I know: it sounds like a movie. Who knows, maybe it is.
Anyway, there’s been an ongoing story about a student nurse who allegedly posted a picture of a patient’s placenta on Facebook. The nursing school expelled her. She filed a law suit. Today, the court ordered her reinstatement. The school subsequently issued a press release indicating its displeasure with the court’s decision.
It was obviously a hot topic on #RNchat last night. You can view the transcript here.
This case isn’t really a big deal in some way – but it is in others. Here are some of my thoughts explaining that [link]:
This is an interesting story. It raises the issues of professional responsibility, how nursing schools should treat their students, the cultural effects of social media and a lot more. It’s certainly a topic to be discussed on #hcsm and other places.
Getting people to like each other is one of the best ways to know what they’re saying, doing and planning. They open up. They trust. They share.
All great spies know this.
So does Facebook.
According to an article by social network researcher Arnold Roosendaal, Facebook’s Like button is more than just a sharing tool. In his paper, tittled Facebook Tracks and Traces Everyone: Like This!, Roosendaal states:
…[the Like button] is also used to place cookies on the user’s computer, regardless whether a user actually uses the button when visiting a website. As an alternative business model this allows Facebook to track and trace users and to process their data. It appears that non-Facebook members can also be traced via the Like button. [emphasis mine]
(I urge readers to download the paper, especially if you want to know more about the work Facebook does behind the scenes with its Like button and other Social plugins and Facebook Connect. Go ahead.)
What’s key here is that even if you don’t have a Facebook account or aren’t logged in to Facebook, the company is likely going to track what you do on the Web.
Since Facebook knows so much about you – your email, your birthday, your contacts, etc. – the Like button could be one of the tastiest cookies a spy could ever eat. Well done, Facebook. Well done indeed!
HEALTHCARE AND PRIVACY
Think of the potential Healthcare privacy implications here.
What will Facebook know, or make, of your health data?
Would Facebook offer you something useful for your health in return?
For example, Facebook could suggest Friends or Groups with similar health concerns and conditions based on the data it collects. Or it could suggest healthcare games or other applications?
Alternatively, Facebook could enable advertisers or data miners to use the data however they wished. As far as I can tell, Facebook has no obligation to HIPAA rules – and neither do application developers or other third parties.
The healthcare ramifications of Facebook’s presence on the Web and its ever-growing knowledge of user data and behavior are bigger than I think we’ve realized.
It’s unlikely that you will see much by way of governmental regulation over Facebook in this regard to privacy. Why? Well, what government would want to impede an endless and continuous flow of personal data into a central repository that it couldn’t have dreamed of creating on its own? None. Zero. Zilch. Nada.
Some people may not care about their privacy. Or: they might not know that they care because they don’t realize just how much data they are revealing as they browse and otherwise use the Internet.
So users and non-users of Facebook should know how their data is being used. How – or if – that kind of awareness is raised is up for question.
Regardless, one thing is becoming clear: Facebook is on its way to virtual omniscience.
SPY VERSUS SPY
Do you see the picture emerging with the rise of Facebook?
Do you still see Facebook as a social network or social platform? Or do you see it’s potential to become a vast intelligence agency that knows more about your behaviors than you do?
There are other players who also spy on us. They don’t call it that, but that’s what it is. Google and Facebook, for instance, are trying to catch up with each other’s going concern so they can rule all. A big war is shaping up. Spy versus spy.
Facebook is the spy who likes me.
Facebook is the spy who likes you.
Not sure if that’s a good thing. But there’s probably not much we can do about it. I guess you could watch this then share it on Facebook and see who Likes it:
Click the image below and read it. You can also read it over here.
This is part of the war I referenced in my partially snarky post on how to work in the Attention Me-conomy. Rather than re-hash the background to the link above, you can get up to speed on what the above image is all about over on GigaOm and then come back here.
Think about Healthcare data.
Think about where that data resides, where it goes and how it travels from one place to another.
Let’s suppose that a magic wand were to be waved and that all of Healthcare came into the 21st Century: your health data is electronically recorded, you and your provider have swift and safe access to it; and you can use the Web and mobile and other kinds of applications to do amazing things related to your health (and life).
Picture that world for a moment: seamless integration of your healthcare data wherever it needs to go.
Now ask: what happens when competing interests war for that data?
To illustrate, say that you conduct a fair amount of health-related activity on two fictional sites: Hoogle and HealthBunch.
Hoogle is the world’s largest repository of searchable and vetted healthcare information. It has other services integrated into it like PHR and some social features, but it’s mostly a search engine for healthcare.
HealthBunch is the world’s largest online healthcare social network. It’s where people who are newly diagnosed go, “check-in” to disease states, search for others with similar conditions, etc. In other words, it has a huge amount of social relationship data.
Now, you want to port a lot of the data and connections you made on Hoogle over to HealthBunch – or vice versa but neither company allows you to do that. Or they make it very hard, and not without some hidden but vaguely mentioned cost. They each want to be the kings of online healthcare.
What do you do? On one service you’ve accumulated a lot of specific healthcare data, while on the other you’ve established important social relations. And now, you’ve decided that you’d like it all in one place (because you are an unabashed brave new worlder).
The thought experiment here is intentionally absurd and extreme. But the basic point is: even if we get to a point where healthcare data flows the way we want it to – for the benefit of patients and providers and, well, everyone – will we still have to contend with data wars?
Google and Facebook’s war – which will likely intensify as Google yet again grabs for the Social Pie in spite of previous failures – may offer us a lesson in the future of healthcare data and social networking.
In a wider sense, I think the Social Information Wars will turn out to be key historical elements of the 21st Century.
Why? Because war and struggle and competition have always been inherent in our social DNA.
Twitter and Facebook and all other social media will not inactivate those tiny pernicious genes and memes of our bodies and cultures. In fact, they will amplify some, while enabling others to be shined upon, examined and – maybe – tempered.
The Social Information Wars – which are wars for the data about us – is, ironically, being fought on the very fields in which we emit that very same data.
Not all of this Social Media stuff is good (and I”m not an Anti Social Median). There are instances when it can be dangerous. There’s much we must consider and flesh out and mindfully observe.
What are we lording over when we share our data with the world?
More importantly: who actually becomes in charge of our data? Because if we aren’t the ones making the rules, others will.
I’ll start closing with a quote from someone who knew a few things about war and politics and human nature:
…the heaviest penalty for declining to rule is to be ruled by someone inferior to yourself. – Plato
Can we rule the country of Facebook once we’re all inside?
Google is a search engine. People search for things.
Youtube is a search engine. People search for things to watch.
Facebook is the Walmart of Social Media. Get used to it.
LinkedIn is a rolodex for business people who aren’t on Twitter.
Twitter is 21st Century telephony. Pick up the phone, hang up and get back to work.
Blogs are for people who aren’t addicted to Twitter, who know about SEO and produce most of the content on all the places listed above.
Email is also a critical component – regardless of what some may think.
That’s pretty much it.
Is this an extremely over-simplified statement of today’s Web? Yep, it sure is. And in today’s Attention Me-conomy, you need simple, simple, simple.
Facebook, Google, and some other things like Youtube and occasional hits off the Tweet Pipe are where you probably need to do you most of your public art.
Facebook and Google: they’re it…for probably the next five years. Ten years from now? Who knows: technologies are moving way to fast to predict that.
I’ve been watching social networks and media for 32 years (no joke). No social network has thus far sustained itself. They almost always decay and fall apart.
Facebook is the exception – it broke the sound barrier. And nobody’s going to take it out of the sky anytime soon.
A decade ago, most people thought Google was just another search engine – that search engines were transient things. They were wrong. Same logic with Facebook. Except Facebook has WAY more data about people and their relationships with each other. And it now has mobile and geolocation – and it’ll continue to own the things that matter to most markers in the coming years.
Google and Facebook will go to war (it’s already going on), and the war will go on. That may or may not be an opportunity for upstarts. But we won’t see any big players emerge anytime soon.
Oh, and pay attention to Apple too. They have $33 Billion in Cash, Cash Equivalents and Marketable Securities and a leader who has seamlessly morphed his business from computers to music to mobile phones. Not a man to dismiss anytime soon. (Repeat: it has $33 Billion in liquid assets. Not paper valuation like Facebook or Twitter. Apple has raw purchasing power.) But as far as social presence, that’s a few years off before it’s determined what role they may have in all this. Same for Microsoft (lol).
And Twitter? Oh, Twitter – my sweet little bird – Twitter will continue to grow and grow until it becomes….Twitter. It’ll be around in some form or another. People run on Dopamine, and Twitter’s got its unique way to supply that drug.
Personally, I wish people valued art and science and nature and having a genuinely good time meeting each other. But that’s me.
The reality is: most people are happy being consumers. And that’s exactly who Facebook is building its mart for.
If you don’t like that, then take advantage of the Web and build your own small and focused community of five or ten or one hundred people. Really – you can start onetoday.
People will disagree with me about what I’m saying here. That’s OK. I want that. In the process I’ll learn a lot from them, because I have no idea what I’m talking about.
But here’s the thing: for people actually doing this stuff in a business context, resources are limited and decisions about allocation are vital.
UPDATE: Regina Holliday in the comments below points out that Flickr is another resource. I agree and for organizations which take pictures of events, etc. should really fold Flickr into their presence.
Healthcare organizations – hospitals in particular – have a moral and fiduciary duty to understand, evaluate and intelligently adapt to the technological and communications conditions of today.
This is a public health matter. In a world where data flows at the speed of electrons, doctors and nurses and other providers have unprecedented access to new ways of getting information and providing care to patients.
The issue of hospitals blocking access to social media like Facebook and Twitter has been a topic of debate. It’s time we address this matter with open minds.
You can catch up on this story if you need to here:
Communication, social exchange and information are critical components of Healthcare
Do you see where I’m going with this?
I know about privacy. And HIPAA. And patient dignity. (In fact, I’ve even had to fight hospital administrators over that last part.)
What I’m saying is: I know how important and concerning these matters are to administrators. They’re not “wrong” in being concerned. It’s the fear which is a problem.
I also know what it’s like to work in an environment with horrible information systems – systems that are disconnected from a world – literally a world – of information, crowd-sourcing and expert curation.
FACEBOOK IS INSECURE AND RISKY
Facebook is a security problem.
You know what’s a security problem in hospitals? Ignorance. Misinformation. Fear.
Surgery can kill you with the wrong cut. Facebook can’t.
Suction tubes can tear your lung tissue. Facebook can’t.
Insulin pumps can shunt you into hypoglycemia and kill you. Facebook can’t.
Hospital acquired infections kill approximately 100,000 people admitted to hospitals per year (that’s practically genocidal). Facebook can’t.
Healthcare has always had to address risk. What makes Facebook so more frightening than a hospital admission?
You know what else is risky? As more of the world uses social media as the leading way to publish and consume breaking news, it becomes easier and easier to miss critical alerts if you’re not monitoring Twitter or Facebook or other media.
Imagine a national disaster and hospitals are asked to partake in efforts, some of which are conducted via Twitter or other public media. Do you want to be in a hospital that has to take last-minute measures with IT to get connected?
See where else I’m going?
A 21ST CENTURY OATH
I can’t speak for other Healthcare professionals about whether or not we have a duty to learn about the Web and 21st Century communications.
But I will speak for myself: I took an oath to protect patients. And even though I don’t practice at the bedside, I consider my work and opinions and evangelism of the dangers and opportunities of the Web as extensions of my oath. I consider it my public health duty to do my best to explore, learn and question as much I as can about the Web.
In other words, I’ve done my best to bring a nursing perspective of the human condition to our understanding and use of the Web. And I have online colleagues who are doing that everyday.
A CAPITAL QUESTION
Should Hospitals block Facebook?
That’s not really the question. Here’s the question:
Should hospitals block the 21st Century?
If they can, then that means they have access to technologies which can also probably cure all disease from the face of the earth.
Then they’d be out of business, and we wouldn’t have to fret about their policies over staples of mainstream communication like Facebook and Twitter. 🙂
And here’s the fiduciary responsibility part: the more comfortable a business is using social media internally, you know what happens? It becomes more proficient in marketing and public relations in our time.
Management is morally obligated to ensure the best care for patients. It’s also legally obligated to do what’s right for Investors.
They’re the ones with capital.
Which is to say: they are the ones who ultimately decide who keeps their job.
It’s a rough economy. Attention is a scarce resource.
Doing your best to know what century you’re in is never a bad career move.
Social Media for regulated industries is…how shall we say…complicated.
Case in point: FDA’s Letter to Novartis concerning its use of the Like button and certain data Novartis had among its meta elements.
You can read great coverage of this story here, here and here. Digitas Health published an excellent alert here.
But I’d like to focus on something else: namely the need for a comprehensive understanding of the Web in 2010 in the context of regulated entities.
OMG, KILL ME: THE WEB IS MORE THAN TUBES!
What I find interesting in this story is the issue of the relevance of meta tag keywords.
Before the Web and search evolved to the point it has today, meta tags were one of the primary ways to provide data about the content on websites.
Initially, most interpretations of the FDA’s letter was that it was clueless about Facebook and online sharing tools. But FDA’s issue was actually more about metadata elements. The FDA may not appear to be particularly social media savvy, but I doubt it’s completely clueless.
But the Web has changed over the last decade: Google and its Page Rank algorithm have become dominant influences on how people find content online. Today, the Web is teaming with all sorts of metadata, from links to trackbacks to tweetbacks to who-knows-what-next.
Now, I’m not suggesting that the FDA’s Letter was necessarily much ado about nothing – there are other search engines besides Google. And fair balance is an important part of the FDA’s obligation to protect the public from over-zealous marketing (from its point of view at least).
The larger issue this raises is: Do we need to completely re-examine the very existence and operations of the FDA? Should we go back to the historical contexts of its origins? After all, they go back to the late 19th and early 20th Centuries! Maybe it’s time for a 21st Century reformation of FDA. Just a thought.
We can debate the technical matters involved in FDA’s Letter forever.
Rather, I’m wondering if there are other priorities, much larger concerns that are more pertinent to the today’s Web than the Web in 1998.
The amount of knowledge about how today’s Web works – from search engines to social sharing to mobile communications – is perhaps way beyond one person’s ability to attain it. It’s also in constant evolution.
So, I think what we need is a way to get regulatory bodies, industry experts, web designers, search engine specialists and others together so that that the right kinds of regulation can ensure the public is safe – both from unscrupulous marketers and regulatory bodies who might not make the most fully informed decisions.
Social Media – especially in the context of branded or unbranded marketing – is a mess.
Fortunately, for the Life Sciences and Healthcare industries, there are alternatives to Marketing. 🙂
…Oh, by the way: you can Like the FDA right here and view a ton of Facebook metadata here.
You can learn how to go beyond just the marketing aspects of social media by attending our upcoming Webinar Healthcare Social Media: Perspectives in Practice. Sign uphere!