From her hospital bed, the little old woman gathered herself beneath her tissue-paper thick blankets and wondered about many of the things she’d face in her future. Though the room wasn’t cold, wringing her hands through the folds of the cheap cloth were all she could do to keep herself calm.
The television blared above her prone body; it made the only noise except for the rasp of her short breath. Occasionally, an orderly passed by but made no effort to breach the curtain door, and made her way down the hall.
A newspaper lay unopened at her side, not a word of it read, mostly because of the glaucoma in her right eye. Thus, the television called out, it being the only thing to steer her thoughts back from the darkness and confusion that seemed to take hold.
A relatively healthy 95-year-old women prior to the automobile accident (that consequently was not her fault), she seemed to suffer the unimaginable at her age and come out alive. Though doctors wouldn’t guarantee her recovery during the first few days, they were more optimistic now that her broken leg, broken arm, fractured wrist, broken shoulder and cracked ribs had not killed her.
She’d made it this far, they reasoned; and if the whole experience didn’t kill her then certainly it would make her stronger.
So alone she sat, except for when the occasional visitor stopped by, much of the time scared and most of it confused.
In came the food, out went the plates. In came a doctor, what was left were his orders. The occasional nurse checked her machines and gave her a pill; conversation was limited to, “How are you feeling today?” or “Are you in pain?”
There’s no surprise she feels out of place. Clearly, thoughts of giving up come to mind and she wonders if she’ll be able to survive the three or four months of required physical therapy for her to recover.
Even worse off, without any real family to guide her through, she sat quietly trapped in her own thoughts.
Finally, at one point, randomly looking at the computers in the room, she said softly, “Everything is mechanical now.” It was a statement, like something said in fear and loathing. She wrung her hands some more and closed here eyes.
When the nurse came in, the old lady requested a pain pill and the nurse left to retrieve it. Upon her return, the nurse handed over the small white pill and a shot of water and said she’d stay until she was sure it had been swallowed.
Thirty seconds later she was gone, again. Alone, the old woman tried to remember her home and its warmth and did her best to recall a lifetime – nearly a full century – in which she’d been engaged lovingly by family and friend.
It’s all mechanical, now, she said again, wondering in silence as her companion, the television, blared on.
The business of explanation deserves its place in healthcare, at least as far as the patient is concerned. In their interactions with their physicians, be in at an office visit or in the emergency room, there’s a great deal more need for those providing the care to walk through the experience with those receiving the care.
Even if it’s a tedious experience for the physician the importance of drawing and engaging the patient can not be understated.
Really, from start to finish, every interaction with every patient should contain some sort of “educational” component at least as far as the care continuum is concerned. During their visits, all patients have questions in which they need/want answers to that ultimately may not be vitally important to the caregiver, but are to those receiving the care.
Even during the documentation process, physicians have a great opportunity to learn more about lives and health choices of their patients, especially if they can get them to speak about the office’s electronic health record system.
Perhaps I’m the outlier given my passion for technology and health IT, but I use my doctor’s use of technology during my office visits to engage my physician. Maybe it’s the reporter in me, but I always seek opportunities to use props or interactions to develop deeper relationships with those around me. Though my physician may think his EHR beyond my comprehension, I like to surprise him and dive right into and ask him about its capabilities.
What can it do?
Why did he choose it?
What does he track the most?
What’s he tracking about me?
Why did he buy it?
Then, when the ice is broken, I dive into more broad-based questions:
Why does he practice?
What is he most passionate about from a care perspective?
Why he chose to practice the field he did, and so on …
Essentially, in the eight minutes he’s taken to see me, I’ve learned enough about him to probably write a profile.
My point is, by taking a peripheral interest in someone even in an extremely short amount of time, there are benefits to be gained. I try to make it an art form and get at people’s stories without them even knowing. Try it sometime. Next time while at a party, observe just how many times someone actually asks you a question about anything. I’ve gone through hours of social engagements without having to answer a single question.
My point is, it’s easy to engage people of all levels even without them knowing it if you get them talking about the one thing they all want to talk about: themselves.
This tactic, if used by physicians, could get all of the information they need out of their patients even if their patients don’t want to be engaged.
According to a new study published by the Journal of the American Medical Association, patients with online access to their medical records were more likely to engage with their physicians, in person and through electronic communication.
Apparently, this is the case for patients of all ages despite whether or not they were diagnosed with a chronic condition.
Likewise, for these same patients, there financial outlay for services was also greater than their counterparts who had no such access to their medical records online.
The Journal suspects a few reasons for this, including: “patients need ‘better, faster, cheaper’ processes of care for diagnosing, treating and monitoring their health. Online access to care may have led to an increase in use of in-person services because of additional health concerns identified through online access. Members might have activated their online access in anticipation of health needs. Members who are already more likely to use services may selectively sign up for online access and then use this technology to gain even more frequent access rather than view it as a substitute for contact with the health care system.”
These results really do seem to mean that there is a verifiable correlation between patient portals and patients’ ability to access records online whenever they want. The findings also suggest that the portals, and subsequent secure electronic communication, encourage patients to interact with their physicians, ask questions, seek treatment and engage.
Even with the spike in expense these folks are adding to the system, this is probably some of the most positive insight to come out, and support the healthcare community, especially as they embark on their role of working toward stage 2 meaningful use attestation.
However, it’s worth pointing out that the one thing that seems to be generating the most buzz in relation to this data are the healthcare expenses the individuals are generating, and I just don’t understand. Someone please help set me straight here. Why is this a bad thing?
If I’m speaking out of turn, please correct me, but here’s how I see this playing out, assuming the information released by JAMA is true.
First, patient portals really do seem to be engaging patients as long as they know to use the system, how to use it and what to use it for. Because they are using the system, they are becoming more concerned about their health and having conversations with their physicians about their concerns.
Next, they want to address their health concerns, so they seek the counsel of their professional healthcare provider. Said counsel costs money and they are paying for the care they seek, therefore, helping build their physician’s practices.
Additionally, because patients are using the system, the practices are meeting the minimum requirements for mandates and will be able to successfully attest to stage 2.
Once the patients receive the care they need, they return to their lives until another ailment shows its head, at which point they return to the portal and continue to engage.
All said, you have an engaged patient population who look to create and value long-term relationships with their physicians and their physicians are able to support and build their practices, and, wait for it … support their patients.
It’s the circle of “life,” if you will. As the population scales beyond those included in the survey, this model is likely going to be the new normal.
Please, please, correct me if I’m wrong, but isn’t this exactly the type of news and headlines everyone with an investment in meaningful use was waiting/hoping for?
I heard a stat recently that it would take eight years to view all of the videos loaded to YouTube each day. With such a volume of content flooding the market, it makes sense to have a plan.
Social media isn’t such a new phenomenon and it absolutely has an impact. As far as patient engagement is concerned, many say it’s one of the only ways to draw patients into the fold; especially important now, of course.
According to a new post from ClickZ, a marketing news site, almost 90 percent of all businesses are utilizing some sort of social media effort (I think that number is a bit high), but it’s very obvious that not as many of these campaigns are even remotely as impactful as they could be.
Establishing a successful program takes a little practice and patience, and probably a little luck. It helps, though, to identity mistakes and to try your hardest to avoid them.
Here are some of the biggest, courtesy of the folks who know at ClickZ:
Not having a plan. No matter the business sector or the business, you have to have a plan. The plan includes strategic objectives and, well, planning. Simply opening some accounts and posting your thoughts isn’t a plan. Plans include goals, and goals are something you work toward and attempt to measure. Just posting any old thing typically doesn’t produce anything of value and, therefore, is pretty much a waste of time.
Not optimizing content. Don’t simply post the same content to all of your social sites. It will grow redundant and bore your audience. According to ClickZ, you have to optimize your content. If you don’t, “You’ll end up with content that isn’t right for the medium, and people will start to ignore you. Take a few extra minutes to customize your post for each medium.”
Posting whatever comes to mind. Don’t simply write whatever comes to your mind and throw it on the web for the world to see. This seems pretty intuitive, but it’s a good reminder that there are often boundaries, especially in healthcare. Think about what you want to write, try to make it interesting and relevant. Think, think, think.
Forgetting not to show not tell: I quote directly from ClickZ. “Stop telling people what you want them to believe about your business and start showing them.” Show them with reports, videos, blog posts and observations. ‘Think about your key value proposition and point of difference, and figure out how to show people via social media.” Good point.
Are you boring? If you don’t have a “voice” and come of as un-insigthful, chances are, you’re boring. “Think about how to make your message interesting to your audience: compare it to something else; use a picture or video; find a more relevant way to share your angle. Just stop being boring.”
Losing focus. Stop trying to speak everyone’s language. Reel it in. Focus your message and stick to your strong points. You know what you do well, why you’re an expert; it’s time to focus speak your mind, but speak of the things in which you know well. Speak your mind, and speak your heart, but stay on point.
With these tips, and your best practices, there’s a good chance you’ll develop an engaged audience.
Perhaps one of the easiest ways to engage patients in the patient engagement process, especially as it relates to meaningful use Stage 2, is to let them know that you are trying to engage them.
Since CMS announced the patient engagement requirement as part of meaningful use, physicians and practice leaders who hope to attest and receive federal incentives have voiced their concern over the requirement since it’s the one element beyond their control.
“The push back from providers is because it’s the one thing they can’t control; they can’t make patients ask for a patient summary and force them to download it,” said Amit Trivedi, healthcare program manager at ICSA Labs, which is a vendor-neutral testing and certification firm that works with EHR vendors. “Originally, I thought it would be upheld. I still don’t think they’ll drop it, but it’s possible they (CMS) may modify it or choose not to audit it.”
Essentially, the patient engagement portion of Stage 2 most likely won’t be dropped, but, according to Trivedi, enforcement of the mandate may not happen right away.
Still, Trivedi says the healthcare community shouldn’t walk away from the patient engagement debate simply because patients don’t seem interested in or accessing their health record. On the contrary, now is the time to begin moving in the direction of creating more awareness with the consuming public.
By taking the approach that if patients don’t ask for something because they don’t want it is faulty, Trivedi said. The same arguments were made by technology vendors prior to meaningful use who he said claimed certain enhancements just were not important to physicians and their patients. However, once incentives were announced and mandates issued, vendors quickly jumped on board to upgrade their systems to meet the new need.
Patient portals are an example of one such tool. Prior to meaningful use, they were considered Cadillac-like add ons that were wanted only by a few practitioners. With meaningful use, they are necessary and required component of the systems.
“You may never be able to make patients download their records, but you have to advertise and make the data available” said Trivedi.
Healthcare is entering the age of a new demographic and though there may be little desire to engage with the current generation, upcoming users are not going to be so patient in seeking their health information. For many, having access to their records will be a right, Trivedi said. Making data available to the public and encouraging patients to access and use it is nothing more than a cost of business.
Other than advertising to patients about the capabilities, Trivedi suggests taking the message to those who truly need access to it, for example, parents of young children and caretakers of the elderly. Though there’s simply no way that a majority of consumer patients will be engaged patients, at least in the short term, it’s much more likely that targeting specific population sets, like those mentioned, will help move the population forward and get people to take greater ownership of their care (or at least the care of those they are caring for).
After all, even with all the data collection and its analysis, its potential for improving greater health outcomes across the population and the move toward structured and transportable data, it ultimately we won’t find the results we’re looking for if the patients are not engaged.
Encouraging patient engagement at the practice level has gotten to be such a popular and all-encompassing subject in recent months that I’ve begun to see a great deal of editorial coverage dedicated to the topic.
In said pieces, columnists offers some practical advice to practice leaders for engaging their patients. Some of it is pretty much common sense while much of it just makes for good customer relations.
Perhaps what’s most telling, though, is that in the age of connectivity and mobility, where we are always on and part of one another’s lives because of technology and devices, it seems as if we have forgotten how to communicate with one another in a one-to-one, face-to-face environment.
My dad was a small business owner and I grew up in his shop. He wasn’t the most graceful individual, but he understood one thing: Without customers, we didn’t pay our bills and in a small town, a grouch was often on the outs and rarely part of the fold. The fact that he kept re-iterating that the customer was “always” right meant something. It stood for something and that “something” was that when our customers came to us they expected a certain level of service and to be treated with a great deal of respect.
He knew, as I do now, that the customer technically can’t “always” be right. It’s just not possible. You can make every concession possible to please your customers, but, in the end, there are going to be those that you can’t keep. And that’s okay.
But, when several editorials are written to coach us how patients should be engaged at the point of care, it’s easy to see that we certainly do live in a different time than even I can remember growing up in not so long ago.
That said here are a few tiny bits of sage advice I thought worthy of passing on.
According to Audrey McLaughlin’s recent post in Physicians Practice, “A great attitude in customer service can be very simple: Choose to be thankful for every patient that walks through your door, whether you are the receptionist, the nurse, the medical assistant, the doctor, office manager or bill collector. You must thank every person that comes in for choosing your medical practice. Let them know that you are grateful that they are there.”
McLaughlin should know. She’s an RN. She’s gained the following insights through experience, and given her confidence in these points, I assume she’s correct.
As she says, integrate an attitude of gratitude into all areas of the patient engagement including during appointment scheduling, telephone calls, check in and check out. Offering a sincere thank you goes a long way for stopping in or arriving on time will go a long way and can help set a positive tone for the visit.
If a patient is late for an appointment, a simple “Thanks for making it in,” goes a long way. But, as with all things that mean something, sincerity is key, she says. The sincerity should not end at the welcome desk, but should flow along through the exam room and back through to check out.
Start to finish, a patient should feel welcomed and appreciated, McLaughlin says.
But she’s not the only one saying such things. On the contrary, this seems to be a movement. Phil Colpas, editor of Health Management Technology recently posted his own blog entry on the same subject.
His take? A smiling staff means a healthier hospital. In his post, Colpas sites a recent study by the organization The Forum: Business Results through People, which states that “delivering better customer experiences starts with developing satisfied employees.”
As Colpas surmises, “In healthcare, the patients are the customers.” An astute observation, and quite true, even if often overlooked.
Healthcare leaders then, to find success, should (quoting Colpas), “Cultivate an environment that encourages employees to feel a part of and actively engage in the processes of patient care and meaningful-use compliance – and all that entails.”
Doing so should encourage a greater level of patient engagement, which is good for all and benefits not only the patient but the practice by driving future “sales” through increased word of mouth referrals, more return visits and patients that are likely to pay on time and invest more in their care.
The customer may not always be right, but making them feel like they are will go a long way toward building your practice into the success you want it to be.
It might take nothing more than a smile and some sincerity.
Will meaningful use Stage 2 reach patient engagement?
Patient engagement now requires patient action. So says the Department of Health and Human Services in meaningful use stage 2.
As a patient, your physician is counting on you to engage with him or her. It’s up to you, folks, to bring it home. Your physician’s incentive, and ultimately his or her potential non-penalty for Medicare, is on your shoulders.
That’s an awful lot of weight to bear. Can’t you feel it? It’s overwhelming. I’m exhausted just thinking about it.
Seriously, though, I’m confused. Someone please set me straight; seriously.
Meaningful use is now up to the patient? Whether or not I choose to interact with my physician via electronic means determines his/her level of success as gauged by the government?
I’m sure I don’t need to recite the language from the ruling, but I’ll do so for good measure.
Five percent of more of patients must send secure messages to their physicians (yes, I said “must”)
Five percent or more of patients must access their health information online (yes, I said “must” again)
The language isn’t written in an inviting tone, but one that tries to demand respect. It doesn’t say “may’ or “can,” if says “must.”
Is this a Ray Kinsella moment and HHS’ field of dreams?
“If you build it, he (they) will come,” sounds the whispered voice across the sky.
Cue the sound of rustling corn fields blowing in the wind as each of us imagine memories of our happy places where dreams live on forever.
If this gets built, will we all come and play? How can this be a requirement of our physicians? How can their level of success, the quality of the care they provide, be gauged based on whether or not I choose to interact with them via the web? After all, I want healthcare, not a Facebook friend or a Twitter follower. (I’m using obvious over exaggeration to make a point.)
I am all for patient engagement and believe it will increase given time and effort behind it, but forcing me — as a patient — to do something makes me a little less likely to follow so easily along. I’m not a lemming, and I don’t intend to be.
Sure, five percent seems like a manageable number; not that big of a deal. Surely, it’s just a few people, right?
Until next time, when the number increases to 25 percent of the overall patient population then 50 percent then 75 percent and so on until it’s just mandatory.
What might be the most troubling, though, is how this affects physicians and practices. Engaging patients to receive incentives and keep from being penalized becomes a marketing function, not a care function.
I can see it now: Your doctor will start offering club-type discount cards and try to cajole you with attractive terms like, “Sign up today for the patient portal and after you send just one email to your physician, you’ll be receive a $5 credit to your account.”
Or, perhaps the whole thing will have physicians sounding like to cashiers at Target: “Sign up for your patient portal access today and you’ll not only receive a nifty tote bag for your things, but you’ll get 25 percent off of of your next purchase!”
Lastly, I’m reminded of the lines of credit card pushers lining the student union of every college in the U.S. trying to convince our young and inexperienced that credit is the same as cash, don’t you know.
As noted on HealthWorks Collective, meeting this portion of the stage 2 requirement will take everyone in the practice, not to mention the support of those outside it.
But portals can only facilitate access to patient’s information, but it can’t force the participation of people to do something they don’t want. Requiring physicians and their practices to encourage me to engage with my care providers is up to me, and no matter how useful or entertaining, whether I choose to engage is something I commit to on my own terms.
Just because “they” build (read as “require”) it doesn’t mean I’ll come.
Electronic health records can build patient loyalty. And using them within a practice and letting patients know about them and their uses, it is more likely that patients will return for service again in the future.
At least that’s the latest news from Kaiser Permanente.
Also according to the health plan/care provider is that patients are more loyal to a practice using an EHR if the practice is also using a patient portal for the patient to access their personal health records.
Accordingly, people using Kaiser’s personal health record to track their health, manage their care and access records through Kaiser’s My Health Manager (the organization’s patient portal) were more likely to stick with the Kaiser health plan than not in future plan years.
Though I maintain my fair share of skepticism about the study featured in the American Journal of Managed Care because Kaiser members are incredibly loyal (I know because I’ve worked with Kaiser members as a benefit plan communications director for a major government program in the region where the study was conducted) and they probably would not have switched plans regardless of the patient portal (and because the study seems somewhat self serving of Kaiser), there may be a nugget of truth here.
Apparently, according the study, Kaiser plan members who used the portal to view their medical records, make or change appointments and communicate with their doctor or other health provider electronically, where more likely to continue to pick the same plan in subsequent plan years.
The results are derived from more than 160,000 Kaiser Permanente Northwest members enrolled in a Kaiser plan between 2005 and 2008. Members who used the portal were more than twice as likely as nonusers to stay with the health plan during the period studied. “The only greater predictors of retention likelihood were more than 10 years of plan membership and a high illness burden,” the study authors wrote.
Essentially, the authors of the study suggest that EHRs integrated with a patient portal are more likely to create loyal patients.
Really, though, the findings of this Kaiser study are nothing new. As have been reported numerous times before, patients continually perceive healthcare technology positively, at least according to my perspective.
In the survey, patients said they felt more comfortable with physicians that used an EHR system, and more importantly, patients felt that the information contained in the medical record was more accurate when they physically saw information being entered electronically. Physicians using EHRs in front of their patients said they felt the most comfortable with the accuracy of the information contained in their records.
Additionally, in the survey I conducted, 45 percent of patients had a “very positive” perception of their physician or clinician documenting patient care with a computer or other electronic device, and patients believe that using an EHR will actually improve care outcomes in the long term.
Physicians and patients also agreed on the benefits of using electronic devices to document patient care during an encounter. The most important benefits of EHRs, as agreed upon by the two groups, were
They give physicians access to patients’ medical records and history in real time.
When appropriate, EHRs help the physician securely and seamlessly share information with other doctors, pharmacies and payers.
EHRs help physician make good decisions about patient care, ultimately driving the quality of patient care.
To put it bluntly, yes, there appears to be a great deal of patient loyalty for physicians using an EHR. Kaiser’s data only seems to strengthen this claim, and, certainly, it appears that integrating technology that’s “interactive,” such as a patient portal, helps foster this connection.
If nothing else, using an integrated EHR seems to generate greater patient engagement and may create more loyalty toward a practice, which ultimately builds stronger practices and potentially more word-of-mouth customer referrals, which help businesses grow.
Those who conceived and brought meaningful use to life can apparently chalk up another victory, according to a new survey conducted by Accenture.
As told by For the Record, patients overwhelming want access not only to their medical records and personal health information through connected devices (mobile or otherwise), but they also want direct electronic access to their physicians.
By “access to their physicians,” I mean they want to interact with their caregivers through web portals and email. Actually, respondents of this survey (88 percent) said they want to receive email appointment reminders from their physicians, while 76 percent of survey takers said they want the option of email consultations directly with their physicians.
Enter the patient portal. Secure, web-based portals that, for most EHR systems, allow patients the opportunity to interact directly with their physicians, view lab results (in certain non-overly sensitive cases), schedule appointments and make payments, among other things. The same patient portals that are required ingredients of meaningful use certified EHR systems.
Despite the arguments over the benefits or lack thereof of meaningful use, the requirement that EHRs contain patient portals so patients and their caregivers can interact with each other seems to be giving the patients exactly what they want.
In the very least, at least according to the results of this survey, patients are more likely to engage with physicians and take greater ownership of their care if they are simply allowed to communicate with their doctors electronically.
And given the seemingly current lack of patient engagement that’s prevalent in our healthcare community, anything that sparks interest in patients should be considered a welcome sign to every healthcare professional. After all, patient engagement will continue to become more popular as consumers take greater ownership of their care as they discover that their healthcare providers are actually easier to access because of electronic health records and patient portals.
Unfortunately, however, the average patient doesn’t know whether his physician offers a practice portal or if the practice uses an EHR as fewer than half of the 1,100 survey participants in the Accenture study didn’t know whether they had access to such systems.
Despite this minor detail, there’s plenty in this survey to celebrate. Specifically, patients clearly want to access their health records electronically and they want to be able to connect with their physicians when they want or need through any connected device wherever they are in the world.
The other good news here, for practice professionals anyway, is that there is plenty of room for and an abundance of opportunity to educate patients about a practice’s internal technology systems. Patients clearly want to know more about the technology their physicians are using in their practices.
If you don’t currently have these systems in place, engaging patients is a great way to find out what they might like to see from you in the future and, if nothing else, the information gathered helps you build and develop your practice and tailor it to your customer’s needs.
As in all areas of life, social media also permeates healthcare. As practice leaders, hospitals and facilities, and providers wrestle with strategies for capitalizing on the communication forum, some have found success while others continue to struggle.
For each person that has made the attempt, though, valuable experiences have been gained, some worth sharing.
In the piece, Sevilla offers advice to physicians about the need to engage in regular and ongoing social media activities.
Physicians, he says, must begin to interact with patients and the public through a variety of social channels including blogs for no other reason than because patients are beginning to demand it. Without the outside the office interactions, patients begin to disengage from their physicians and seek alternative sources who are willing to meet them where the live.
Seville offers a few compelling reasons for physicians and their practices to engage socially, including:
Social media allows physicians the opportunity to tell their story – telling your story provides evidence of your experience and helps establish you as a leader in the space. Doing so also helps patient consumers have a reason to “buy in” to your system.
Social media allows you to find a community – by connecting with others, you are able to establish bonds, develop stronger collaboration with peers and bring people together for a unified cause.
Social media allows you to discover your passions outside the practice – social media helps you explore new ventures and avenues for creating relationships and bonds outside of the practice.
Social media leads to free marketing opportunities – social media helps you connect with others, Sevilla said. Those connections mean you are marketing yourself and your practice without having to spend anything but your time.
Social media allows physicians the opportunity to manage their online reputations – conversations are taking place about many of us, physicians or not. If we know what is being said, you can help protect ourselves and your practices.
There are a few things Sevilla fails to mention in the piece, though.
For example, social media is more than about building one’s own brand and developing recognition for one’s own efforts. Engaging in social media is about creating relationships with others; specifically, patients.
As such, when using social media tools in the healthcare setting, you must stay close to your customers. Social media can, and should, be used to generate conversations with the public and build relationships with those you are serving. In doing so, you gain ground in each of the areas Sevilla mentions above.
In addition, physicians and practice leaders may consider using social media as an educational tool for patients. With less than 10 minutes of face time with a physician on average, patients can turn to their social media tools to learn more about a certain procedure, to ask generalized questions or to learn how the practice’s online patient portal, appointment setting or how billing and payment processes work.
Also, consider using your Twitter feed to ask questions of your patients. Conduct informal surveys asking for feedback about visit times, practice hours or services offered. Set up a weekly or monthly lunch-hour Twitter chat where a physician takes generic questions from the public or set aside a week each month to provide health and wellness tips about certain conditions.
The results of these efforts may surprise you. And soon, you’ll discover that conversations on social media are two way rather than one sided. Perhaps you’ll even have your own strategies to share.