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John S. Luo, MD
Primary Psychiatry. 2007;14(2):21-24
Dr. Luo is assistant clinical professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California in Los Angeles; past president of the American Association for Technology in Psychiatry (AATP) in New York City; and Gores Informatics Advocacy chair at the AATP.

Disclosure: Dr. Luo is a consultant to S.M.A.R.T. Link.


The Internet has become a vast network of information that offers users a sense of connectivity in addition to multi-media content. Chat rooms and discussion forums allow users to meet and form relationships. Ten years ago, people meeting Online might have been perceived as strange, but today, there are numerous Online sites dedicated to the process of finding a mate. In this manner, the social nature of the Internet has become the latest rage, with the increasing use of social-networking sites such as MySpace1 and Friendster,2 available not only for personal use but for professional networking as well. Despite the popularity of social networking for finding people with similar interests and establishing friendships, professional networking in health care has been slow to establish. A search on Pubmed3 reveals no articles about professional social networks in the medical literature, and even magazines such as Health Data Management4 and Healthcare Informatics5 have not covered this topic in significant detail. However, Google6 has recently purchased both YouTube7 and JotSpot,8 sites which promote the aspect of sharing videos and document collaboration, respectively. This action indicates that the Internet’s social aspect remains a significant driver of content and connection. This column reviews the progress of professional social networking in the healthcare setting.

Patient-Oriented Networking

Many patients have found that the Internet is not only a great resource of medical information but also features Online communities for support. Robert Hsiung, MD, at the University of Chicago, has hosted PsychoBabble, a message board for patients on a large number of topics, which began with psychopharmacology and has expanded to include other topics such as psychology, health, and substance use.9 Realmentalhealth.com10 also provides patients with forums on various topics and offers the ability for users to create their own journals and profiles. Members can post comments on each others’ posts, creating an Online social-networking site that promotes mental health treatment and wellness. Members can attend groups that meet virtually in chat rooms at specified times on issues such as schizophrenia, eating disorders, and self-injury. Chat rooms create a sense of discussion with real-time posts, in contrast to forums where posts and additional comments are archived for viewing. At the DailyStrength Web site,11 patients can create an account with a certain degree of anonymity. Patients can also create an Online journal, join an Online support community, and invite family and friends to join. Community news and friends’ progress are communicated via E-mail alerts. Virtual “hugs” help members support one another in a public display of affection. There are >500 communities dedicated to specific medical and life challenges, and members of these communities provide group support at all times of the day. In addition to friends and family, various medical experts contribute to these communities. Patients can share their experiences with various treatments as well as recommend doctors. PsychCentral12 is a Web site that provides more than topic forums. It also has a wealth of information for patients about various mental health disorders, treatments, and links to additional resources. Patients can search for clinical trials involving patients with their condition, be alerted via simple syndication feeds on health news, and ask questions of the site’s founder, clinical psychologist John Grohol, PsyD.

General Concepts

In real space, networking is all about meeting people, establishing a connection, following up on contact, and continuing the relationship. Many personal and professional social connections are often serendipitous in nature or created by intermediaries who make the effort to consider and then facilitate initial contact. This columnist remembers making his first connections at the American Psychiatric Association Fall Component meeting in Washington, DC on September 9, 1996. Attending the meeting of the Committee of Asian-American Psychiatrists and speaking with some members led to attending the meeting of the Committee of Information Systems. This networking opportunity led to meeting colleagues interested in information technology and, eventually, specialization in medical informatics. The primary benefit to extending networks electronically through social-networking software is the ability to find resources and like-minded colleagues beyond one’s primary network in a more organized fashion. Instead of relying on a colleague to create the connection, social-networking software allows the member greater flexibility in finding contacts by either browsing his or her network or searching the entire site using key search terms.

Each social-networking site generally requires the creation of an account and an associated profile. In addition to the standard demographic and method of contact information, profiles typically contain current work location, professional title, previous work experience, education, and other information of interest such as awards and expertise. Profiles can be set for members who are open to direct contact and willing to field questions, or for the types of contact preferred, such as consulting work, patient referrals, and job opportunities. Some social-networking sites promote miscellaneous and more personal information. For example, Orkut13 provides text fields to indicate personal interests in music, movies, books, sports, and hobbies. Ryze14 provides the opportunity to post events for networking or information exchange as well as a classifieds section with jobs, real estate, and roommate offers. In general, it is best to complete profiles with as much relevant information as possible in order to enhance the likelihood of profile views and contacts.

The strength of the social network lies in the number of connections in one’s direct network as well as the depth and breadth of one’s colleague network. With >9 million members in various industries, LinkedIn15 is one of the largest professional networking sites. Potential contacts can be found using key search terms. The social-networking site would then indicate how many degrees of people separate the user from a potential contact, with various routes of introduction. On LinkedIn, a request for contact is made to the final recipient and this request is passed down the chain. Each person or degree of contact has the decision to either pass on the request or to deny it. An alternative is to make direct contact if that person’s E-mail address is known, and, if the E-mail address is unknown, a direct contact may be purchased.

One of the more time-consuming processes is to make invitations for people to join the network. LinkedIn provides a toolbar that works with Microsoft Outlook to facilitate creating invitations. It determines which of a user’s contacts are most frequently contacted, and if appropriate, a one-button “click” invites them to join the network. In addition, contact information on LinkedIn and Microsoft Outlook is updated. A nice feature the site offers is an alert when a user’s contacts change their LinkedIn profile, which is usually indicative of a job change. Spoke16 also offers software that works with Microsoft Outlook to add an address book to the Spoke network. One disadvantage of using these tools is if a mixture of personal and professional E-mail addresses and contacts are in an address book. The LinkedIn-Outlook toolbar can be set to search only in certain mail folders for potential contacts. The Spoke application requires that excluded contacts are entered directly into the application. One difficulty is that both of these software tools are only available for the Microsoft Windows version of Outlook. LinkedIn also offers a browser-based toolbar that is compatible with the Mac OS X browser Firefox, which offers one-button search for LinkedIn contacts, bookmarks of contacts, and jobs.

Vertical Markets

A difficulty in joining a large network, such as LinkedIn with its millions of members, is that it may be extremely difficult to make a link to the appropriate contact. In particular, if the depth of connections is >3, the likelihood of a response diminishes since more people have to agree to pass on the request for information and connection, and the timeframe of response may be longer. LinkedIn does provide a method of direct contact with several levels of premium accounts, which range from $60­–$2,000 per year. Another difficulty with the large social-networking site is that the site may not have enough detailed features. For example, the site Youngfeds.org17 was created in order to address the specific needs of early-career federal employees for sharing job offerings, blogs and editorial writing, and offering career advice and after-hours events. Although LinkedIn has a large number of members who are physicians, there are greater numbers of physicians specializing in medical informatics on the networking site. One explanation for the relative disparity of informatics specialists on the LinkedIn social network is that the largest majority of members are in technology-related fields, such as information technology and services, computer software, and telecommunications, which comprises approximately 45% of the network.

In health care, there are limited numbers of professional social networking sites. Konnects18 has a medical focus group with rather low numbers of physicians. The majority of their medical focus group are actually consultants, Web site designers, and office managers. Sermo19 is a network of physicians of all specialties but its focus is not on networking. It is focused on the collective medical practice experience of its network of physicians. Membership requires verification of identity using information such as medical school, graduation year, and state license number, which are presented to the user on signup in a multiple-choice list. Once the account is created, members then browse a list of various questions and post answers. In addition, members rate which questions are important and relevant. The goal is to improve medical insight via peer consultations and develop a knowledge base. This forum is essentially anonymous since members cannot view each other’s demographic information other than name of who posted a comment. An interesting aspect of membership is Sermo also enables physicians to be financially rewarded for their astute observations and clinical insights. Rewards are for the author of a posting that has been identified for payment, or a vote on a posting that has been invisibly earmarked in the system may earn a payment. Sermo has raised funds from organizations, the United States federal government and investment institutions, who have an interest in getting early indication of events that may impact health care. Members are also ranked based on their postings. Highly-rated ranks and adding answers to a posting corroborated by others who vote increase the rank of the member. The intent behind Sermo’s ranking system is to encourage physicians to submit their observations and then corroborate or dispute their colleagues’ observations based on their own experiences. The criteria that determine rank identify and reward users who are making positive contributions to the community. The Sermo network sends a message when there is a topic of interest to the member, seeking their opinion.

Currently, the only dedicated professional social networking site at this time for physicians and researchers in the health sciences, including biomedical engineers, psychologists, pharmacologists, and public health researchers, is MyMedwork.20 A clear advantage of utilizing dedicated healthcare professional sites, such as Sermo, is that all members are validated against the state licensing board list of practitioners. On MyMedwork, the network has grown in a grassroots fashion, using a pioneer group that was validated and who then vouches for new members. Even on LinkedIn and other established professional networking sites, there is a risk that the contact profile has been created with false credentials. On MyMedwork, the goals and resources are similar to general professional networking sites. It enables members to enhance professional relationships by connecting to colleagues they already know; finding and reconnecting with former classmates, colleagues, and collaborators; establishing and cultivating new relationships locally, regionally, nationally, internationally, and across various specialties and fields; highlighting their own skills, interests, research, experiences, and accomplishments to increase prominence; and connecting and communicating to improve clinical decision-making, referrals, and innovation. One of the major innovations is the use of special tags in a Pubmed search to virtually mark those articles written by members that associate them with their member profiles. In this way, when other members search for articles on particular topics, the articles found on Pubmed written by MyMedwork members will be highlighted, indicative that the article is likely of interest. In the future, clinical trials will also be available for referral or collaboration.

Conclusion

In the technology industry, as a general trend, physicians have been slow to adopt new technology. Although it is difficult to pinpoint the reason why physicians have been slow to embrace professional social networking, one explanation may be that with busy professional lives, virtual networking appears to provide less of an immediate return for the time and energy spent when compared to using traditional local resources. However, with specialty issues including dealing with complicated and treatment-refractory cases or research in specific areas such as medical informatics, it makes sense that adding an electronic networking piece may be the better solution whether networking be used for a patient referral, answers to specific questions not clearly indicated in the medical literature, or finding a new job in another location. An analogy would be that people find it is better to purchase items in the local store, but if that specialty item is not in the local vicinity, most people would not hesitate to go onto the Internet. A parallel process has been that while the amount of information available on the Internet has increased almost exponentially, better mechanisms utilizing social contexts have been used to search and find the right information quickly. An example of this synergy is the development of professional social-networking sites such as ZoomInfo21 and Ziggs22 that use a combination social network and search engine to help people find the professional contacts they need. PP

References

1. MySpace. Available at: www.myspace.com. Accessed January 3, 2007.

2. Friendster. Available at: www.friendster.com. Accessed January 3, 2007.

3. Pubmed. Available at: www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed. Accessed January 3, 2007.

4. Health Data Management. Available at: http://healthdatamanagement.com. Accessed January 3, 2007.

5. Healthcare Informatics. Available at: www.healthcare-informatics.com. Accessed January 3, 2007.

6. Google. Available at: www.google.com. Accessed January 3, 2007.

7. Youtube. Available at: www.youtube.com. Accessed January 3, 2007.

8.  JotSpot. Available at: www.jotspot.com. Accessed January 3, 2007.

9. Psycho-Babble. Available at: www.dr-bob.org/babble/. Accessed January 4, 2007.

10. Real Mental Health. Available at: www.realmentalhealth.com. Accessed January 4, 2007.

11. DailyStrength. Available at: www.dailystrength.org. Accessed January 4, 2007.

12. PsychCentral. Available at: http://psychcentral.com. Accessed January 4, 2007.

13. Orkut. Available at: www.orkut.com. Accessed January 5, 2007.

14. Ryze. Available at: www.ryze.com. Accessed January 5, 2007.

15. LinkedIn. Available at: www.linkedin.com. Accessed January 6, 2007.

16. Spoke. Available at: www.spoke.com. Accessed January 6, 2007.

17. YoungFeds. Available at: www.youngfeds.org. Accessed January 7, 2007.

18. Konnects. Available at: www.konnects.com. Accessed January 7, 2007.

19. Sermo. Available at: www.sermo.com. Accessed January 8, 2007.

20. MyMedwork. Available at: www.mymedwork.com. Accessed January 8, 2007.

21. ZoomInfo. Available at: www.zoominfo.com. Accessed January 9, 2007.

22. Ziggs. Available at: www.ziggs.com. Accesssed January 9, 2007