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Click to play: YouTube and similar sites have more doctors getting ready for their close-ups

Capitalizing on the growth and popularity of Web videos, some physicians are now turning to the camera as an inexpensive tool for communicating with patients. Sometimes there's even a marketing impact.

By — Posted Jan. 7, 2008

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Loring Jacobs. MD , an internist from Las Vegas, wanted to find a more personal way to tell patients their routine test results, otherwise relayed through a phone call, an automated system or a nurse.

So Dr. Jacobs began making video e-mails, giving patients the results himself, and explaining them in more detail. If the news is bad, Dr. Jacobs sends a video requesting that the patient make an appointment.

Dr. Jacobs has been sending video e-mails for about seven months. He said he does it because his patients like it, not only because they can see him talk about their test results, but also because they like how tech-savvy the video e-mail makes him appear.

"They say, 'Thanks,' and then, 'How did you do that?' " Dr. Jacobs said.

That "how" question is one a small but growing number of physicians are trying to figure out, as they incorporate the use of Internet video into their practices.

Doctors are creating video blogs, or posting video of lectures or procedures, or as Dr. Jacobs is doing, adding video to e-mail. Some are posting video to their own Web sites, to YouTube or to doctor- or health-specific sites.

Creating Web video doesn't have to be expensive. Dr. Jacobs pays $9 per month for his video e-mail system and made a one-time purchase of a webcam, which can sit atop or near the computer and feed video straight into it. A webcam can cost as little as $25.

Nina Sossamon-Pogue, with BenefitFocus, a Charleston, S.C.-based health IT company that recently launched the open-source video site icyou.com, said video is a way to make things easier for patients to understand what the physician wants to convey.

"Instead of handing the patient a pack of information they can now ... say, 'Go on this Web site and I am right there and I can tell you more,' " she said.

"It's one thing to read what someone has done and read what they say," Sossamon-Pogue said. Patients get more out of seeing the physicians, "to see what they have to say."

Many patients are familiar and comfortable with Web video. A recent study of Internet users by the Pew Internet American Life Project found that 57% of Internet users have watched videos online, and most have shared what videos with others.

The Pew study also found trends in what types of videos viewers prefer. Although younger viewers (ages 18 to 29) are more likely to prefer amateur videos, more than 60% of viewers overall prefer professionally produced videos.

But even if a production team isn't in the budget, there are ways to get your video noticed, experts say. But physicians always should keep HIPAA privacy and security laws in mind when considering use of patient footage, experts say.

Marketing your practice

For doctors, the reasons are varied as to why they are breaking into video. But for most, it's about marketing. (Even when it isn't about marketing, Web video can still work that way. Dr. Jacobs said he has gotten 10 new patients from word-of-mouth, even though he doesn't market his e-mail videos widely.)

Some videos run more like television commercials, complete with all the necessary information, such as office hours and locations. Others feature rare treatments or therapies that a practice offers, aimed at patients doing online research.

Some physicians are producing educational videos for continuing medical education credit or news-related videos to post to their own Web sites.

"These days you have to be real creative with your demographics. [Patients] are more tech-savvy now," said Charles E. Crutchfield III, MD, a dermatologist from Eagan, Minn. He uses a $169 digital video recorder to capture before-and-after shots of patient procedures, then posts them on YouTube.

Paul Harch, MD, an emergency physician from New Orleans who also runs a hyperbaric oxygen therapy center, learned the power of Internet video from one of his patients.

Dr. Harch has been making videos of his patients for more than 17 years as a way to track their progress. His staff uses a handheld VHS camera -- outdated by today's standards -- to record his interaction with patients after each HBOT session.

When the family of a 17-year-old boy who was severely injured in an automobile crash in June 2004 was given a copy of his tape, they were so stunned by it that they posted it on YouTube on May 2, 2007.

The video breaks nearly all the rules the experts say make a good video: The quality is poor; the tape is long; it contains no graphic elements; and the message it tries to send isn't clear without some prior frame of reference. But the video has been viewed almost 11,000 times.

The nine-minute video is a collection of snippets from a consecutive recording of the boy's progress during an 18-month period. The first scene shows the teen in a near vegetative state, not able to lift his head or speak an intelligible word. By the end, the boy is walking, talking and even playing practical jokes on Dr. Harch.

Dr. Harch said most viewers likely found the video by searching for information on treatment of severe brain injury. The video got so much attention that Dr. Harch since has posted it on his own Web site, along with promotional videos explaining HBOT. While he is enjoying the attention the video has gotten, he doesn't plan to start a YouTube series.

"It is unfunded and very time-consuming," Dr. Harch said, adding that most of his videos are long because they track progress over extended periods and would need editing. "They are more for the patients." But if he eventually gets funding, he would like to have a team of neurologists rate the best ones for their clinical value and use them for marketing.

In the case of Richard Lipton, MD, a neurologist with the Albert Einstein College of Medicine in The Bronx, New York, video found him.

He had planned to post some educational material online for patients with chronic headaches when Healthology, on online health video depository, called him. Healthology helped Dr. Lipton, a headache specialist, produce an educational video that describes different types of headaches and treatments. He said the videos are a great way to give his patients information and are appreciated more than a stack of pamphlets.

Sean Maloney, president of Dramatic Health, a video production company that recently launched an open-source Web site, HealthTheatre.tv, for physicians and patients, said video provides a "real opportunity to learn new stuff, new concepts and new innovations in ways in which you only get from observing."

In addition to the HealthTheatre Web site, Dramatic Health, which has a channel on YouTube youtube.com/user/dramatichealth, produces videos for clients, mostly pharmaceutical companies and medical device makers, using content supplied by physicians.

Before you shoot

There are many issues that need to be resolved before a physician commits to Web video.

If you are posting lectures or other educational content, there is the issue of recognizing your expertise, or admitting when you might not be the most qualified person to speak to a certain topic, said Ryan A. Stanton, MD, an emergency medicine resident with the University of Kentucky HealthCare system. In his second year of residency, he did a month-long internship in Boston with ABC News where he wrote and produced medical stories for the network's health team. Since the internship ended, he has continued to produce one or two stories a month for ABC in which he is the reporter. He also does videos for the hospital's public relations department as well as his own department.

"You must be honest with yourself if you are qualified or knowledgeable enough to talk about [a specific topic] to an audience that isn't educated on the topic. You either need to be educated on the topic, or find someone who is," Dr. Stanton said.

Another necessary skill is the know-how to pull the video together. Many physicians go it alone, and experts say the Internet audience is used to video that doesn't exactly meet Hollywood standards.

Alternatively, a number of production companies will offer free help in exchange for physician-driven content, or a physician can hire a production team (costs vary). But experts warn physicians to review contracts carefully to ensure that they maintain final editorial approval and to verify how the content may be distributed in the future.

Dr. Crutchfield says it's not necessary to spend a lot of time or money trying to make yourself look like a professional actor or director. "Part of the charm ... is that it's done by you."

The one area in which you should not go it alone is ensuring that the videos are HIPAA compliant, experts say.

Dr. Crutchfield has a permission form drawn up by an attorney stating that the before-and-after photos can be used for a variety of purposes, including marketing. Long before he considered doing videos, Dr. Crutchfield used patient photos in marketing brochures and on his own Web site. He used the same disclosure form he is now using for video.

In addition to permission forms, Dr. Stanton said, UK HealthCare has a policy of including a copy of the form in the patient's medical chart and noting that they agreed to be videotaped or photographed.

Finally, physicians who produce Web videos say you need to commit to the time needed. Video making does not have to be an arduous process, but, doctors say, it's not the sort of thing done in a few minutes.

Dr. Jacobs, who sends video e-mail, said his inexpensive system has much broader capabilities, but he doesn't have time to explore the options. Someday Dr. Jacobs would like to do video blogs, or post videos on YouTube that contain lectures or other health-related content.

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ADDITIONAL INFORMATION

Production primer for physicians

New to making videos? Experts offer the following tips to help novices make effective videos and get them noticed:

  • Know the primary message you want to convey before shooting begins.
  • Speak directly to the camera in the same manner as you would to a patient, using language a lay person can understand.
  • Keep it as brief as possible, since viewers tend to have short attention spans.
  • If you are telling a story, do not get too in-depth. Highlight resources for more information.
  • For news-related videos, strike a balance of interviews and visuals that will hold your viewers' interest.
  • If you are not qualified to speak on a topic, interview someone who is.
  • When submitting to YouTube or other public Web sites, use specific terms to name your video so prospective viewers can find it more easily.

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Remember to watch those security tapes

Even if you aren't considering using videos to promote your practice or communicate with patients, video may already be running -- for building security.

And like with other video, content found on security surveillance tapes could be subject to HIPAA, depending on the angle of the camera, according to health care attorneys.

Deborah Gersh, partner with DLA Piper's Chicago office, said there's no HIPAA governance over cameras placed outside a practice, or even in common areas where anyone could walk and be seen. But "if you have cameras inside, then I think it becomes dicier," she said.

Attorney Brenna Arceo, from the Sacramento, Calif., firm of Nossaman Guthner Knox and Elliott, said that if personal health information is captured on a videotape, "A covered entity provider may only use or disclose PHI held on security footage in accordance with the privacy rule and the provider's privacy policies."

"You have to be careful about being overly concerned, but it's good to be prudent," Gersh said. An example of going overboard would be to assume that someone captured on a tape walking into a practice has had their right to privacy violated.

The person captured on tape could be the mail person, she pointed out, or someone meeting a practice employee for lunch. Even if it were a patient, the recording would fall under HIPAA's "incidental" rule, which allows exceptions for unavoidable events.

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Video surveillance sees how often doctors and nurses wash their hands

Of course health care workers wash their hands.

Or maybe not.

A video review showed the Dr. Osh and Associates Ambulatory Surgery Center in Macon, Ga., that employees weren't washing their hands often enough.

The podiatric surgery center recently completed a 40-week pilot program aimed at improving hand-washing compliance. Before the experiment, Evaristus Oshiokpekhai, DPM, the owner of the practice, said he thought compliance rates were pretty good. But a baseline found employees were washing their hands only about 38% of the time.

The pilot program was conducted by Arrowsight, a Mt. Kisco, N.Y.-based company launched about seven years ago with its ParentWatch system, designed to help parents keep a remote eye on children in day care facilities.

By the end of the hand-washing program, compliance rates rose to more than 95%, according to Dr. Oshiokpekhai and the company.

"The whole experience was a positive one and served as a good motivation factor to employees," Dr. Oshiokpekhai said. The center decided to continue use of the system.

A large hospital in New York, which didn't want to be revealed until its own announcement was made, will be the next to install the system, said Adam Aronson, a spokesman for Arrowsight.

He said using the program in the hospital setting is proving to be challenging because of concerns over patient privacy and the inability to turn cameras off. Therefore, this system will rely on sensors that record traffic in and out of patients' rooms, in addition to cameras positioned over sinks and hand-sanitizing fluid dispensers.

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