Contact: Jim Bradford, MedITechFirst

January 26th, 2011

Healthcare I.T. Consulting
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A Doctor’s Guide to Not Going Broke Under Obamacare

August 19th, 2010

Doctors are becoming increasingly concerned that the hidden and explicit costs of Obamacare will have a devastating effect on Medicare. In 2010 many doctors barely break even when treating their Medicare patients and the situation is getting worse. The following is a brief list of options facing private practice physicians as we move into the Obamacare era:

  1. Refuse to treat Medicare patients: I predict that physicians exiting Medicare will soon become a stampede. The stampede will precipitate a national crisis. In a utopia the government would respond by increasing physician compensation under Medicare. In the economically fragile America of the 21st century this will not happen. It is more likely that our government will explore ways to force doctors to continue treating Medicare patients and require physicians to endure the resulting reduction in income.
  2. Retire: Some older physicians are considering this but “getting out while the getting is good” is not an option for many early and mid career doctors.
  3. Move into an exotic practice: There are a number of fields that will be insulated from the coming compensation crunch: botox clinics, concierge medicine, sports medicine and so on.  Many doctors are either not qualified to enter these fields or they find such exotic practices unattractive for a variety of reasons.
  4. Move to affluent communities: There are many communities in America (mostly large urban centers) that have affluent, well-insured populations. Unfortunately the stampede out of Medicare will very likely become a stampede into affluent communities. These may well become islands of medical “hyperservice” with an abundance of well qualified competing medical practices.
  5. Flee the country: It is a big world and many developing economies are desperate for Western medicine. Some of these places are also nice locales in which to live (Brazil for example). Although the compensation crisis and the diminished incomes it produces may lead to a medical brain drain, emigration is such a major disruption of a person’s life, that it will probably not be a serious option for most doctors.
  6. Adjust the patient mix: This, I believe, is the winning solution. Doctors need to consider adjusting the “mix” in their patient populations to enhance the number of well insured patients they treat. This will require marketing and that is an area with which many physicians have little experience. An inexpensive, easy and surprisingly effective marketing tactic is to use social media (examples of social media include: Facebook, Twitter, and Blogging). Subsequent articles in this series will explore the tactics of using social media to market medical practices to upscale clientele.

Several articles already posted in the Bradford Report may also be useful:

  1. Should Doctor’s Tweet?
  2. The Role of Social Media in Attracting Web Site Traffic
  3. (For the ambitious reader) Twitter–Facebook’s Ugly Sister

For advice on using social media to market your specific practice please feel free to contact me at:

~Jim Bradford, Ph.D.

Should Doctor’s Tweet?

August 9th, 2010


  1. Set up a Twitter account in the name of the practice
  2. Advertise the account among the practice’s patients (office signs, special business cards, etc)
  3. Hand out 1 page instruction sheets to show patients how to set up and use their own Twitter accounts
  4. Accept only current or former patients as followers
  5. Initiate a dialog with the patient population through the account’s tweets


  1. A great means of soliciting feedback on current services
  2. A good way to “test the waters” for proposed changes and new services
  3. A good source of suggestions on such things as continuing care, web pages, new services the patient community would like, etc.
  4. Superb public relations for the practice
  5. The novelty of the approach can generate some good “buzz” for the practice (local newspaper articles, etc)

Twitter–Facebook’s Ugly Sister

August 1st, 2010


The Role of Social Media in Attracting Web Site Traffic

June 11th, 2010

A decade ago the most important way of attracting visitors to websites was through search engine optimization (SEO). Although SEO is still an important component of a website strategy, the growth of social media (blogs, interactive eZines, Twitter, chat, Facebook and so on) has added a new strategy in the quest for website visitors—social relevance.

It is often said that “content is king” when describing what it is that draws people to websites. For content to be an effective website “draw” it must meet one or more human needs. It can be entertaining (e.g., The Onion,; it can address the social desires of its visitors (e.g., 43 Things,; it can address the professional needs of its visitors (e.g., LinkedIn,; it can be informative (e.g., Wikipedia,; or it can be used to solve problems (e.g., wikiHow,

Many corporate sites provide only routine information about their organization presented in language that is about as exciting as the tax code. SEO for such sites is like providing a well drawn map to the South Bronx – the map is great but nobody wants to go there. In addition, many corporations view website creation a little like building a factory—there is a large investment up front followed by a relatively small investment in ongoing maintenance. In the social media age creating a successful website is more like managing a publication—success involves a sustained effort targeted at the site’s most important constituencies.

PinnacleHealth has two major constituencies—the medical community and the patient community. The medical community helps establish PinnacleHealth’s reputation, can provide patient referrals and comprises the pool of prospective applicants when the organization recruits new doctors. The patient community consists of past, current and prospective users of PinnacleHealth’s services. The key question for each group is what needs can the PinnacleHealth site address on an ongoing basis?

As an example, consider the needs of the medical community. This community is already highly engaged in social media. The social landscape is dominated by a half dozen influential blogs (KevinMD,  HIS Talk, etc.) and a small number of aggressively published eZines (Health B2B Marketing, Fierce Practice Management, etc.). These publications define the online social environment for the medical community and they are a rich source of issues that are of immediate concern to doctors.

We recommend that PinnacleHealth use its website to engage the medical community through articles and “op-ed” pieces on the current hot topics in the online medical media. For example, the Federal Trade Commission currently expects doctors and other healthcare providers to take time away from the practice of medicine to help fight identity theft through a program called the “Red Flag Rules.”  Needless to say this is a highly controversial initiative. Recently, Senators John Thune and Mark Begich have proposed a bill that would exempt doctors from this obligation. What is PinnacleHealth’s position on this? If healthcare organizations act as “identity theft cops” what impact will it have on their relationships with the patient communities they serve? What are the legal risks of falsely accusing a patient of identity theft? How much time does this take away from the practice of medicine? The opportunities for opinion, comment, surveys, case studies, and creative solutions on this one issue are nearly endless. It is also a good example of the kind of content that characterizes successful websites in the age of social media.

What are Twitter’s Problems?

February 18th, 2010

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by Jim Bradford, MediCHI Consulting

: This is the second in a series of 3 twitter articles:

  • Twitter 1: What is Twitter good for?
  • Twitter 2: What are Twitter’s problems?
  • Twitter 3: How could Twitter be improved?

1.      What are Twitter’s problems?

I don’t know who invented the screwdriver but I can easily imagine his or her frustration. Here we have an elegantly simple tool for driving screws. The name says it all. There is no need for a user guide, or online help, or night courses at the local community college. You just buy a screwdriver and a bag of screws and you’re set!

Unfortunately the human race is endlessly inventive. We use screwdrivers to pry open paint cans, to depress those annoyingly recessed valves in pneumatic tires, and occasionally as a weapon during those regrettable domestic disputes that occur while trying to assemble Wal-Mart furniture.

Twitter was built to emulate the text messaging capability of mobile phones. However, over the past few years the Twitter user community has invented all kinds of new ways to use this simple tool. Unlike screwdrivers software systems can grow and evolve. I believe that the time has come for Twitter to do so. This section outlines a few of the major problems that are holding Twitter back.

“Flow By”: You may remember the famous opening scene of the first Star Wars trilogy that features a few lines of text scrolling off  into hyperspace. Imagine that the text was scrolling at twice the Star Wars speed. Imagine the tense concentration you would need to keep up. Now double the scrolling speed again and you will have produced an information processing task roughly equivalent to following the Twitter updates from a couple hundred people. The more people you follow the worse it gets. I call this the “flow by” problem. It is nearly impossible to keep up with the stream of consciousness postings of dozens of people–it simply flows by too quickly. This is of little consequence if the postings concern the dyspeptic ordeals of the family cat but it is a major deficiency if you are using Twitter to debate a political issue or monitor an evolving corporate crisis. Twitter needs to develop tools for keeping track of dialogs, multilogs, and focused discussion.

Dilution: Unless you are very selective in your choice of people to follow you are likely to receive a great deal of trivia about other people’s lives. I call this process, in which informative Tweets are buried in trivia, “dilution.” For example, I collected the following gems from one of my Twitter accounts during a 10 minute period on a Saturday afternoon:

Everything has its beauty but not everyone sees it.
How to Download Music Off You Tube.
Do NOT Pay For White Teeth!
Florida looking good in their second pre-season game against Troy.
Hearing my brother & niece argue about her taking a bath.

When I recall that my primary interest is the design and evaluation of user interfaces for healthcare I.T., these Twitter gems start to look a lot like cubic zirconia.

Is My Targeted Audience Reading Me? If my purpose in sending short segments of text to perfect strangers is to communicate, then it is important that my followers read my Tweets and I read theirs. The “flow by” and “dilution” problems make this hard to do. It is impossible to know who has read a Tweet and fairly difficult to track the responses. This is where the Twitter “text message” model breaks down. Text messages are most often 1-to-1. Dialogs flow naturally out of 1-to-1 interactions. It would be easy to contrast the Twitter dynamic by saying it is many-to-many but it is actually worse than that. Your “many” (consisting of your followers) is not the same as my “many.” Human communication needs a social environment in which there is a reasonable expectation that all parties receive the messages that form the basis of human interaction. In this respect Twitter reminds me of one of those European art films in which  all the characters are talking and nobody is listening.

Hard to Hold a Serious Conversation: The fans of Twitter might argue that the service was never intended to be a discussion list. I’ll concede the point but even though microblogging wasn’t meant to serve as a discussion list its postings often create the desire to discuss. In Twitter there is no capacity to hold a sidebar discussion. I believe that within the Twitter community there is an unmet need for some clever amalgam of microblog + chat room + discussion list. It’s a safe prediction that in the highly entrepreneurial environment of social media, if Twitter doesn’t invent a way to combine microblogging and discussion then someone else will.

The Rise of Twam: Our capitalist economy finds its most uncouth expression in the phenomenon of Internet spam. At first examination it might seem that Twitter has a natural immunity to Twam (Twitter spam). Each user explicitly selects those accounts that he or she will “follow.” Unfortunately a social etiquette has evolved within the Twitter community that encourages you to follow those users who have opted to follow you. This reciprocity has opened the door to Twam. In the past year or so a substantial percentage of Tweets are created by software programs known as “bots” (“bot” is short for “robot”–a program that imitates the behavior of humans in chat environments such as the venerable IRC, “Internet Relay Chat”–one of the earliest social media systems). Within the Twitter community these bot-driven accounts are known as “zombies.” Recent studies have suggested that up to a quarter of all postings on Twitter comes from zombies [“Twitter Zombies: 24% of Tweets Created by Bots”, ]. So far the Twitter support team has been losing the intellectual arms race with the Twammers but rumblings within the community suggest that people are becoming more selective in choosing who they will “follow back.”

Nice to Meet You: For a service that is categorized as a “social media” Twitter is surprisingly bad at building relationships between people. For reasons outlined earlier in this article, it is hard to react and respond to specific postings and have others react and respond to yours. Of the several metaphors that can be used to describe the Tweeting experience one that emphasizes Twitter’s failures as a social medium is that it is like giving a speech to a group of people who are themselves in the process of giving speeches. Everyone is in the process of sending out “one to many” communications. The most frequent result is that people talk past each other and this is antithetic to forming meaningful (or even casual) relationships.

2.      Summary

In my examination of Twitter’s shortcomings I found 6 major deficiencies:

  • Flow By
  • Dilution
  • Cannot discover if messages have been read
  • Hard to hold a conversation
  • Twam
  • Poor at creating and building relationships

The next article in this series will offer some suggestions for improving Twitter (including a focus on some of the underlying user interface issues).

Should we leave tweeting to the birds?

December 28th, 2009

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by Jim Bradford, MediCHI Consulting

: This is the first in a series of 3 twitter articles:

  • Twitter 1: What is Twitter good for?
  • Twitter 2: What are Twitter’s problems?
  • Twitter 3: How could Twitter be improved?

1.       Twitter Overview

If you have been living in a cave for a few years you may not have heard about the Twitter phenomenon. The service was developed in 2006 by Jack Dorsey. Twitter was inspired by cell phone text messaging which had already gained enormous popularity among teens. The idea was to send short message service (SMS) text messages via the Internet for free (a big win for the parents of text-addicted teens). Although there is no technical reason to adhere to the 140 character limit for text messages, Twitter limits message length to maintain the feel of texting. The original Twitter prototype was developed in about 2 weeks and from a usability perspective, it shows.

In the past 18 months Twitter use has grown explosively attracting approximately 1 million users who post about 3 million messages a day. The original teen users have largely been lost in a crowd of doctors, CEO’s, teachers and scientists. The key question “Is Twitter a passing fad (the digital equivalent of the pet rock) or a technology that is becoming a fixture of our technocivilization?” has yet to be answered.

2.      What is Twitter good for?

The original intent of the Twitter design was to create an online infrastructure to support teen texting. I left my teen years behind four decades ago but I imagine the great issues of teendom haven’t changed (boys, girls, who likes/dislikes who, and various answers to the perennial “Wazzup?”). As the user population has evolved so have the applications. In the recent contretemps following the Iranian presidential election, protesters used Twitter to keep the world informed of their struggle after the government ejected most professional journalists.

In my personal observation of Twitter traffic over the past two years (as well as several suggestions by Patricia Anderson at the University of Michigan) there are 8 areas in which Twitter has proved useful: social grooming (explained below), contact with the flock, news gathering, marketing, opinion sampling, topic-based research, crisis response, and ask-your-peers information gathering.

Social Grooming: Many higher primates (chimpanzees, gorillas, telemarketers) live in tribal groups. Group affiliation and status are maintained through grooming behavior in which one primate will pick parasites out of the fur of another tribal member. Since humans are embarrassingly short of fur our species has invented social chatter to take the place of primate grooming. This is close to the original intent of Twitter. The content of the messages is largely irrelevant – it is the contact and its acknowledgment that serve the essential social processes.

Contact with the Flock: Our political leaders (at all levels) tend to live busy lives. Nevertheless the average citizen has little contact with the people we elect. The sophisticated technology users on the Obama team began a quiet revolution in the way our leaders interact with their various flocks. Social networking sites have played a major role in this new outreach. A number of national figures (Senator McCain, Secretary Clinton and of course, the White House) have used Twitter to share a kind of public diary of their activities (Senator McCain’s postings are by far the most interesting–it has been fascinating to see how much minutiae a national leader must deal with). I suspect that Tweets between our leaders and their constituents tend to be one-directional because technology has yet to find a way to facilitate a meaningful dialog involving hundreds of thousands of people.

News Gathering: The news business has seen a lot of change in recent years. Cable news channels, the struggle of print media, the blurring line between entertainment and news, the politicization of news, the importance of news aggregators (such as the Drudge Report) and the rise of the blogging community have opened the door to all kinds of news gathering innovation. One of these is the use of “citizen reporters.” In a world of “sound bite news” Twitter is the perfect medium. Short, on-the-scene observations from ordinary people have proved a compelling supplement to professional reporting. In addition, more and more celebrities have begun to tweet. These 140 character glimpses into the lives of the rich, the beautiful and the famous are closely monitored by news organizations in the hope of being the first to report on breaking news.

Marketing: The vast and growing population of Twitter users is a very tempting target for marketers. It is very easy to subscribe to a user as a “follower.” Twitter etiquette encourages users to return the favor. This opens the door for the “follower account” to send unsuspecting users an endless stream of “Twam” (my term for Twitter spam). It is not clear whether Twamming generates much revenue. As a usability and medical systems consultant I aggregate news items of interest to my prospective clients and post them on my website. I then Twam my Twitter followers with the news item headline and the address of my website. The technique certainly drives up traffic to my site but I am not convinced that it is generating any useful business. The jury is still out.

Opinion Sampling: If you have a decent number of followers (at least 100) then you can usually post a question and get a useful answer. You must, of course, actually find the Tweets containing replies from a much larger flow of Tweets on other topics (Twitter provides a messaging capability but it is common for people to reply to questions with Tweets of their own). I have used Twitter to find new academic reference material for my research and to get quick, “straw vote” reactions to design ideas. It would be fairly easy to enhance Twitter to provide polling and sampling utilities. It is easy to imagine politicians soliciting feedback this way and news organizations using real time Twitter polls to engage with their audiences.

Topic-Based Research: Hashtags are used to tag Twitter postings as relevant to one or more topics. For example, in my postings on Electronic Medical Record systems I tag the post with #emr. Other Twitter users can search for recent posts on any given hashtag (a directory of hashtags can be found at: Twitter’s search function (currently found in the right margin of a Twitter screen) can be used to follow all posts containing a given hashtag. For example, searching on #emr will bring up all posts containing this tag displayed in chronological order. The list of postings can be used to find users with similar interests who can then be followed on Twitter. This is inarguably the most powerful way to network on Twitter. The network you create can serve as a powerful research resource. Remember that there is no rule against creating multiple Twitter identities. It is often useful to devote a particular identity to a specific interest.

Crisis Response: There are two kinds of crisis for which Twitter has proved useful. One is the “violent event” category (hurricanes, earthquakes, terrorist attacks). Even supposing that the technical infrastructure that supports Twitter (Internet servers, cell phone towers, etc.) remain intact, the kind of reporting possible through Twitter is more suited to news gathering than it is to coordinating relief efforts.

There is however, a different kind of crisis for which Twitter can be very useful. Poisoned peanuts, poisoned pet food, and products with manufacturing defects all represent crises to companies and  even entire industries. Twitter is the ultimate vox populi (voice of the people). Corporate crises tend to surface on Twitter long before they make the news. Major corporations should monitor hashtags associated with their name and the names of their products as a matter of routine.

Once a crisis response has been initiated Twitter can also offer a useful window on how the public is responding. Of course, Twitter is one tool out of many but it is one that risk management executives should take seriously.

Ask-Your-Peers Information Gathering: Once your list of followers is big enough Twitter is a pretty good resource for “neighbors chatting over the fence” interactions. My daughter has a dog that seems to have only a couple of functioning neurons. The intellectually challenged pooch has a thing for skunks. My daughter was at her wit’s end trying to deodorize her pet. I posted a quick question on Twitter and within a few moments I had lots of things to try (one of them even worked). As long as your questions are appropriate for  your follower demographics Twitter can serve as a kind of real time Wikipedia.

3.      Summary

In my examination of the ways that Twitter is used, I found 8 major areas of application:

  • Social Grooming
  • Contact with the Flock
  • News Gathering
  • Marketing
  • Opinion Sampling
  • Topic-Based Research
  • Crisis Response
  • Ask-Your-Peers Information Gathering

The list is surprisingly long and it is a tribute to human ingenuity. This is particularly true when we consider Twitter’s many limitations. These will be covered in my next article, “What are Twitter’s problems?”

New Workshop from MediCHI: Your patient has a pulse, does your software?

December 10th, 2009

Learn more at the The Defensive Buying Workshop

Defensive Buying – Your Key to Selecting the Best Medical Software

December 9th, 2009

Just published, “Defensive Buying – Your Key to Selecting the Best Medical Software” in HCPLive,

Guest Article: Coping with Stress of Senior Home Care

December 8th, 2009

Senior home care is making the decision to care for your aging parents or loved ones in their home or in your home allowing them their independence but taking on the responsibility of their being the caregiver.  Caring for aging parents or loved ones carries a lot of responsibility and a range of emotions.  No matter how much love in your heart, carrying the load of caring for your loved one will leave you drained physically, emotionally and possibly financially.    Coping with the stress of senior home care has to be managed or you will not be able to be an effective caregiver.

Managing the stress of senior home care is all about taking charge.  Take charge of your thoughts, your emotions, your schedule, your environment and the way you deal with problems and unexpected situations.  The ultimate goal of coping with the stress of senior home care is to achieve a balanced life.

How to reduce, prevent, and cope with the stress of senior home care:

Senior home care requires organization – Organize your time and your schedule.  Write everything down so that you or another family member has reference to phone numbers, doctors, medications, in home senior care providers, important insurance and financial numbers.

Start a personal journal– Share your feelings about the stress of senior home care.  Writing down your thoughts will help you to take charge of your emotions.

Prioritize your health and well-being.   Nurturing yourself is a necessary not a luxury.  Healthy ways to relax and recharge:

  • Go for a walk
  • Call a good friend
  • Sweat out the tension with a good workout
  • Write in your journal
  • Curl up with a good book
  • Take a long bath
  • Eat healthy and exercise regularly
  • Play with your pet
  • Work in your garden
  • Listen to music
  • Savor a cup of warm coffee or tea

Give yourself a break – Enlist the help of a professional senior home care provider. Senior home care providers such as Visiting Angels can provide daily or weekly help to everyday chores, errands, hygiene, meals or transportation needs just to name a few.  Senior home care providers can also provide a respite to you responsibilities with as little as 15 minute notice to avoid unnecessary stress if your schedule needs help.

Coping with the stress of senior home care is the only possible way to be an effective caregiver to your loved ones.  Your mental and physical health must take priority or you will not be able to manage what needs to be done.  Take advantage of these tips.  Organize yourself, express yourself, nurture yourself and help yourself by arranging for assistance with a senior home care provider.

Bio:  Linda Dunkelberger is a freelance writer and editor.  “Coping with Stress of Senior Home Care” shares tips for coping with the stress of senior home care.  Visiting Angels is a senior home care provider that helps seniors with everyday tasks, errands, meals, transportation, just to name a few services.  For more information on Visiting Angels in your area, see