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Engaging with Patients Online
The do’s and don’t’s, and what’s to gain
Katja Reuter, PhD
Director of Digital Innovation and Communication
Southern California Clinical and Translational Science Institute (SC CTSI)
University of Southern California
Presented at the Annual Meeting of the American College of Rheumatology (ACR) and Association
of Rheumatology Health Professionals (ARHP), Nov 15, 2016, Washington DC
Presenter Disclosure Information
Katja Reuter, PhD
Southern California Clinical and Translational Science Institute
University of Southern California
Financial Disclosure
No relevant financial relationships exist.
Today’s Focus
Digital and social media communication strategies
Not reflected are promsing options such as mobile
health, electronic health records, meaningful use, etc.
Defining a Successful Digital Scholar
Digital
Scholar
Researcher who understands how to
use the wealth of possibilities that the
web offers to achieve his/her research
goals.
Research Roadmap
Digital
Scholar
Develop a
Research
Idea
Secure
Funding
Design
a Study
Start-Up
a Study
Find
Collaborators
Build your
Reputation
& Network
Manage Your
Online
Reputation
Collect
& Manage
Your Data
Analyze
a Study
Measure
your
Reach &
Impact
Recruit
Study
Participants
Disseminate
Your
Findings
Today’s Focus
1. The potential
2. Finding and listening to patients online
3. Developing your digital communications strategy
4. Engaging and recruiting patients through digital
communication approaches
5. Digital health content regulations, guidelines, and
ethics
6. Measuring the results of your digital efforts
7. Online reputation management
The Digital Patient
Ref. Pew Internet Research. Social Media Usage: 2005-2015. Pew Research Center, October 2015.;
http://www.cdwcommunit.com/perspectives/expert-perspectives/todays-digital-patient/
65% of Adults Use Social Networking Sites
Nearly tenfold jump in the past decade
Misconceptions
People don’t want to read about clinical research online.
Actually: The use of the Internet as a top source for clinical
research information has increased significantly (46% in 2013).
[Ref. Report on clinical trial information seekers. Perceptions and insights study. The Center for Information &
Study on Clinical Research Participation; 2013.]
More than 40% of the public reports that they have used social
media to learn about clinical research, with social network
Facebook topping the list. [Ref. Harris-Interactive, 2004.]
Who Can be Reached through
Social Media?
35% of all those 65 and older report using social media.
Young adults (ages 18 to 29) are the most likely to use
social media – fully 90% do.
Women (68%) and men (62%) use social media at similar
rates.
[Ref. Social Media Usage: 2005-2015. Pew Research Center, October 2015.
http://www.pewinternet.org/2015/10/08/social-networking-usage-2005-2015/]
Misconceptions
There are no notable differences in social media usage by
racial or ethnic group (65% of whites, 65% of Hispanics, and
56% of African-Americans).
[Ref. Social Media Usage: 2005-2015. Pew Research Center, October 2015.
http://www.pewinternet.org/2015/10/08/social-networking-usage-2005-2015/]
More than half (56%) of those living in the lowest-income
households now use social media.
Those who live in rural areas are less likely than those in
suburban and urban communities to use social media (58% of rural
residents, 68% of suburban residents, and 64% of urban
residents).
Today’s Focus
1. The potential
2. Finding and listening to patients online
3. Developing your digital communications strategy
4. Engaging and recruiting patients through digital
communication approaches
5. Digital health content regulations, guidelines, and
ethics
6. Measuring the results of your digital efforts
7. Online reputation management
Digital Scholar Presentation: Part 1
LeAnna J. Carey
SYMPLUR
“What Rheumatologists Can Learn from Patients’ Online
Conversation?”
Monday, November 14, 2016
Social Media Listening/Monitoring
 Listen to ongoing conversations about the study disease or related
aspects to learn…
Who talks about the disease area?
What do they say?
Who are the influencers in the disease community?
Consider the voices of patients, physicians, disease
advocates, disease foundations, researchers, medical
centers
Tool Example: The Disease Hashtag Project
Ref. http://www.symplur.com/healthcare-hashtags/diseases/
Example: #Rheum hashtag
Ref. http://www.symplur.com/healthcare-hashtags/rheum/
Tool Example: Social Mention
Ref. http://www.socialmention.com/
What Do Influencers Say?
What Social Media Platforms Do They Use?
Today’s Focus
1. The potential
2. Finding and listening to patients online
3. Developing your digital communications strategy
4. Engaging and recruiting patients through digital
communication approaches
5. Digital health content regulations, guidelines, and
ethics
6. Measuring the results of your digital efforts
7. Online reputation management
Leverage the Spoke-Hub Model
Your Web Page is the Hub
Your Study Web Page is the Hub
Leverage the Spoke-Hub Model
H U B
Your Study
Web Page
v
Online
Search
Engaging with Patients Online: The do’s and don’t’s, and what’s to gain
Share More than Your Research Publications
Research Data & Negative Results
Research Articles (Manuscripts)
Presentations
Images, Video, Podcasts
Perspective/Thought leadership
E x a m p l e s
Software Code
Contributing on Social Media
 Share links: Photos, videos, infographics, tips, novel information,
interesting facts, stats, quotes related to your study
 Answer questions and provide value, e.g., share resources -- re-use
existing content if possible (guide to managing post-surgery pain or
infographic on new treatment option)
 Share random thoughts, e.g., Without clinical studies, medical
treatment would always remain the same. Thanks to all of those who
participate.
 Promote, encourage, and support others
 Target specific populations to increase your relevance
http://33charts.com
Blog Example
Melissa Terras
Professor of Digital Humanities
in, Department of Information
Studies, University College
London; Director of UCL Centre
for Digital Humanities.
Twitter: @melissaterras
“What became clear to me very quickly
was the correlation between talking
about my research online and the spike
in downloads of my papers from our
institutional repository.
Academics need to work on their digital
presence to aid in the dissemination of
their research, to both their subject
peers and the wider community.”
Perspective
http://digitalmediaandscience.wordpress.com/2012/10/05/more-people-look-at-research-if-it-is-promoted-
via-social-media-a-case-study-2/
Tweeting an Open Access Paper
http://melissaterras.blogspot.com/2011/11/what-happens-when-you-tweet-open-access.html
Melissa Terras
Professor of Digital Humanities
in, Department of Information
Studies, University College
London; Director of UCL Centre
for Digital Humanities.
Twitter: @melissaterras
“Upon blogging and tweeting,
within 24 hours, there were, on
average, 70 downloads of my
papers. Now, this might not be
internet meme status, but that’s a
huge leap in interest.”
Perspective
http://digitalmediaandscience.wordpress.com/2012/10/05/more-people-look-at-research-if-it-is-promoted-
via-social-media-a-case-study-2/
Jove: Peer Reviewed Scientific Video Journal
http://www.jove.com,
Example: http://www.jove.com/video/50182/movement-retraining-using-real-time-feedback-of-performance
Citing Social Media Content
http://blog.apastyle.org/apastyle/2013/10/how-to-cite-social-
media-in-apa-style.html
Social Media Video
Figshare
http://figshare.com
You can share…
Figures
Datasets
Media (including video)
Papers (including pre-prints)
Posters
Filesets (groups of files)
Slideshare
http://www.slideshare.net
You can share…
Figures
Datasets
Media (including video)
Papers (including pre-prints)
Posters
Filesets (groups of files)
Turn Your Research Results into an Infographic
Infographics are liked
4x more than presentations,
23x more than documents
Infographics are shared
2x more than presentations,
3x more than documents on other
social networks, such as LinkedIn,
Twitter and Facebook.
http://image.slidesharecdn.com/071813slides
haremakinggreatinfographics2-ig-
130721190926-phpapp01/95/what-makes-
great-infographics-1-638.jpg?cb=1379569751
http://blog.slideshare.net/2013/09/11/infograp
hics-are-more-viral/
http://www.easel.ly
Using Easel.ly to Create Infographics
Citing Infographics
http://blog.apastyle.org/apastyle/2013/10/how-to-cite-social-media-in-apa-style.html
Today’s Focus
1. Defining digital patient engagement
2. Finding and listening to patients online
3. Developing your digital communications strategy
4. Engaging and recruiting patients through digital
communication approaches
5. Digital health content regulations, guidelines, and
ethics
6. Measuring the results of your digital efforts
7. Online reputation management
Examples of Digital Recruitment Successes
Pregnant women were recruited via Facebook and Twitter in 6
months (12-fold higher rate of ±7.5 recruits/month compared to traditional approach)
[Ref. Shere M, Zhao XY, Koren G. The role of social media in recruiting for clinical trials in
pregnancy. PLoS One. 2014 Mar 26;9(3):e92744. ]
45
529 Mothers accessed survey -- promoted via Twitter in nearly 3
months; 299 (56.5%) fully completed it
[Ref. O'Connor A, Jackson L, Goldsmith L, Skirton H. Can I get a retweet please? Health
research recruitment and the Twittersphere. J Adv Nurs. 2014 Mar;70(3):599-609.]
251 People who had searched for stroke-related information online
completed survey -- promoted via Google Search in nearly 4
months (1% out of 25,292, 200+ website visits/day)
[Ref. Kim AS, Poisson SN, Easton JD, Johnston SC. A cross-sectional study of individuals
seeking information on transient ischemic attack and stroke symptoms online: a target for
intervention? PLoS One. 2012;7(10):e47997.]
Social Media
Search Engine Marketing
Anthony Kim, MD
Assistant Professor of Neurology
and is Medical Director of the
UCSF Stroke Center
“We were surprised to see that tens of
thousands of people were regularly
‘asking’ a search engine about stroke-
related symptoms in many cases
shortly after the onset of symptoms.
In fact, every month, about 100 people
were finding our study website by
entering the query: “Am I having a
stroke?” directly into their Google
search box.”
Perspective
http://digitalmediaandscience.wordpress.com/2012/10/31/am-i-having-a-stroke-connecting-with-patients-in-
new-ways-as-they-search-for-health-information-online/
Recruiting Patients Online
http://digitalmediaandscience.wordpress.com/2012/10/31/am-i-having-a-stroke-connecting-with-patients-in-new-ways-as-they-search-
for-health-information-online/
http://digitalmediaandscience.wordpress.com/2012/10/31/am-i-having-a-stroke-connecting-with-patients-in-new-
ways-as-they-search-for-health-information-online/
Digital Information about
Clinical Studies: Checklist
 The creator of digital/social media content is responsible for it.
 Abide by institution’s media guidelines.
 Ensure that the study sponsor is informed of your digital/social
media activity.
 Refrain from providing significant details of any clinical study –
focus on basic study information. Suggestion: Link digital media
content to study page with more information
 Beware of proprietary information.
[Ref. 13]
[Ref. 13]
 Avoid making claims of treatment efficacy or side effects. Use
disclaimers to reduce risk.
 Avoid disclosure of preliminary results or non-public information.
 Bloggers involved in the study should not write about trial or
drug, device, or treatment (could be viewed as advertising).
 Avoid using social media for eligibility screening, refer to
institution and study team.
Digital Information about
Clinical Studies: Checklist
Evaluation Example Messages
You want to promote a study that focuses on the drug nivolumab to see whether it
may help to prevent relapsing in patients with acute myeloid leukemia in remission
after chemotherapy. Relapse remains the main failure of treatment in patients with
acute leukemia after chemotherapy. Nivolumab has already shown impressive
immune therapy results in patients with melanoma, kidney cancer, and non-small-cell
lung cancer. You are trying to enroll men and women 18+.
• Trial length is 2 years.
• Number of visits: 1 every 2 weeks
• Procedures: Blood counts, bone marrow exam, toxicity test
• Compensation: $150
• Medical cost coverage: Drug at no cost; standard follow-up insurance
Breakout Session
Would you use any of these Twitter messages?
#1
#2
#3
Evaluate Example 1
Would you use this Facebook message?
Evaluate Example 2
Would you use this Facebook message?
Evaluate Example 3
Would you use this Facebook message?
Promoting Clinical Research Digitally
Social Media and
Search Engines
Organic Advertising (Paid)
Twitter Yes No
Facebook Yes Yes (Approval required)
Youtube Yes Yes (Approval required)
Pinterest Yes No
Instagram Yes Yes (Approval required)
Google Search Yes Yes (Approval required)
Limited overview
Based on platform posting guidelines, July 2016
[Ref. 13]
 State new treatment, drug, device as investigational/in testing.
 Avoid coercion, the practice of persuading someone to do something
by using force or threats.
 Don’t imply favorable outcomes or post claims regarding safety,
e.g., better treatment, better chances to be cured, safe treatment.
 Don’t promise free medical treatment.
 Don’t emphasize payment for participants, e.g., participants may be
compensated for their time
Digital Recruitment Messages Checklist
FDA and IRB Guidelines Apply to Digital Messages
Today’s Focus
1. Defining digital patient engagement
2. Finding and listening to patients online
3. Developing your digital communications strategy
4. Engaging and recruiting patients through digital
communication approaches
5. Digital health content regulations, guidelines, and
ethics
6. Measuring the results of your digital efforts
7. Online reputation management
Laws and Regulations
Like all research involving humans, federal and
state laws govern social media recruitment
activity.
In addition to Common Rule, FDA regulations,
HIPAA and HITECH may apply.
What IRB Needs to Know
Examples of social media content for IRB review:
 Layout mockup of the web page, including text and any links
provided to the potential participants
 Text of Google Search ad and a static view of the page to
which the ad will direct traffic
 Text of Facebook post or ad and any images and links that
are included
If the social media content is visible to potential study participants, you
should assume it will need IRB approval.
Let IRB know that your social media recruitment strategy and materials will
comply with existing IRB and applicable FDA regulations related to human
subject research. This means adherence to 21 CFR §56 as explained in the
FDA’s longstanding document titled, “Recruiting Study Subjects – Information
Sheet, Guidance for Institutional Review Boards and Clinical Investigators”.
Protection Against HIPAA Violations and
Inappropriate Posting
1. Pay attention to Protected health information (PHI)
1. Draft response messages to manage comments that include PHI,
include them in your IRB protocol for review
Examples:
On Twitter: Dear [@mention]: To protect your privacy, we suggest
you delete your message. Please contact us directly URL/or phone
number
On Facebook: Dear [FIRST NAME]: Thank you for your interest in
our clinical study at Keck Medicine of USC. To ensure the privacy
and confidentiality of [your or your family member’s] health
information, we had to delete your comment. To help answer your
question, please contact us directly via [email], text or phone
[PHONE NUMBER]. We’d be happy to give you a call.
Managing Active Study Participants
 Help them understand that sharing details about their participation
online can …
 distort the results of the study and essentially cause the trial to fail,
 influence how other people perceive or report their own symptoms,
making it hard to tell whether a given drug or treatment is working,
 unblind the study, i.e., if neither the participants nor the clinical trial site
team knows who is on an active drug or a placebo, some participants may
be taking a placebo. Information you share could lead them to report
symptoms that they are not actually experiencing, and
 be misinterpreted by the public, journalists and others.
 TIPS FOR GETTING IT RIGHT
Template Language (Part 1)
 Do discuss your experience confidentially with your
family and other people who are close to you.
 Do talk with your family doctor and other healthcare providers. It’s
important to let them know that you are in a clinical trial.
 Do ask your clinical trial team to provide guidance about where to
obtain reliable educational material online.
 Do keep a journal or take notes on your cell phone so you can make a
list of things to talk about with your clinical trial doctor and study team at
your clinical trial.
Template Language (Part 2)
 Don’t talk publicly, including online, about your
participation in a clinical trial.
 Don’t post online including on social media about your experience in the
trial, including about side effects or about how you think the drug is working.
 Don’t solicit trial advice or information from online friends or people
other than the primary investigator and study team at your clinical trial site.
 Don’t respond to questions or comments online related to the trial
you’re involved in.
 If you do see study-related posts online, please tell the study team.
Understanding Social Media Citations
http://www.apastyle.org/products/4210512.aspx
Citing Social Media Content
http://blog.apastyle.org/apastyle/2013/10/how-to-cite-social-
media-in-apa-style.html
Google+
Citing Social Media Content
http://blog.apastyle.org/apastyle/2013/10/how-to-cite-social-media-in-apa-style.html
Twitter, Individual Author
Today’s Focus
1. Defining digital patient engagement
2. Finding and listening to patients online
3. Developing your digital communications strategy
4. Engaging and recruiting patients through digital
communication approaches
5. Digital health content regulations, guidelines, and
ethics
6. Measuring the results of your digital efforts
7. Online reputation management
Tracking Key Performance Indicators
Examples:
Retweets/Repins
Shares
Replies/comments
Likes
Social media
analytics;
GoogleAdwords
Initiation of
Contact with
Study Team
Social Media
Engagement
Link
Engagement
Website
Engagement
Impressions
Clicks Examples:
Users
Sessions
Time spent on page
Pageviews
Exits
Social media
built-in analytics, e.g.,
Twitter, Facebook,
Pinterest; Google
Adwords
Social media
analytics; Google
Adwords; Buffer;
Hootsuite; Tweetdeck;
Kuku.io; Link
shortening services,
e.g., Ow.ly
M E A S U R E M E N T
T O O L S
Google Analytics;
Piwik
Google Analytics;
Piwik
Altmetrics (Article Level Metrics)
 Citations
 Usage: Downloads, Views
 Social Media Mentions, Shares, Likes,
Comments, Links, Clicks, etc.
 Referring data and knowledge bases
Tools that Calculate Altmetrics
 ImpactStory
 Altmetric.com
 Plum Analytics
 CitedIn
ImpactStory: Example of a Tracking Tool
ImpactStory: Example of a Tracking Tool
Plum Analytics Profile: Antony Williams
Courtesy of
PlumAnalytics
Social Media Reach by Topic Areas
Courtesy of
PlumAnalytics
Funders Start Showing Interest in Alternative
Metrics
http://eprints.icrisat.ac.in/12069/1/value-all-research-products.pdf
Autism Speaks Tracks Research Impact
http://www.ebscohost.com/newsroom/stories/autism-speaks-to-use-plumx-to-track-research-impact
Using Altmetrics in Applications for Promotion
Review by Researchers
Steve Pettifer, PhD
Computer scientist
University of Manchester, UK
Twitter: @srp
“[My mentor] took a look and said,
‘What the hell are these badges
doing in your CV?’ But once I
explained them, he said, 'Well, give
it a go.’ It hit the right note at the
right time. I'm definitely a convert.”
Pettifer added the number of views and public
engagement (e.g., social media mentions) to the CV
entry. He got his promotion. He does not know for
sure whether the metrics helped, but he plans to use
them on future grant applications.
http://www.nature.com/naturejobs/science/articles/10.1038/nj7463-491a
Today’s Focus
1. Defining digital patient engagement
2. Finding and listening to patients online
3. Developing your digital communications strategy
4. Engaging and recruiting patients through digital
communication approaches
5. Digital health content regulations, guidelines, and
ethics
6. Measuring the results of your digital efforts
7. Online reputation management
Online Reputation Management for
Physician-Scientists
1. Pay attention to physician rating and review websites (Note: The
Centers for Medicaid and Medicare Services (CMS) maintain their own
Hospital Consumer Assessment of Healthcare Providers and Systems)
Yelp.com
HealthGrades.com
Vitals.com
RateMD.com
YellowBook.com
LinkedIn.com
Manta.com
MerchantCircle.com
Google+LocalZocDoc.com
RealSelf.com
InsiderPages.com
SuperDoctors.com
Citysearch.com
YahooMaps.com
AngiesList.com
Bing.com
RealSelf.com
UCompareHealthCare.com
YellowBot.com
YahooLocal.com
Avvo.com
EveryDayHealth.com
Wellness.com
Examples; last updated Nov 11, 2016
Online Reputation Management for
Physician-Scientists
1. Pay attention to physician rating and review websites (Note: The
Centers for Medicaid and Medicare Services (CMS) maintain their own
Hospital Consumer Assessment of Healthcare Providers and Systems)
2. Monitor online content that mentions your name and medical practice
(automation saves time)
F R E E F E E A P P L I E S
Google Alerts
SocialMention
Hootsuite
Tweetdeck
Trackur
Reputology
Review Trackers
Review Push
Chatmeter
Reputation Ranger
Review Concierge
Reputation Health
Reputation.com
SocialDraft
Examples; last updated Nov 11, 2016
Online Reputation Management for
Physician-Scientists
1. Pay attention to physician rating and review websites (Note: The
Centers for Medicaid and Medicare Services (CMS) maintain their own
Hospital Consumer Assessment of Healthcare Providers and Systems)
2. Monitor online content that mentions your name and medical practice
3. Improve your online reputation, e.g., encourage patients to share their
positive experiences online via social media, a monthly newsletter, or a
blog. (Note: Asking patients to sign a GAG order is not recommended if
you want to improve your online reputation.)
Online Reputation Management for
Physician-Scientists
1. Pay attention to physician rating and review websites (Note: The
Centers for Medicaid and Medicare Services (CMS) maintain their own
Hospital Consumer Assessment of Healthcare Providers and Systems)
2. Monitor online content that mentions your name and medical practice
3. Improve your online reputation, e.g., encourage patients to share their
positive experiences online via social media, a monthly newsletter, or a
blog. Or, use a third-party service to monitor and manage your
reputation, e.g., Iron Comet, .
4. Don't ignore positive or negative feedback online, e.g., make the effort
to contact the patient personally to discuss it and encourage them to
update their feedback if it is negative. Or, use a third-party service to
monitor and manage your reputation, e.g., Iron Comet, Reputation.com.
When Responding to Online Comments,
Remember to Follow HIPAA Guidelines
1. Don’t share the patient’s physical or mental health information that
could potentially identify him/her.
2. Respond in generalizations, such as “We strive to deliver quality care to
all patients.”
3. Never use patient names in a response, even if they identify themselves
in the comment.
4. Take the conversation offline by asking patients to call your office if you
need to discuss the review further.
Example Responses:
Positive Reviews
1. Thank you for the positive feedback! We appreciate the support.
2. We strive to provide the highest quality in patient care. Thank you so much
for sharing this story with us!
3. Thank you for connecting with us about this experience with our staff. We
will be sure to share this appreciation.
4. Thank you for giving us a great score! Our dedicated staff takes great pride
in serving the <city name> community.
5. Thank you so much for taking the time to share these. Our staff will pass
along the kind words!
6. Our practice aims to deliver the highest quality patient care. We love to hear
about these positive Thanks for sharing this feedback with us!
Example Responses:
Negative Reviews
We are sorry to hear this and truly value your Patient experience is important
to us at <practice name>, so we will make every effort to address any
concerns you may have. Your comments have been shared with <contact at
practice – position/first name >. If you would like to speak with someone about
this experience, please call <position, phone number>.
We are sorry to hear about the long wait time at our practice. We will look into
this and make every effort to improve our wait times in the future.
We are very sorry to hear about this experience in our practice and would like
to look into it. Please call <contact at practice- position/first name> so that we
can get further information to address the situation.
We are always sad to hear someone had trouble reaching our office. We want
all of our patients to be able to communicate with our office easily, so we will
re-examine our phone procedures.
Example Responses:
Negative Reviews
We sincerely apologize for any scheduling and billing issues experienced at
our practice and value this feedback. We are dedicated to providing timely,
patient- centered, quality care and regret that this was not the experience
described. As we work to improve our processes, please don't hesitate to
reach out to our office at <office phone number/PM direct line> to express
your concerns.
Thank you for bringing this billing matter to our attention. We would
appreciate the opportunity to discuss this matter further so the situation can
be Please contact our staff at <### - ### - ####> at your convenience.
Thank you.
Thank you for making us aware of this experience. We sincerely apologize
for any inconvenience that was caused. Please reach out to <contact> at
<phone number> so that we can help resolve this issue.
A C C E S S R E S O U R C E S
http://sc-ctsi.org/digital-scholar/
Thank you!
Contact Information
Katja Reuter, PhD
Director of Digital Innovation and Communication
Southern California Clinical and Translational Science Institute (SC CTSI)
University of Southern California
Email: katja.reuter@usc.edu
Twitter: @dmsci
Blog: https://digitalmediaandscience.wordpress.com

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Engaging with Patients Online: The do’s and don’t’s, and what’s to gain

  • 1. Engaging with Patients Online The do’s and don’t’s, and what’s to gain Katja Reuter, PhD Director of Digital Innovation and Communication Southern California Clinical and Translational Science Institute (SC CTSI) University of Southern California Presented at the Annual Meeting of the American College of Rheumatology (ACR) and Association of Rheumatology Health Professionals (ARHP), Nov 15, 2016, Washington DC
  • 2. Presenter Disclosure Information Katja Reuter, PhD Southern California Clinical and Translational Science Institute University of Southern California Financial Disclosure No relevant financial relationships exist.
  • 3. Today’s Focus Digital and social media communication strategies Not reflected are promsing options such as mobile health, electronic health records, meaningful use, etc.
  • 4. Defining a Successful Digital Scholar Digital Scholar Researcher who understands how to use the wealth of possibilities that the web offers to achieve his/her research goals.
  • 5. Research Roadmap Digital Scholar Develop a Research Idea Secure Funding Design a Study Start-Up a Study Find Collaborators Build your Reputation & Network Manage Your Online Reputation Collect & Manage Your Data Analyze a Study Measure your Reach & Impact Recruit Study Participants Disseminate Your Findings
  • 6. Today’s Focus 1. The potential 2. Finding and listening to patients online 3. Developing your digital communications strategy 4. Engaging and recruiting patients through digital communication approaches 5. Digital health content regulations, guidelines, and ethics 6. Measuring the results of your digital efforts 7. Online reputation management
  • 7. The Digital Patient Ref. Pew Internet Research. Social Media Usage: 2005-2015. Pew Research Center, October 2015.; http://www.cdwcommunit.com/perspectives/expert-perspectives/todays-digital-patient/
  • 8. 65% of Adults Use Social Networking Sites Nearly tenfold jump in the past decade
  • 9. Misconceptions People don’t want to read about clinical research online. Actually: The use of the Internet as a top source for clinical research information has increased significantly (46% in 2013). [Ref. Report on clinical trial information seekers. Perceptions and insights study. The Center for Information & Study on Clinical Research Participation; 2013.] More than 40% of the public reports that they have used social media to learn about clinical research, with social network Facebook topping the list. [Ref. Harris-Interactive, 2004.]
  • 10. Who Can be Reached through Social Media? 35% of all those 65 and older report using social media. Young adults (ages 18 to 29) are the most likely to use social media – fully 90% do. Women (68%) and men (62%) use social media at similar rates. [Ref. Social Media Usage: 2005-2015. Pew Research Center, October 2015. http://www.pewinternet.org/2015/10/08/social-networking-usage-2005-2015/]
  • 11. Misconceptions There are no notable differences in social media usage by racial or ethnic group (65% of whites, 65% of Hispanics, and 56% of African-Americans). [Ref. Social Media Usage: 2005-2015. Pew Research Center, October 2015. http://www.pewinternet.org/2015/10/08/social-networking-usage-2005-2015/] More than half (56%) of those living in the lowest-income households now use social media. Those who live in rural areas are less likely than those in suburban and urban communities to use social media (58% of rural residents, 68% of suburban residents, and 64% of urban residents).
  • 12. Today’s Focus 1. The potential 2. Finding and listening to patients online 3. Developing your digital communications strategy 4. Engaging and recruiting patients through digital communication approaches 5. Digital health content regulations, guidelines, and ethics 6. Measuring the results of your digital efforts 7. Online reputation management
  • 13. Digital Scholar Presentation: Part 1 LeAnna J. Carey SYMPLUR “What Rheumatologists Can Learn from Patients’ Online Conversation?” Monday, November 14, 2016
  • 14. Social Media Listening/Monitoring  Listen to ongoing conversations about the study disease or related aspects to learn… Who talks about the disease area? What do they say? Who are the influencers in the disease community? Consider the voices of patients, physicians, disease advocates, disease foundations, researchers, medical centers
  • 15. Tool Example: The Disease Hashtag Project Ref. http://www.symplur.com/healthcare-hashtags/diseases/
  • 16. Example: #Rheum hashtag Ref. http://www.symplur.com/healthcare-hashtags/rheum/
  • 17. Tool Example: Social Mention Ref. http://www.socialmention.com/
  • 18. What Do Influencers Say? What Social Media Platforms Do They Use?
  • 19. Today’s Focus 1. The potential 2. Finding and listening to patients online 3. Developing your digital communications strategy 4. Engaging and recruiting patients through digital communication approaches 5. Digital health content regulations, guidelines, and ethics 6. Measuring the results of your digital efforts 7. Online reputation management
  • 20. Leverage the Spoke-Hub Model Your Web Page is the Hub
  • 21. Your Study Web Page is the Hub Leverage the Spoke-Hub Model H U B Your Study Web Page v Online Search
  • 23. Share More than Your Research Publications Research Data & Negative Results Research Articles (Manuscripts) Presentations Images, Video, Podcasts Perspective/Thought leadership E x a m p l e s Software Code
  • 24. Contributing on Social Media  Share links: Photos, videos, infographics, tips, novel information, interesting facts, stats, quotes related to your study  Answer questions and provide value, e.g., share resources -- re-use existing content if possible (guide to managing post-surgery pain or infographic on new treatment option)  Share random thoughts, e.g., Without clinical studies, medical treatment would always remain the same. Thanks to all of those who participate.  Promote, encourage, and support others  Target specific populations to increase your relevance
  • 26. Melissa Terras Professor of Digital Humanities in, Department of Information Studies, University College London; Director of UCL Centre for Digital Humanities. Twitter: @melissaterras “What became clear to me very quickly was the correlation between talking about my research online and the spike in downloads of my papers from our institutional repository. Academics need to work on their digital presence to aid in the dissemination of their research, to both their subject peers and the wider community.” Perspective http://digitalmediaandscience.wordpress.com/2012/10/05/more-people-look-at-research-if-it-is-promoted- via-social-media-a-case-study-2/
  • 27. Tweeting an Open Access Paper http://melissaterras.blogspot.com/2011/11/what-happens-when-you-tweet-open-access.html
  • 28. Melissa Terras Professor of Digital Humanities in, Department of Information Studies, University College London; Director of UCL Centre for Digital Humanities. Twitter: @melissaterras “Upon blogging and tweeting, within 24 hours, there were, on average, 70 downloads of my papers. Now, this might not be internet meme status, but that’s a huge leap in interest.” Perspective http://digitalmediaandscience.wordpress.com/2012/10/05/more-people-look-at-research-if-it-is-promoted- via-social-media-a-case-study-2/
  • 29. Jove: Peer Reviewed Scientific Video Journal http://www.jove.com, Example: http://www.jove.com/video/50182/movement-retraining-using-real-time-feedback-of-performance
  • 30. Citing Social Media Content http://blog.apastyle.org/apastyle/2013/10/how-to-cite-social- media-in-apa-style.html Social Media Video
  • 31. Figshare http://figshare.com You can share… Figures Datasets Media (including video) Papers (including pre-prints) Posters Filesets (groups of files)
  • 32. Slideshare http://www.slideshare.net You can share… Figures Datasets Media (including video) Papers (including pre-prints) Posters Filesets (groups of files)
  • 33. Turn Your Research Results into an Infographic Infographics are liked 4x more than presentations, 23x more than documents Infographics are shared 2x more than presentations, 3x more than documents on other social networks, such as LinkedIn, Twitter and Facebook. http://image.slidesharecdn.com/071813slides haremakinggreatinfographics2-ig- 130721190926-phpapp01/95/what-makes- great-infographics-1-638.jpg?cb=1379569751 http://blog.slideshare.net/2013/09/11/infograp hics-are-more-viral/
  • 36. Today’s Focus 1. Defining digital patient engagement 2. Finding and listening to patients online 3. Developing your digital communications strategy 4. Engaging and recruiting patients through digital communication approaches 5. Digital health content regulations, guidelines, and ethics 6. Measuring the results of your digital efforts 7. Online reputation management
  • 37. Examples of Digital Recruitment Successes Pregnant women were recruited via Facebook and Twitter in 6 months (12-fold higher rate of ±7.5 recruits/month compared to traditional approach) [Ref. Shere M, Zhao XY, Koren G. The role of social media in recruiting for clinical trials in pregnancy. PLoS One. 2014 Mar 26;9(3):e92744. ] 45 529 Mothers accessed survey -- promoted via Twitter in nearly 3 months; 299 (56.5%) fully completed it [Ref. O'Connor A, Jackson L, Goldsmith L, Skirton H. Can I get a retweet please? Health research recruitment and the Twittersphere. J Adv Nurs. 2014 Mar;70(3):599-609.] 251 People who had searched for stroke-related information online completed survey -- promoted via Google Search in nearly 4 months (1% out of 25,292, 200+ website visits/day) [Ref. Kim AS, Poisson SN, Easton JD, Johnston SC. A cross-sectional study of individuals seeking information on transient ischemic attack and stroke symptoms online: a target for intervention? PLoS One. 2012;7(10):e47997.] Social Media Search Engine Marketing
  • 38. Anthony Kim, MD Assistant Professor of Neurology and is Medical Director of the UCSF Stroke Center “We were surprised to see that tens of thousands of people were regularly ‘asking’ a search engine about stroke- related symptoms in many cases shortly after the onset of symptoms. In fact, every month, about 100 people were finding our study website by entering the query: “Am I having a stroke?” directly into their Google search box.” Perspective http://digitalmediaandscience.wordpress.com/2012/10/31/am-i-having-a-stroke-connecting-with-patients-in- new-ways-as-they-search-for-health-information-online/
  • 41. Digital Information about Clinical Studies: Checklist  The creator of digital/social media content is responsible for it.  Abide by institution’s media guidelines.  Ensure that the study sponsor is informed of your digital/social media activity.  Refrain from providing significant details of any clinical study – focus on basic study information. Suggestion: Link digital media content to study page with more information  Beware of proprietary information. [Ref. 13]
  • 42. [Ref. 13]  Avoid making claims of treatment efficacy or side effects. Use disclaimers to reduce risk.  Avoid disclosure of preliminary results or non-public information.  Bloggers involved in the study should not write about trial or drug, device, or treatment (could be viewed as advertising).  Avoid using social media for eligibility screening, refer to institution and study team. Digital Information about Clinical Studies: Checklist
  • 43. Evaluation Example Messages You want to promote a study that focuses on the drug nivolumab to see whether it may help to prevent relapsing in patients with acute myeloid leukemia in remission after chemotherapy. Relapse remains the main failure of treatment in patients with acute leukemia after chemotherapy. Nivolumab has already shown impressive immune therapy results in patients with melanoma, kidney cancer, and non-small-cell lung cancer. You are trying to enroll men and women 18+. • Trial length is 2 years. • Number of visits: 1 every 2 weeks • Procedures: Blood counts, bone marrow exam, toxicity test • Compensation: $150 • Medical cost coverage: Drug at no cost; standard follow-up insurance
  • 44. Breakout Session Would you use any of these Twitter messages? #1 #2 #3
  • 45. Evaluate Example 1 Would you use this Facebook message?
  • 46. Evaluate Example 2 Would you use this Facebook message?
  • 47. Evaluate Example 3 Would you use this Facebook message?
  • 48. Promoting Clinical Research Digitally Social Media and Search Engines Organic Advertising (Paid) Twitter Yes No Facebook Yes Yes (Approval required) Youtube Yes Yes (Approval required) Pinterest Yes No Instagram Yes Yes (Approval required) Google Search Yes Yes (Approval required) Limited overview Based on platform posting guidelines, July 2016
  • 49. [Ref. 13]  State new treatment, drug, device as investigational/in testing.  Avoid coercion, the practice of persuading someone to do something by using force or threats.  Don’t imply favorable outcomes or post claims regarding safety, e.g., better treatment, better chances to be cured, safe treatment.  Don’t promise free medical treatment.  Don’t emphasize payment for participants, e.g., participants may be compensated for their time Digital Recruitment Messages Checklist FDA and IRB Guidelines Apply to Digital Messages
  • 50. Today’s Focus 1. Defining digital patient engagement 2. Finding and listening to patients online 3. Developing your digital communications strategy 4. Engaging and recruiting patients through digital communication approaches 5. Digital health content regulations, guidelines, and ethics 6. Measuring the results of your digital efforts 7. Online reputation management
  • 51. Laws and Regulations Like all research involving humans, federal and state laws govern social media recruitment activity. In addition to Common Rule, FDA regulations, HIPAA and HITECH may apply.
  • 52. What IRB Needs to Know Examples of social media content for IRB review:  Layout mockup of the web page, including text and any links provided to the potential participants  Text of Google Search ad and a static view of the page to which the ad will direct traffic  Text of Facebook post or ad and any images and links that are included If the social media content is visible to potential study participants, you should assume it will need IRB approval. Let IRB know that your social media recruitment strategy and materials will comply with existing IRB and applicable FDA regulations related to human subject research. This means adherence to 21 CFR §56 as explained in the FDA’s longstanding document titled, “Recruiting Study Subjects – Information Sheet, Guidance for Institutional Review Boards and Clinical Investigators”.
  • 53. Protection Against HIPAA Violations and Inappropriate Posting 1. Pay attention to Protected health information (PHI) 1. Draft response messages to manage comments that include PHI, include them in your IRB protocol for review Examples: On Twitter: Dear [@mention]: To protect your privacy, we suggest you delete your message. Please contact us directly URL/or phone number On Facebook: Dear [FIRST NAME]: Thank you for your interest in our clinical study at Keck Medicine of USC. To ensure the privacy and confidentiality of [your or your family member’s] health information, we had to delete your comment. To help answer your question, please contact us directly via [email], text or phone [PHONE NUMBER]. We’d be happy to give you a call.
  • 54. Managing Active Study Participants  Help them understand that sharing details about their participation online can …  distort the results of the study and essentially cause the trial to fail,  influence how other people perceive or report their own symptoms, making it hard to tell whether a given drug or treatment is working,  unblind the study, i.e., if neither the participants nor the clinical trial site team knows who is on an active drug or a placebo, some participants may be taking a placebo. Information you share could lead them to report symptoms that they are not actually experiencing, and  be misinterpreted by the public, journalists and others.  TIPS FOR GETTING IT RIGHT
  • 55. Template Language (Part 1)  Do discuss your experience confidentially with your family and other people who are close to you.  Do talk with your family doctor and other healthcare providers. It’s important to let them know that you are in a clinical trial.  Do ask your clinical trial team to provide guidance about where to obtain reliable educational material online.  Do keep a journal or take notes on your cell phone so you can make a list of things to talk about with your clinical trial doctor and study team at your clinical trial.
  • 56. Template Language (Part 2)  Don’t talk publicly, including online, about your participation in a clinical trial.  Don’t post online including on social media about your experience in the trial, including about side effects or about how you think the drug is working.  Don’t solicit trial advice or information from online friends or people other than the primary investigator and study team at your clinical trial site.  Don’t respond to questions or comments online related to the trial you’re involved in.  If you do see study-related posts online, please tell the study team.
  • 57. Understanding Social Media Citations http://www.apastyle.org/products/4210512.aspx
  • 58. Citing Social Media Content http://blog.apastyle.org/apastyle/2013/10/how-to-cite-social- media-in-apa-style.html Google+
  • 59. Citing Social Media Content http://blog.apastyle.org/apastyle/2013/10/how-to-cite-social-media-in-apa-style.html Twitter, Individual Author
  • 60. Today’s Focus 1. Defining digital patient engagement 2. Finding and listening to patients online 3. Developing your digital communications strategy 4. Engaging and recruiting patients through digital communication approaches 5. Digital health content regulations, guidelines, and ethics 6. Measuring the results of your digital efforts 7. Online reputation management
  • 61. Tracking Key Performance Indicators Examples: Retweets/Repins Shares Replies/comments Likes Social media analytics; GoogleAdwords Initiation of Contact with Study Team Social Media Engagement Link Engagement Website Engagement Impressions Clicks Examples: Users Sessions Time spent on page Pageviews Exits Social media built-in analytics, e.g., Twitter, Facebook, Pinterest; Google Adwords Social media analytics; Google Adwords; Buffer; Hootsuite; Tweetdeck; Kuku.io; Link shortening services, e.g., Ow.ly M E A S U R E M E N T T O O L S Google Analytics; Piwik Google Analytics; Piwik
  • 62. Altmetrics (Article Level Metrics)  Citations  Usage: Downloads, Views  Social Media Mentions, Shares, Likes, Comments, Links, Clicks, etc.  Referring data and knowledge bases
  • 63. Tools that Calculate Altmetrics  ImpactStory  Altmetric.com  Plum Analytics  CitedIn
  • 64. ImpactStory: Example of a Tracking Tool
  • 65. ImpactStory: Example of a Tracking Tool
  • 66. Plum Analytics Profile: Antony Williams Courtesy of PlumAnalytics
  • 67. Social Media Reach by Topic Areas Courtesy of PlumAnalytics
  • 68. Funders Start Showing Interest in Alternative Metrics http://eprints.icrisat.ac.in/12069/1/value-all-research-products.pdf
  • 69. Autism Speaks Tracks Research Impact http://www.ebscohost.com/newsroom/stories/autism-speaks-to-use-plumx-to-track-research-impact
  • 70. Using Altmetrics in Applications for Promotion Review by Researchers Steve Pettifer, PhD Computer scientist University of Manchester, UK Twitter: @srp “[My mentor] took a look and said, ‘What the hell are these badges doing in your CV?’ But once I explained them, he said, 'Well, give it a go.’ It hit the right note at the right time. I'm definitely a convert.” Pettifer added the number of views and public engagement (e.g., social media mentions) to the CV entry. He got his promotion. He does not know for sure whether the metrics helped, but he plans to use them on future grant applications. http://www.nature.com/naturejobs/science/articles/10.1038/nj7463-491a
  • 71. Today’s Focus 1. Defining digital patient engagement 2. Finding and listening to patients online 3. Developing your digital communications strategy 4. Engaging and recruiting patients through digital communication approaches 5. Digital health content regulations, guidelines, and ethics 6. Measuring the results of your digital efforts 7. Online reputation management
  • 72. Online Reputation Management for Physician-Scientists 1. Pay attention to physician rating and review websites (Note: The Centers for Medicaid and Medicare Services (CMS) maintain their own Hospital Consumer Assessment of Healthcare Providers and Systems) Yelp.com HealthGrades.com Vitals.com RateMD.com YellowBook.com LinkedIn.com Manta.com MerchantCircle.com Google+LocalZocDoc.com RealSelf.com InsiderPages.com SuperDoctors.com Citysearch.com YahooMaps.com AngiesList.com Bing.com RealSelf.com UCompareHealthCare.com YellowBot.com YahooLocal.com Avvo.com EveryDayHealth.com Wellness.com Examples; last updated Nov 11, 2016
  • 73. Online Reputation Management for Physician-Scientists 1. Pay attention to physician rating and review websites (Note: The Centers for Medicaid and Medicare Services (CMS) maintain their own Hospital Consumer Assessment of Healthcare Providers and Systems) 2. Monitor online content that mentions your name and medical practice (automation saves time) F R E E F E E A P P L I E S Google Alerts SocialMention Hootsuite Tweetdeck Trackur Reputology Review Trackers Review Push Chatmeter Reputation Ranger Review Concierge Reputation Health Reputation.com SocialDraft Examples; last updated Nov 11, 2016
  • 74. Online Reputation Management for Physician-Scientists 1. Pay attention to physician rating and review websites (Note: The Centers for Medicaid and Medicare Services (CMS) maintain their own Hospital Consumer Assessment of Healthcare Providers and Systems) 2. Monitor online content that mentions your name and medical practice 3. Improve your online reputation, e.g., encourage patients to share their positive experiences online via social media, a monthly newsletter, or a blog. (Note: Asking patients to sign a GAG order is not recommended if you want to improve your online reputation.)
  • 75. Online Reputation Management for Physician-Scientists 1. Pay attention to physician rating and review websites (Note: The Centers for Medicaid and Medicare Services (CMS) maintain their own Hospital Consumer Assessment of Healthcare Providers and Systems) 2. Monitor online content that mentions your name and medical practice 3. Improve your online reputation, e.g., encourage patients to share their positive experiences online via social media, a monthly newsletter, or a blog. Or, use a third-party service to monitor and manage your reputation, e.g., Iron Comet, . 4. Don't ignore positive or negative feedback online, e.g., make the effort to contact the patient personally to discuss it and encourage them to update their feedback if it is negative. Or, use a third-party service to monitor and manage your reputation, e.g., Iron Comet, Reputation.com.
  • 76. When Responding to Online Comments, Remember to Follow HIPAA Guidelines 1. Don’t share the patient’s physical or mental health information that could potentially identify him/her. 2. Respond in generalizations, such as “We strive to deliver quality care to all patients.” 3. Never use patient names in a response, even if they identify themselves in the comment. 4. Take the conversation offline by asking patients to call your office if you need to discuss the review further.
  • 77. Example Responses: Positive Reviews 1. Thank you for the positive feedback! We appreciate the support. 2. We strive to provide the highest quality in patient care. Thank you so much for sharing this story with us! 3. Thank you for connecting with us about this experience with our staff. We will be sure to share this appreciation. 4. Thank you for giving us a great score! Our dedicated staff takes great pride in serving the <city name> community. 5. Thank you so much for taking the time to share these. Our staff will pass along the kind words! 6. Our practice aims to deliver the highest quality patient care. We love to hear about these positive Thanks for sharing this feedback with us!
  • 78. Example Responses: Negative Reviews We are sorry to hear this and truly value your Patient experience is important to us at <practice name>, so we will make every effort to address any concerns you may have. Your comments have been shared with <contact at practice – position/first name >. If you would like to speak with someone about this experience, please call <position, phone number>. We are sorry to hear about the long wait time at our practice. We will look into this and make every effort to improve our wait times in the future. We are very sorry to hear about this experience in our practice and would like to look into it. Please call <contact at practice- position/first name> so that we can get further information to address the situation. We are always sad to hear someone had trouble reaching our office. We want all of our patients to be able to communicate with our office easily, so we will re-examine our phone procedures.
  • 79. Example Responses: Negative Reviews We sincerely apologize for any scheduling and billing issues experienced at our practice and value this feedback. We are dedicated to providing timely, patient- centered, quality care and regret that this was not the experience described. As we work to improve our processes, please don't hesitate to reach out to our office at <office phone number/PM direct line> to express your concerns. Thank you for bringing this billing matter to our attention. We would appreciate the opportunity to discuss this matter further so the situation can be Please contact our staff at <### - ### - ####> at your convenience. Thank you. Thank you for making us aware of this experience. We sincerely apologize for any inconvenience that was caused. Please reach out to <contact> at <phone number> so that we can help resolve this issue.
  • 80. A C C E S S R E S O U R C E S http://sc-ctsi.org/digital-scholar/
  • 81. Thank you! Contact Information Katja Reuter, PhD Director of Digital Innovation and Communication Southern California Clinical and Translational Science Institute (SC CTSI) University of Southern California Email: katja.reuter@usc.edu Twitter: @dmsci Blog: https://digitalmediaandscience.wordpress.com

Editor's Notes

  1. From prescreening potential doctors to reading about symptoms and viewing their treatment information, or keeping tabs on their exercise regimes—Modern patients are active online. They are educated and informed before seeing the doctor.
  2. Note: At the same time, there continues to be growth in social media usage among some groups that were not among the earliest adopters, including older Americans.
  3. Note: 80%+ of Americans seek health information online
  4. Note: At the same time, there continues to be growth in social media usage among some groups that were not among the earliest adopters, including older Americans.
  5. Note: 80%+ of Americans seek health information online
  6. A hashtag is a word or phrase preceded by a hash or pound sign (#) and used to identify messages on a specific topic – developed on Twitter and now used on other platforms such as Instagram and Facebook.
  7. Social Mention is a social media search and analysis platform that aggregates user generated content from across the universe into a single stream of information. It allows you to easily track and measure what people are saying about you, your company, a new product, or any topic across the web's social media landscape in real-time. Social Mention monitors 100+ social media properties directly including: Twitter, Facebook, FriendFeed, YouTube, Digg, Google etc. Social Mention currently provides a point-in-time social media search and analysis service, daily social media alerts, and API. Contact us at: hello@socialmention.com
  8. The National Rheumatoid Arthritis Society (NRAS) is calling for 1,000 new recruits to join its Remission Mission. By making a pledge and uploading a photo on the new Remission Mission interactive photo wall, NRAS hopes to raise awareness of the need for improved management of the disease for the 690,000 people in the UK who live with this debilitating condition.
  9. The Common Rule is a rule of ethics regarding biomedical and behavioral research involving human subjects in the United States. HIPAA (Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology.
  10. Protected health information (PHI) under US law is any information about health status, provision of health care, or payment for health care that is created or collected by a "Covered Entity" (or a Business Associate of a Covered Entity), and can be linked to a specific individual. Names; Geographical identifiers smaller than a state; Dates (other than year) directly related to an individual; Phone numbers; Fax numbers; Email addresses; Social Security numbers; Medical record numbers; Health insurance beneficiary numbers; Account numbers; Certificate/license numbers; Vehicle identifiers and serial numbers, including license plate numbers; Device identifiers and serial numbers; Web Uniform Resource Locators (URLs); Internet Protocol (IP) address numbers; Biometric identifiers, including finger, retinal and voice prints; Full face photographic images and any comparable images; and Any other unique identifying number, characteristic, or code except the unique code assigned by the investigator to code the data.
  11. http://www.apastyle.org/products/4210512.aspx http://www.teachthought.com/technology/how-to-cite-social-media-scholarly-writing/
  12. US NSF
  13. Using Altmetrics in Applications for Promotion Review by Researchers
  14. Online ratings and reviews are valuable tools for attracting new patients and retaining your current ones.
  15. Online ratings and reviews are valuable tools for attracting new patients and retaining your current ones.
  16. Online ratings and reviews are valuable tools for attracting new patients and retaining your current ones. Gag order: A small group of doctors around the country are asking their patients to sign medical gag orders, which prevent patients from sharing any details about their experience.
  17. Online ratings and reviews are valuable tools for attracting new patients and retaining your current ones. If you're really serious about getting stubborn content removed, you may want to look into online defamation laws or laws that protect certain segments of the population. However, keep in mind that a lawsuit or legal action may only serve to draw more attention to the link that you'd like to get rid of. Google policy allows for the removal of certain sensitive information, including financial information or identification numbers that may put you at risk for identity theft or financial fraud. Google also removes or hides certain offensive images and videos. You may also be able to have Google remove content that violates the law from search results. If you have information that falls under Google's removal policies, it's a good idea to reach out to the search engine for help. However, keep in mind that removing the content from Google is not the same thing as removing it from the Internet: the page will still exist, and the link can still be shared.
  18. Online ratings and reviews are valuable tools for attracting new patients and retaining your current ones.
  19. Online ratings and reviews are valuable tools for attracting new patients and retaining your current ones.
  20. Online ratings and reviews are valuable tools for attracting new patients and retaining your current ones.
  21. Online ratings and reviews are valuable tools for attracting new patients and retaining your current ones.