Author + information
- Received October 2, 2018
- Revision received December 4, 2018
- Accepted December 30, 2018
- Published online March 4, 2019.
- Purvi Parwani, MBBSa,
- Andrew D. Choi, MDb,∗ (, )@AChoiHeart@purviparwani@DrMarthaGulati,
- Juan Lopez-Mattei, MDc,
- Samreen Raza, MDd,
- Tiffany Chen, MDe,
- Akhil Narang, MDf,
- Erin D. Michos, MD, MHSg,
- John P. Erwin III, MDh,
- Mamas A. Mamas, BM BCh, MA, DPhili and
- Martha Gulati, MDj
- aDivision of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
- bDepartments of Medicine and Radiology, The George Washington University School of Medicine, Washington, DC
- cDepartments of Cardiology and Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- dThe Baylor Plano Heart Hospital, Plano, Texas
- eDepartment of Medicine, University of Pittsburgh Medical Center, Heart & Vascular Institute, Pittsburgh, Pennsylvania
- fDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- gDepartment of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- hDepartment of Medicine, Baylor Scott & White Health/Texas A&M College of Medicine, Temple, Texas
- iKeele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
- jDepartment of Cardiology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
- ↵∗Address for correspondence:
Dr. Andrew D. Choi, The George Washington University School of Medicine, Division of Cardiology, 2150 Pennsylvania Avenue NW, Suite 4-417, Washington, DC 20037.
Cardiology professionals have used social media platforms such as Twitter to gain exposure to new research, network with experts, share opinions, and engage in scientific debates. The power of social media to communicate openly, with wide-reaching access worldwide, and at a rate faster than ever before makes it a formidable force and voice. However, evolving individual and institutional use has resulted in uncertainty for all parties on how to optimally advance this newer digital frontier. Thus, the purpose of this paper is to: 1) introduce the basics of social media usage (with the focus on Twitter); 2) provide perspective on best social media practices in academic and clinical cardiovascular medicine; and 3) present a vision for social media and the future of cardiovascular medicine.
Social media (SoMe) has become ubiquitous across society, with approximately 2 billion users worldwide and over 70% of Americans using a variety of SoMe platforms. Cardiology professionals have used SoMe platforms such as Twitter to gain exposure to new research, network with experts, share opinions, and engage in scientific debates (1). Across academic medicine, the influence of SoMe is increasing; a search in PubMed of “social media and medicine” in September 2018 yielded over 4,749 publications since 2008. Meanwhile, evolving individual and institutional use has resulted in uncertainty for all parties on how to optimally advance this newer digital frontier. Thus, the purpose of this paper is to: 1) introduce the basics of SoMe usage (with the focus on Twitter); 2) provide a perspective on best SoMe practices in academic and clinical cardiovascular (CV) medicine; and 3) present a vision for SoMe and the future of CV medicine.
Basics of Social Media
There are multiple SoMe platforms with broad multimedia tools, including Facebook, Instagram, Snapchat, and Doximity. In recent years, Twitter, a free microblog of up to 280 characters per message, has enabled global reach within the CV community. User accounts, either individual or organizational (defined by the symbol “@” followed by a unique identifier) may post short messages or “Tweets.” Other users can interact with Tweets via posting comments, “liking,” or “retweeting.” Furthermore, engagement is measured through “impressions” or the number of times content is displayed. Users can also attach hashtags (#) to words or phrases that allow for easy searches and for users to find specific content across multiple SoMe platforms. Some of the most widely used cardiology hashtags are listed in Table 1.
Social Media in Education and Advancement for the Individual CV Clinician and Researcher
SoMe is an effective tool, facilitating communication, medical education, and collaboration around CV disease, among a broad spectrum of individual health care stakeholders. Individual CV professionals have created free open-access medical education (#FOAMEd) in several interactive formats. One example is the educator-led tweetorial, a short series of grouped multimedia tweets containing educational content centered around a particular topic. Tweetorials are often structured in an interactive fashion with polls to prompt active learning, stepwise revelation of diagnostic clues, and opportunities for questions and feedback.
Cardiology fellows-in-training (FITs) have initiated the creation of innovative and impactful educational SoMe content. In July 2018, the American College of Cardiology (ACC) FIT Council organized tweetorials through the hashtag #FITSurvivalGuide on a variety of fundamental clinical topics. The open platform allows clinicians at all levels of seniority to contribute equally to #FOAMed material. This academic discourse has promoted in-depth scientific discussions in real time, often focused around late-breaking clinical trials. In addition, interesting, unusual, and challenging clinical cases can be readily disseminated worldwide, resulting in a rich online collection of angiograms, echocardiograms, and data from other CV imaging modalities.
For academic cardiologists, institutions have begun considering SoMe and digital activities as part of their criteria when considering academic appointments and promotions (2). In preparation for their promotion packages, academic cardiologists can develop a SoMe portfolio that documents digital activities, demonstrates evidence of the quality and impact of their digital work, and shows how their SoMe work aligns with institutional priorities (2).
Social Media in Creating New CV Networking/Communities
Perhaps the biggest advantage of CV SoMe is its utility in crowd-sourcing the perspectives of individual cardiologists, cardiothoracic surgeons, patients, CV technicians, and lifestyle advocates who have the common goals of promoting CV education, advocacy, health, or overall betterment of patient care. These initial online relationships often extend from the virtual world to real-life networking, tweet-ups at national and international conferences, and text groups. An example of this is the Women in Cardiology community that has come together on both Facebook and Twitter. Encompassing nearly 900 international members on Facebook, the community serves as a support group for female cardiologists who are addressing challenges such as work-life integration, gender-related issues, and the salary gap. Grassroots CV advocacy has gained another dimension of reach on SoMe to spread awareness, especially in heterogenous population groups. #SouthAsianCVD and #GoRedforWomen are some examples of successful SoMe CV advocacy campaigns. These campaigns allow unique opportunities for CV professionals to communicate jointly with other interested constituencies.
Social Media in Journals and Conferences
SoMe enables CV journals to drive engagement, increase journal visibility, and rapidly disseminate content to new audiences globally through new digital strategies (3). These strategies include incorporating appropriate hashtags, using images, creating poll questions, or adding visual abstracts. Many leading journals, including @JACCJournals, have appointed physician SoMe Editor(s) who combine academic expertise in their field with a track record of successful online engagement (e.g., affinity with digital media, broadly followed) to lead these efforts (3). In addition, a group of interventional cardiologists recently started an entirely Twitter-based journal called “Tweet-book: Cardiovascular Interventions” to publish peer-reviewed cases that are posted on Twitter.
There has been increasing emergence of Twitter-based journal clubs that meet virtually and provide a forum that allows for diversity of inclusion of participants across disciplines and across the globe. Podcasts, online journal clubs (e.g., #JACCclub and Twitter Live), and SoMe chats are other emerging methods (often led by the physician SoMe Editor) to enable increased engagement of health care professionals for high-priority papers.
The traditional impact factor of a journal, based on citation counts, may not fully capture readership impact. To augment this, journals also track alternative metrics (or “altmetrics”) that encompass an amalgam of web traffic, SoMe shares, and media mentions of a paper, and may potentially inform funding agencies about the impact of the research they funded (4). Although the full impact of SoMe on article views remains uncertain, ranging from neutral to beneficial, a recent paper found a modest correlation of an altmetric attention score with the number of citations for the 8 CV journals with the highest impact factors for papers published from 2015 to 2017 (5).
Cardiovascular meetings and congresses (Table 1) have embraced SoMe as a means to expand the reach and dissemination of education and science. Unbound by time limits or travel limitations, SoMe allows for expanded participation and viewing talks and posters using Periscope, Twitter, Facebook, and Instagram, with expanded post-presentation peer discussion. Analogous to an audience member standing at the microphone, the online discussion incorporates sophisticated analyses through a democratization of voices, sometimes coupled with engagement of the investigators themselves (6).
Social Media in Organizational CV Promotion
Health care providers such as hospitals are increasingly leveraging SoMe platforms to promote content consistent with the individual, departmental, and organizational clinical or research enterprise. Prominent cardiology societies like the ACC (@ACCinTouch) actively post the latest CV content to allow experts from across the globe to discuss ideas and provide critiques on new and upcoming research in a centralized, deregulated space. The ACC’s @CardioSmart account provides easy updates for clinicians and patients that are readily accessible at the touch of a fingertip through SoMe. Patients and patient advocates have also used SoMe to speak out about issues surrounding heart disease.
Social Media Best Practices
It is important for clinicians to remember that their online presence is within the public arena and therefore can have far-reaching implications. Any public account where professional medical discussions originate from the United States must remain compliant with the Health Insurance Portability and Accountability Act (HIPAA) (7). In contrast, in the European Union, the General Data Protection Rules stipulate that data that have been rendered anonymous are no longer considered personal (7,8). The U.S.-based HIPAA rules have a much broader interpretation. There are well-known cases where U.S. physicians posting on social media omitted protected health information, but not enough to prevent identification of a patient, resulting in legal consequences (9). SoMe users should familiarize themselves with the data governance regulations within their own institutions and health care systems related to images, case narratives, and the like.
At the same time, the American Hospital Association also noted institutions evolving from an initial policy of discouragement to a more commonsense policy for individual social media use (9). It notes some risks of avoiding SoMe, such as missed opportunities to correct misleading health information and to engage with the broader community about new advances.
When sharing clinical cases in SoMe, in addition to avoiding sharing protected health information, it is also important that commentaries remain professional and respectful. Offensive or demeaning remarks are not acceptable and may impact the reputations of health care centers, clinics, teams, and individuals, in addition to offending patients. Patient-clinician communication should best be left to HIPAA-compliant hospital-endorsed communication platforms.
The Future of Social Media Within CV Medicine
The use of SoMe is evolving, and advances in technology and software platforms will, by necessity, drive how this content is used or delivered to health care professionals. As previously discussed, a wide range of material is actively posted across multiple SoMe platforms in real time, and yet, the archiving systems of many SoMe platforms is archaic, with little functionality for searching or storing content for future use. Future development of this functionality across SoMe platforms will increasingly be important.
Major congresses currently promote digital strategies for delegates attending the meeting physically. It is conceivable that societies may use SoMe to run virtual congresses in the future, particularly in parts of the world where cost considerations may be particularly relevant. The awarding of continuing medical education credits for educational content posted on SoMe at such events is particularly challenging, so innovative approaches will be required to capture use of this content. For example, SoMe companies are able to track the number of users engaged with their platforms as well as the time that each individual user follows live-streaming from congresses or engages in discussion around a presentation or educational content posted on SoMe. Vendors awarding continuing medical education credits for societies or meetings could potentially use this information to permit the issuance of credit hours for SoMe users. A natural evolution of the case-based tweetorial discussions and twitter journal clubs mentioned earlier may be the development of virtual multidisciplinary team meetings across SoMe platforms, which may be particularly relevant in situations where a particular type of expertise is not available locally.
SoMe has transformed the cardiology community in a very short time, and its impact, influence, and relevance remains important but is under constant evolution (Table 1, Central Illustration). It is important that CV professionals direct the content of the community, rather than allow this to be driven by others. Its power to communicate openly, with wide-reaching access worldwide and at a rate faster than ever before, makes it a formidable force and voice. Rather than resist it, the CV community should embrace it for the purposes that will benefit the entire community and patients, but we should also understand its limitations and the responsibilities that come with the use of such media.
Dr. Parwani has served as a Social Media Consultant to the JACC Journals. Dr. Choi has served as the Social Media Editor for the Journal of Cardiovascular Computed Tomography. Dr. Lopez-Mattei has served as a Social Media Co-Editor for the Journal of Cardiovascular Magnetic Resonance. Dr. Narang has served as the Social Media Editor for the JACC Journals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Abbreviations and Acronyms
- American College of Cardiology
- Health Insurance Portability and Accountability Act
- social media
- Received October 2, 2018.
- Revision received December 4, 2018.
- Accepted December 30, 2018.
- 2019 American College of Cardiology Foundation
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- Cabrera D.,
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- Chisolm M.S.
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- Central Illustration
- Basics of Social Media
- Social Media in Education and Advancement for the Individual CV Clinician and Researcher
- Social Media in Creating New CV Networking/Communities
- Social Media in Journals and Conferences
- Social Media in Organizational CV Promotion
- Social Media Best Practices
- The Future of Social Media Within CV Medicine