access to a "doctor advisor" who can help you "optimize your visibility on the site." Both "pro" and "spotlight" offer additional benefits, such as integrating patient reviews on your practice website, promotions on Facebook and Twitter, extended directory listings, and exposure in your local area. RealSelf does not discuss costs of membership until you have claimed your profile.

Only you can determine if RealSelf is beneficial to you and your practice. If, for example, you’re not looking for new patients, then you might find it unnecessary. But at the very least, you’ll know what RealSelf is the next time a fellow cosmetic physician brings it up at a conference. And it’s never a bad idea to be familiar with current social technologies that may affect your livelihood.

If you’ve used RealSelf, let us know what you think. For more information, visit RealSelf.com.

Disclaimer: I have no financial interest in RealSelf and am not an active member.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @Dermdoc on Twitter.

If you have patients who express interest in cosmetic procedures, and especially if you are a cosmetic dermatologist or a plastic surgeon, you might want to familiarize yourself with RealSelf.com. Founded in 2006, RealSelf is an online community for learning and sharing information about cosmetic surgery, dermatology, dentistry, and other elective treatments. In 2013, the site had 36 million unique visitors, and it is expected to grow.

Why might RealSelf be relevant for you? Simply put, it’s another channel to market you and your practice. It works by allowing physicians to answer users’ questions about cosmetic procedures ranging from rhinoplasty and liposuction to tattoo removal and Botox. Over time, your participation can lead to new consultations at your practice.

To ensure credibility, physicians must be board-certified in order to join RealSelf’s physician community. There is an element of game mechanics: The more active the physician, the more exposure his or her profile and practice receives. Similarly, paid subscriptions lead to more exposure than free subscriptions (more on this later.) Although this model does not appeal to some physicians, many of them do like the platform, and see it as a way to build a reputation as an expert and to market their practices.

Unlike doctor review sites that focus on the physician, RealSelf focuses on the procedure. For each procedure, users will find actual patient reviews and before and after photos, as well as Q&A’s with board-certified physicians. Users will also find licensed physicians in their area as well as the average cost for the procedure. RealSelf believes that patients value transparency, and including prices creates transparency.

Since most patients genuinely want to help other patients make informed medical decisions, the reviews tend to be thoughtful and thorough, and many of them contain multiple before-and-after photos. As a physician perusing the patient reviews, you’ll start to notice that most of them are reasonable. For example, customer satisfaction with laser treatment for melasma was 51%, whereas satisfaction for laser treatment for rosacea was 80%.

Patients and prospective patients are flocking to the site because it allows them to share their experiences, interact with other patients, and gain access to physician experts in the field. Many patients have difficulty making decisions about cosmetic procedures; RealSelf aims to alleviate their fears and help them "make confident health and beauty decisions." If a prospective patient wants to see a video of tattoo removal or Botox injections, he or she can. If a patient wants to ask physicians their opinions, he or she can. According to RealSelf, physicians have answered over 500,000 questions on the site.

Of course, all this isn’t free for physicians. RealSelf is a business. They have a tiered membership – free, pro, and spotlight. To obtain free membership, you simply visit the site and follow the prompts to "claim your profile." Once your profile is completed, you will have access to a "doctor advisor" who can help you "optimize your visibility on the site." Both "pro" and "spotlight" offer additional benefits, such as integrating patient reviews on your practice website, promotions on Facebook and Twitter, extended directory listings, and exposure in your local area. RealSelf does not discuss costs of membership until you have claimed your profile.

Only you can determine if RealSelf is beneficial to you and your practice. If, for example, you’re not looking for new patients, then you might find it unnecessary. But at the very least, you’ll know what RealSelf is the next time a fellow cosmetic physician brings it up at a conference. And it’s never a bad idea to be familiar with current social technologies that may affect your livelihood.

If you’ve used RealSelf, let us know what you think. For more information, visit RealSelf.com.

Disclaimer: I have no financial interest in RealSelf and am not an active member.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @Dermdoc on Twitter.

My wife and I recently (and successfully) had our kitchen and bathrooms remodeled. It wouldn’t have been possible without Pinterest.

For the uninitiated, Pinterest is a wildly popular social media site that allows users to find, share, and organize images called "pins." Pinterest launched in September 2010, and today it has more than 70 million active users. It’s one of the fastest-growing social media sites in history, and it ranks as one of the Top 50 most-visited websites in the United States.

In a previous column about Pinterest, I mentioned several reasons why it’s important for your medical practice. More than 80% of Pinterest users are female, and, according to the U.S. Department of Labor, women make 80% of health care decisions for their families. Therefore, Pinterest could be a persuasive marketing tool for physicians looking to expand their practices. Pinterest also can be an effective platform to share patient stories, to introduce your practice and staff to the public, and to show before and after images of medical procedures.

New research from Vision Critical, the world’s leading provider of Insight Communities, discovered a surprising new finding about Pinterest (published in the July-August 2013 issue of Harvard Business Review).

The researchers examined "showrooming," a phenomenon whereby shoppers visit actual stores to examine merchandise before purchasing it online. They say the threat is so intense to brick-and-mortar stores that at least one merchant has begun charging people to browse in his store! Their research, however, shows much less of a threat. Of the 3,000 social media users they surveyed, only 26% reported "regularly engaging in showrooming."

What they found more surprising was that 41% of respondents said that practice "reverse showrooming;" that is, they browse online first then purchase the product in a store. That’s exactly what my wife did when choosing and purchasing our new furniture, lighting fixtures, wallpaper, paint, and more.

This led me to contemplate how "reverse showrooming" might help a physician market his or her medical practice. First, understand that Pinterest relies on aspirational messaging. Marketers use images that tap into our desires, wants, and dreams. Pinterest typically represents our idealized selves – the fashion-forward woman, the perfect garden wedding, the sublime oceanfront hotel room. Pinterest is about the version of you that you want to become. The you with flawless skin, lustrous hair, and smooth thighs.

Pinterest can be a powerful marketing tool for dermatologists, particularly cosmetic dermatologists. Consider the Pinterest customer base: Data show that 83% of Pinterest users are female and 45% are aged 35-54 years. Consumers turn to Pinterest largely for fashion and beauty, DIY projects, home design, inspiration, education, humor, and product recommendations. In fact, Pinterest has become the No. 1 traffic driver to websites of women’s lifestyle magazines.

You can use Pinterest to drive traffic to your office website, where people can book appointments or buy products online. Although no formal data exist for physician referrals from Pinterest, the study showed that the social-to-sale purchasing power was 17% for hair and beauty products and women’s and men’s apparel.

How can Pinterest help you market your practice and encourage "pinners" to "reverse showroom" into your office? Let’s use the example of a cosmetic surgeon who is seeking to expand her patient base and promote her organic skincare product line.

Pinterest users are more likely to purchase items that are easy to find. So, if they’re looking for an organic sunscreen, and they click through the Pinterest image the doctor posted and land on her website where they can buy it, then they’ll be more apt to do so. Research shows that the likelihood of a purchase increases by an additional 34% when there are existing reviews and recommendations for the product, and 30% when there are product details provided.

Pins don’t have to be strictly medical; consider more purely social boards that relate to your specialty, such as the following examples:

Family practice doctors could use Pinterest for wellness promotion, with boards for spreading happiness, healthy recipes, and habits of healthy families. Oncologists could use Pinterest to share inspirational patient testimonials, best foods for chemotherapy patients, and support for caregivers. Ob.gyns could use Pinterest as an outreach tool for expectant and new moms with boards for breast-feeding tutorials, fashionable maternity clothing, and cool baby gear.

Pinterest has proven to deliver value to businesses. With the above recommendations, you can quickly and cost-effectively add this platform to your marketing and patient relationship efforts.

Dr. Jeffrey Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @Dermdoc on Twitter.

My wife and I recently (and successfully) had our kitchen and bathrooms remodeled. It wouldn’t have been possible without Pinterest.

For the uninitiated, Pinterest is a wildly popular social media site that allows users to find, share, and organize images called "pins." Pinterest launched in September 2010, and today it has more than 70 million active users. It’s one of the fastest-growing social media sites in history, and it ranks as one of the Top 50 most-visited websites in the United States.

In a previous column about Pinterest, I mentioned several reasons why it’s important for your medical practice. More than 80% of Pinterest users are female, and, according to the U.S. Department of Labor, women make 80% of health care decisions for their families. Therefore, Pinterest could be a persuasive marketing tool for physicians looking to expand their practices. Pinterest also can be an effective platform to share patient stories, to introduce your practice and staff to the public, and to show before and after images of medical procedures.

New research from Vision Critical, the world’s leading provider of Insight Communities, discovered a surprising new finding about Pinterest (published in the July-August 2013 issue of Harvard Business Review).

The researchers examined "showrooming," a phenomenon whereby shoppers visit actual stores to examine merchandise before purchasing it online. They say the threat is so intense to brick-and-mortar stores that at least one merchant has begun charging people to browse in his store! Their research, however, shows much less of a threat. Of the 3,000 social media users they surveyed, only 26% reported "regularly engaging in showrooming."

What they found more surprising was that 41% of respondents said that practice "reverse showrooming;" that is, they browse online first then purchase the product in a store. That’s exactly what my wife did when choosing and purchasing our new furniture, lighting fixtures, wallpaper, paint, and more.

This led me to contemplate how "reverse showrooming" might help a physician market his or her medical practice. First, understand that Pinterest relies on aspirational messaging. Marketers use images that tap into our desires, wants, and dreams. Pinterest typically represents our idealized selves – the fashion-forward woman, the perfect garden wedding, the sublime oceanfront hotel room. Pinterest is about the version of you that you want to become. The you with flawless skin, lustrous hair, and smooth thighs.

Pinterest can be a powerful marketing tool for dermatologists, particularly cosmetic dermatologists. Consider the Pinterest customer base: Data show that 83% of Pinterest users are female and 45% are aged 35-54 years. Consumers turn to Pinterest largely for fashion and beauty, DIY projects, home design, inspiration, education, humor, and product recommendations. In fact, Pinterest has become the No. 1 traffic driver to websites of women’s lifestyle magazines.

You can use Pinterest to drive traffic to your office website, where people can book appointments or buy products online. Although no formal data exist for physician referrals from Pinterest, the study showed that the social-to-sale purchasing power was 17% for hair and beauty products and women’s and men’s apparel.

How can Pinterest help you market your practice and encourage "pinners" to "reverse showroom" into your office? Let’s use the example of a cosmetic surgeon who is seeking to expand her patient base and promote her organic skincare product line.

Pinterest users are more likely to purchase items that are easy to find. So, if they’re looking for an organic sunscreen, and they click through the Pinterest image the doctor posted and land on her website where they can buy it, then they’ll be more apt to do so. Research shows that the likelihood of a purchase increases by an additional 34% when there are existing reviews and recommendations for the product, and 30% when there are product details provided.

Pins don’t have to be strictly medical; consider more purely social boards that relate to your specialty, such as the following examples:

Family practice doctors could use Pinterest for wellness promotion, with boards for spreading happiness, healthy recipes, and habits of healthy families. Oncologists could use Pinterest to share inspirational patient testimonials, best foods for chemotherapy patients, and support for caregivers. Ob.gyns could use Pinterest as an outreach tool for expectant and new moms with boards for breast-feeding tutorials, fashionable maternity clothing, and cool baby gear.

Pinterest has proven to deliver value to businesses. With the above recommendations, you can quickly and cost-effectively add this platform to your marketing and patient relationship efforts.

Dr. Jeffrey Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @Dermdoc on Twitter.

My wife and I recently (and successfully) had our kitchen and bathrooms remodeled. It wouldn’t have been possible without Pinterest.

For the uninitiated, Pinterest is a wildly popular social media site that allows users to find, share, and organize images called "pins." Pinterest launched in September 2010, and today it has more than 70 million active users. It’s one of the fastest-growing social media sites in history, and it ranks as one of the Top 50 most-visited websites in the United States.

In a previous column about Pinterest, I mentioned several reasons why it’s important for your medical practice. More than 80% of Pinterest users are female, and, according to the U.S. Department of Labor, women make 80% of health care decisions for their families. Therefore, Pinterest could be a persuasive marketing tool for physicians looking to expand their practices. Pinterest also can be an effective platform to share patient stories, to introduce your practice and staff to the public, and to show before and after images of medical procedures.

New research from Vision Critical, the world’s leading provider of Insight Communities, discovered a surprising new finding about Pinterest (published in the July-August 2013 issue of Harvard Business Review).

The researchers examined "showrooming," a phenomenon whereby shoppers visit actual stores to examine merchandise before purchasing it online. They say the threat is so intense to brick-and-mortar stores that at least one merchant has begun charging people to browse in his store! Their research, however, shows much less of a threat. Of the 3,000 social media users they surveyed, only 26% reported "regularly engaging in showrooming."

What they found more surprising was that 41% of respondents said that practice "reverse showrooming;" that is, they browse online first then purchase the product in a store. That’s exactly what my wife did when choosing and purchasing our new furniture, lighting fixtures, wallpaper, paint, and more.

This led me to contemplate how "reverse showrooming" might help a physician market his or her medical practice. First, understand that Pinterest relies on aspirational messaging. Marketers use images that tap into our desires, wants, and dreams. Pinterest typically represents our idealized selves – the fashion-forward woman, the perfect garden wedding, the sublime oceanfront hotel room. Pinterest is about the version of you that you want to become. The you with flawless skin, lustrous hair, and smooth thighs.

Pinterest can be a powerful marketing tool for dermatologists, particularly cosmetic dermatologists. Consider the Pinterest customer base: Data show that 83% of Pinterest users are female and 45% are aged 35-54 years. Consumers turn to Pinterest largely for fashion and beauty, DIY projects, home design, inspiration, education, humor, and product recommendations. In fact, Pinterest has become the No. 1 traffic driver to websites of women’s lifestyle magazines.

You can use Pinterest to drive traffic to your office website, where people can book appointments or buy products online. Although no formal data exist for physician referrals from Pinterest, the study showed that the social-to-sale purchasing power was 17% for hair and beauty products and women’s and men’s apparel.

How can Pinterest help you market your practice and encourage "pinners" to "reverse showroom" into your office? Let’s use the example of a cosmetic surgeon who is seeking to expand her patient base and promote her organic skincare product line.

Pinterest users are more likely to purchase items that are easy to find. So, if they’re looking for an organic sunscreen, and they click through the Pinterest image the doctor posted and land on her website where they can buy it, then they’ll be more apt to do so. Research shows that the likelihood of a purchase increases by an additional 34% when there are existing reviews and recommendations for the product, and 30% when there are product details provided.

Pins don’t have to be strictly medical; consider more purely social boards that relate to your specialty, such as the following examples:

Family practice doctors could use Pinterest for wellness promotion, with boards for spreading happiness, healthy recipes, and habits of healthy families. Oncologists could use Pinterest to share inspirational patient testimonials, best foods for chemotherapy patients, and support for caregivers. Ob.gyns could use Pinterest as an outreach tool for expectant and new moms with boards for breast-feeding tutorials, fashionable maternity clothing, and cool baby gear.

Pinterest has proven to deliver value to businesses. With the above recommendations, you can quickly and cost-effectively add this platform to your marketing and patient relationship efforts.

Dr. Jeffrey Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @Dermdoc on Twitter.

The last time I gave the talk, "Help! I’ve Been Yelped!" to physicians, there was a full house, a sometimes defiant, sometimes incredulous but always engaged full house. Most physicians don’t like Yelp and other online doctor rating sites because of the potential for negative reviews.

In past columns, I’ve written about these sites and how to respond to negative reviews and comments. Now, I’m going to share data on the use of online reviews and why they are important.

We live in a digital world that values reviews. We compare hotels on TripAdvisor.com before booking them and read reviews on Amazon.com before ordering products. We "like" or "dislike" Facebook pages and give thumbs up or thumbs down to videos on YouTube. We even rate physicians’ comments on medical question-and-answer sites such as HealthTap.com.

But how much do all of these online ratings really matter? A 2012 Nielsen report that surveyed more than 28,000 Internet users in 56 countries found that online consumer reviews are the second-most-trusted source of brand information, following only recommendations from family and friends. In other words, we trust online reviews and use them to make our own decisions.

The same is true when it comes to shopping for a doctor. According to an Internet-based survey of 2,137 adults published in the February issue of JAMA, 59% of respondents said that online doctor ratings were either "somewhat important" or "very important" when choosing a physician (2014;11:734-5).

Similarly, the "2013 Industry View Report" by Software Advice found that 62% of respondents said they read online reviews when seeking a new doctor. Although HealthGrades.com was the most commonly used site, Yelp.com was the most trusted. Forty-four percent of those respondents considered Yelp the most trustworthy review site followed by Health Grades (31%), Vitals.com (17%), and ZocDoc.com (7%).

Whether or not we trust Yelp and other online review sites, our patients do. In the JAMA survey, 35% of respondents said that they selected a physician based on good ratings, while 37% said that they avoided a physician with negative reviews. The 2013 Industry View Report also found that 45% of respondents ranked "quality of care" as the most important type of information sought about a doctor. And since many patients equate service with quality, reviews that focus on service matter.

This isn’t an entirely bad thing. If we really listen to what patients are saying, their comments can help us to improve service and communication. And, in some instances, it can lead to stronger doctor-patient relationships. Like many other industries, health care is moving toward transparency, and doctor rating sites are a key component of that.

Dr. Jeffrey Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. He has published numerous scientific articles and is a member and fellow of the American Academy of Dermatology, and a member of the Telemedicine Association and the American Medical Association, among others. He is board certified in dermatology as well as medicine and surgery in the state of California. Dr. Benabio has a special interest in the uses of social media for education and building dermatology practice. He is the founder of The Derm Blog, an educational website that has had more than 2 million unique visitors. Dr. Benabio is also a founding member and the skin care expert for Livestrong.com, a health and wellness website of Lance Armstrong’s the Livestrong Foundation. Dr. Benabio is @Dermdoc on Twitter.

The last time I gave the talk, "Help! I’ve Been Yelped!" to physicians, there was a full house, a sometimes defiant, sometimes incredulous but always engaged full house. Most physicians don’t like Yelp and other online doctor rating sites because of the potential for negative reviews.

In past columns, I’ve written about these sites and how to respond to negative reviews and comments. Now, I’m going to share data on the use of online reviews and why they are important.

We live in a digital world that values reviews. We compare hotels on TripAdvisor.com before booking them and read reviews on Amazon.com before ordering products. We "like" or "dislike" Facebook pages and give thumbs up or thumbs down to videos on YouTube. We even rate physicians’ comments on medical question-and-answer sites such as HealthTap.com.

But how much do all of these online ratings really matter? A 2012 Nielsen report that surveyed more than 28,000 Internet users in 56 countries found that online consumer reviews are the second-most-trusted source of brand information, following only recommendations from family and friends. In other words, we trust online reviews and use them to make our own decisions.

The same is true when it comes to shopping for a doctor. According to an Internet-based survey of 2,137 adults published in the February issue of JAMA, 59% of respondents said that online doctor ratings were either "somewhat important" or "very important" when choosing a physician (2014;11:734-5).

Similarly, the "2013 Industry View Report" by Software Advice found that 62% of respondents said they read online reviews when seeking a new doctor. Although HealthGrades.com was the most commonly used site, Yelp.com was the most trusted. Forty-four percent of those respondents considered Yelp the most trustworthy review site followed by Health Grades (31%), Vitals.com (17%), and ZocDoc.com (7%).

Whether or not we trust Yelp and other online review sites, our patients do. In the JAMA survey, 35% of respondents said that they selected a physician based on good ratings, while 37% said that they avoided a physician with negative reviews. The 2013 Industry View Report also found that 45% of respondents ranked "quality of care" as the most important type of information sought about a doctor. And since many patients equate service with quality, reviews that focus on service matter.

This isn’t an entirely bad thing. If we really listen to what patients are saying, their comments can help us to improve service and communication. And, in some instances, it can lead to stronger doctor-patient relationships. Like many other industries, health care is moving toward transparency, and doctor rating sites are a key component of that.

Dr. Jeffrey Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. He has published numerous scientific articles and is a member and fellow of the American Academy of Dermatology, and a member of the Telemedicine Association and the American Medical Association, among others. He is board certified in dermatology as well as medicine and surgery in the state of California. Dr. Benabio has a special interest in the uses of social media for education and building dermatology practice. He is the founder of The Derm Blog, an educational website that has had more than 2 million unique visitors. Dr. Benabio is also a founding member and the skin care expert for Livestrong.com, a health and wellness website of Lance Armstrong’s the Livestrong Foundation. Dr. Benabio is @Dermdoc on Twitter.

The last time I gave the talk, "Help! I’ve Been Yelped!" to physicians, there was a full house, a sometimes defiant, sometimes incredulous but always engaged full house. Most physicians don’t like Yelp and other online doctor rating sites because of the potential for negative reviews.

In past columns, I’ve written about these sites and how to respond to negative reviews and comments. Now, I’m going to share data on the use of online reviews and why they are important.

We live in a digital world that values reviews. We compare hotels on TripAdvisor.com before booking them and read reviews on Amazon.com before ordering products. We "like" or "dislike" Facebook pages and give thumbs up or thumbs down to videos on YouTube. We even rate physicians’ comments on medical question-and-answer sites such as HealthTap.com.

But how much do all of these online ratings really matter? A 2012 Nielsen report that surveyed more than 28,000 Internet users in 56 countries found that online consumer reviews are the second-most-trusted source of brand information, following only recommendations from family and friends. In other words, we trust online reviews and use them to make our own decisions.

The same is true when it comes to shopping for a doctor. According to an Internet-based survey of 2,137 adults published in the February issue of JAMA, 59% of respondents said that online doctor ratings were either "somewhat important" or "very important" when choosing a physician (2014;11:734-5).

Similarly, the "2013 Industry View Report" by Software Advice found that 62% of respondents said they read online reviews when seeking a new doctor. Although HealthGrades.com was the most commonly used site, Yelp.com was the most trusted. Forty-four percent of those respondents considered Yelp the most trustworthy review site followed by Health Grades (31%), Vitals.com (17%), and ZocDoc.com (7%).

Whether or not we trust Yelp and other online review sites, our patients do. In the JAMA survey, 35% of respondents said that they selected a physician based on good ratings, while 37% said that they avoided a physician with negative reviews. The 2013 Industry View Report also found that 45% of respondents ranked "quality of care" as the most important type of information sought about a doctor. And since many patients equate service with quality, reviews that focus on service matter.

This isn’t an entirely bad thing. If we really listen to what patients are saying, their comments can help us to improve service and communication. And, in some instances, it can lead to stronger doctor-patient relationships. Like many other industries, health care is moving toward transparency, and doctor rating sites are a key component of that.

Dr. Jeffrey Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego and a volunteer clinical assistant professor at the University of California, San Diego. He has published numerous scientific articles and is a member and fellow of the American Academy of Dermatology, and a member of the Telemedicine Association and the American Medical Association, among others. He is board certified in dermatology as well as medicine and surgery in the state of California. Dr. Benabio has a special interest in the uses of social media for education and building dermatology practice. He is the founder of The Derm Blog, an educational website that has had more than 2 million unique visitors. Dr. Benabio is also a founding member and the skin care expert for Livestrong.com, a health and wellness website of Lance Armstrong’s the Livestrong Foundation. Dr. Benabio is @Dermdoc on Twitter.

"You should always consider three differential diagnoses for each patient." This was sound advice from my dermatology residency director, but advice I often neglect to take. What about you?

If you are like most of us, then your brain in clinic is on autopilot. It instantly selects the diagnosis and moves on. But when pushed by a confusing rash or a disease unresponsive to our standard treatment, we quickly encounter the limits of the human brain.

When stumped, we all do the same thing: Recruit more eyeballs (and brains). We find a colleague nearby and pull him into the room. "So, what do you think this is? What would you do?" Although often helpful, this method is inefficient and fails to capitalize on the most important of all medical tools: the computer.

Unlike our brains, computers in the form of clinical decision support (CDS) tools, are not prone to cognitive errors. Good CDS tools aren’t subject to top-of-mind biases. Their ability to generate differential diagnoses exceeds even the masters among us. Fortunately, there is such a CDS for skin disease: VisualDx.

VisualDx is a CDS tool focused on dermatologic conditions. It covers common and rare skin conditions and has more than 25,000 professional images.

What’s unique here is that VisualDx is more than a database of images. "It is truly a diagnostic decision support tool that allows you to search by multiple factors at once – symptoms, diagnoses, medications, medical history, travel, skin color, etc.," said Dr. Noah Craft, practicing dermatologist and chief medical officer of VisualDx.

In contrast to textbooks and other medical knowledge databases, this system is designed for easy, point-of-care use – it makes a dermatologist’s or even a primary care physician’s work easier. By quickly reviewing photos and diagnostic pearls, our brains are supercharged with deep differentials and management ideas.

For example, I recently had a patient who presented with papulosquamous eruptions that involved his body and hands. Among other diagnoses was secondary syphilis. Yes, I had thought of that, but a quick scan through VisualDx prompted me to ask about other symptoms, including vision changes (which he had). The patient also had HIV. Quick, which test is the best for me to order? Too slow, it’s already there in front of me on my screen.

In addition to improving quality, tools such as these also can improve access. Studies from the company show that the average user saves between 15 and 26 minutes per day using their product. For the working dermatologist, that means being able to see two additional patients a day.

VisualDx also educates and empowers patients. Don’t believe those bumps you have are molluscum? You can see here that these photos look exactly like the bumps you have. Rather than explain conditions through difficult doctor-speak, physicians can show complex knowledge to patients visually. As Dr. Craft notes and many of us have experienced: "For many patients, seeing is believing."

Whether it’s corroborating a diagnosis or exploring treatment options, having the doctor and patient share the same screen is an effective way to increase comprehension and build trust. No matter how good our drawings on the back of a prescription pad may be, they are not as accurate or helpful as curated digital photos. Our screen-savvy patients will soon expect this type of technology with every visit.

Good digital medicine tools also will help remedy one of medicine’s oldest and most glaring defects: We don’t account for the fact that the vast majority of health care happens in between doctor visits. Now patient education doesn’t stop at the culmination of the visit. Physicians can either print or e-mail images and information to patients so that they can have an accurate record at home to share with family members and caregivers.

VisualDx is a leading technology in what will be the future of medicine: Digital tools that serve doctors with everything they need to diagnose and treat patients with a click or flick of the screen. Having ten thousand treatment options instantly in your pocket – try that with any lab coat reference book.

Oftentimes, technology is more sparkle than substance. Not so with VisualDx. Have you used it in your practice? Let us know what you think about it.

For more information and to learn how to subscribe, visit www.visualdx.com. VisualDx is a paid subscription service.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Dr. Benabio said he has no financial interest in VisualDx, but he has had complimentary access. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.

"You should always consider three differential diagnoses for each patient." This was sound advice from my dermatology residency director, but advice I often neglect to take. What about you?

If you are like most of us, then your brain in clinic is on autopilot. It instantly selects the diagnosis and moves on. But when pushed by a confusing rash or a disease unresponsive to our standard treatment, we quickly encounter the limits of the human brain.

When stumped, we all do the same thing: Recruit more eyeballs (and brains). We find a colleague nearby and pull him into the room. "So, what do you think this is? What would you do?" Although often helpful, this method is inefficient and fails to capitalize on the most important of all medical tools: the computer.

Unlike our brains, computers in the form of clinical decision support (CDS) tools, are not prone to cognitive errors. Good CDS tools aren’t subject to top-of-mind biases. Their ability to generate differential diagnoses exceeds even the masters among us. Fortunately, there is such a CDS for skin disease: VisualDx.

VisualDx is a CDS tool focused on dermatologic conditions. It covers common and rare skin conditions and has more than 25,000 professional images.

What’s unique here is that VisualDx is more than a database of images. "It is truly a diagnostic decision support tool that allows you to search by multiple factors at once – symptoms, diagnoses, medications, medical history, travel, skin color, etc.," said Dr. Noah Craft, practicing dermatologist and chief medical officer of VisualDx.

In contrast to textbooks and other medical knowledge databases, this system is designed for easy, point-of-care use – it makes a dermatologist’s or even a primary care physician’s work easier. By quickly reviewing photos and diagnostic pearls, our brains are supercharged with deep differentials and management ideas.

For example, I recently had a patient who presented with papulosquamous eruptions that involved his body and hands. Among other diagnoses was secondary syphilis. Yes, I had thought of that, but a quick scan through VisualDx prompted me to ask about other symptoms, including vision changes (which he had). The patient also had HIV. Quick, which test is the best for me to order? Too slow, it’s already there in front of me on my screen.

In addition to improving quality, tools such as these also can improve access. Studies from the company show that the average user saves between 15 and 26 minutes per day using their product. For the working dermatologist, that means being able to see two additional patients a day.

VisualDx also educates and empowers patients. Don’t believe those bumps you have are molluscum? You can see here that these photos look exactly like the bumps you have. Rather than explain conditions through difficult doctor-speak, physicians can show complex knowledge to patients visually. As Dr. Craft notes and many of us have experienced: "For many patients, seeing is believing."

Whether it’s corroborating a diagnosis or exploring treatment options, having the doctor and patient share the same screen is an effective way to increase comprehension and build trust. No matter how good our drawings on the back of a prescription pad may be, they are not as accurate or helpful as curated digital photos. Our screen-savvy patients will soon expect this type of technology with every visit.

Good digital medicine tools also will help remedy one of medicine’s oldest and most glaring defects: We don’t account for the fact that the vast majority of health care happens in between doctor visits. Now patient education doesn’t stop at the culmination of the visit. Physicians can either print or e-mail images and information to patients so that they can have an accurate record at home to share with family members and caregivers.

VisualDx is a leading technology in what will be the future of medicine: Digital tools that serve doctors with everything they need to diagnose and treat patients with a click or flick of the screen. Having ten thousand treatment options instantly in your pocket – try that with any lab coat reference book.

Oftentimes, technology is more sparkle than substance. Not so with VisualDx. Have you used it in your practice? Let us know what you think about it.

For more information and to learn how to subscribe, visit www.visualdx.com. VisualDx is a paid subscription service.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Dr. Benabio said he has no financial interest in VisualDx, but he has had complimentary access. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.

"You should always consider three differential diagnoses for each patient." This was sound advice from my dermatology residency director, but advice I often neglect to take. What about you?

If you are like most of us, then your brain in clinic is on autopilot. It instantly selects the diagnosis and moves on. But when pushed by a confusing rash or a disease unresponsive to our standard treatment, we quickly encounter the limits of the human brain.

When stumped, we all do the same thing: Recruit more eyeballs (and brains). We find a colleague nearby and pull him into the room. "So, what do you think this is? What would you do?" Although often helpful, this method is inefficient and fails to capitalize on the most important of all medical tools: the computer.

Unlike our brains, computers in the form of clinical decision support (CDS) tools, are not prone to cognitive errors. Good CDS tools aren’t subject to top-of-mind biases. Their ability to generate differential diagnoses exceeds even the masters among us. Fortunately, there is such a CDS for skin disease: VisualDx.

VisualDx is a CDS tool focused on dermatologic conditions. It covers common and rare skin conditions and has more than 25,000 professional images.

What’s unique here is that VisualDx is more than a database of images. "It is truly a diagnostic decision support tool that allows you to search by multiple factors at once – symptoms, diagnoses, medications, medical history, travel, skin color, etc.," said Dr. Noah Craft, practicing dermatologist and chief medical officer of VisualDx.

In contrast to textbooks and other medical knowledge databases, this system is designed for easy, point-of-care use – it makes a dermatologist’s or even a primary care physician’s work easier. By quickly reviewing photos and diagnostic pearls, our brains are supercharged with deep differentials and management ideas.

For example, I recently had a patient who presented with papulosquamous eruptions that involved his body and hands. Among other diagnoses was secondary syphilis. Yes, I had thought of that, but a quick scan through VisualDx prompted me to ask about other symptoms, including vision changes (which he had). The patient also had HIV. Quick, which test is the best for me to order? Too slow, it’s already there in front of me on my screen.

In addition to improving quality, tools such as these also can improve access. Studies from the company show that the average user saves between 15 and 26 minutes per day using their product. For the working dermatologist, that means being able to see two additional patients a day.

VisualDx also educates and empowers patients. Don’t believe those bumps you have are molluscum? You can see here that these photos look exactly like the bumps you have. Rather than explain conditions through difficult doctor-speak, physicians can show complex knowledge to patients visually. As Dr. Craft notes and many of us have experienced: "For many patients, seeing is believing."

Whether it’s corroborating a diagnosis or exploring treatment options, having the doctor and patient share the same screen is an effective way to increase comprehension and build trust. No matter how good our drawings on the back of a prescription pad may be, they are not as accurate or helpful as curated digital photos. Our screen-savvy patients will soon expect this type of technology with every visit.

Good digital medicine tools also will help remedy one of medicine’s oldest and most glaring defects: We don’t account for the fact that the vast majority of health care happens in between doctor visits. Now patient education doesn’t stop at the culmination of the visit. Physicians can either print or e-mail images and information to patients so that they can have an accurate record at home to share with family members and caregivers.

VisualDx is a leading technology in what will be the future of medicine: Digital tools that serve doctors with everything they need to diagnose and treat patients with a click or flick of the screen. Having ten thousand treatment options instantly in your pocket – try that with any lab coat reference book.

Oftentimes, technology is more sparkle than substance. Not so with VisualDx. Have you used it in your practice? Let us know what you think about it.

For more information and to learn how to subscribe, visit www.visualdx.com. VisualDx is a paid subscription service.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Dr. Benabio said he has no financial interest in VisualDx, but he has had complimentary access. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.

Tell me a story. Is there anyone who hasn’t uttered those four words? As humans we are hard wired to both tell and listen to stories. Indeed, professional storyteller Bill Harley, in a 2012 TEDx talk entitled, "Stories Out Loud," said that storytelling is "at the very center of what it means to be human."

This is why storytelling is a powerful marketing tool for you and your practice. In a noisy social media world, stories allow your voice to be heard.

Here are some reasons why you should be using storytelling to market your practice:

• A story is experiential – it shares an experience or observation.

• Stories help us make sense of our lives.

• They help you connect with your patients, build trust, and market your brand.

• They can capture your patients’ attention.

• They can inspire and appeal to emotions.

• Stories are easier to remember than facts and statistics.

• They feel authentic and help show the real you and real patients.

• Stories can be educational by putting difficult concepts into meaningful context.

• They can be an effective call to action for patients.

How powerful is storytelling? Do an Internet search of "patient stories," and the results will feature some of the country’s top hospitals such as the Mayo Clinic, Memorial Sloan-Kettering Cancer Center, and St. Jude's Children's Research Hospital. Take some time visiting these sites. Watch a few videos and ask yourself what makes them effective.

When it comes to marketing your practice, you can tell stories in person to patients, on video, in blog posts, or even in images on sites like Pinterest. Although videos can be done by a professional videographer using ambient lighting and music, they don’t have to be. You might decide to videotape a procedure with your video camera or upload patient stories using your iPhone.

Before using a story, remember to respect patients’ privacy and to get their consent appropriately if they are identifiable in a story. Make sure your story is short, relevant, and compelling and leaves the consumer with a better understanding of the issue.

Do you use stories in your practice? Do you have tips for physicians on how to use stories effectively in their practice? Please share them.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.

Tell me a story. Is there anyone who hasn’t uttered those four words? As humans we are hard wired to both tell and listen to stories. Indeed, professional storyteller Bill Harley, in a 2012 TEDx talk entitled, "Stories Out Loud," said that storytelling is "at the very center of what it means to be human."

This is why storytelling is a powerful marketing tool for you and your practice. In a noisy social media world, stories allow your voice to be heard.

Here are some reasons why you should be using storytelling to market your practice:

• A story is experiential – it shares an experience or observation.

• Stories help us make sense of our lives.

• They help you connect with your patients, build trust, and market your brand.

• They can capture your patients’ attention.

• They can inspire and appeal to emotions.

• Stories are easier to remember than facts and statistics.

• They feel authentic and help show the real you and real patients.

• Stories can be educational by putting difficult concepts into meaningful context.

• They can be an effective call to action for patients.

How powerful is storytelling? Do an Internet search of "patient stories," and the results will feature some of the country’s top hospitals such as the Mayo Clinic, Memorial Sloan-Kettering Cancer Center, and St. Jude's Children's Research Hospital. Take some time visiting these sites. Watch a few videos and ask yourself what makes them effective.

When it comes to marketing your practice, you can tell stories in person to patients, on video, in blog posts, or even in images on sites like Pinterest. Although videos can be done by a professional videographer using ambient lighting and music, they don’t have to be. You might decide to videotape a procedure with your video camera or upload patient stories using your iPhone.

Before using a story, remember to respect patients’ privacy and to get their consent appropriately if they are identifiable in a story. Make sure your story is short, relevant, and compelling and leaves the consumer with a better understanding of the issue.

Do you use stories in your practice? Do you have tips for physicians on how to use stories effectively in their practice? Please share them.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.

Tell me a story. Is there anyone who hasn’t uttered those four words? As humans we are hard wired to both tell and listen to stories. Indeed, professional storyteller Bill Harley, in a 2012 TEDx talk entitled, "Stories Out Loud," said that storytelling is "at the very center of what it means to be human."

This is why storytelling is a powerful marketing tool for you and your practice. In a noisy social media world, stories allow your voice to be heard.

Here are some reasons why you should be using storytelling to market your practice:

• A story is experiential – it shares an experience or observation.

• Stories help us make sense of our lives.

• They help you connect with your patients, build trust, and market your brand.

• They can capture your patients’ attention.

• They can inspire and appeal to emotions.

• Stories are easier to remember than facts and statistics.

• They feel authentic and help show the real you and real patients.

• Stories can be educational by putting difficult concepts into meaningful context.

• They can be an effective call to action for patients.

How powerful is storytelling? Do an Internet search of "patient stories," and the results will feature some of the country’s top hospitals such as the Mayo Clinic, Memorial Sloan-Kettering Cancer Center, and St. Jude's Children's Research Hospital. Take some time visiting these sites. Watch a few videos and ask yourself what makes them effective.

When it comes to marketing your practice, you can tell stories in person to patients, on video, in blog posts, or even in images on sites like Pinterest. Although videos can be done by a professional videographer using ambient lighting and music, they don’t have to be. You might decide to videotape a procedure with your video camera or upload patient stories using your iPhone.

Before using a story, remember to respect patients’ privacy and to get their consent appropriately if they are identifiable in a story. Make sure your story is short, relevant, and compelling and leaves the consumer with a better understanding of the issue.

Do you use stories in your practice? Do you have tips for physicians on how to use stories effectively in their practice? Please share them.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.

A new year holds so much potential. It’s often when we’re at our most ambitious and optimistic. A time when we’re more likely to try something new – learn a language, take up CrossFit, or, even, dive into the social media ocean.

In this column over the last year, I have written about many different social media platforms including Facebook, YouTube, and Pinterest. Many physicians have e-mailed me asking, "Do I really need to be doing social media? Is it more than just a fad?" My answer was and still is, Yes!

The medical landscape is continually evolving, and social media continue to disrupt the traditional roles of doctor and patient. We now have "e-patients," "digital doctors," and doctor-rating sites; hospitals have Facebook pages, and surgeons are tweeting live surgery. Never has the field of medicine been so transparent.

Although I don’t have a crystal ball, I can assure you that social media are here to stay for a long time. So, if you’ve only dipped your toe in the social media waters so far, keep reading; you might find some inspiration to take the plunge in 2014:

• 90% of adults aged 18-24 said they would trust medical information shared by others in their social media networks. Social media communications are simply word of mouth enhanced by technology. Instead of telling their immediate family about you at the dinner table, your patients now have the ability to tell hundreds or thousands of people about you on social media. Create compelling content, make it shareable, and you’ll help build positive word of mouth.

• Social media users are more likely to trust health-related content written by physicians than by any other group. There is a tremendous amount of health care information online, much of it inaccurate. That means content produced by you (for example, through Facebook updates, YouTube videos, and blog posts) is likely to be shared more frequently and to help build your brand as a trusted physician.

• 47% of patients share their medical information online with doctors, and 43% do so with hospitals.

• 77% of patients used search engines prior to booking their medical appointment. If you’re not online, patients won’t find you.

• 41% of patients said social media would affect their choice of a specific doctor, hospital, or medical facility. Online word of mouth has an impact on you and your practice.

• 58% of health care marketers use blogs vs. 74% of all marketers. Maintaining a blog helps you build brand loyalty and gives you a competitive edge against physicians who aren’t online.

• YouTube traffic to hospital websites has increased 119% year to year. Because they’re visual, videos tend to be more memorable for social media users. Whether videos are used to share poignant patient stories, educate patients about specific diseases and treatments, or show how a clinical procedure is performed, they allow you to connect more intimately with patients and prospective patients, and put a human face on your practice.

• Parents are more likely to seek medical information online. Data show that 22% of parents use Facebook vs. 14% of nonparents, and 20% of parents use YouTube vs. 12% of nonparents. Parents want online information they can trust; that means information created by you.

• 51% of patients said they would feel more valued if their health care provider communicated with them digitally. This means exploring other modes of communication such as e-mail, newsletters, blog posts, and Facebook updates.

• 60% of physicians surveyed said social media improve the quality of care delivered to their patients. From physician online communities to Google hangouts, physicians are learning from one another, and often from patients, making them better clinicians.

Sources include DC Interactive Group, Demi and Cooper Advertising, Media Bistro, PWC Health Research Institute, and TeleVox.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.

A new year holds so much potential. It’s often when we’re at our most ambitious and optimistic. A time when we’re more likely to try something new – learn a language, take up CrossFit, or, even, dive into the social media ocean.

In this column over the last year, I have written about many different social media platforms including Facebook, YouTube, and Pinterest. Many physicians have e-mailed me asking, "Do I really need to be doing social media? Is it more than just a fad?" My answer was and still is, Yes!

The medical landscape is continually evolving, and social media continue to disrupt the traditional roles of doctor and patient. We now have "e-patients," "digital doctors," and doctor-rating sites; hospitals have Facebook pages, and surgeons are tweeting live surgery. Never has the field of medicine been so transparent.

Although I don’t have a crystal ball, I can assure you that social media are here to stay for a long time. So, if you’ve only dipped your toe in the social media waters so far, keep reading; you might find some inspiration to take the plunge in 2014:

• 90% of adults aged 18-24 said they would trust medical information shared by others in their social media networks. Social media communications are simply word of mouth enhanced by technology. Instead of telling their immediate family about you at the dinner table, your patients now have the ability to tell hundreds or thousands of people about you on social media. Create compelling content, make it shareable, and you’ll help build positive word of mouth.

• Social media users are more likely to trust health-related content written by physicians than by any other group. There is a tremendous amount of health care information online, much of it inaccurate. That means content produced by you (for example, through Facebook updates, YouTube videos, and blog posts) is likely to be shared more frequently and to help build your brand as a trusted physician.

• 47% of patients share their medical information online with doctors, and 43% do so with hospitals.

• 77% of patients used search engines prior to booking their medical appointment. If you’re not online, patients won’t find you.

• 41% of patients said social media would affect their choice of a specific doctor, hospital, or medical facility. Online word of mouth has an impact on you and your practice.

• 58% of health care marketers use blogs vs. 74% of all marketers. Maintaining a blog helps you build brand loyalty and gives you a competitive edge against physicians who aren’t online.

• YouTube traffic to hospital websites has increased 119% year to year. Because they’re visual, videos tend to be more memorable for social media users. Whether videos are used to share poignant patient stories, educate patients about specific diseases and treatments, or show how a clinical procedure is performed, they allow you to connect more intimately with patients and prospective patients, and put a human face on your practice.

• Parents are more likely to seek medical information online. Data show that 22% of parents use Facebook vs. 14% of nonparents, and 20% of parents use YouTube vs. 12% of nonparents. Parents want online information they can trust; that means information created by you.

• 51% of patients said they would feel more valued if their health care provider communicated with them digitally. This means exploring other modes of communication such as e-mail, newsletters, blog posts, and Facebook updates.

• 60% of physicians surveyed said social media improve the quality of care delivered to their patients. From physician online communities to Google hangouts, physicians are learning from one another, and often from patients, making them better clinicians.

Sources include DC Interactive Group, Demi and Cooper Advertising, Media Bistro, PWC Health Research Institute, and TeleVox.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.

A new year holds so much potential. It’s often when we’re at our most ambitious and optimistic. A time when we’re more likely to try something new – learn a language, take up CrossFit, or, even, dive into the social media ocean.

In this column over the last year, I have written about many different social media platforms including Facebook, YouTube, and Pinterest. Many physicians have e-mailed me asking, "Do I really need to be doing social media? Is it more than just a fad?" My answer was and still is, Yes!

The medical landscape is continually evolving, and social media continue to disrupt the traditional roles of doctor and patient. We now have "e-patients," "digital doctors," and doctor-rating sites; hospitals have Facebook pages, and surgeons are tweeting live surgery. Never has the field of medicine been so transparent.

Although I don’t have a crystal ball, I can assure you that social media are here to stay for a long time. So, if you’ve only dipped your toe in the social media waters so far, keep reading; you might find some inspiration to take the plunge in 2014:

• 90% of adults aged 18-24 said they would trust medical information shared by others in their social media networks. Social media communications are simply word of mouth enhanced by technology. Instead of telling their immediate family about you at the dinner table, your patients now have the ability to tell hundreds or thousands of people about you on social media. Create compelling content, make it shareable, and you’ll help build positive word of mouth.

• Social media users are more likely to trust health-related content written by physicians than by any other group. There is a tremendous amount of health care information online, much of it inaccurate. That means content produced by you (for example, through Facebook updates, YouTube videos, and blog posts) is likely to be shared more frequently and to help build your brand as a trusted physician.

• 47% of patients share their medical information online with doctors, and 43% do so with hospitals.

• 77% of patients used search engines prior to booking their medical appointment. If you’re not online, patients won’t find you.

• 41% of patients said social media would affect their choice of a specific doctor, hospital, or medical facility. Online word of mouth has an impact on you and your practice.

• 58% of health care marketers use blogs vs. 74% of all marketers. Maintaining a blog helps you build brand loyalty and gives you a competitive edge against physicians who aren’t online.

• YouTube traffic to hospital websites has increased 119% year to year. Because they’re visual, videos tend to be more memorable for social media users. Whether videos are used to share poignant patient stories, educate patients about specific diseases and treatments, or show how a clinical procedure is performed, they allow you to connect more intimately with patients and prospective patients, and put a human face on your practice.

• Parents are more likely to seek medical information online. Data show that 22% of parents use Facebook vs. 14% of nonparents, and 20% of parents use YouTube vs. 12% of nonparents. Parents want online information they can trust; that means information created by you.

• 51% of patients said they would feel more valued if their health care provider communicated with them digitally. This means exploring other modes of communication such as e-mail, newsletters, blog posts, and Facebook updates.

• 60% of physicians surveyed said social media improve the quality of care delivered to their patients. From physician online communities to Google hangouts, physicians are learning from one another, and often from patients, making them better clinicians.

Sources include DC Interactive Group, Demi and Cooper Advertising, Media Bistro, PWC Health Research Institute, and TeleVox.

Dr. Benabio is a practicing dermatologist and physician director of health care transformation at Kaiser Permanente in San Diego. Connect with him on Twitter @Dermdoc or drop him a line at benabio@gmail.com.