Let’s start with a few acknowledgements:

• People may be saying bad things about your business on the Web already, you just don’t know about it. This is not as likely for elder care providers as it is for Comcast, AT&T or Microsoft, but still… Have you done a Google search lately? You may be surprised. To borrow a line from the Godfather, “Keep your friends close and your enemies closer.” Better to have people post negatives about you where you can easily find them (on your own Web presence) and respond than to have negative comments floating out there on the Internet with no redress at all.
• When you do a public presentation, you risk someone publicly saying something negative. Part of live interaction with the public is taking the risk that you may have to deal with an uncomfortable bit of criticism. No one would say you shouldn’t do presentations, or shouldn’t be interviewed on a radio call-in show. Why run away from social media for this reason? The solution is to be prepared with a reasonable way to respond.
• In elder care, the overwhelming amount of comments are positive. I have taught workshops where some of the early adopters of social media were in attendance. After several YEARS of blogging and doing Facebook, one said that she literally had 300 positive comments before anyone posted a negative comment. I’ll take those odds!
• You do have the ability to delete negative comments. While it is not in the spirit of the open dialogue and engagement inherent in social media, it is always your prerogative to get rid of a posting that you think is completely off-base or inappropriate.

What are the comments you can/should just delete?
Some people are just grouchy. They like to pick fights. (Called “Internet Trolls”.) They may be offensive or abusive. They may use profanity. (Called “Ragers.”) They may have forgotten to take their meds for a few days… You meet all kinds.

Publishing an inclusion/deletion policy helps. Some items you might decide to categorically delete would include comments that are:

• Abusive, unlawful, threatening, harassing, embarrassing or hateful (racist, sexist, ageist…)
• Obscene or offensive, using profane language
• Defamatory or libelous
• Infringements on the copyrights of others
• Advertisements or solicitations for business (aka spam)
• Impersonations of someone else
• Off-topic to the discussion
• Of a private, medical nature (although this is not negative per se, think HIPAA)

You not only have the ability to delete these posts, you can also block them from posting again. (You may wish to do this for the more obstreperous ones. Deleting a comment can anger a poster and inspire them to comment again and again. If they are irrational, this is even more likely.)

Comments that have a rational tone to them should be kept and responded to. Not only because the individual deserves a reply, but also because your Fans will want to know what you have to say. If they see you have deleted a rational albeit negative comment, you will lose credibility in the Internet crowd. Kremlin-esque policies are frowned upon on the Web, especially in social media.

Monitor frequently (once a day at least). If someone does put a negative comment up, you want to begin putting your policy/response in motion as soon as possible. For platforms such as Facebook, you can have comments forwarded to your email so you can immediately see (or as often as you check email) who has said what.

A blog is the “safest” social media platform as you can set it so all comments have to go through an approval process before they are posted publicly. If your leadership team is especially squeamish about negative comments, start with a blog rather than Facebook. The greater control on this platform will ease anxieties. It also allows you to hold “borderline posts” until you have a reply ready to release right after you “publish” the negative comment.

A difference of opinion is a good thing. Community engagement is a primary goal of social media and by its nature implies a certain amount of debate. While a lovefest is lovely (all positive comments), if people care enough to challenge something you have said or done, part of building community and building relationships is to respect their opinions and participate in the conversation.

The Air Force, of all agencies, has an infographic for its comment response policy. It provides a handy flowchart that might help you decide how to respond.

Some people suggest leaving non-abusive but obviously irrational posts alone. Your Fans will likely recognize the person as off-base and discount their comments. Or one of your Fans may even step in and come to your defense.

I tend to think this is more relevant advice for larger companies with very large Fan bases (in the thousands range) as the number of Fans who actually post on a business page tends to be less than 2%. If you have 100 or fewer Fans (the average small business has 65), the chances of one of them defending your honor gets pretty slim. Don’t forget, our client base tends to be of a generation that is not as active in terms of posting comments. They may even feel that you are being treated unfairly, but that doesn’t mean they will jump in on your behalf.

It’s not a good idea to let negative comments linger unaddressed. Depending on the intensity of the comment, if your Fan base has not stepped forward within half a day, it would be good for you to reply. The more balanced and rational the comment, even if it is misguided, the more quickly it deserves a response. To that end:

• Take a deep breathe. Count to 10. Don’t take it personally.
• Resist the temptation to defend your company or yourself. Defensiveness is considered poor “Netiquette.” Take your cue from the editorial replies in the “Letters to the Editor” section of the local paper, or a suggestion bulletin board at a local store. The “goal,” if you will, is to demonstrate your openness and responsiveness.
• Gather the facts. Connect with anyone who had contact with this individual. Recheck your sources if it’s a disagreement about an article.
• Respond politely and concisely. This is a public conversation, but other readers will not wade through paragraphs of text. You want your Fans to see that you are responsive. If you can’t do justice in a paragraph, summarize your response and then post a link to a FAQ page or some other venue where those who are interested can read further details.
• Have a negative comments committee in place. It’s difficult for one person to retain perspective. Optimally, you would have several people who are on tap to quickly vet a response before it gets posted. Having several sets of eyes review the response is the best way to be sure that it accurately reflects your company tone.

What if there is truth in the comment?

• Thank the commenter and apologize. There is a very strong ethic of transparency and honest relationship-building on social media. In this culture, defensive smoke-and-mirrors is worse than any error you could have committed. Be humble. Admit your humanity. Work with integrity to address the issue.
• Describe what you will do to prevent a recurrence in the future. If there is a policy problem, an internal communication glitch, something that can be changed systemically, great! Let the person, and your audience, know about your intended changes. It’s not only the right thing to do, but it also demonstrates to all your followers that you listen and respond.
• Do what you can to publicly address the problem now (within bounds of privacy). Certainly if there was an inaccuracy in one of your posts, rectify it right away.
• Offer contact information, if appropriate, to help resolve private issues offline. Posting a name and phone number is the best way to show your eagerness to address the situation and make things right. One hospice workshop attendee said they invited the commenter to talk with them offline so they could rectify the situation. When they had, the hospice then asked the commenter to post about that experience. It worked out well for everyone.

If you would like to see sample Comments Policies, check out the policies of other health care organizations (e.g., Mayo Clinic, Kaiser Permanente) that are shared on the Social Media Governance website.

How have you handled negative comments?

For this entry, we’re going to look at defamation, libel and false light. To be honest, when I started researching this, I didn’t think it was much of an issue for elder care professionals.

• But then I started thinking about the comments followers leave. Are we liable for their libel?
• And then I learned about “false light,” an easy mistake to make.
• I also started thinking about advocacy roles. I realized that there may be times when we need to speak up, against unfair laws or dangerous or abusive practices.

Hmmm.

And even if you don’t define yourself as an advocate (not that you should), the weird thing about the Internet is that even one obscure little blogpost could end up being seen by millions. Double hmmm. That puts the stakes a little higher than your average brochure or flyer and makes it wise to understand how to say what you need to say AND protect yourself.
Recognizing that I am not a lawyer, here is a thumbnail set of definitions and guidelines I gleaned from the Citizen Media Law Project of Harvard University:

• “Defamation” is “a legal claim involving injury to reputation caused by false statements of fact.”
• “Libel” is written defamation, while “slander” is the spoken variety.
• “False light” is like defamation, but has to do with untrue implications rather than direct statements of false information. For instance, posting a picture of someone who is gaunt by an article about cancer, might imply that the person had cancer. This is the type of error I think is most likely to happen in the field of elder care.

As a rule, we tend to shy away from controversy. Harsh, critical commentary is not usually the style with elder care professionals. But if there is something you just have to let fly on, it appears that as long as you are extremely clear that this is your opinion, and your facts are true, your legal liability is limited.

Again, I am not a lawyer.

The Citizen Media Law Project recommends some guidelines to consider:

• Would you be upset if these things were said about you? The Golden Rule may not be the gold standard of legal liability, but it’s a good first step. The phrases that seem most upsetting are those that you need to inspect and edit extra carefully.
• How sure are you of your facts? Follow good journalistic practices and only use reliable sources. Especially in light of those sensitive phrases, you want to be sure that you are publishing only truthful information. A truthful statement that harms another’s reputation is not libel. However, you may be open to other suits if the information is especially private (e.g., private financial records of an individual or business. We already know you would not publish medical information!)
• Seek comment from the person/organization in question. Fair is fair. And there may be an explanation you hadn’t thought of.
• Document your sources. In the unhappy event that you go to trial, you will have a record of where you learned what.
• Clarify what is fact and what is opinion. Words like “in my opinion” and “I believe” will help. But context as well as the language needs to draw the line clearly. False implications often occur when the context is blurry, such as the innocent mistake of poor picture placement described above.
• Avoid inflammatory language. Passionate rhetoric can be really fun. I LOVED writing it when I was in college. But it also tends to fan the flames. Give your staff guidelines. Unless it is your intent to rile things up (e.g., you are doing community advocacy about a piece of legislation that you feel is patently unfair or biased), you may want to have a second set of cooler eyes read through the text before you click “Publish.”
• Beware of conflict of interest. If your remarks impact a competitor, you could be liable for a fair trade lawsuit.
• Retract or correct inaccurate statements. The horse may be out of the barn, but if you give your corrections the same prominence as your initial statements, you are at least demonstrating your intent to be fair.

But what if your followers are the ones who post something defamatory?

It turns out, you are not liable. The Communications Decency Act legally protects you from liability for user-submitted communication. As long as the posting was submitted by someone outside your organization, you are not legally on the hook. That said, talk to your business liability insurance carrier. They may have some opinions on the matter.

Regardless of liability, however, what is the tone you wish to set? Controversy is popular. You will get a lot of traffic, especially with spicey headlines. (My most popular blogpost so far was a somewhat feisty anti-ageism piece entitled “Don’t call me ’senior’!“)  But is the traffic you receive going to come away with an accurate sense of your business’ personality?

Perhaps being a strident advocate is part of your professional image. (I do get pretty feisty about ageism.) By all means, then, have at it with the above precautions. But if you ask yourself, “What adjectives do I want potential clients to associate with my business?” and you come up with softer ones, such as “warm, caring and compassionate” then statements that might lead to defamation or false light might not be in your best interest.

It’s perfectly fine to remove defamatory comments, although it is considered best practice to publish an inclusion/deletion policy.  This will help your staff understand your guidelines, and provide public warning/disclosure/justification for any comments you choose to delete.

For samples of inclusion and deletion policies other healthcare companies use in social media, I recommend the Social Media Governance website.

You need to be sure they do not violate HIPAA nor say things even in their personal posts that reflect poorly on your company.

In the next few blog entries, I am turning my attention to the legal risks of publishing online. After HIPAA, I would say the next most likely transgression has to do with intellectual property violations.

Intellectual property rights apply to anything you publish (in print, or on your website, blog or Facebook page). Many companies, rightfully so, encourage employees to Like, Share and Comment on the company Facebook page or blog. And certainly your official “post-ers” are employees. In that light, be sure you are clear with everyone about what can and can’t be posted from a legal point of view. You don’t want a lawsuit!

Before we go much further, I am not a lawyer. I am drawing my information from two sources:
•    Citizen Media Law Project of Harvard University
•    Legal Guide for Bloggers from the Electronic Frontier Foundation

“Intellectual property” is a fancy way of describing “products of the mind.” It is in our country’s interest to encourage innovation, thus the federal government has set up laws designed to protect the rights of innovators. It takes skill (and time and money to develop skill), not to mention talent and creativity to come up with new ideas.

There is also a certain amount of risk (also involving time and money) to perfect new ideas and get them ready for market. Legally, then, the creators deserve to have protection so they can control their “products of the mind” and reap any monetary or social rewards.

How does this relate to social media? Well, you’d be amazed how many blogs I see, or Facebook pages with a Notes section that has out-and-out lifts of other people’s materials. Or graphics that have simply been “borrowed” from another website.

People often type in whole articles and think that by listing the name of the author, they are covered. Not so! (One hospice even copied my whole e-library and entered all 60 pages of it (!) into their company website. They were not intending to break the law. They just didn’t realize that writing on the Internet was not up for grabs!)

Because the Internet has a basic ethic of “sharing,” it’s easy to forget that all the laws of copyright, trademarks and trade secrets apply just as they do in print.

• Copyright: The Citizen’s Media Project aptly describe copyright as “protecting the fruits of creative efforts.” The owner of a copyright has the exclusive right to manage how, when and by whom their work is displayed, reproduced or distributed. Copyright ownership lasts, as a general rule, for about 70 years and can be transferred to heirs or whomever the copyright owner wishes. Writing, photos, drawings, videos, photographs, music, coding for software, all of these are products of the mind that can be copyrighted.
• Trademarks: Your branding is your trademark. It’s usually your name, perhaps a slogan, and often has a symbol (i.e., logo) attached. The idea of a trademark is to keep others from appearing to be you and gaining business advantages that they have not earned. Trademarks can be owned locally by simply having used them in a specific region for a number of years (common law). But for trademarks to be protected nationally, they must be registered with the U.S. government.
• Trade secrets: Confidential customer lists, vendor lists, billing or staffing policies…anything that might provide a competitive edge is considered a trade secret.

When you think of policies to guide employees in their posts, you must think not only about protecting what you have created, but also about preventing your employees from inadvertently infringing on the intellectual property rights of others.

• Using text written by others: As a rule of thumb, you may quote from others as long as you use only a few lines, quote verbatim, and distinguish the passage as a quote (with quotation marks and an acknowledgement of the author). If you want to use more than a few lines of text, contact the author and get written permission. Note any copyrights and declare beside them that the materials have been “Reproduced with permission.” With Internet materials, it is considered polite to include a link to where you found the material originally. (Or use the “Share” feature on Facebook, or “Retweet” on Twitter.) Many authors are very happy to let you reprint their entire article for free as long as you link to their blog, website, or other online presence. The exception to this general permissions rule is that articles published by a government entity are considered “public domain.” Your tax payer dollars paid for them so you can use as much of them as you want and do not need to ask permission.
• Writing your own text:  Although there is an official copyright protection procedure with the federal government, simply noting the copyright symbol, the year and the name of your company puts a stake in the ground alerting others to the fact that you consider this copyrighted material. If you are telling the story of a volunteer, or patient or family, you also need get their permission, in writing as their story is their “asset.” This is true not only for intellectual property reasons, but in the case of patients and families, extremely important for HIPAA compliance.
• Using graphics, photos, music or videos created by others: You need to get permission of the artist/creator in writing. It is best to also note their copyright for the material and “Reproduced  with permission” somewhere close to the artwork. You can also consider using stock photography sites that offer royalty-free graphics for a nominal fee. You generally do not need to give written credit in this instance, unless you have specifically licensed the materials as “editorial content.” Check with the terms and conditions of the stock photography company.
• Graphics, photos, music or videos that you create: As with written materials, a copyright symbol with the year and name of your company is generally adequate to protect your rights. If you have a fancy graphics company helping you, these works of art can even be digitally branded so if someone lifts it, you can easily identify it as yours. (Like a chip in a stray cat.) It’s always safest to keep written permission on file, even from staff members who have participated in the creation of the work, or are the subject of the photograph, video, etc. If you are using images or voice recordings of individuals in your community, you absolutely need to get their permission, especially if they are patients or clients as this invokes HIPAA privacy protections.
• Use of logos (trademarks): You should have a clear style sheet available to all employees that delineates how, when and who can post your logo. Similarly, caution your employees to never lift the logo of another company and post it on your social media account. Even if the company is an allied business or strategic partner, they need to be consulted before their trademark is published in your context. (It’s theirs to share, not yours…Do unto others…)
• Precautions regarding trade secrets. Certainly in elder care, it’s different than for retail or manufacturing. You don’t have 13 specially selected herbs and spices as part of your secret sauce. Still, it does not hurt to be clear about the kinds of things you think are inappropriate to share. You have competitive advantages, and your employees may have access to those. An employee could inadvertently reveal something that is very strategic. Sadly, a disgruntled employee can also make potentially damaging revelations. (And if they are no longer in your employ, you don’t have the most obvious options.) Consult your attorney about including a passage regarding confidentiality of trade secrets as part of a hiring document. It may not stop the revelation from being made after a termination, but it may give you some teeth for a cease and desist order.

What have you done to help your employees avoid intellectual property infringements?

According to Idealware, software reviewers for non-profits, Facebook is a great way to:

• get people to subscribe to your e-newsletter
• drive traffic to your company site
• promote events

What’s your experience been?

Data include findings from Transcend Hospice Marketing and Pew Internet and American Life. Stay tuned next week when I’ll be blogging there about social media and family caregivers.

Plan November activities that make the family caregiver’s life easier and let the press know.

Sponsoring educational events or launching an educational service is known as “content marketing.” Ideas for content marketing include a workshop or webinar you can record and make available later. An e-newsletter, or an online library of educational articles (we call this an “e-library”) is another form of content marketing. If you follow best practices for Facebook or blogging, 80% of your posts will be educational for your audience; only 20% will be about you and your service.

The wonderful part about content marketing is that you have a great resource that others will be likely to share, including the press.

Here are ways that some of my clients have been getting media coverage:

Check out the TV news story my client was able to get for her chronic care e-library.

The news station would never have done a story on a company’s commercial page. But she got nearly 2 minutes of TV time for her e-library. The camera showed her logo at several spots in the story. Plus, she was interviewed and was able to convey the depth of commitment she holds for supporting families involved in elder care. Because November was National Family Caregiver month, and her e-library is a resource being offered generously to for family caregivers, it garnered all kinds of goodwill, AND publicity. She could not have bought that kind of exposure.

I have another client who got the local paper to run a story on his e-library.

He has also done cross-platform marketing on radio, appearing regularly on the local “Health Connection” radio talk show where he spotlights family caregiver issues. He may feature a topic from his e-newsletter, and certainly refers callers and listeners regularly to his e-library at elderpages.com/pittsburgh.

You can listen to one of his radio spots. Go to the entries from October 12, 2011 and click on the Health Connection audio. Another client is doing something similar, appearing on local TV’s “Medicine in Meadville,” and doing a monthly gig on news talk radio, station WMGW.

A different client used her advanced illness e-library as a source of a trivia contest on the radio. Wednesday at 11:00 became the Family Caregiver Corner where she would get on the line with the local DJ on the classic rock (Boomer) station and ask a question.

The DJ would lead in, “Okay all you family caregivers out there, time to jump on the Internet. If you are caring for a parent or loved one who is seriously ill, now is the time to go to seriousillness.org/[name of her community]. We’re going to ask you a question, and the first caller to phone in the right answer and tell us what page they found it on will receive a $25 gift card from [name of local medical supplier, or pharmacy or …].” She got these gift cards donated in exchange for the mention.

Then the DJ would read out the question. It might be something like: “What percentage of people have actually written an advance directive?” [30-35%, see the page on Starting the Conversation]  “Hospice includes home visits with a nurse; a nurse’s aide coming out twice a week to help with bathing; and home visits from a social worker and a chaplain. How much does it cost a person on Medicare to have hospice services?” [Nothing, hospice is paid 100% by Medicare. See the page on Cost and Eligibility].

My client would confirm that the answer was correct, then the DJ would chat up the caller. “Have you ever had a friend or family member on hospice?”…Most of the time the caller had some knowledge and was very positive about hospice. My client was prepared to address negative comments too, although none ever came up as far as I know.

Another client has set up a “Caregiver College” lunch and learn series. They offer a lunch and a speaker on a topic of timely interest, for example, “Veteran’s Benefits” in November. They have been running the college for several years now and have cultivated a loyal following of seniors (spousal caregivers). They are even partnering with the local library for evening presentations which seems to draw more of the adult children.

Content marketing like this allows you to position yourself as a thought leader. If you focus on regularly offering helpful, educational information to family caregivers, they will associate you as the expert in elder care. You are building name recognition and brand loyalty. When an elder care need arises, your business is most likely to be top of mind.

And when you offer helpful resources, you are very likely to engage the media. Whether it’s radio, TV, a website, or a lecture series, if you have resources for family caregivers, let the press know.

What did you do for families in November? How did you engage the media?

The trick with open enrollment is how to know if the current plan is worthwhile, and what, if any, would be better?

Here are 5 online tools to help your clients make these decisions:

• Medicare Open Enrollment. This FAQ webpage, sponsored by Medicare, has a very simple layout with step-by-step instruction on how to start the research process, how to choose a plan, how to save money, and where to get personalized help.
• Medicare Plan Finder. This page cruises the Medicare database to help viewers find drug plans and Medicare Advantage plans offered in their geographic region. If the searcher has complete Medicare information (Medicare number, Date Part A became effective and the beneficiary’s date of birth), the database will offer even more customized possibilities with more accurate price information. Good information to have on hand is a list of current prescription medications and the pharmacies used. This will help to calculate whether you are likey to fall into the “donut-hole.” You will then be able to select what types of plans to look at (Prescription drugs, Medicare plans with drug coverage and Medicare plans without drug coverage). Plans are presented in lowest to highest cost order. There is also Plan Rating feature in the right hand column, giving you a sense of Medicare’s quality rating of the plan based on number of complaints and consumer ratings of satisfaction and service. You can select 3 plans at a time and compare them side-by-side. There is a link for getting more information about each plan, or and even a link that goes straight to the online enrollment form. Medicare provides a 12 minute orientation video describing how the Plan Finder works.
• Find a Medi-gap policy. Similar to the Medicare Plan Finder, this tool helps the viewer select from a range of Medigap plans that are available, including a comparison to the current plan.
• Get personalized help. Every state has a State Health Insurance Assistance Program (abbreviated, “SHIP”). With this website, you can find the SHIP office nearest you and the contact information for setting up a counseling appointment.
• Overview documents. AARP offers numerous educational articles about Medicare and all the different types of policies. I especially like the one about open enrollment scams and how to spot them. AARP also provides interactive tools, such as a “donut-hole” calculator and a “de-coder” for translating Medicare’s quarterly summary of services received.

For those who want more information, AARP is holding a free, one-hour webinar about Medicare basics and open enrollment. It will be held Thursday, 11/17 from 2:00 – 3:00 Eastern. Registration is required.

To begin with, according to Pew Internet and American Life, health information seeking is the third most popular Internet activity, preceded only by email and using a search engine generally. Eight out of every 10 Internet users seeks health information online. Family caregivers are more active in their searching than any other group (including patients), often by a double-digit margin.

An analysis of health information searches relating to elder care revealed that:

• 17% of health searchers are looking up memory loss, dementia or Alzheimer’s disease
• 14% want to learn about how to manage chronic pain
• 12% are looking for long-term care for the elderly or disabled
• 7% want information about end-of-life decisions

In another report, Pew Internet also looked into what topics people tend to turn to the Internet for, as opposed to turning to their doctors. The Internet topics include:

• Emotional support for dealing with a health issue
• A quick reference for an everyday health issue
• Practical advice for coping with day-to-day health situations

If you want to be found by family caregivers, you want to write on the issues listed above. You might also want to read our blog post about attracting new elder care clients via search and how to reach the pre-hospice audience.

Within your chosen topic, strategically pick keywords and phrases based on what your audience is likely to use.

Remember, search engines are picky. You might have a dynamite page that talks in depth about memory loss, but if you refer to it as “forgetfulness,” it won’t come up in a search for the term “memory loss.” And relatively few people search for “forgetfulness.” Before you choose your keywords, therefore, check out Google’s external keyword tool. This will tell you which phrases are searched the most.

For instance, in the last month, an analysis of U.S. searches for terms pertaining to “memory loss” reveals:

• Alzheimer: 1,220,000 searches
• Alzheimers: 823,000 searches
• Dementia: 550,000 serches
• Memory loss: 246,000 searches
• Cognitive impairment: 40,500 searches
• Forgetfulness:  33,100 searches

Think in terms of the words your target audience is likely to use. Here’s where the interpretation comes in. Thanks to large public education campaigns, Alzheimer’s Disease is well known by the general public. Oddly enough, more people search for the inaccurate singular “Alzheimer” than they do for “Alzheimers.” I don’t think I’d intentionally misspell the word, though.

If your topic is not specifically about Alzheimer’s disease, an initial look at the data might lead you to consider the word “dementia.” But I wouldn’t be surprised if a lot of the people searching that word were professionals, not the target audience of family caregivers. You can see the dilemma. In the educational e-newsletters and e-libraries we create for clients, if we aren’t talking about Alzheimer’s Disease in particular, we use a sprinkling of “dementia” and “memory loss” just to cover both bases.

It’s important to pay attention to the placement of keywords on the webpage. Insert the keyword, or phrase, in the title, in subheads, in boldface, and in links coming to the page from other pages within your site. (If you can arrange for other people to use those keywords or phrases in their links to your page, all the better!) One of the ways our products help our clients is that our 60+ pages link to their company website using local search terms pertinent to care seekers, such as “hospice in Baton Rouge,” “home care in west Michigan,” or “home health in north Orange County.”

Search engines will score your page more highly for the words in titles, links, etc. than they will for words used in the regular text of the article.

With National Family Caregiver Month now upon us, please dedicate some text and attention to family caregivers. If they are your target audience, you will also be serving yourself to optimize your website with content they are searching for.

If you have questions about content marketing, or would like to license our educational content for family caregivers (brandable educational e-newsletters and e-libraries), please email me at tasha@elderpagesonline.com, or give me a call at 707-477-0700. We’d be happy to work with you.

Two weeks ago, in San Diego, I delivered a workshop at the NHPCO Clinical Team Conference on using the Internet safely to collaborate across the continuum. I highlighted ways that providers can share information in HIPAA-compliant fashion, with each other, but ALSO with patients and their family caregivers. The emphasis was on tools that facilitate the four factors that tend to reduce re-admissions, as demonstrated by the research of Dr. Eric Coleman of the University of Colorado:

• Medication management
• Getting a follow-up appt with the doctor within 7-10 days
• Knowing the signs of a problem
• Dynamic tools that facilitate communication

In my session, I spoke about free online services, such as MedActionPlan.com, that allows providers to create a real time, password-protected medication schedule they can make available to the patient/family. This also includes a calendar and appointment feature, which addresses the first two components of improved care transitions.

I also spoke about Heart360.org, the interactive tool developed by the American Heart Association that covers the last two components for improved care transitions. Heart360 allows the patient/family to record bp, weight, blood sugar, etc. (or download them from tele-monitoring devices). Heart360 also provides real time, dynamic feedback about the patient’s cardiac values with a user-friendly interface that addresses health literacy issues by employing the metaphor of red light (emergency, call the doctor), green light (good to go) and yellow light (caution, a problem is developing, engage in Plan B).

Providers can set up Heart360’s red/yellow/green light parameters. They can also set it up to send them alerts if a patient’s numbers fall outside the normal limits, and to remind the patient of Plan B actions if a yellow light alert is triggered. Through Microsoft Health Vault, Heart360 users can also engage with their providers using its secure email function to ask questions and receive answers. All of these are available for free.

At the NAHC conference in Las Vegas two weeks ago, I attended a session on Home Health and IT. While it was inspiring to hear how things are progressing with provider-provider sharing of information, when I asked about including the patient/family in terms of access to records or participation on the team, they looked at me like I was from Mars. Sigh…

I couldn’t believe the need to include the patient/family was considered such a non-sequitor to the topic. Dr. Coleman’s Care Transitions Study was a seminal piece of research, identifying the problem of care transitions early on and measuring cost-effective interventions with the “home team” that were estimated to save the health system nearly $300,000 in a year. This was not brand new information.The 15 Medicare QIO care transition demonstration projects grew directly out of this study.

After NAHC, and then giving my presentation in San Diego a few days later, imagine my delight when I learned that Dr. Coleman was going to be a guest speaker at a web conference last Friday entitled “Putting the IT in Care TransITions“!

I was not disappointed. (And I’m not from Mars!) There were 4 breakout sessions:

• Discharge process
• Medication management
• Flow of information
• Patient/caregiver activation

Threaded throughout the discussions were references to the need to have patients/families participating. Recommendations included:

• Having the patient (or proxy) identify goals.
• Having a way for the patient (or proxy) to express his/her preferences and unique situation.
• Identifying the team members and their roles/responsibilities.
• Negotiating the medication schedule (recognizing patient is not just passive taker of medicine; acknowledging the importance of knowing what’s really being taken).
• Creating a process, with supportive tools, to facilitate COLLABORATIVE decision-making. (Think of the medical record as a single shared document in the cloud where everyone can make/track changes, including the patient.)
• Establishing actionable tools that provide feedback/accountability of all team members: “X” was to be done at “Y time” by “Z.” Did that happen? If not, what did happen? Perhaps create alerts to prompt Y…
• Encouraging rich media (photos, videos) so the qualitative aspects come out, literally giving the patient a voice. Make it so the patient is not just a series of lab results.
• Empowering the patient (or proxy) to take the info with them (e.g., download to a thumb drive).
• Secure messaging so patients can communicate with providers.

The videos and slides from the conference have been made available via the Web. A search for “itrans” on twitter.com will give you a feed of om-going commentary.

Many thanks to the conference sponsors (John Hartford Foundation, Kaiser Permanente, Gordon and Betty Moore Foundation), Health Affairs, which will be publishing the proceedings, and Brian Ahier (@aheir) who was the tweet meister of the event. This was a supremely on-target conference. It was also put on in a very thoughtful way, making superb use of technology in terms of helping remote attendees participate through online voting, tweeting, slideshare, etc.

Any health IT success stories to share? Any wishes you would like to see in terms of health IT and care transitions?