Web 2.0 and Social Media for Cardiologists - one-click solutions

I was preparing for my presentation at a major medical conference in India.  The presentation is on use of Social Media for Physicians.  The conference is focused on mostly cardiology topics for general internists.  The organizers asked me to make sure the talk was practical and could leave the attendees with some easy to follow take home points.

As always the challenge with a presentation is knowing your audience.  I did not have a good feel for this, not having attended this conference before.  I struggled to select the appropriate content for the presentation.  I needed to show them what was possible, and then what they could do to get started.

I decided to give them some highlights on using Google Reader to stay current with medical (cardiology) literature and use of Twitter to network with cardiologists and to get updates and insights.  To make it easy for them to get started I created

• An OPML bundle of cardiology journal feeds and
• A Twitter list of cardiologists to follow - this post by Larry Husten was very helpful to get started.

Having gone through that effort, it is probably worthwhile to share these for others to use and share.

Getting your cardiology journals delivered to your "doorstep"

• Get started with Google Reader
• Then subscribe to 11 top cardiology journals and 3 blogs with one click.  (Click on subscribe)
• Go to Google Reader and all 11 journal feeds should be available at one place.  These can be tagged and shared on Twitter, FB or Google+, Tumblr etc and also be searched!

RSS Feed Bundle or 11 top Cardiology Journals

Getting your cardiology fix on Twitter

• Create a Twitter account (optional for read-only mode)
• Go to the Twitter cardiology list
• View Tweets and follow the conversations and links
• Join Twitter to participate

Twitter List for Cardiology Updates

So there you are - 2 quick one-click solutions to introduce cardiologists into Web 2.0/Social Media.

Addendum:
A conversation with @Allan Palmer on Google+ made me realize that this might have come across as a final solution for the attendees.  I need to stress that this is just the first step. There are several frameworks for understanding why some people are late to adopt IT innovations.  The Technology Adoption Model is based on:

• Perceived Usefulness and 
• Perceived Ease of Use

The Diffusion on Innovation theory by Rogers adds that an innovation must be easy to try, and its use should be visible to others (peers).  

Based on these frameworks, one would seek to provide late adopters an easy to use approach to try these tools, and allow them to see other colleagues using it.  Ideally one would add some hypothetical cases to illustrate the utility.

Thus for this conference, I could create an example of a patient on a statin who has questions about adding niacin to the regimen or a patient with history of coronary artery disease who is on a betablocker and getting severe fatigue from it.  These would lead to recent articles on these topics and conversations on Twitter and blog posts about these studies.

3 Case Studies for managing information and staying organized

At a several recent meetings, colleagues have mentioned how they are finding it increasingly difficult managing information in various different settings.

Some examples:

1.  One colleague needs to have regularly scheduled meetings with a group of physicians.  They need to share and collaboratively author documents.  Not everyone can attend these meetings consistently.
2.  Another colleague finds it difficult to keep up with literature in his specialty.  He gets a lot of print journals, but does not have a streamlined way of recalling recent studies and finding them quickly when needed.
3.  A third colleague finds that she is getting disorganized, gets distracted and is unable to complete elective but high stake tasks.

Three very common problems and here are the solutions I proposed to them.  One criteria I used was to use  tools that were free.

1.  I suggested that he start using Google+ and Google Docs.  It is very surprising how many people do NOT know about these tools.  Sure there are other ways to do this but the sheer simplicity of Google Docs is a winner for any group with members that might be technically challenged.  The commonest question I get is, "How do I save the document?" Some other questions are, "How do I share this document?" or "Does it track versions?" 

I suggested he set up a Google circle with the participants.  He could then start a Google document and set it up to be editable by anyone with a link.  He could then copy the link and share it with the Google circle.  He could also start a Hangout at the next meeting to discuss the document and those who could not attend live, could participate via the Hangout.  Using Google Hangout with extras they could collaboratively edit the document.  

The part he loved was that at the end of the Hangout, the document was finalized and he did not have to send it to anyone.  They could all see it on Google Docs.  

2.  This conversation started when the colleague was complaining about the flood of lab results, copied charts, refill requests etc in his EHR inbox.  I mentioned a recent Archives article where they found that 50% of such messages and alerts are not important.  Even in the important messages 80% of the text is irrelevant to the critical message.  He was surprised I was able recall the article and pull it up quickly on my laptop.  

I described how I use Google Reader to subscribe to key journals in my area of interest.  In addition I have set up RSS feeds on specific key words from PubMed.  As I scan through the articles, I tag and organize them by specialty.  I share some of these articles with colleagues on Twitter or Google+ which leads to some interesting discussions and helps ingrain the article in my memory.  

The part that really works is finding the article that you have scanned/read/shared.  Google reader has an excellent search function and quickly pulls up any article in your set of journals whether you have read it or not.  

If you can spend some time each week scanning through your journals of interest on Google reader, you can generally recall studies that got published and can retrieve the article very quickly.

To get him started, I gave him a link to a bundle of medicine journals I follow.  He was able to get started with these with 1 click!

3.  The last case prompted me to suggest something that I have just started using.  One of my medical students recommended Workflowy to me.  This tool is another case of things being so simple that they just work.  Workflowy lets you create a bulleted hierarchical list.  The web page can be opened in any browser including on mobile devices.  You start off by creating a high level list like

• Personal
• Family
• Work

and then create sub-items.  You can add notes to the items and strike through items that you have completed.  I am planning a trip to Peru and the amount of stuff that needed to be done e.g. flights, train tickets, forms for the consulate, Machu Picchu entrance tickets, hotels, SIM card etc. all needed to be completed.  Putting it together in one list and then adding notes of web sites, phone numbers, confirmation numbers etc made the whole process very organized.  I was able to share the list with my wife who could also complete and cross off certain items.  Being able to spend a few minutes to complete elective tasks takes a huge burden off ones shoulders and is very stress relieving.  If still need more help, you can use the Pomodoro extension on your browser (Chrome) to block off all distractions for a specified amount of time till you complete the task.

I will be first to admit that I am not the most organized of people and am constantly trying to find solutions for this.  Still these are tools I use regularly (except the Pomodoro) and they help immensely.  

Sharing from Google Reader to Google+

One of the tenets of social constructionism is that learning is most effective when a learner's experience includes constructing a meaningful object.  In the world of online social media, this can include a blog post or a comment on an article.

I tend to read all my journals as an RSS feed in Google Reader.  I have blogged about this model before.  I then use Google Reader's "Send to" feature to share certain articles on Facebook or Twitter with a few additional comments summarizing my take home points on the article.  This can generate some additional comments from followers and friends sometimes leading to rich discussions.

Googleplus is a terrific tool for such discussions.  

• I have a chance to share with a wider audience (since I don't limit my circles like I did on facebook) 
• There is no 140 character limits like on Twitter and the comments are organized like a conversation.

Big Problem:

Google Reader does not have a Send to Google+ feature!!  Google what were you thinking?  Sparks is no replacement for Google Reader.

Now there is a nice workaround

• On Chrome:  
• Set up Buzz to connect to your Google Reader shared items
• Share from Google Reader to Buzz
• In G+ profile page to to the Buzz tab
• Click on Share in the Google bar at the top right of the page
• Drag the hyperlinked title from item in Buzz to the share box, select your circle and share
• In FireFox (courtsey http://davidvielmetter.com/tricks/share-google-reader-items-on-google-plus/) 
• You can drop links from Google Reader items directly to the Share box on the top right.  
• In both cases, make sure you first click to open the share box.  Then drag and drop the link.

Have fun!

Model for a Journal Club using Google Reader and Facebook OR if the prophet does not go to the Mountain.... bring the journal club to FB!

Challenge:
Create a collaborative learning environment for discussing key journal articles for our residency program.

Proposed solution:
Create an automated method for posting key journal articles to an online discussion group.  Each article abstract should be a separate post in the forum with space for comments.

Assumptions:
With tighter duty hour restrictions, going online might be more acceptable.
Most residents use social networking (e.g. Facebook) and have Google accounts - so our solution should try and leverage these 2.
It would be more likely to succeed if we go to where the energy is (Facebook) rather than create a new site with a new log in.
A few faculty members or Chief Residents would take on the task of filtering and selecting the articles.

Model for using Google Reader and Facebook Groups for an Internal Medicine Journal Club

Steps:

1. Faculty member/Chief Residents set up Google Reader accounts
2. Subscribe to RSS feeds for some selected Journals in their specialty.
3. Periodically (at least weekly) review the feeds and share some of the most relevant articles in Google Reader
4. Find the RSS feed for their shared items list
5. Create a Group in Facebook (possibly a closed group so only members can view and comment)
6. Authorize the Facebook Application RSS Graffiti for this Group. (only group admins can do this)
7. Create a feed in RSS Graffiti with the RSS feed of the shared items list
8. Ensure that specific settings are modified and test for the posts to show up within about 30 minutes.
1. You have to authorize RSS Graffiti for your Facebook account before it will work on your Facebook Group.
2. You have to be the admin for that FB group
3. Edit the feed and under the Filter tab, make sure you change to date to when there are some items to show.  By default it is set to the time of creation of the feed in RSS Graffiti
4. Edit the feed and under the More tab, make sure you are posting as yourself and not as the Group.
9. Invite/add members to the Group.
10. Enjoy!

Screenshot of the Journal Club in a Closed Facebook Group

Resources:
Google Reader
Subscribe to important medicine journals with one click (you can also click on the button in the right column of this blog)
Facebook Groups
RSS Graffiti Blog and RSS Graffiti FB app

Practical model for using the Information Processing Theory to stay current with (medical) literature

The Information Processing Theory compares the human brain to a computer and suggests that just like we can make a computer work better by changing the processor, motherboard or RAM and the programming, the human can also become more sophisticated thinkers with appropriate strategies, sensory inputs and rules.

While I don't know how well validated this theory is, it does describe an interesting flow of information from the sensory register to short term memory to long term memory.
The wikipedia describes it thus

Sensory register: the mental processing unit that receives information from the environment and stores it fleetingly.
Short-term memory: the mental processing unit in which information may be stored temporarily; the work space of the mind, where a decision must be made to discard information or to transfer it to permanent storage, in long-term memory.
Long-term memory: the encyclopedic mental processing unit in which information may be stored permanently and from which it may be later retrieved.

The way I understand it, Constructivism works great for understanding how we can facilitate learning of new concepts e.g. medical students learning anatomy in their first year. Active learning, Problem based small group discussions, etc.

When we think about how to help a practicing physician keep up with medical updates in his or her specialty, it is a different setting. The person already knows the subject, is busy and probably does not have much time for collaborative learning in small groups. The constructs have already been formed during medical school, residency and subsequent experiences. It seems self directed learning using the principles of the Information Processing Theory would very helpful to help the physician refine these constructs on a longitudinal basis. Let me show you a model of how this would work.

Software needed:

1. Google Reader This is a free web application and all it requires is a free Google account.
2. Zotero I have referred to Zotero in a previous post. It is a free bibliography and citation tool that works as an add on to Firefox.

Screen shots of the Model:

Overview of Google Reader



Google Reader Detail:



Zotero Overview:


Zotero Details:


Retrieval from Zotero:

Steps in the Model:

1. Set up RSS subscriptions to your specialty medical journals in Google Reader
2. This allows abstracts of articles flow into your Reader automatically and allows you to view these in one place
3. This is equivalent to the sensory register mentioned above. When you browse through the RSS feeds, you "receive the information from the environment and store it fleetingly"
4. As you scan through the abstracts, you can in Google Reader mark the ones that seem significant and relevant with a star. The Google Reader automatically tracks the ones you have browsed and removes them from the "home screen".
5. You have thus gone through the process of determining whether the abstracts are to be discarded or to be processed for storage in long term memory. This is similar to the short term memory proposed in the Information Processing Theory.
6. When you have more time and inclination, you return to the Google Reader using Firefox that has the Zotero plug-in installed.
7. You click on the hyperlink to the abstract and from there to the full text article if you have access. You read the abstract and determine that it is worth "storing". Zotero allows you to take a "Snapshot" of the article and annotate it with notes, keywords and highlights. The bibiliography information of the article along with the annotated snapshot and notes and keywords are all stored in your Zotero library
8. Zotero allows each reference item to be included in several collections. Thus as an Internist, I have collections for all subspecialties of medicine - e.g. Cardiology, Pulmonary etc.
9. This process of analysing the article, annotating it and adding keywords, notes and sorting into collections is similiar to encoding that is described in Constructivism and helps move the information into a more permanent long-term storage.
10. The entire Zotero library is searchable and allows for easy retreival of previously processed information. As information is recalled and applied more often, it is more likely to become true knowledge.

Try it out, you have nothing to lose and possibly a lot to gain!