Dr. Alexander J. Towbin

How a thriving social media presence can benefit radiology departments

November 24, 2017
by John W. Mitchell, Senior Correspondent
From the way we interact with our friends and family to how we get our news and buy products, the world is truly a different place with the Internet and social media.

For Dr. Alexander J. Towbin and his colleagues at CCHMC, social media has presented an interactive opportunity to educate patients, challenge colleagues and bolster their standing internationally as a thought leader in pediatric imaging.

Whether through Facebook, Twitter, Instagram, Figure 1 or their blog, CCHMC’s radiology department has helped forge a new way for imaging teams to interact with the world. HealthCare Business News spoke to Dr. Towbin about how other organizations can follow their example, mounting cybersecurity concerns, his most successful blog post and more.

HCB News: You have been advocating for imaging departments to embrace social media for several years now. Are you seeing a shift toward greater utilization?
Alexander Towbin: I see more and more departments doing it, but I also see that it’s hard to do well. We’ve been able to distinguish ourselves in how we’ve done it, but it is a big challenge for a lot of departments to do. I think there are a few things that have helped us succeed at it. But, it’s not that it can’t be replicated, it’s just a lot of work.

HCB News: What do you think are the biggest barriers?
AT: One is time, and that’s probably the biggest barrier. It takes a lot of work, and it generally falls to one person or a small group of people. The other barriers have to do with acceptance. At many hospitals, it’s difficult to get social media and a departmental type of account through a marketing department.
It’s hard for one person or a small group of people to have knowledge of everything going on in a department, especially in larger departments where that becomes an overwhelming barrier. Often, it requires content experts who are engaged. So, someone who has been hired to do marketing, for example, has a hard time creating content because it is so technical. It ends up falling to the technical people who are busy with their technical jobs.

HCB News: And social media has become more acceptable?
AT: Yes, it has, and people are more interested in it in their everyday life and see the value of it, both in a good way and a bad way. We see what’s happening with politics and the role that social media has played in politics. We see it in entertainment and how media campaigns are based around social media now. So that’s very attractive. It also gets you in a place where you want to be and lets you interact with your patients or your colleagues in a way you couldn’t before. And the cost of entry is very low.

HCB News: How can social media platforms make radiologists’ and referring physicians' lives easier?
AT: It is hard to say there is a true return on investment. I think where it really helps is when you go to meetings like RSNA and find a way to fit into the meeting, to get the commentary on what you are listening to, what you are seeing. It’s also a place to learn very quickly and to learn about brand new things very quickly.

You’ll often learn about breaking news through Twitter or on another social channel, and the same works in medical education, using medical education very loosely. There are millions of articles published every year in scientific journals. To find any one article is difficult unless you’re looking for it. Social media at least is another way to get that article out there in another way that someone may find it and be interested. So, your followers may be able to see that link, and that triggers something they wouldn’t have actively sought out. People are learning because of that.

At conferences, we’re able to share slides from our presentation, and share figures and information from our posters, so that’s another way to get that educational content out. At RSNA, for example, I may have a couple hundred people in the room listening to me. But through social media, I may be able to get a couple thousand or more impressions, people seeing the information that we’re tweeting out. So, you can distill the talk at RSNA down to a couple of slides and get the major teaching points to a larger number of people.

HCB News: Are you finding social media is useful in discussing patient cases?
AT: Yes. We have a case of the day that we discuss on Instagram and on Figure 1. We do a lot to protect the privacy of patients. But we use those cases to direct teaching points related to a specific case. When we’re doing that we talk about the disease, not about the patient. If it's a tumor, for example, we talk about the imaging findings of the tumor or things that predispose a patient to get that type of tumor. But I don’t talk about the specific treatment that patient got or that patient’s specific history

HCB News: How can social media improve patient care?
AT: I think it’s about education and awareness. We have examples where trainees have told us that they learned about a disease process and then treated it based on cases we’ve shared.

For example, if a child or anyone swallows a button battery like you find in a watch, that can really damage your esophagus or your food pipe, and it can do so very quickly. So, it’s important for a radiologist to recognize what those batteries look like compared to, say, a coin.

We can teach someone and hopefully lead to better care. The anecdotal feedback is that it’s happened. When we’re sharing our research or position papers that are authored by people in our department, we’re again getting that research out that hopefully helps change the way people think, or change the practice for the better.


HCB News: How did your background lead you to become a leading advocate for health care social media?
AT: The way it started was by looking for a way to promote the cool things the informatics team does every day and every year. I thought there were two ways we could really promote ourselves.

The first was the traditional academic route of doing research and publishing academic articles and going to meetings and presenting data or giving lectures on our experience, and we were already doing that. The other way would be advertising, which, in some ways, has never really hit medicine. It does with pharmaceuticals or device manufacturing, but there has never really been much from the education side of advertising. So, we thought social media presented a unique opportunity to do so at essentially zero cost.

We grew our social media enterprise with tools like Facebook and Twitter, then moved to starting a blog. The goal of the blog is patient and family education and engagement. We moved in our last step to Instagram and Figure 1 to teach our colleagues and other medical professionals at any skill level, even people who maybe aren’t in medical school or nursing school yet, all the way through people who are fellowship trained specialists and engage them at their level in a way that is respectful to our patients.

HCB News: For providers hoping to develop a social media presence, what are some tips to get started?
AT: It’s important to think about what your goals are. We have tried to do that with every new platform we roll out. Who is our audience? For the blog, for example, our audience is patients and family, and our content is therefore constructed very differently than Twitter, where our audience is medical professionals. Or Instagram, where our audience is people with a medical interest. Twitter is maybe the most specific where we target the radiology community as much as anything else.

We don’t cross promote very often because it doesn’t make sense for us, but knowing our audience means we can create content for that specific group and also build reproducible content. So, on Twitter, we may share articles or live Tweet conferences, or share our Instagram case of the day. On the blog, we would do things like meet the team. Who’s caring for your child? These are our radiologists. What does it feel like and why do we do things? What does it feel like to get a head CT or what does it feel like to get contrast? Why do we give contrast? Why do we make your child not eat anything before an ultrasound study of the abdomen? Those types of frequently asked questions.

We also do things to get kids excited about imaging. One of my favorite examples is we took X-rays of candy bars for Halloween. We have a slider bar on the blog you can slide back and forth to see the picture and slide it the other way to see the X-ray. Stuff like that. We’ve also done games.

HCB News: But you have to have someone who wants to do it.
AT: Yes, you do. The blog team is the largest. That requires the most work and I have the largest team helping me to do that. Twitter is just me. Instagram, we have two or three people doing a lot of the work.


HCB News: Has the uptick in hackers targeting health care impacted the CCHMC social media strategy in any way? What steps can be taken to increase security?
AT: It does have me concerned. There is no patient information anywhere in our accounts, so I’m not worried about that. What I’m more concerned with is if they hack our accounts and post something that is inappropriate.
All of the social media accounts have increased their security and we stay abreast of that. We’ve enabled multi-factor authentication, making sure a phone number is required and strengthening passwords.

HCB News: Can you describe one of your most successful social media postings?
AT: I can tell you about one on the blog. We wanted to do a blog because it’s enduring material, unlike social media. They are searchable on Google, so the thought was we'd create posts, and people find them when they need them.

One of our most popular posts is on the difference between sedation and general anesthesia. A lot of our children need help to get through imaging studies, particularly MR, and we’re talking about our youngest kids mostly, the babies up through 5 or 6 years of age. There’s a blog post outlining the differences and what it does to your child, how your child is going to feel afterwards.

It started like most blog posts where we get 50 or 100 views over the first few days and then it really tails off, close to zero. But this one went down like that and then slowly after six months started rising. And now we’re getting month over month thousands of views on that post with over 100 views a day most days. Now it’s at close to 60,000 to 70,000 views for that single post.

That's one where I feel really good that hopefully we're providing information to parents that helps them with what their child is going to be going through. It doesn’t have to be that they are being treated at Cincinnati Children’s. If we’re helping them overall to gain knowledge to ask the right questions of their doctor wherever they live, we’re happy about that.