Review of Twitter for Infectious Diseases Clinicians: Useful or a Waste of Time?
Review of Twitter for Infectious Diseases Clinicians: Useful or a Waste of Time?
Debra A. Goff 2 3
Ravina Kullar 1 2
Jason G. Newland 0 2
0 Department of Pediatrics, Division of Infectious Diseases, Children's Mercy Hospital-Kansas City, University of Missouri-Kansas City , Missouri
1 Clinical Scientific Director, Department of Medical Affairs, Cubist Pharmaceuticals , Lexington, Massachusetts
2 Received 4 December 2014; accepted 24 January 2015; electronically published 4 February 2015. fectious Diseases, The Ohio State University Wexner Medical Center, Department of Pharmacy , 410 West 10th Ave, Rm 368 Doan Hall, Columbus, OH 43210 (debbie
3 Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus
Twitter is a social networking service that has emerged as a valuable tool for healthcare professionals (HCPs). It is the only platform that allows one to connect, engage, learn, and educate oneself and others in real time on a global scale. HCPs are using social media tools to communicate, educate, and engage with their peers worldwide. Twitter allows HCPs to deliver easily accessible real-time clinical information on a global scale. Twitter has more than 500 million active users who generate more than 58 million tweets and 2.1 billion search queries every day. Here, we explain why Twitter is important, how and when an infectious diseases (ID) HCP should use Twitter, the impact it has in disseminating ID news, and its educational value. We also describe various tools within Twitter, such as Twitter Chat, that connect and bond HCPs on a specific topic. Twitter may help ID HCPs teach others about the global responsible use of antimicrobials in a world of escalating antimicrobial resistance.
Twitter; social media; infectious diseases; education.
New and emerging diseases require infectious diseases
(ID) healthcare professionals (HCPs) to stay
up-todate with their knowledge. In the past 15 years within
the United States, ID HCPs saw the threat of smallpox
and anthrax in 2001, monkeypox in 2008, H1N1 in
2009, Middle Eastern respiratory syndrome, and
enterovirus D68 and Ebola in 2014 as examples of emerging
diseases that require HCPs to have up-to-date and easily
accessible knowledge to effectively manage patients.
Traditionally, new information is acquired by reading
medical journals and attending conferences. However,
during an ID outbreak, acquiring information in real
time is critical. As the world watched the tragedy of
Ebola unfold, the world was also connecting with each
other on social media to discuss and learn about this
disease in real time on Twitter .
Founded in 2006, Twitter is a free social networking
service that has emerged as a valuable tool for HCPs.
More than 75 000 HCPs worldwide, comprised of
physicians, pharmacists, nurses, and healthcare
consultants, send 152 000 tweets per day of which 31% are
from the United States . In fact, Twitter has grown
by more than 500%; only 23 HCPs signed up for this
social media site when it was launched in 2006.
Today, Twitter has more than 500 million active users
who generate more than 58 million tweets and 2.1
billion search queries per day . Twitter has become a
daily part of many HCPs lives, allowing them to
communicate real-time healthcare information and medical
alerts to a large global audience, including those who
are considered experts or thought leaders in a particular
field, and to solicit feedback.
Twitter is changing the way people interact and learn.
The always-on culture of today is accustomed to
bitesized, on-demand learning. This type of learning
transitions to medical trainees who have grown up with
computers, smartphones, iPads, and Wi-Fi. They think
about problems and resolve them very differently from
those of previous generations . The decades-long tradition of
using textbooks to answer ID-related questions has been
replaced by medical apps for smartphones and UpToDate, an
online database . There is also a need among HCPs to deliver
easily accessible, real-time, pertinent information to peers
around the worldTwitter can meet this need.
Here, we describe how Twitter can be used to educate and
engage ID HCPs and be used as a worldwide communication
network. We also discuss how Twitter can be easily integrated
into the daily workflow of busy HCPs.
GETTING STARTED ON TWITTER
Twitter allows users to write and read online posts known as
tweets that are limited to 140 characters. Users follow other
HCPs with similar interests, organizations, and medical journals.
Users may tweet information from conferences in real time, share
links to journal articles, and participate in live Twitter chats and
journal clubs with HCPs interested in similar topics. Unlike
Facebook, Twitter does not require users to mutually connect with
one another. Twitter users follow others, and the recipient
can choose whether or not to follow back. As displayed in Figure 1
, the dissemination potential of Twitter is what makes it so
Table 1. How to Get Started on Twitter
Create a profile at www.twitter.com.
Create a short user name; avoid underscores, dashes, and
Upload your photo so others can associate your name with your
Write a short description of yourself. Identify yourself as a
physician, pharmacist, nurse, or healthcare provider. Be
Follow other healthcare providers who have interesting tweets.
Follow infectious diseases organizations.
Follow medical journals.
Send your first tweet.
valuable in terms of the number of people it is able to reach
Table 1 describes how to get started on Twitter. An in-depth
description of how to get started on Twitter has been previously
described [7, 8]. We recommend HCPs always identify themselves
on Twitter as a physician, pharmacist, nurse, or HCP. Tweets from
HCPs hold a greater level of authenticity and trust .
Twitters primary access point is the companys website, www.
twitter.com. Users must first go to this site to register and create
their profile. There are additional ways to access Twitter in the
from Oxford University Press .
Figure 2. Twitter symbols.
is read, it may be retweeted by clicking on the retweet icon. One
can search Twitter for specific ID topics or conferences using a
hashtag (#; Table 4). For example, #Ebola will populate tweets
that include the hashtag Ebola. This is a good way to find
experts who tweet on a particular topic. When someone
interesting is found, a click on follow will ensure that their tweets
appear in an individuals timeline of tweets. Symplur, a Twitter
analytics website for healthcare hashtags, started the Healthcare
hospital or office and while on the go. Twitter makes official apps
for all major smartphones that add functionality and features that
Hashtag Project. They grouped more than 5000 disease and
appeal to different users. Popular apps on iOS (iPhone and iPad)
include Tweetbot 3, Twitterific 5, and Echofon ; for Android
medical conference hashtags . HCPs can register a hashtag
for a disease (eg, #MRSA [methicillin-resistant Staphylococcus
phones, apps include Tweetcaster, Tweedle, and Hootsuite .
aureus]), a conference (eg, #idweek2014), or a healthcare term
Before starting to tweet, users need to be familiar with
Twit(eg, #SaveAbx [Save antibiotics]).
ter symbols (Figure 2) and the terminology listed in Table 2.
Harnessing the power of Twitter involves finding the right
peoWhen viewing tweets with a link of particular interest, the
link can be forwarded to ones email and the article can then
ple to follow. New users will listen (read tweets) more than talk
be saved for future reference or printed out. Tweets can be
se( posting tweets). A selected list of ID HCPs, organizations, and
lected as a favorite by clicking on the star. This alerts the
sendjournals to follow on Twitter is provided in Table 3. This is not
er that someone liked their tweet and also allows the user to
meant to be inclusive but provides a starting point for readers to
group all favorites in their personal Twitter account.
follow selected experts. The following criteria for selecting
individuals to follow were used: the person has more than 200
followers; the majority of their tweets are related to ID; and the
persons Twitter biography identified them as a HCP.
After selecting people and organizations to follow, its time to
send a tweet. For example, a first tweet could be from an article
in Clinical Infectious Diseases. While reading the article on a
computer or smartphone, the reader finds the Twitter icon
WHEN TO TWEET
The most common reason HCPs avoid Twitter is the perceived
lack of time to learn and perform a new activity. However, once
the basics are understood, it takes very little time to post a tweet.
We recommend that new users develop a daily Twitter routine
such as reading and tweeting 5 to 10 minutes in the morning
and clicks on it (Figure 3). This will launch Twitter and create
prior to patient care rounds or clinic. Another simple way to
ina link to the article. A few compelling words are written about
corporate tweeting is to tweet from journals tables of contents
Table 2. Twitter Terminology
A tag that is used to organize tweets and find topics. Think of it as a tool to find keywords. To tweet about antibiotics,
type #antibiotics in the tweet. This allows your tweet to be found by any user who searches Twitter to find tweets
A term used to describe when a topic or hashtag is used so often that it is one of the most popular in the world. For
example, #ebola was trending during the October 2014 outbreak.
A short 160-character personal description that appears in your profile.
How you are identified on Twitter. For example, Mary Smith is @marysmith.
Subscribing to a Twitter account is called following. Anyone can follow or unfollow anyone else. To follow someone,
tap on the follow button next to the user name.
A Twitter metric that describes the number of unique Twitter users who receive your tweets.
A Twitter metric for the total number of times a tweet is delivered, including repeats.
A measure of how diverse a Twitter audience is for a topic. A high R:E ratio (0.60.99) indicates a wider and more diverse
group of people received tweets about a topic. A low ratio (00.19) means there were a lot of tweets around a keyword
or hashtag but the tweets were not retweeted by followers.
Dedicated to breaking news, the latest research and clinical trial
results, meeting coverage, and more
Provides breaking medical news
Provides news from the American Society for Microbiology
Works globally to improve antibiotic access, policy, and clinical
Provides information and updates in pediatric ID
Dedicated to educating the public and healthcare professionals
Provides flu-related updates
Division of HIV/AIDS Prevention
Division of Viral Hepatitis
United Nations health agency
CDC director, MD, and disease detective
ID pharmacist, author of Antibiotics Simplified
ID pharmacist, global antimicrobial stewardship educator
Co-chair South African Antibiotic Stewardship Programme,
president of the Federation of Infectious Diseases Societies of
Editor of Journal of Hospital Infection
ID epidemiologist and health services researcher
Social medias leading physician
Professor of microbiology, director of Antibiotic Action, chair in
Public Engagement for British Society for Antimicrobial
Director of Infection Control Programme and World Health
Organization external lead
Director of Antimicrobial Stewardship, associate director of
Clinical Epidemiology & Infection Prevention for Univesity of
CaliforniaLos Angeles Health
Pediatric ID physician
Pediatrician who uses social media to connect with her patients
Pediatric ID physician and social media editor for @PIDSociety
Pediatric ID physician dedicated to the appropriate use of
Pediatrician and executive director of Digital Health at Seattle
New England Journal Medicine
Infection Control & Hospital
Lancet Infectious Diseases
Journal American Medical
Infectious Diseases News
Medscape HIV & ID
National Institute of Allergy and
Infectious Diseases News ASM Newsroom The Alliance for the Prudent Use of Antibiotics
Pediatric Infectious Diseases
National Foundation for Infectious
Diseases CDC CDC CDC
World Health Organization
Society for Healthcare
Epidemiology of America
American Society of Microbiology
Official Twitter channel for American Society of Microbiology
Mission is to prevent and control healthcare-acquired infections
Tom Frieden, MD
Jason Gallagher, PharmD
Debra Goff, PharmD
Marc Mendelson, MD
Eli Perencevich, MD
Kevin Pho, MD
Laura Piddock Didier Pittet, MD Daniel Uslan, MD Pediatrics
Nick Bennett, MD
Natasha Burgert, MD
Saul Hymes, MD
Jason Newland, MD
Wendy Sue Swanson, MD
1.7 M 9047 1686
Table 3 continued.
British Society for Antimicrobial
Infectious Diseases Society of
Associations for Professionals in
Infection Control and
Pediatric Infectious Diseases
Sharing Antimicrobial Reports for
Peggy Lillis Foundation C diff Foundation Save Antibiotics @BSACandJAC
Provides education on appropriate use of antimicrobials
Twitter Name @TheUrgentNeed @IDSAInfo @APIC
UK global initiative to increase awareness and discover,
research, and develop new antibiotics
One-stop shop for ID information
Improves health by preventing the spread of infection in
healthcare settings through education and implementation of
Promotes excellence in the diagnosis, management, and
prevention of pediatric ID
Collaboration of childrens hospitals working to improve
Provides Clostridium difficile awareness, empowering
advocates and shaping policy
Educates and advocates for Clostridium difficile infection
Pew Trust campaign to save antibiotics
received via email. Many HCPs outside the United States do not
have free access to journals, so a tweet that provides a link to a
compelling new article is a great way to educate peers and share
USAGE OF TWITTER TO DISSEMINATE
INFECTIOUS DISEASES NEWS
The rise of Twitter has created new possibilities for
communicating with and learning from other HCPs as well as allowing
for ID HCPs to use Twitter to recruit patients in clinical trials
for chronic diseases or vaccine trials. Twitter has been referred
to as an essential tool for every physician leader  and as
being crucial to the development of medicine today .
Several researchers have shown a correlation between Twitter use
and dissemination to others on ID topics. Mishori et al 
used Topsy, a Twitter data aggregator , to determine the
number of followers, the number of accounts a user is following,
the number of tweets, and the information dissemination
potential of 4 medical networks: the American Medical
Association, American Academy of Family Physicians, American
Academy of Pediatrics, and American College of Physicians.
During the 3-month study period, each network had thousands
of followers and an information dissemination potential
ranging from 6.9 to 122 million people. This study displays the
dissemination potential of Twitter in the healthcare network.
Dyar et al  were the first to investigate daily worldwide
tweets and retweets of the word antibiotic over a 1-year period.
They found that Twitter users published 135 billion messages
and 243 000 of those messages contained the word antibiotic,
with 39 000 being retweets. The peak activity periods in
antibiotic tweets occurred during the following periods: January 2013,
following the recommendation of the UK chief medical officer
(CMO) to incorporate antibiotic resistance in the national risk
register; March 2013, after publication of the UK CMOs annual
medical report, which discussed the threat of resistant bacteria;
March 2013, as a result of the US Food and Drug
Administrations statement on concerns about the safety profile of
azithromycin; and September 2013, after the release of the Centers for
Disease Control and Preventions (CDCs) antimicrobial
resistance threat report. Interestingly, the announcement released by
the CMO reached more than 20 million users in a single day.
This study portrays a valuable tool within Twitter, that is, the
ability to search every tweet ever made via Twitters searchable
Further, since the 2009 H1N1 public health emergency, the
Internet was cited as the most frequently used resource to learn
more about the pandemic . H1N1 actually marks the first
global pandemic that has occurred since the age of Twitter.
Chew and Eysenbach  performed an in-depth analysis of
tweet content during the H1N1 pandemic. Between May 2009
and December 2009, the authors archived more than 2 million
tweets containing the keywords or hashtags (#) H1N1, swine
flu, and swineflu. From a random selection of 5395 tweets,
90.2% of them provided links when a reference was necessary,
allowing others to confirm the credibility of the tweet. News
and information were found to be the most commonly tweeted
H1N1-related material (52.6%). Only 4.5% of tweets were
classified as possible misinformation or speculation. The authors also
found that significant increases in H1N1-related tweet volume
corresponded with H1N1 news events such as the World Health
Organizations pandemic level 6 announcement . Other
publications have demonstrated the utility of Twitter to disseminate
information on H1N1 [21, 22] and improve H1N1
vaccination rates [23, 24]. Twitter has not only proven useful in H1N1
outbreaks but also in other outbreaks such as the 2011 Legionella
pneumophila outbreak in Los Angeles, California .
Lastly, with the first 2 known cases of Americans working in
West Africa being infected with Ebola on 28 July 2014, this
virus dominated Twitter conversations. There were 200 000
healthcare social media
Table 4. Selected Infectious Diseases Twitter Hashtags (#)
a Hashtags make words searchable on Twitter, allowing the user to observe a
conversation about a particular disease.
tweets within 1 hour after the announcement of the first case
of Ebola diagnosed in the United States. The number of tweets
on Ebola exceeded 550 000 for a single day, surpassing the
months averages. More than 10 million tweets mentioning
the word Ebola were sent between September 16 and October
6 from 170 countries . It is quite apparent that discussions
about ID are a worldwide topic where Twitter has been a key
resource in conversing with others about significant ID topics.
EDUCATIONAL IMPACT OF TWITTER
Since Twitters inception, 583 articles on Twitter have been
published, with 34% being published from January 2014 to
November of 2014. A PubMed search of the phrase Twitter
medical education yielded 56 unique articles. Surgeons and
urologists appear to be early thought leaders in adapting Twitter
for medical education, and the ID community can learn from
these disciplines to enhance their use of Twitter. For instance,
the International Urology Journal Club formed an online
Twitter journal club. In the first 12 months, 189 users participated
from 19 countries and 6 continents, tweeting a mean of 195
tweets per month and generating a mean reach or impressions
of 130 832 per month . This far exceeds the reach of
traditional journal clubs. Club members concluded that there is
unlimited scope for journal clubs in all specialties to follow their
example. In addition, they were able to engage international
HCPs; thereby, fostering international relationships. An
international journal club would be valuable to ID in identifying
and treating infections as every new and emerging ID is just a
plane ride away.
Further, surgeons and urologists are using Twitter to amplify
the content of scientific meetings. At the 2014 European
Association of Urology meeting, Twitter impressions reached 7.35
million, with 5903 tweets sent by 797 participants . Cochran
and colleagues measured the impact of Twitter at the 2013
Academic Surgical Congress and concluded that Twitter greatly
expanded the available audience for professional meetings
and broadened the discussion venue for scholarly activity .
At the 2014 annual Making a Difference in Infectious Diseases
conference, which is dedicated to antimicrobial stewardship for
physicians and pharmacists, a workshop on Twitter for Infectious
Diseases Healthcare Providers was held. The conference planners
registered the hashtag #MADID14 with the Healthcare Hashtag
Project . Conference participants signed up for Twitter and
then learned how to follow each other and tweet live from the
conference. A total of 235 participants sent 1482 tweets with
346 153 impressions during the 3-day conference. Attendees
were able to connect with thought leaders and, more importantly,
maintain the connection through Twitter post-meeting.
Several institutions are using social media to engage with
patients and other HCPs. For example, Mayo Clinic is wholly
embracing social media as evidenced by the creation of their
Center for Social Media. Their stated mission is to lead the
social media revolution in healthcare, contributing to health and
well being for people everywhere . Having close to 1
million followers on Twitter, the 2014 Harris Poll EquiTrend
survey named Mayo Clinics website the top health information
website, ahead of WebMD .
In a recent survey of 3500 scientists from 95 countries, 13%
routinely used Twitter to share and follow discussions on
research-related issues relevant to their field . Panahi et al
 conducted a survey among physicians from around the
world who were active users of social media to determine the
potential benefits and challenges to using social media. The primary
reasons for joining social media were staying connected with
colleagues, reaching out and networking with the wider community,
sharing knowledge, engaging in continued medical education,
benchmarking, and branding. Twenty-two physicians stated
that they used Twitter frequently, primarily due to the large
clinical presence on Twitter. The physicians stated that since they
were busy and had limited time to read journal articles, Twitter
kept them up-to-date on what was going on in the field
worldwide as they were able to quickly review peer-reviewed
information. Twitters accessibility on mobile devices has allowed
physicians to retrieve information with the touch of a finger,
making it possible to review Twitter updates in real time when
it is convenient for them. Further, the primary advantage of
joining Twitter was the physicians ability to network with like-minded
peers worldwide. As noted by the physicians, social media has
allowed them to connect with other clinicians globally and work
on projects, publish manuscript, and create joint podcasts.
A highly valuable tool within Twitter that bonds and connects
individuals on a specific topic is Twitter Chat. Twitter Chat is a
discussion that takes place in real time at a pre-arranged time on
a pre-arranged subject. Participants use a predetermined
hashtag, which allows them to identify all of the relevant tweets. The
chat is open to all individuals who have a Twitter account,
allowing diverse groups of people worldwide to ask questions,
learn about a specific topic, or just observe a conversation.
For ID HCPs, this venue can be used to educate the public
regarding accurate information that they need to know in
addition to educating HCPs.
On 8 October 2014, the CDC conducted a Twitter Chat that
allowed individuals to ask questions of the CDC regarding
Ebola after the first case was identified in the United States
. The CDCs Get Smart About Antibiotics campaign hosted
an antibiotic resistancethemed Twitter chat (#SaveAbx)
during the 2014 campaign week. Several countries participated in
the CDCs 24-hour global antibiotic resistancethemed Twitter
Chat (#AntibioticDay). These campaigns offered collaborative
opportunities to promote appropriate antibiotic use to a diverse
global audience. In addition, the CDC recommended using the
Get Smart Twitter Chats as a way for hospitals to kick off and
start antimicrobial stewardship programs . Kaiser
Permanente physicians led a 2014 Twitter Chat on flu (#fluchat),
encouraging HCPs and patients to chat with experts on
flurelated topics. Disseminating worldwide, Public Health
England, part of their Antibiotic Guardian campaign, hosted the
2014 #AntibioticGuardian Twitter Chat that targeted patients,
policy makers, prescribers, and HCPs. HCP experts led this
chat and answered questions .
POTENTIAL PITFALLS OF TWITTER
Twitter users need to be aware of potential pitfalls. First, patient
confidentiality is of paramount importance . Discussing
unique stories on Twitter, while potentially educational, could
violate Health Insurance Portability and Accountability Act
standards if information that could identify a patient is shared.
Furthermore, while Twitter allows clinicians to engage with
their patients and families, giving specific medical advice via
Twitter should be avoided as the clinician will likely be unable
to share important information (only 140 characters per tweet).
Twitter, like all social media, is susceptible to
misinformation. Clinicians must guard against spreading erroneous or
questionable information while establishing trust with their
audience. To combat lack of trust, it is important to follow
reputable individuals by ensuring that the person has a photo and
biography along with a profile. Further, only links and
information that are from reliable sources should be retweeted. While
Twitter can be a powerful tool to publicize research findings,
users must not tweet embargoed articles. Additionally, although
national meetings provide opportunities to tweet new research,
these presentations have not been peer reviewed and the context
of the tweets can be lost in 140 characters.
Finally, it is important to recognize that online behavior
becomes part of a users permanent Internet identity. Whatever is
written on Twitter, stays on Twitter and is also indexed on
Google, so comments about patients or employers are not
recommended. In addition, an employers policy for tweeting
should be consulted. HCPs often include a statement in their
Twitter biography stating tweets are my own to clarify that
their tweets do not represent their place of employment.
Twitter for HCPs is unique as it is the only platform that allows
one to connect, engage, learn, and educate oneself and others in
real time on a global scale. For the ID HCP, Twitter may help
them teach global responsible use of antimicrobials in a world
of escalating antimicrobial resistance.
Potential conflicts of interest. R. K. is employed by Cubist
Pharmaceuticals and owns Cubist Pharmaceuticals stock; the views expressed here are
her own and not necessarily those of Cubist Pharmaceuticals. All other
authors report no potential conflicts.
All authors have submitted the ICMJE Form for Disclosure of Potential
Conflicts of Interest. Conflicts that the editors consider relevant to the
content of the manuscript have been disclosed.
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