Nevertheless, I was taken aback by the question. Working one block from Twitter in the South Park area of San Francisco, I had taken it for granted that social media has become part of everyday life. When I tried to describe the idea that sharing more of yourself on the web can make life richer and more interesting, the good doctor looked at me with confusion and maybe a tinge of disgust. Sharing in healthcare is not social, and to a lot of healthcare people, “social media” sounds more like a communicable disease than a great new idea or solution.

Sharing in healthcare has always been, and probably for most of us should remain, an intensely personal and private act. It is not surprising that social media and healthcare haven’t come together, at least not under the auspices of major health care institutions. Despite some forward thinking efforts of a few pioneers like Mayo Clinic, which recently even sponsored a “Tweetcamp”, most of the use of social media in health has come from grass roots efforts as people find information and support from other people who share similar needs, experiences and circumstances.

Sharing through social media is an act of faith that the benefits of being “out there” with your ideas and content will outweigh the risks to your privacy and personal space. Millions of people have already gotten over than hurdle and have determined that social media makes life richer and more interesting. Social media is about people having a conversation online. For many, this already includes health.

Since I didn’t do such a great job in explaining social media at the time I was confronted with the question, I thought I would list the top 10 social media tools that I use routinely and explain why I use them. Some of these tools could have a profoundly positive impact on health, particularly in chronic care, wellness, and prevention, but I will leave that to a different discussion. These are the tools I use personally.

1. Facebook: Facebook is a website that helps you communicate with the people you already know, or at least with people you don’t mind publicly declaring that you know. It is great for sharing photos, videos, notes about your experiences and adventures, parties and get-togethers, books you are reading — things that you find interesting but would never send out in a mass email. Facebook is not really for work. It’s for friends. Although you shouldn’t expect your kids to “friend” you, it can be a great way to keep an extended family connected. You also can keep in touch with people you used to work with or used to go to school with, people in your community, or people you met along your life journey. Without Facebook, many of those relationships would wither and fade away over time. With Facebook, you maintain a constant awareness of your extended relationships and often find a surprising number of ways to reconnect.

2. Twitter: Twitter is for sharing thoughts and ideas and with people you don’t necessarily already know but with whom you share a common interest. These are the people you might want to get to know better in the future. Although there has been much hoopla about sharing trivial or mundane personal details, Twitter has actually evolved rapidly into a professional media. It is a great way to discover new people and professional connections as you cumulate a group that cares what you have to say. If all you have to say is what you had for breakfast, don’t expect to make a lot of interesting new friends. I used to get my news from the front page of Google News (the newspaper subscription is long gone). Rather than news from a front page determined by popularity, I am much happier to see what the people I follow on Twitter are reading and find interesting. Twitter is a broadcast channel, kind of like a modern ham radio. The whole world can hear your messages, and some of them start to tune in and talk back.

3. Meetup: Meetup is a fabulous platform that has been underrated and underreported in the past few years, despite the fact that milllions of events, mini-conferences, clubs and organizations regularly organize, recruit, and connect through Meetup, all over the world. If you want to meet real live people who share your interests, find interesting speakers, artists, or entrepreneurs sharing their stories and talents, or if you want to learn or try something new, look for a meetup near you. There are groups about everything, from semantic web technologies and artificial intelligence to rock climbing and paint dancing. I try to go to at least one meetup on some topic of interest every month, and it has been better than most conferences that I used to pay thousands of dollars to attend.

4. WordPress: WordPress is the leading blogging platform, a content management system that makes it easy to create your own website in a blog format. You can personalize your blog by choosing from thousands of styles and themes, or create your own with just a beginner knowledge of web design. This blog is done using WordPress, and as you can see I created a style to make it look just like my Twitter page. In addition to changing the theme or style, many people have developed free extensions to the functions and features of WordPress through plugins. These extensions and themes together with a thriving open source community makes WordPress an extremely powerful content management system that you can use for just about anything.

5. YouTube: Millions of people use YouTube to discover and share videos. It has replaced television as the primary source of interesting new content that we talk about around the water cooler. YouTube feeds my secret desire to make a movie some day. I have posted a few videos of my own, which are extremely easy to edit and upload from a Mac using iMovie. Get ready for an explosion of real-time video content sharing on YouTube as it gets even easier for anyone with a modern smartphone to shoot, edit and upload short videos without even touching a computer.

6. Basecamp: Basecamp combines the functionality of blogging and discussion boards with to do lists, milestones and file sharing. It is designed and optimized to help small teams collaborate on projects, whether it is organizing a family reunion or developing an iPhone app. Basecamp is famous for not responding to user requests for new features and insisting on a minimalist set of functions. Because of their focus on simplicity, Basecamp is a project management tool that does not require a team a training session to instantly improve productivity and communication. Each project only can be accessed by those people who belong on the project team. Basecamp is a great example of social media tools applied to collaboration online.

7. Slideshare: When I make a presentation at a conference, I like to post the powerpoint file on Slideshare so that the participants can view it and discuss it after and even before then actual presentation. Viewers also can embed your slideshow in their blog, tweet about it, or share it on Facebook if they are so inclined. The presentation format remains the most pervasive way to share and idea and lead a group discussion, and Slideshare is a great way to share your presentations online. It is also a great way to find ideas and discover other the presentations of other people.

8. 3banana: 3banana is the easiest way to take notes online and on your phone and keep them synchronized wirelessly and always handy. I like to jot things down that I want to remember, clip things I find on the web, or draft random ideas that I might want to blog about or share later. I need the fastest and easiest way to get my thoughts and ideas into the system, and know that I can come back to them. With Facebook, Twitter, and even WordPress, you need to have a pretty good idea that you want to share with the world before you start typing. I like to start with 3banana, because every note is private by default, but if I decide to share a particular note I can easily post a private link to it. Every shared note is then the onramp to a conversation because people you share with can leave comments.

9. Blip.fm: Blip.fm is like Twitter for music. You can find just about any song, add it to your channel as a DJ, and stream it right from the web rather than downloading it to your computer. You find songs because they were posted by other DJs, and then you can see what other songs that person was posting. You can follow and cheer other DJs that you like, and DJs that share your taste might start following you as well. It is a great way to discover music by discovering people with whom you share musical taste. The website design is great and it’s a lot of fun.

10. Ning: For most social networking activities, I like Facebook, but sometimes you are part of a private group or club that wants to have a dedicated private network with the same kind of functionality. Ning makes it easy to set up your own private Facebook-like website for your own group. You can use the content management system to design just about any web functions and modules you like, plus you have the ability to administer groups, blogs, friend list, mailings and all sorts of other things that are useful to just about any membership organization.

There are lots of other great social media tools that help you collaborate on documents, review books and restaurants, make and sell T-shirts, and even become a contributor to the world’s largest encyclopedia.

One question I will get from my professional friends is “What about LinkedIn? Isn’t that a social network?” LinkedIn is a place to post your resume, and maybe other people and recruiters will find it. But it isn’t really social in the same ongoing and interactive manner as my top 10, despite some attempt to add social networking features. If you use it once and rarely go back, it is not a conversation. It’s not social media.

Social media is about sharing and discovering, building and enhancing relationships with other people. It has already changed the world, from social life to the political landscape. Since healthcare is such an important institution in modern society, approaching 20% of our country’s economic activity, there is no doubt that social media will find tremendous uses in health as it will in every other field.

This is my current top 10 social media tools. I would love to hear your top 10, as well as your ideas for how to use them.

Social media is often defined as “people having a conversation online.” In contrast to mass media produced by a few, social media is generated by grass roots efforts of millions of people. It has become the largest and most interesting use of the web.

Despite the fact that health care is one of the most information intensive fields, the health care industry notoriously lags behind every other industry in its adaptation of information technology. To get our initial bearings, we decided to kick off the discussion by asking the audience to describe their own personal use of social media.

I was happily surprised to hear many personal stories, including using the Barack Obama iPhone application to mobilize “get out the vote” efforts, and using Myspace to find band members for weekend gigs—personal examples given by senior leaders of some of the largest and most influential health care organizations in California!

The challenges we face in reforming, modernizing, and improving health care are not for a lack of talented and committed people eager to make things better. Health care is a field full of committed and smart people applying a continuous stream of innovation in addressing difficult challenges.

Efforts to create the more proactive and responsive models of care enabled by the Internet, however, have been stymied for a decade by outdated policies that too often reward inefficiency and penalize prevention.

The health care industry may not need to solve all of its problems, however.

Some of the challenges in chronic care, public health, and wellness that currently seem so intractable to our institutions may have surprising community-based and grass roots solutions, enabled and spread through social media.

Social Media Primer Transcript

1. Social Media Primer for Health Care Executives
   Steve Brown
   Adaptive Business Leaders
   December 11, 2008

   http://brown2020.com

2. Social Media Defined:
   People
   having a conversation
   online
3. What are we sharing?
   Ideas: WordPress and Blogger
   Friends: Facebook
   Photos: Flickr
   Status: Twitter
   Websites: Digg
   Videos: YouTube
   Slides: Slideshare
   Documents: Scribd
   Music: Myspace
   Events: evite
   Books: Amazon
   Restaurants: Yelp
   Travel tips: Tripadvisor
   Articles: ArticlesBase
   Notes: 3banana
4. Social media is growing rapidly
   WordPress unique users
   Facebook unique users
   Twitter unique users
5. Just for a sense of scale…
   Comparison of Google Trends data
   Global Warming, Football, Sex, Facebook
6. Why are we sharing?
   Because life is richer when we share
7. Why Should Health Care Executives Care About Social Media?
   Social Media is about Connectedness. In Business and in Life, Connectedness Wins
   Barack Obama Case Study
   Connectedness is part of the solution to:
   Wellness challenges including obesity and lifestyle diseases that relate to our own motivation and behavior
   Chronic care management challenges exacerbated by isolation, loneliness, depression
   Aging population challenges resulting from cognitive decline and neurological disease
   Public health and research challenges that depend on the velocity and relevance of real-world information
8. In Google, Winning is a Function of Connectedness
   PageRank: How many pages link to the pages that link to you?
   BarackObama.com Case Study: What was the number one issue of the campaign?
9. The Most Connected Sites Win
   Comparison of BarackObama.com and JohnMcCain.com
   Pages and backlinks as a result of social media
10. Digging Deeper Into Obama vs. McCain. Looking at the 501st page in Google
    JohnMcCain.com content: Campaign generated press releases
    BarackObama.com content: User generated blogs and local groups
11. Traditional Media:Passive, expensive, celebrity driven. People you only think you know.
    From Barbara Walters Presents: The Most Fascinating People of 2008.
12. Social Media:Active, engaged, free.Real people, real conversations.
13. Real Time Activity on Facebook from Palantir
    120 million active users, now 4th most trafficked website
    10 billion photos, adding 30 million per day
14. Social Media and Your Business
    How do people find and judge your organization?
    How do you listen to and motivate your employees?
    How do you listen to and motivate your members?
15. Top Three Barriers To Social Media
    “None of my friends are there”
    “I feel thrust into a public space”
    “It’s too much effort”
16. Overcoming Barriers: Social Media For Adults
    Applications that have value even before you have any “friends” on the network
    Applications that start with private thoughts and share gradually, with clear privacy control
    Applications that effortlessly integrate with what you already know and do
17. For Discussion: Potential Applications of Social Media in Health Care
    Wellness
    Chronic Care
    Brain Fitness
    Public Health
    Research
18. Chronic Care 1.0
    Scripted
    Top Down
    Inherently Limited
    Labor Intensive
    Home health monitoring technology examples
    Honeywell Hommed Genesis
    Intel Health Guide
19. Chronic Care 2.0
    Unscripted
    Grass Roots
    Open-Ended
    Social
    Display of social network of informal caregivers
20. Real Life is Unscripted
    wefeelfine.org
21. Real People are Diverse
    wefeelfine.org
22. Real Needs are Highly Personal
    wefeelfine.org
23. Connectedness and Your Brain: Keep Learning and Stay Engaged – Or Else!
    From “The Coming Neurological Epidemic” TED talk by Biochemist Gregory Petsko
24. Social Networks and Brain Health
    Women who had daily contact with friends and family cut their risk of dementia by almost half.
    If you stay connected, you have a better shot. Whenever we have even the most basic exchange, we have to think about how to respond, and that stimulates the brain—Valerie Crooks, clinical trials administrative director at Southern California Kaiser Permanente Medical Group, lead author.
    American Journal of Public Health 1221-1227, July 2008, Vol 98, No. 7
25. Social Graph on Facebook
    More connected outside = More connected inside
    Brain map from brainmaps.org
26. Social Media: A New Window Into Human Behavior
    Unprecedented ability to measure social and emotional behavior of a populations
    Opportunity to understand problems based on real world data, not from the laboratory!
    Who is currently at the forefront of human behavior research? Social media companies!
27. Every Day Presents a New Way to Connect, Engage, and Learn
    Ocarina iPhone Application from Smule: your phone becomes an electronic flute you can play with people around the world.

My Social Graph on Facebook

The image above was generated by the Nexus application on Facebook. It is a visualization of my social graph: The interconnections between the people I know on Facebook. Social graphs look a lot like how we visualize neural processing in the brain. The image that follows is just such a neural processing map from Brainmaps.org.

Brain network image from brainmaps.org

The computer on your desktop processes explicit instructions sequentially. Your brain, on the other hand, uses parallel processes to recognize patterns in sensory input and generate implicit instructions.

Social networking technology enables us to communicate more quickly with more people with far more contextual cues than ever before. It is not surprising that when lots of brains start to connect and share information on social networks, it looks like a biological system.

Some might think of all these extra cues as noise, but there is little doubt that the latency in connecting people is being reduced radically. The question is what will emerge as more of the earth starts to build more relationships in this new way.

Social Media is a Conversation: Visualization of Interactions on Facebook

In The Lord of the Rings, a palantír stone was like a crystal ball. When you looked into the stone, you could see what was happening near other palantíri around the world. If you could learn to manipulate the stones, you could gain great power by using the stones not only to see the physical world, but also to peer into the history, the thoughts, and the intentions of other people around the world.

Palantír is an apt name for a new project from Facebook that might allow us for the first time to glimpse the world from Facebook’s point of view. Palantír is a visualization of the data flowing through and collected by Facebook: Conversations, comments, photos, friend requests, pokes, status updates, and more.

Each action is represented by a light particle or an icon that floats into the atmosphere from its point of origin on the earth. Conversations and interactions between people become three dimensional splines of light or comets traversing the globe connecting the locations of the participants. These are the artifacts of the social interaction of 120 million of earth’s citizens. It is a stunning display of our interconnectedness, a heatmap of human interaction on the network.

Mark Zuckerberg first launched the website that would become Facebook on February 4th, 2004. It was only for Harvard students, to help people get to know each other. It clearly found a need: Half of the student body signed up in the first two weeks. Chris Hughes and Duston Moskovitz joined Mark to work on the site. Four months later, Facebook had added 30 more college networks. That summer, Facebook moved to Palo Alto, joined forces with the cofounder of Napster, Sean Parker, raised $500,000 from the cofounder of PayPal, Peter Thiel, and never left.

Four years later, Facebook is the 4th most trafficked website in the world, and counts 85% of American college students as members. Barely out of college himself, Facebook co-founder Chris Hughes would help change the world again as Director of Online Organizing for Barack Obama, proving the power of social media to motivate and mobilize people to action.

Facebook has become the number one place on the web to share photos, hosting more than 10 billion photos already, and adding another 30 million new photos every day. In addition to photos, users are sharing everything from what they are doing right now to the latest news, thoughts, ideas, opinions, events, music, books, movies, and more. It is hard to comprehend so much data. Facebook engineers Jack Lindamood, Kevin Der, and Dan Weatherford created Palantir to help us visualize it.

Facebook is considering releasing the Palantír to the public as a feature, so that Facebook users everwhere can look into the crystal ball of Facebook data and see how the world is buzzing with interconnectedness and conversation. This is just a tiny glimpse, however, of the stunning view of the world that must be possible from inside the walls of Facebook.

Biochemist Gregory Petsko gave a talk at TED forecasting how an aging population will lead to an epidemic of neurological diseases like Alzheimer’s and Parkinson’s disease. As advancing science cures or reduces the mortality of other diseases, the last to go is the brain. More people than ever are living long enough to face cognitive decline. Is that really such bad news?

As the focus of medicine shifts to the brain, we will see new advances and discoveries in brain science. We have already learned that the brain is plastic and can continue to grow and develop even into old age—if we keep challenging ourselves to learn new things. Petsko ends his talk with what we can do about neurological disease: “use it or lose it.” An entire industry of brain fitness and brain training is emerging because baby boomers don’t want to lose their minds.

While many have expressed concerns about how immersion in digital media technology is shaping the brains of young people, not enough people are talking about the potentially positive impact of new social media on the brains of people young and old.

Social media, and the rapidly changing digital devices and tools that enable it, force us to learn something new every day. To fully participate, we need to write down our thoughts and ideas, take notes on our experiences, and share them. We need to form sentences, make decisions about which photos to keep, edit the videos down to something compact enough to share, and choose soundtracks to spice them up.

Participating in social media can be hard cognitive work. Writing a WordPress blog post, editing a YouTube video, or touching base with 100 old friends on Facebook is like a good hard run for the brain. One of the best remedies for the neurological epidemic might be sitting right in front of you right now.

You would probably have much less of an awareness of the world beyond the vicinity of Budrio, not much past the big city of Bologna. But you knew your neighbors: Their stories, their experiences, their music, their relationships, and their gossip all had a place in your brain.

In the next century people would gain an ever-expanding awareness of the world beyond their local community through the virtual experiences of mass media. Starting with motion pictures, then television, 24-hour news channels, and the Internet, the world would become a lot smaller. We now live in a state of continuous awareness of the entire world. At the same time, we have become less aware of and connected to the people in our own local communities.

There has been much written lately about brain training and brain plasticity, and how we are entering the brain fitness age. If our experiences with the world can change the wiring of our brains, then how is our immersion into the constant stimulation of digital media affecting us? Is our continuous experience with the larger world through digital media impairing our ability to socially connect with our neighbors?

The brain maps of our ancestors just a century ago probably included many more connections for the social network of our local community. Some of that map has probably been superseded and replaced by our current awareness of and pseudo-relationships with the celebrities of the mass media. Too many of us know all about the daily activities, relationships, and gossip of Paris Hilton and Britney Spears, but do not even remember the names of our neighbors.

The Ocarina application for the iPhone from Smule is a deeply compelling example of how a new generation of social media technology could be the start of a new kind of community experience. The social media experience surely will change our brains, and I believe in a highly positive direction. Learning to play the ocarina on the iphone gives us yet another chance to learn new skills, which keeps our brains fit and growing. The brain training impact of individual practice is trivial, however, compared to the deep impact of connecting us to a new global community.

We might not know our geographical neighbors, but more than ever we can find and connect with our creative, intellectual and spiritual neighbors, anywhere in the world. And from our home late at night, we can hear them playing a new tune. And we can join them.