Before the Obama administration set aside billions to accelerate the dissemination of EHRs, providers were slow to adopt them. As recently as 2 years ago for example, a study published in the NEJM revealed that only 4% of non-hospital based providers had fully implemented an EHR, and only 13% more had a partial installation.

By contrast, the growth of social media including Facebook, Twitter, YouTube, blogs and virtual communities like Sermo and Physician Connect, has been explosive.

Enterprising providers have already deployed sophisticated social media strategies to extend their brand around the world. The Mayo Clinic for example, maintains several blogs, a Facebook fan page (which has 8,800 fans), a library of YouTube videos and a Twitter page (7,120 followers).

And within months after Alan Copperman, the vice chairman of obstetrics and reproductive science at Mount Sinai launched pair of YouTube videos on in vitro fertilization, 40,000 people had viewed them.

Many physicians also leverage social media to help their patients access illness support networks, a heretofore difficult undertaking for homebound or geographically isolated patients, or those with rare diseases. The result is that a short doctor visit can turn into an ongoing dialogue in which patients are empowered by a continuous flow of relevant information.

But social media also creates new and vexing challenges for providers and medical educators, and few if any claim to have figured out how to address them.

Consider questions like these, which physicians deal with thousands of times each day: Should I accept friend requests from patients on Facebook? Should I trust the input provided by unknown physicians on Sermo? Am I liable if I miss my patient’s tweet indicating his shortness of breath had worsened?

In some ways, the challenges are most acute for the youngest physicians, who grew up with Facebook. Unlike their older counterparts, they are intimately familiar with social media, but have in many cases become ensnared by it.

Thousands of newly minted physicians have long-since created detailed personal social histories and exposed them on Facebook to hundreds, perhaps thousands of people. Their challenge is to manage this archive while forging identities as professionals.

A study by Lindsay Thompson and colleagues the University of Florida has shed light on the challenge. They found that of the 44% of medical students at the UF Medical School who maintained Facebook profiles, only 37% made their entries private. More than half shared information regarding their sexual orientation with others, while 58% shared their relationship status and half shared political opinions.

A closer inspection of the profiles of 10 randomly-selected medical students revealed that 7 included photos showing them drinking alcohol, and 5 of these implied excessive drinking. Three students had joined groups that were either flagrantly sexist (“Physicians looking for trophy wives in training”) or racially charged (“I should have gone to a blacker college”).

The boundary-blurring effects of social media extend in every direction since nowadays medical students, nurses, housestaff, fellows and senior physicians are frequently linked together, and the chain is only as strong as its weakest link.

A nurse who blogs carelessly about a negative encounter with a patient might be linked through a physician to that patient or her family, for example…and although thoughtful deployment of privacy settings can prevent most of this, the fact is many health care professionals aren’t paying attention to the risk.

What has been done so far to mitigate the risks associated with social media?

Many have issued warnings. "Caution is recommended,” wrote Jules Dienstag in an email to Harvard medical students. The Dean for Medical Education explained in the communiqué that when “using social networking sites such as Facebook…items that represent unprofessional behavior that are posted by you on such sites reflect poorly on you and the medical profession. Such items may become public and could subject you to unintended exposure and consequences."

Similarly, Drexel University College of Medicine recently warned students that information on social-networking sites can impact decision making regarding their applications to residency programs.

Warnings ike these will have a favorable but still largely inadequate impact, much like a “Dangerous Rip-Currents” sign posted at a beach. By the time people read the warning, they are at the beach, in wet suits, having driven an hour to get there.

Some believe the challenges posed by social media are large enough to warrant the promulgation of formal guidelines for using social media in health care, modeled after the American Medical Informatics Association’s “Guidelines for the Clinical Use of Electronic Mail with Patients” which were published just as providers began relying heavily on that medium.

Such an approach begs questions like who has the authority to issue such guidelines, or whether they could impact behavior without an associated means for enforcement. Of course no one seriously believes that the use of social media in healthcare should be regulated, so it would seem the most likely alternative is to modify medical school curricula and beef-up continuing medical education in a way that helps professionals leverage the benefits while mitigating the risks of social media.

Approaches like this are covered in the final post of this series, to be published soon. For now, we conclude that social media has indeed become a disruptive force in medicine because of its explosive growth, the unprecedented scale and scope of communication possibilities it enables, and the incessant challenges it poses to heretofore well-defined and easy-to-maintain personal and social boundaries.

With social media, the genie is out of the bottle.

Author's Note:The purpose of this 5-part series is to make the case for implementing a widespread, systematic approach to HIT education in medical schools and continuing medical education programs for physicians. Previous posts reviewed challenges posed by the HIT Deluge, the Impact of EHRs on Medical Education, and Tweaking Medical Education to Leverage the Benefits of EHRs.

Glenn Laffel is a physician with a PhD in Health Policy from MIT and serves as Practice Fusion's Senior VP, Clinical Affairs.  He is a frequent writer for EHR Bloggers, where this post first appeared.

This blog originally appeared at The Health Care Blog.

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