A 2 circle Google+ Migration Strategy for Newbies.

There has been a lot of agonizing over the Google+ circles.   People are trying to sort their "friends" and family and acquaintances into all kinds of groups and overlapping subgroups.  Opinions range about how many busy people will take the time to understand the nuances of the asymmetric circles.  Will this scare people away from trying Google+?

A very simple solution could be as follows



Create 2 circles

1. Former Facebook folks


• These are all the friends and family that you "friended" on FB.  This meant you saw everything they posted, and vice-versa.  - This maybe a good time to clean house ;-)


• This assumes that like the majority of FB users you did not care to select a subgroup of your friends when posting.


• You will immediately start seeing anything these friends post in your stream.


• When posting something you decide if you want it to go out to all your former FB friends.


• When reading your stream, with one click you can convert it to a FB equivalent


2. Former Twitter folks


• These are all the folks you followed on Twitter.


• This will allow you to read all their comments just like in Twitter


• You can post publicly what you would normally post to twitter.

You cannot control who will read your posts.  You can hope that folks you add to your circles will reciprocate.  Then they can read your posts depending on how they filter their stream. 

Now you are all set.

When posting in FB mode, post to just your FB circle

When posting in Twitter mode, post publicly

When reading in FB mode filter by FB circle

When reading in Twitter mode, filter by Twitter circle

As time passes and need arises, start creating subgroups of your major circles.  Periodically check who is adding you to their circles and reciprocate appropriately.  Once all your contacts are in G+, may be tempted to stop checking FB, Twitter, (and your mail?)!  Till then there is a Chrome extension to share on FB and Twitter from Google+.  You can find it here.

Fortunately for Twitter Google+ has no hashtags.

Now this is not what I did when I started but trying to explain Google+ to a couple of friends, I realized that we learn by comparing anything new to what we know.  Since we know FB and Twitter, we keep comparing Google+ to these.  That is fair enough, and this model will help folks get used to Google+ and they can figure out the exceptions and limitations.  There are many nuances but rather than become a case of paralysis by analysis, just start and be extra careful about what you post till you get the nuances.  

Making EHRs More Meaningful for Physicians - Part I

Using Social Media/Networking and Web 2.0 Ideas for EHRs.



While EHRs have a lot of potential, their design could be much better. There is a feeling that the needs of the physicians have been ignored during the design process. It is high time, physicians spoke up loud and clear on their needs.



As more information is collected within the EHR, it becomes progressively more difficult to review it in an efficient manner. This is due to several factors but I am going to focus on just 2 right now:

• The office visit notes tend to be very long with the meaningful portions buried amongst all the requirements for medico-legal and billing and coding needs.


• The information is not appropriately tagged or categorized.  For example, when I am managing a patient's reflux disease, I like to look at all the related notes, medications, tests etc. in one place. This would prevent overlooking something and provide better care while saving the physician time.

Web 2.0 means that users create content and help create meaning from the content by appropriately tagging and curating it.  In EHRs while care givers create content, it is not at present easy to make sense from it.  We rely on various system solutions like ICDs and CPTs which are often like fitting square pegs in round holes.  They serve the purpose for everyone but the physicians taking care of the patient.  It is high time, physicians did something to make sense of the EHR data for themselves.  So here is a proposal.

1. With every note, the care giver will create a short Twitter-like post to summarize the thoughts and plans.


2. This summary will be tagged with the appropriate organ-system or category (one or more)


3. The patient's EHR will have an overview page with the (reverse) chronologically arranged Twitter-like summaries from every encounter.  These could be sorted/filtered/searched.


4. The tags from these summaries would be used to create a wiki where each tag would be a topic and all summaries created by various physicians tagged by that topic would be automatically collated under that header.

Here is a mock-up of what this could look like.  To explore how this works, pause the presentation and click on the various tabs, hyperlinks and tags to see the proposed functionality.

Social EHR

View more presentations or Upload your own.

Click here to see the slide set as a flipbook.

Or just take a quick look at the non-interactive images below:

A twitter feed of summaries from encounters.  Each summary is linked to the full note.

Office visit note with Summary at top.  Appropriate tags added.

A Wiki for the GI topic with all encounter summaries tagged with [gi].  Additionally has timeline for GI related decisions.

Medication tab showing timeline of medication changes with links to encounters notes when changes were made.

These are "back of the envelope" designs and clearly need to be thought through in detail.  The concept though should be quite obvious from these.  Any EHR company out there listening?  Someone want to build an open-source EHR based on these principles that will truly help the physician and the patients?  

The astute reader must have noticed the "Part-I" next to the title of this post.  Yes there is more to come.  

Leverage your Global Twitter network to find answers to Clinical Questions!

Just last night I got to experience first-hand how the Global Twitter Network can help one find answers to questions almost instantly.  When you use Twitter for a while, you get to know and trust people whom you communicate with frequently.  These people might have similar interests but also have expertise in various other areas and can help direct one to answers that might not be easy to find.  Just like any thing else on the web, one still has to appraise the evidence and apply it appropriately.  A great advantage of twitter is that around the globe, it is highly likely that someone is awake and has some time to look for the answer.  You can also "mention" a person you know might have the answer in your tweet and if thus draw their attention to the question.



So here is a brief example of how the Global Twitter Network works.