Perhaps the most shocking moment from the 2016 HIMSS conference in Las Vegas that highlights the long road to embracing patient opinion on social media occurred during the opening plenary session.
Mark Barner, CIO of Ascension Health, commented that he doesn’t particularly care about patients going on Twitter to complain about problems with nonclinical issues such as hospital food and parking.
If that raised eyebrows, what Island Coast Pediatrics, a practice in Fort Myers, Florida, reportedly did was jarring. It apparently dropped at least eight families from its patient rolls last month over negative comments parents posted in a closed Facebook group.
Indeed, these are extreme examples and perhaps instances of not-so-enlightened healthcare players when it comes to valuing patient ratings and crowdsourced reviews. Yet, for even those providers that would like to be aware of what is being said and respond, there hasn’t been enough critical mass of social media opinions or a centralized repository that hospitals can mine to get a pulse of public opinion.
“The evidence is that the mass of people are not using rating sites,” according to health economist, consultant and patient engagement specialist Jane Sarasohn-Kahn. “We do not have yet the be-all, end-all, whole enchilada to make it easy.”
Sarasohn-Kahn was talking about consumers rating physicians and hospitals, but it’s the same for institutions trying to figure out how they are doing. There just isn’t a definitive source of information that aggregates and filters patient sentiment.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Hoping to fill the void, Boston Children’s Hospital’s HealthMap, a public health surveillance initiative, created CrowdClinical, which launched in February 2015. CrowdClinical goes to Twitter, Reddit and other “patient-centric” social media sites, including online patient community Inspire, according to John Brownstein, chief innovation officer at Boston Children’s.
“If patients are already talking about you, why not go to them? Why not seek out what people are saying?” Brownstein said. “There’s opportunities to understand the patient voice.”
CrowdClinical employs machine learning and natural-language processing to categorize what people are saying. Brownstein wants to package custom reports about public opinion for hospitals, but is waiting on the HealthMap team to finalize its algorithms.
“We’re focused on making the data as useful as possible,” he said.
Hospitals can use CrowdClinical as a tool to improve quality, Brownstein said. Insights and trends identified from aggregating patient posts can serve as an “early sentinel” of potential problems, he pointed out.
Brownstein was one of the authors of a 2015 paper in the BMJ that studied how Twitter can help measure how patients perceive quality of care. The researchers found that hospitals mentioned more positively in tweets had lower 30-day readmission rates, among other things.
What the study and subsequent observation by Brownstein has also found, perhaps surprisingly, is that it’s not all sour grapes on social media and rating sites.
“It’s actually pretty balanced in terms of praise and complaints,” Brownstein said.
However, on consumer rating sites like Yelp, it’s not as balanced. In fact, healthcare comments there are overwhelmingly positive, according to Emily Washcovick, manager of local business outreach for the San Francisco-based company.
An analysis of online reviews of physicians from 2014 from Software Advice, a Texas company, found that less than 20 percent of posts about physicians were negative. This mirrors a University of Michigan study published in the Journal of the American Medical Association.
“Most [users] are actually generating content about positive experiences,” Washcovick said, echoing Brownstein.
Healthcare is the third-most reviewed type of service on Yelp, after restaurants and retail stores, she reported. People go into detail in all three segments, since users can’t just leave a star rating. They actually have to write something.
Here’s an interesting tidbit about the consumer review site: Yelp’s roots actually are in healthcare. When the company started in 2004, CEO and Co-founder Jeremy Stoppelman was relatively new to the Bay Area. When he got sick, he didn’t have a physician and didn’t know where to turn to evaluate his options.
“That’s where he got the idea for reviews,” according to Washcovick.
Yelp reviews of healthcare providers consider more factors than even Medicare’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, she contended. So it’s important for healthcare providers to pay attention to such consumer-facing sites.
Last year, Yelp teamed with investigative journalism shop ProPublica to add quality and outcomes data to the ratings pages of 25,000 hospitals, nursing homes and dialysis clinics, hopefully improving that experience.
Social media and rating websites certainly can be helpful for patients and providers alike, but healthcare consumerism still is in what Sarasohn-Kahn called a “1.0” phase.
Word of mouth remains the most popular method for finding healthcare providers, though a Nuance Communications study from a year ago found that 54 percent of young millennials — ages 18-24 — check physician ratings before seeing a doctor. That compares to 39 percent among the general population.
More might look online if they could be certain about the accuracy and specificity of what they were reading.
“You’ve got this patchwork quilt of choices, but where does the consumer go?” Sarasohn-Kahn said. “Unless it’s a specific condition, it’s very fragmented.”
And then there is Healthgrades, which Sarasohn-Kahn finds to be “mature and accurate.” But that company’s reports are pricey, and thus only really suitable for people facing life-threatening conditions.
Zagat Survey, known for its easy-to-use restaurant reviews, teamed with health insurer WellPoint — now called Anthem — in 2008 to allow patients to rate their doctors. But that never really took off, and eventually fizzled.
“It’s just really hard to point people to one place,” Sarasohn-Kahn lamented.
But things are moving in the direction of transparency and consumer-friendliness, albeit slowly. And increasingly, patient experience and satisfaction are becoming important considerations in value-based care. As the Nuance survey hinted and the CrowdClinical effort exemplifies, consumers want their voices to be heard and providers — Ascension CIO Barner’s comments notwithstanding — want to know what people are thinking about them.
Geisinger Health System in Pennsylvania last year began offering a money-back guarantee for some services, the equivalent to a warranty for car repairs.
“That’s where this is going to go,” Sarasohn-Kahn said. “Providers need to stand behind their care.”
She noted that Nemours Children’s Health System, based in Wilmington, Delaware, gets good Press Ganey scores for patient satisfaction “because they focus on the 360-degree patient experience.”
For his part, Brownstein was moved by Barner’s comments, which prompted CrowdClinical to begin following social media comments about Ascension.
“We added Ascension to the list [of organizations we track] after that,” Brownstein said. “You have to be listening to your customers.”
Photo Credit: CrowdClinical
