Geolocation services: Have your patients put you on the map?

Mobile applications let people "check in" anywhere to let others know where they are -- including your practice. But applications also let people talk about you.

By — Posted Dec. 20, 2010

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Seeing patients texting in your waiting room is not new. But what you may not know is that the patients who appear to be texting are actually on the Internet telling their friends and social networks where they are, and what's going on around them.

Through a technology called geolocation, mobile smartphone users have the ability to "check in" at various businesses and locations, alerting their virtual friends to their whereabouts. They do this using mobile phone applications that work with a smartphone's GPS system, which identifies the users' location. Though it began as a way for people to let friends know where they could be found, people are now using geolocation networks to check in anywhere from the bus stop to the grocery store, from their favorite restaurant to your waiting room.

Why should you care? Because these same applications that are allowing patients to check in allow the user to provide instant reviews, observations and critiques. So after you leave that patient's exam room, they could have feedback about their visit with you posted online before you even review the next patient's chart. Or, they could be posting critiques while they're waiting before the appointment, or waiting for you in the exam room.

Many of the applications operate mostly as a game, allowing users to collect digital souvenirs and passport stamps (Gowalla) or earn badges or titles such as "mayor" (Foursquare) when they check in the most times at a particular location. You might be surprised to learn that someone might be the declared mayor of your practice. The sites often allow users to post their location to other social media sites, such as Facebook and Twitter.

As the sites evolve, some business owners have tried to capitalize on geolocation by offering discounts or incentives to people who check in for the first time or the most times, or who earn a new title.

But is checking in at a practice something physicians should encourage patients to do?

Probably not, experts say. But there are some ways physicians and patients could benefit from the technology. And it might not involve checking in at all. Even if you have no desire to become an active participant in the geolocation craze, at the very least you should be aware that people are actively using the tools.

People are checking in

Marshall Kirkpatrick, co-editor of the technology blog ReadWriteWeb, said he was visiting the dentist recently when he showed his dental hygienist the list of people "checked in" at the dental office on Foursquare at that moment, "and she freaked out," he said.

Concerned about the HIPAA implications, she quickly said she couldn't confirm or deny that those patients were there. She was most startled by that fact that the information was so readily available.

What she didn't initially understand was that the patients listed as checked in at the practice had checked themselves in and had made a conscious decision to tell the world where they were, Kirkpatrick said.

The idea of a patient broadcasting the fact they are sitting at a medical practice is probably a foreign concept to most physicians.

"Medical professionals are trained to be cautious about medical data," Kirkpatrick said.

Even though the patients are checking in voluntarily using geolocation services, that doesn't mean physicians can't have some control over what the patients find when they check in. In fact, says Chris Boyer, senior manager of digital communications with Inova Health System in Falls Church, Va., every physician should go on the sites to see what information is available, and if it's accurate.

Boyer once looked up Inova's various locations and found that a number had incorrect information, such as wrong addresses or phone numbers. This happens because the applications, especially Google's geolocation application, pull data from multiple online sources. And other geolocation applications use Google's mapping features to display your location.

Boyer said Google's geolocation application, Google Places, is a good spot for physicians to begin searching for listings on their practices. Doing a search there, combined with a simple Google search, will help identify other (non-geolocation) listings of your practice. If any of these listings contain incorrect information, that information may trickle down to the geolocation app users, he said.

Some applications allow you to claim the listing as the owner of the business. Doing so allows you to correct information or add details.

On some apps, users manually can create a business listing if one doesn't exist already, which is also how incorrect information -- and sometimes multiple listings for the same location -- get listed. But, Boyer said, he would advise doctors against creating their own listing unless they want to use it to promote something specific. Figuring out what a physician practice could promote gets a little tricky.

Anthony LaFauce, director of digital strategy for SpectrumScience, a health care public relations firm in Washington, D.C., said he has seen pharmacies using geolocation applications to promote services such as flu shots. Physician practices could do similar promotions, he said, but so far he hasn't seen any doing it.

Encouraging patients to check in might seem like an easy way to promote the practice, but Boyer said he would not recommend that, either. He said physicians who encourage patients to post to geolocation apps might send the wrong message, because it would equate to them encouraging repeat visits -- a good strategy for retailers, but not for physician practices. There's also the issue of HIPAA. Patients who knowingly give up their health information in no way violate HIPAA or implicate their physicians. But encouraging patients to check in and possibly make public their health information may be a fine line doctors want to avoid, experts say.

David Harlow, a health attorney and a health law blogger from Newton, Mass., said physicians should have a policy or statement in place that serves as a reminder to patients that anything posted online -- in any forum -- is not private. (See correction)

Other experts wonder how many patients really would be interested in checking in at a doctor's office and, if so, what the limitations to that might be. First of all, the type of clinic would be a big determining factor, said Mark Scrimshire, director of Internet Channel Strategy at CareFirst BlueCross BlueShield and also an organizer for HealthCamp, a participant-driven conference focused on social media in health care.

Scrimshire said the subject of geolocation's potentially limited reach in health care came up at a recent HealthCamp gathering, and several attendees, in a joking manner, wondered aloud how many people would be willing to check in at, say, an STD clinic or a plastic surgeon's office.

Despite the limitations, and the unwillingness of many patients to use the geolocation services at a health care facility in the same way they would other businesses, many believe there is still a great potential for the technology.

For patients, it could prove very useful for finding a new doctor, Scrimshire said.

The technology also could help patients make better real-time decisions. For example, if an app user checks in at a fast-food restaurant, a notification could be sent to remind them to stay away from the french fries.

"If we can help people make these micro choices, such as ... 'Today, I am going to choose the chicken instead of the Mac and fries,' those micro choices add up. So let's make it so we can help people," Scrimshire said.

Combining geolocation with mobile technology makes it easier for patients to apply a large amount of information to the things they already do without making them think too hard about doing it. This is why many believe geolocation will play a larger role in health care in the future. But it may be in ways no one today can imagine. Just like how, until recently, no doctor would imagine patients broadcasting to the Web that they were in their physician's office.

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Geolocation applications

The number of geolocation services and applications are growing every day. Often, these apps allow users not only to say where they are, but also to give their opinion of the place -- and instantly share that with people they are connected to on other social media sites.

Here is a list of some of the more well-known apps and their descriptions:

Foursquare: Allows users to check in and earn badges or become "mayor" for checking in the most times.

Gowalla: Gives users virtual passport stamps and digital souvenirs for checking in.

Facebook Places: Allows Facebook users to check in to let their Facebook friends know where they've been.

Google Places: Allows users to find businesses based on their current locations.

Brightkite: Combines the act of checking in with the ability to follow others and to post and respond to comments.

Loopt: Combines Loopt and Facebook friends and allows users to see where their friends are on one map.

ArcGIS: Allows users to create their own customized maps using their own data.

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Can physicians "check in?"

Geolocation applications in health care aren't just for patients. There are also many ways physicians can use the tools to broadcast where they are -- without violating any privacy laws.

Bunny Ellerin, president of Ellerin Health Media, a communications consultancy in Brooklyn, N.Y., said she is aware of several physicians who use apps such as Foursquare to check in at conferences in order to network and plan get-togethers with other physicians, which she thinks is very useful.

But she also sees potential disadvantages and dangers for physicians checking in and broadcasting to the world their every move.

"If you're checking in socially and someone has a medical event, you put yourself in a fairly precarious situation," because people may seek you out and rely on you to respond to the event, she said.

Ellerin said physicians responding to disasters could check in so that emergency responders know they are a physician and are there to help.

Experts say it might be useful for doctors to routinely check in when doing rounds at hospitals. In case of a large disaster for which many health professionals would be needed, it would make it easier to mobilize doctors if they were checked in and the hospital could track their whereabouts. Even outside the hospital, checking in could be useful in situations where physicians want to respond to an event or a disaster.

David Harlow, a health law attorney and blogger, said there also could be a use beyond physicians letting people know where they are. For example, he said, by using Foursquare's badge approach, which allows users to earn badges or become "mayor" for checking in the most at certain locations, hospitals could create apps that reward physicians for best practices.

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This article originally misidentified the location of health law consultant and blogger David Harlow. He is from Newton, Mass. American Medical News regrets the error.

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