Please Join Us During #HealthSystemsChat in #SocialVR Every Other Week!

Every couple of weeks I host Health Systems Chat in Social Virtual Reality via @AltspaceVR. For each event, I write a blog post, usually with reference links and a relevant video. You’ll find my posts, means to register for the event, and instructions on how to participate at the Health Systems Chat URL:

Please join us!


A Tweetchat Code of Conduct (A Workflow!)

Introductory Remarks

I participate in a lot of tweet chats: #HITsm, #HCLDR, #HealthXPH, #MakersHour, #MEQAPI, #IrishMed, #HTreads, and #KareoChat, to name a few, plus lots of one-time chats hosted by companies and organizations (especially by @HIMSS). I also host #HealthSystemsChat, a social virtual reality event, about twice a month. It’s not a tweetchat, per se, but I do occasionally need to block participants for trollish behavior. (And yes, I’m thinking of crafting a Social VR Code of Conduct for that series of events.)

Until recently, I’ve not seen a need for a tweetchat code of conduct. However, this tweet, from @GilmerHealthLaw prompted me to rethink, research, and, finally, draft (and redraft) a tweetchat code of conduct. This post contains considerable prefatory material (reasoning, research, rumination, etc.). Impatient? Follow this link to the actual draft tweetchat code of conduct.

What is a code of conduct? Here is the resource I consulted.

A tweetchat code of conduct has four parts: a description of unacceptable tweets, how the code of conduct will be enforced, how and to whom to report behavior violating the code of conduct (workflow!), and materials guiding tweetchat organizers and participants how to respond to reports of egregious behavior. A code of conduct is not a promise to be nice. It is a promise to punish the guilty, backed up by specific and well-publicized levers and buttons to push. Its existence is intended to prevent the need to execute it. But this effect only works if potential offenders perceive their costs will exceed their “benefits.”

I searched Twitter and the web via Google for an example of an existing tweetchat code of conduct. All I could find were many (excellent!) conference codes of conduct.

Conferences and tweetchats are similar in some ways (both are social!), but also differ in important ways. For example, one means of enforcing a conference code of conduct is to physically bar an offender from the conference (and possibly offer their money back). At the extreme, in the worst case, police could be summoned to remove someone from the conference. What does it mean to bar someone from a tweetchat? They didn’t pay to attend. They aren’t physically present somewhere to be barred from. So, that aspect of the analogy between conferences and tweetchats breaks down.

On the other hand, evidence for behavior violating a tweetchat code of conduct is arguably easier to gather and assess than a conference code of conduct. After all, in real-life, face-to-face situations, what would be the equivalent of a screenshot?

While I’ve borrowed ideas (and literally stretches of text) from a variety of sources, to which I link at the end of this post, I’ve adapted that content considerably, to fit into the tweetchat paradigm. Specifically, some of the following text comes from

Finally, the following technically isn’t a tweetchat code of conduct; it’s a template for a tweetchat code of conduct. Substitute into it your tweetchat hashtag and date or schedule and lists of tweetchat organizers, and then publish, publicize, and refer to it during execution of what it promises to do. (So, yes, it is a kind of workflow…) That said, one could, at the beginning of a tweetchat, link to this template and indicate it applies to an about-to-occur tweetchat. But I encourage you to copy and adapt to make it your own. Then publish in a prominent place associated with your tweetchat. And tweet during the beginning of your tweetchat.

Tweetchat Code of Conduct

All in participants in our [insert tweetchat hashtag and date or schedule here] tweetchat are [required|encouraged] to agree with the following code of conduct. Tweetchat organizers will enforce this code throughout the event. We expect cooperation from all participants to help ensure a safe environment for everybody.

Need Help?

Please contact [insert list of tweetchat organizers here, but make sure their accounts are open to DM from anyone].

Prohibited Behaviors & Potential Remedies

The [insert tweetchat hashtag] tweetchat is dedicated to providing a harassment-free tweetchat experience for everyone, regardless of gender, gender identity and expression, age, sexual orientation, disability, physical appearance, body size, race, ethnicity, nationality, religious or political beliefs (or lack thereof), or technology choices. We do not tolerate harassment of tweetchat participants in any form. In particular, sexual and sexist language and imagery are not appropriate. Conference participants violating these rules may be privately or publicly admonished by tweetchat organizers, muted, blocked, or reported to Twitter (perhaps systematically en masse by other tweetchat participants).

Participants asked to stop any harassing behavior are expected to comply immediately.

If a participant engages in harassing behavior, the tweetchat organizers may take any action they deem appropriate, including warning the offender or approaching other tweetchat participants for help.

If you are being harassed during our tweetchat, notice that someone else is being harassed, or have any other concerns, please contact one or more tweetchat organizers immediately. Supply links to tweets AND screenshots of harassing tweets. Corollary: When in doubt, screenshot first.

While this is a tweetchat code of conduct, not a more general code of conduct, we expect tweetchat participants to follow these rules at all tweetchat-related events: meet-ups, conferences, conference calls, and other social media platforms.

Closing Remarks

This tweetchat code of conduct is intended to be a living and organic document. It is potentially an authoritative draft (an oxymoron, I know!). It is authoritative in the sense that even in its draft form, it can be linked to and cited to promote prosocial and ethical tweetchat behavior and warn off and punish antisocial and unethical tweetchat behavior. But it is also a draft in at least two senses. It is intended to be improved through constructive suggestion as well as copied and adapted by tweetchat organizers.

In fact, this tweetchat code of conduct is intentionally incomplete, at least from my personal point of view. For example, I have not mentioned escalating to employers or trade associations. Nor contacting security or police.

Neither have I created an exhaustive list of prohibited behaviors. Basically, harassment is any behavior demeaning to any human being on Twitter. However, I have listed categories of human being that deserve extra protection due to historical patterns of discrimination and disrespect.

And, finally, I’ve not discussed rehabilitation and forgiveness, though I’ve not seen those topics addressed in the conference codes of conduct either. Nonetheless, I think someone who has offended but has reflected on, and rehabilitated, their behavior, should know there is a potential future route (workflow?) to back to good standing in a tweetchat community.

I, therefore, admit this authoritative draft tweetchat code of conduct is deficient. I’d love to see how others improve all four of the necessary components: descriptions of unacceptable behavior, the manner of enforcement, specific workflows, and reference materials.

What is the copyright of this blog post? You may copy and adapt for any purpose whatsoever, though I hope you use it for its intended purpose, to make tweetchats even more wonderful than they are! You don’t even have to link to here (link) and mention me (@wareFLO on Twitter). Though it would be nice of you to do so! And at the very least, I’d love to know if you find it useful in some way.

My final bit of advice? Adopt a code of conduct BEFORE you need one.


  • Codes of Conduct 101 + FAQs (Excellent!)
  • Conference Code of Conduct
  • Your Science Conference Should Have a Code of Conduct
  • Drafting an Effective Ethical Code of Conduct for Professional Societies: A Practical Guide
  • TED Code of Conduct
  • P.S. BTW, workflow sighting! (In: Drafting an Effective Ethical Code of Conduct for Professional Societies: A Practical Guide)

    I Spent Nine Hours In Social Virtual Reality and It Was Weird But Wonderful!

    For nine hours, during the What’s The (Healthcare) Fix Conference and its live video stream, I hosted a chat room in social virtual reality using @AltspaceVR and the recently released Oculus Go VR headset. I’ll describe some technical stuff first, and then the more social.

    Let’s get the weird technical stuff out of the way!

    What I was specifically interested in was this: After nine continuous hours in virtual reality, how would the real world look like immediately after removing my VR headset?

    First, while the Oculus Go has a 101-degree field of view, I notice a fish-eye effect in which perhaps about 120- or 130-degrees is compressed into that 101-degree view. Therefore, given how human nervous systems adapt and compensate, I expected a brief opposite effect, some sort of tunnel vision (like looking through low-power binoculars). And this is exactly what occurred, though it only lasted about five minutes. Second, and this struck me most, “reality” looked abnormally drab! In retrospect, I should have expected this. Virtual reality is full of bright colors. The real world looks drab in contrast. Again, I should emphasize, these aftereffects went away after a few minutes.

    I don’t expect to spend nine continuous hours in VR again, though I might still do it if special circumstances called for it. But I’m glad I tried it for a number of reasons. First, someday folks may actually go to work in virtual reality, and nine hours approximates the length of the traditional work day (tho most people I know work much longer than that). Second, I bumped into several social VR users who are retired, and already spend many hours every day in social virtual reality. From my experience I can somewhat extrapolate to their experience. Third, my Oculus Go ($199-$249 on Amazon), with an external micro-USB power source, worked continuously for 9-hours. It was only when I exited the @AltspaceVR app and tried to start a different app, that the VR headset froze and I had to force a reboot. Since Oculus Go is brand new, I was surprised it worked so well for so long with no problems.

    Now for the social!

    I don’t have access to statistics, except how many registered (25) and how many emojis were sent during the event (272 hearts, happy and sad faces, hands waving and clapping, streaming upward over our avatar heads). But I’d guesstimate about hundred different participants hung out and chatted with me during the nine hours. Some appeared, stayed for an hour, left, and then came back later, several multiple times (“Excuse me, I’m picking up my sister at the train station, I’ll see you later!”) During several peaks, perhaps almost 20 of us milled around, sometimes in separate groups. Just as in the real world, the farther away you are from someone, the lower the audio volume. So two different groups can have separate conversations, tho, I could often faintly hear the other groups converse.

    Sometimes folks voluntarily helped out. At one point I was having a one-on-one discussion with someone in the corner of the room, while everyone else was congregated on the other side. However, as new people arrived, I could hear earlier arrivals giving the same welcome speech, almost word-for-word to new arrivals.

    What was my orienting welcome speech? (Some of the early arrivals, who stayed hours, heard it dozens of time!)

    Excuse me everyone, I’d like to welcome [user name]! (available over their head if you click on them with your controller). I hope you don’t mind me giving you a short introduction to what is going on here. I’ve been holding a series of events about healthcare. Last week we discussed science fiction and healthcare. The week before we talked about telehealth and virtual reality. This week is an experiment. These events are usually an hour long. But today I’m in VR for nine hours, because there is an online event called What The Fix! It’s about listening to patients tell their stories. If you go that URL over there, in that wall of words, you can watch that video live stream. What we’re doing here is sort of a version of that. You don’t have to answer this question, but it is the question that has mostly been guiding our conversation. Have you been ill, or been close to someone who was ill, and did it change you in some way. Perhaps change your philosophy of life? Or perhaps form an opinion about healthcare? As I said, you are free to simply listen to us. Or, if anything strikes a chord, please share your thoughts with us.

    And then I’d pause, sometimes for 30 seconds. Usually, eventually, the new arrival said something very thoughtful. Something that triggered others to say something, often supportive, or relaying a similar experience or thought. Once in a great while the new arrival figuratively looked like a deer caught in our headlights and simply vanished. Which usually caused some chuckles and comments (Well, we scared them away, didn’t we!) Once in while the answer was, no, at this moment I have nothing to share. But then later, after they’d listen to several other tell their stories, or after seeing several arrivals do so, they stepped forward again to contribute.

    In nine hours, listening to a hundred people, I heard a lot of stories. I also heard lot of strangers offering a lot of support to each other. For long stretches, sometimes thirty or forty minutes or so, I said nothing. I, and sometimes a half a dozen others, simply pivoted our avatar heads, and therefor our implied gaze, back-and-forth between two or three interlocutors.

    Since to me this was a grand experiment, and I therefore did not know what to expect, I had resigned myself to the thought that perhaps I might be alone, in virtual reality, for nine hours. It is possible to bring up a web browser to check email, Twitter, news, videos, etc. That was my plan B, which I never executed, because I was never alone during the nine hours. Several times we were down to two people, one other person plus me. I think they felt they would feel guilty about leaving! So they stayed until someone showed up.

    Me: Hey, you don’t have to stay to keep me company, if you have something else to do, but I do appreciate you hanging out with me!

    Them: Nah, I got nothing else going on at the moment. I’ll stick around; see who else comes a long.

    We ran out of things to say. One time we simply stood there, waiting, looking around, not saying anything.

    Them: Hey, there’s someone!

    I turn around to look out the window, to see someone has materialized outside in the park. They come closer. I launch into my welcome speech. More people show up. Eventual there is bunch again. Conversation is flowing. And I look around, and that one person who had been so supportive, had quietly departed! I hope I bump into them again!

    Again, I can’t do justice to the stories I heard, or how complete strangers so supported each other. This was a unique experience for me in several ways. In addition to its nine-hour length, it was about a “touchy-feely” subject I usually don’t talk about. (And I did indeed tell my own story, several times.) I most easily chat about technical topics: telehealth, science fiction in healthcare, augmented reality in healthcare (an upcoming social VR event I’m hosting). I was actually a bit fearful about whether I would be up to some of the more emotional aspects. I found myself falling back on my experience during medical school, when I participated in a twice-a-week group therapy session (addressing people in round-robin fashion, “How did you feel about that?”, etc). This sort of thing is definitely not my forte. But I’m glad I took the risk and did it. I got a lot out of it. From sharing my own story, feeling inspired by stories I heard, and being impressed and thankful for others’ supportive reactions to the shared stories.

    About ninety percent of the attendees come from the AltspaceVR community. They saw the event featured, or they happened to be logged in and saw the live event. I “friended” everyone I could. This works like Facebook, not like Twitter, in that social associations are reciprocal. When you go online, you see who else is online, at home (in their homespace), or participating in an event.

    Of special note are attendees who came from my healthcare Twitter community! I’d like to give a shout out to you! Thank you for participating! Thank you for noting your #socialVR experience on Twitter (see tweets below). I hope you come again, to one of my future events. I hope you get a VR headset so you can dive into the deep end of the pool, so to speak. And I hope you eventually host your own events in social VR, I can attend them. Just as with the relationship between social video and Twitter, I see a very positive and synergistic relationship between social VR and Twitter. I’d like to follow on Twitter the people I meet in social VR. Social VR can generate great content to publish and tweet about. Though one has to be careful in this regard. Due to the sensitive and personal nature of shared stories about illness, I did not stream video to Periscope (or Youtube). And, just as I loved meeting people I know only through Twitter via group social video channels such as Blab or Firetalk, I love meeting and getting to know my Twitter friends better, in social VR!

    In closing, here some tweets from, and about, my Twitter friends who visited me for a taste if social VR. Most of you used one of the 2D PC/Mac/Android clients. I hope you get a VR headset (Oculus Go is the least expensive option at the moment, but there are several non-VR headset options) and we get together again soon!

    Thank you Becky!

    Thank you for stopping by, Monica! (Think we were at about the four or five hour mark, and we were getting a bit silly, so when you popped it may have seemed like we’d gone off the rails, so to speak! We did settle down in a bit and returned to more serious discussion of substantive issues.)

    Thank you for participating Lisa!

    Kimberly, Grace, I hope to see you even sooner in #socialVR! Check out my next #HealthSystemsChat (Augmented Reality in Healthcare).

    PS What people saw when they arrived (plus, of course, other avatars representing other people).

    Thoughts on Just Completed Behavioral Health in Social Virtual Reality Event: Personal, Respectful, Insightful

    Yesterday, during the National Council for Behavioral Health Conference, I hosted a one-hour meetup about behavioral health in social virtual reality, using the @AltspaceVR social VR platform. 42 potential participants indicated their interest beforehand. I’d guestimate about 20 ultimately showed up. The conversation was excellent, a provocative mix of personal stories, research, and insight. In the following, I’ll summarize some of the most interesting moments and observations.

    First of all, I’ll set the stage, in this case, literally! We were avatars in a virtual set. The virtual set was a large room, with (apparently) a wood floor and a large projection screen on which I displayed one of the most favorited and retweeted #NatCon18 tweets. Three walls of floor-to-ceiling windows separated us from a mountaintop park and a sky full of clouds.

    Here is a tour of the virtual space I used (the same as that I used during the recent #HIMSS18 conference)…

    Our avatars are somewhat customizable. I was a brunette male in a blue shirt, almost, but not quite, a stick-figure man. But most of the other attendees appeared as floating robots. Some robots had hands that occasionally gesticulated. Heads, and therefore implied gazes, were in constant motion as we looked around at each other, depending on who was speaking, along with occasional nodding of heads in agreement. By the way, as far as I could tell, each of us was anonymous except for our AltspaceVR user handle (mine was ‘wareFLO’, the same as my Twitter handle, though I could have chosen a different AltspaceVR name to display).

    About half a dozen avatars congregated and conversed. The rest wandered around, sometimes stopping to listen, and to occasionally interject or be drawn into the conversation. Others went off, some outside, gathering in what I assumed were conversations… the greater the distance between you and another avatar, the less the audio volume, just like in real life.

    While I’ve occasionally hosted social VR events attended by one or two people, mostly to experiment with this new (to us) social media experience, this was the first larger scale event I’ve hosted. Frankly, I did not know what to expect. Should I be prepared to give a presentation to an audience? Should I ask people to introduce themselves? Should I just throw out questions, hoping to provoke conversation? Turns out, the last option felt most natural. I asked two or three questions about why folks came to this particular event about behavioral health, and eventually, someone answered. Which led to other folks chipping in. Which led to twisty-turny conversation, mostly about personal experiences with, and subsequent research about, such things as drug and alcohol rehabilitation as well as depression, but also about what social virtual reality has meant to each of us. One theme that came up multiple times was that anonymity behind our (to my eyes) cartoon character avatars was a plus. More than one person indicated or implied that while they were quite shy, that they were more comfortable communicating in the manner we were communicating.

    By the way almost everyone was wearing a VR headset. Thus, they felt as if they were literally present in this virtual space. I found this interesting, while I have a VR headset, I was using one of the 2D desktop clients; I was the host and might have to occasionally quickly type a URL. Also, using the 2D Mac or PC clients is a great way to dip your virtual toes into AltspaceVR, prior to the expense of a compatible VR headset.

    Here is how the conversation started off…

    As a group, we speculated how stress might contribute to triggering mental illness episodes. We discussed how workplace culture can be oppressive when it comes to alternative lifestyles. We talked about kindling (“process by which a seizure or other brain event is both initiated and its recurrence made more likely”) in the context of alcoholism and epilepsy, which lead to a discussion of PTSD (post-traumatic stress disorder).

    Then the conversation pivoted to VR technology itself, including speculations about a new generation of less expensive standalone  VR headsets about to be released. Here, I took advantage of having some real VR experts present to ask a lot of questions, such as how some folks were able to have, and gesticulate with, virtual hands (requires high-end headsets and extra hand movement detection hardware) and how much that added to the  VR experience. One person remarked that they gesture a lot with their hands in real-life, so it definitely feels more natural to them to be able to do in VR. Someone joked that someone was giving me a virtual massage, and I turned around to see that indeed was the case. What a strange but interesting moment that was!

    Then I asked if folks saw any uses for  VR in behavioral and mental health. I heard several yeses. We discussed how it is potentially easier for many people to speak to a VR avatar than a real person, even if there is a real person behind the avatar. I said I was reminded of research from decades ago about patients more comfortable about divulging sensitive information to computer interviewer. I wondered, can  VR help with social anxiety? Someone noted they were afraid of public speaking, but they experience no such anxiety in social VR.

    I asked if anyone had participated in the Blab group social video platform a few years ago. Some had. I noted that some folks from my Twitter social media community had really taken to Blab, but that others were resolutely resistant. I wondered if some of what we were discussing about VR and social anxiety might be relevant.

    Interesting, someone raised their hand (an emoji of a hand appeared over their avatar’s head) to explain they were absolutely petrified anxious in real-world social situations but had no problem at all in social VR. (Of course, I’m thinking, wow, they had no problem raising their hand and telling us, a room full of strangers, this personal experience, wow…). Further, they believed their experience in social VR was also helping them better manage their social anxiety in the real world social situations.

    We talked about VR tech again for a while…. but then again conversation returned to emotional well-being. An attendee referenced an AltspaceVR user (not at this event) who had lost his parents, and been terribly disfigured, in an automobile accident, but found great solace participating in social VR. This sort of story certainly stimulates my imagination about how social VR can help not just shy people, but folks in more extreme psychological and physical difficulty.

    We eventually went past our scheduled hour by about 10 minutes. As folks took their leave, and we said our goodbyes, I felt just like when I occasionally throw a small party in the real world, and we’ve finally come to the end of the night, even though it was still 1:10 PM in the afternoon.

    Here are several observations, looking back on the experience. First of all, despite anonymity, there was no troll-ish behavior, not one bit. I occasionally Periscope, and invariably have to block one or two commenters. AltspaceVR also has the ability for the host to block a participant, but I didn’t want to have to use it. Everyone seemed quite kind toward each other. In fact, I was reminded, somewhat, of group therapy sessions I participating in when I was a medical student. I hope all of my future social  VR experiences are as pleasant.

    Finally, the topic of Ready Player One did not come up, not even once. 🙂

    I hope I have piqued your interest in social  VR, and the  AltspaceVR platform. If you’d like to participate in one of my upcoming Health Systems Chats in Social VR Series of events, head on over to!

    Smartbutton Social Media Sightings Before, During, and After #HIMSS18 #BEAM4healthContest!

    A.S. (Antescript, the opposite of a postscript…) I think programmable interactive smartbadges, smartbuttons, wearable health IT conference hardware, are the future of conference badge technology! One cool idea will/would for a vendor to give all their representatives a BEAM smartbutton and control their slideshow content from a central marketing situation room. As the conference progresses, topical content could be continually updates, sort of like the daily newspapers at HIMSS18.

    In the past I’ve been to several hardware conferences (such as the Open Source Hardware Summit) that gave attendees programmable computers with displays that functional as customizable interactive badges. Around the first of the year I researched programmable conference badges to assess the state of the art. I even started to build my own, out of a Raspberry Pi Zero, battery, and LED display. And then I discovered the BEAM Authentic customizable programmable smartbutton. I tweeted a 2:20 minute video of a slide show I created (about workflow, of course)…

    …and @Lygeia suggested we buy a button to give away during HIMSS18 as part of what came to be the #BEAM4healthContest.

    Specificially, we looked for patients telling a story about how they used technology to empower themselves. While there eventually were 73 tweets with the #BEAM4healthContest hashtag, there were probably more like a hundred to total, if you count tweets misspelling or omitting the hashtag. The post collects some of the most interesting, including videos of, and graphics for, the BEAM smartbutton.


    Oh, the winner of the #BEAM4healthContest? @MedPinkRanger! She create the following animated GIF, telling her story… watch it and let us know what you think she said!

    Me? I see a long and winding road. Lots of dead ends, but also lots of persistence. Finally finding the door to a diagnosis. Ending, finally, with a very clever Conway Game of Life explosion! (visual pun?)

    PS More recent tweets about BEAM Authentic:

    Social Media Ambassadors’ Patient Power Tech Challenge Winners & Next Steps

    The #BEAM4healthContest contest spearheaded by Lygeia Ricciardi & Chuck Webster was a fun way to learn & highlight patient empowerment through information and technology

    By Lygeia Ricciardi (@Lygeia)

    A sample #BEAM4healthContest entry

    In our roles as Social Media Ambassadors for HIMSS, Chuck Webster (@wareFLO) and I teamed up to run a contest celebrating patient power through information and technology and, at the same time, exploring a new technology.

    What We Did

    Using blog posts (HIMSS18 Social Media Ambassadors kickoff patient power tech challenge), Twitter, and LinkedIn, we challenged participants (the contest was open to anyone) to create an image celebrating patient power using the BEAM button—a digital smart button you wear on your clothing that lights up like a mini-TV screen. Using an app on your phone you can program the button to show a still image, slideshow, or short GIF movie. The button lets you bring digital communication right into the physical room with you, without the distraction of turning to a phone.

    Contestants used the BEAM app to design images, and share them on Twitter. We announced the winner and an honorable mention at a meetup at HIMSS, and made awards including a BEAM button (for the First Place) and some awesome 3D-printed gear made by Chuck (for Honorable Mention).

    The Winners

    We had some creative entries—thanks to all who submitted them! First Place went to Twitter user Pink Ranger (@medpinkranger), based in Boston, who submitted a couple of entries. One was a crossword made up of words related to patients, technology, and health:

    Crossword by First Place winner Pink Ranger

    What really impressed us about Pink Ranger, though, was her animated GIF made from 121 individual JPG images that shows how technology creates a sense of connection in healthcare. In her words, electronic health records (EHRs) “open doors and give us a bigger picture. As we engage more with one another, magic happens.” This is her GIF:

    Animated GIF by First Place winner Pink Ranger

    Unfortunately, the BEAM button doesn’t yet enable users to upload and project their original GIFs the way they can display images and slideshows—but that feature is in the works. For now, BEAM users are restricted to using GIFs from a subset of existing ones on

    Honorable Mention went to Lisa Davis Budzinski (@Lisadbudzinski), a patient advocate and the cofounder of Central Pain Nerve Center. Her BEAM slideshow rotated to show the Central Pain Nerve Center logo; an image of herself and her co-founder, Rebecca Brandt, illustrating the fiery pain nerve patients endure; and a playful picture of them displaying their pink socks. Pink socks and the #pinksocks virtual community is a grassroots effort related empathy and change in healthcare. (Side note: it always makes me happy to link parallel advocacy and change efforts to leverage and amplify each others’ work!)

    Images from the BEAM slide show that won Honorable Mention

    We received other great entries, like this one from fellow HIMSS Social Media Ambassador and Janae Sharp (@CoherenceMed), related to health IT and mental health.

    So What?

    Through the #Beam4healthcontest we tried a new technology, celebrated patient power, and connected via social media with some fabulous people with creative ideas.

    We also learned that launching a tech challenge just days before the HIMSS conference isn’t the best timing. Although the contest was not limited to HIMSS participants, many of the 40K or so HIMSS attendees were overwhelmed by the task of finding a cup of coffee, never mind downloading an app and designing and submitting a creative message. If we’d started earlier, we likely would’ve had more participation. In addition, we discovered the limitations of this particular technology (as mentioned above, BEAM doesn’t *yet* let you upload a homemade GIF or transmit directly from a social media feed, though both functionalities are in the works). But by definition exploring technologies on the edge means trying what is and imagining what might be in the near future.

    So what’s next? Personally, I intend to keep experimenting with BEAM and other digital tools that are new to me, as well as looking for ways they can empower patients and other individuals to be their healthy, best selves. And Chuck is consistently pushing the envelope in technical tinkering and applications to improving workflow!

    We are considering running another contest involving BEAM or another gadget that is just out of the mainstream. What do you think? Would you want to participate? If so, what technologies would you like to learn about, and what would make the process most easy and fun for you?

    Augmenting 21st Century Health Conferences with Social Virtual Reality

    In previous related posts (1, 2, 3) I’ve discussed social virtual reality (using @AltspaceVR) and my use of it during the recent HIMSS18 conference. In this post I present one possible path toward incorporating social media, virtual reality, and augmented reality into the health conference experience.

    The goal will be to smoothly blend IRL/F2F (In-Real-Life/Face-to-Face) physical experience with online social virtual reality and augmented reality digital experience.

    The first requirement is a virtual conference space that mirrors, in some ways, the physical conference space. While building such a space may seem like a lot of work, startups are already working on automatic conversion of digital architectural files into virtual reality models and experiences. Most social virtual reality platforms have tools for creating custom virtual event spaces. Here is a tour of the space I used during #HIMSS18. It was prebuilt. I did no customization except the HIMSSTV video and the floating white text orient new arrivals. However, it gives you a sense of how you can move around and what avatars look like.

    Imagine something like the above event space, but a bit larger and containing rows of exhibitor booths. Each booth has a table and a backdrop. Both contain, on their virtual surfaces, various branding information (logos, taglines, etc.) and content (text, video, interactive apps, etc.). At the end of the aisle is a viewing area and a virtual projection screen. You are wearing a virtual reality headset and appear to others as they appear to you, as a customizable cartoon character-like VR avatar. You can move around and talk to other attendees. If you are using a VR headset, you feel as if you are physically present in this virtual space.

    During the actual, physical conference, videos of keynotes and select parallel sessions are streamed live. Audio is audible within viewing area, but subsides to a murmur when you are between the virtual exhibitor booths.

    At the physical conference, each booth is equipped with an inexpensive (~$100) 360 video spherical camera capable of live streaming 360 video over Youtube Live. Here is an example of video I streamed from the recent HITMC conference in New Orleans.

    Click through to Youtube and view in appropriate browser or VR headset to view in 360 video mode. One of the four dozen inexpensive #HIMSSVR VR glasses I sent to my favorite Twitter friends work great too!

    In a compatible browser you can pan around to look in any direction, including look back to see folks emerge out of the audience to receive their awards. One award recipient was not physically present, but watched the announcement of their receiving the award. If you watch until the end, you see folks milling around, chatting, next to the camera. While video resolution is low, it nonetheless feels as if you are literally present, especially when the camera is addressed, or glanced at, directly.

    Here is my 360 video camera rig from #HIMSS18…

    Now imagine waking over to a booth, clicking on a link or hotspot (possibly represented by a 360 spherical camera on a tripod) and then suddenly viewing the booth, including staff, attendees, and conversations among them, from the point of view of a 360 video camera among them. The feeling of transition is reminiscent over changing to street view in Google Earth. Someone in the booth looks at you (that is, looks at the 360 video camera) and say, “Oh, hi!” And then conversation ensues. Viewer comments can be seen via the Youtube Live activity stream. (Yes, typing is difficult while wearing a VR headset! One might temporarily doff the headset and switch to web browser 2D mode, or, in the not not too distant future, use a device such as the Tap glove to enter text without an apparently keyboard.)

    That is what can be done in the near term, using existing, inexpensive technology. In the longer term, if this is a workable and desirable vision, you’ll see more seamless, turnkey, services offered by startups. Also, we’ll see lots of improvements in every dimension, from higher resolution 360 video (s)ee examples from the recent #VirtualMed18 conference 360 video livestream, which used a high-end 360 video camera) to more customizable avatars (so they will look more like their owners) to cheaper, more comfortable, functional, and convenient (look for standalone Daydream and Oculus headsets next month!).

    So, what will a similar experience be like farther in the future, say, by 2050? Try this out. Yes, it seems like science fiction, but then SF has predict most of our modern technologies!

    My Social VR Avatar on my Social Smartbutton

    Wearable smart glasses and virtual reality headsets will be anachronisms. Their functional will be in us (implants, in our eyes, or even brains), and surround us in such a way we don’t even notice it (ambient & ubiquitous computing).

    Here will be a typical morning for a potential health conference attendee. An internal alarm clock gently nudges them awake. Lying in bed, without opening our eyes, we review notifications which apparently scroll up the inside of our eyelids. They’ve been filtered and sorted by our implanted AI assistant. With which we can silently converse via subvocalization, so as to not wake our spouse. We mark a future health conference as interesting.

    Later, conference details scroll up the wall in your breakfast nook. You notice a virtual option. You authenticate (to get the discount) and pay via a combination of blockchain and bitcoin.

    Meanwhile, someone else, who you’ve never actually met in real life, but is your best friend, sees the same conference. Since they live in the same town where is to be held, they choose to physically attend.

    On the day of the conference, you walk into a white room, the floor of which moves in any directly (like an omni directional treadmill, this already exists). You blink slightly longer than usual, an contextual AI interprets this as a command (like a click) to enter the conference venue. When open your eyes, the white walls are now 360 screens surrounding you with what appear to be the actual conference venue (this also exists, and was demoed at HIMSS18 in the Intermountain booth).

    Meanwhile, your friend walks across the park, into the physical event facility, and as they do, you see them seemingly enter your immediate vicinity, near the health conference “registration desk” (no longer needed for that function, but present out of tradition, and as a point of common reference, for example, “I’ll meet at the reg desk). Your friend is projected, via augmented reality (perhaps glasses, perhaps smart contact, or perhaps smart implanted corneal lens), into the room with you, the backdrop of which is the health conference venue.

    You two then walk togther, to your first session. The floor moves beneath your feet. The venue’s background shifts perspective. And your friend appears to walk beside you.

    And so on! You get the idea. Virtual reality, augmented reality, the internet of things, will all work together to create the illusion that you and your friend, plus hundreds of colleqgues (some physically present, most virtual present), are attending a health conference together!

    Wrap Up!

    I hope you’ve found my fevered speculations about the future of health conferences, leveraging virtual, augmented, and mixed reality technology, entertaining. But I also want to be educational. Just like the four dozen #HIMSSVR glasses I sent out to Twitter pals (just in time for some of you to feel as if you sat in the front row at #VirtualMed18), I’m trying to combine two worlds I love, the HITSM/HCLDR twitter sphere, and the social VR-sphere. I hope you’ll invest some time playing around with this cool tech, so you can become a pioneer in the heath conference experience on demand (after a great book about VR, Experience on Demand).

    By the way, great minds think alike. Lot of people are thinking about how to use virtual reality and augmented reality at trade shows! An obvious use is to entice folks into your booth so they can experience AR or VR, and to then show them something about your produce. But folks are also beginning to think along the lines of this post. How can we blend physical and digital tradeshow experiences?

    Here are some interesting references.

    PS It’s also worth thinking about how virtual reality, augmented reality, and smart buttons and badges fit into today’s #HITSM questions! See my Smartbutton Social Media Sightings Before, During, and After #HIMSS18 #BEAM4healthContest!

    BTW, today’s #HITSM tweetchat is about the future of health conference experience, so…

    T1: What can conference organizers do to provide tangible value to conference registrants – and those considering registering for the conference – BEFORE the event starts? #HITsm

    Send attendees inexpensive VR googles, which work with either iPhone or Android, to view 360 videos of exhibitor products and services in action. Perhaps from the point of view of the patients! Though I’m not sure how many people would willingly go through ED and then into and out of surgery this immersively! (Wait, actually, I think a lot of rollercoaster, bungee cord jumping adrenaline junkies would jump at that chance!). These same VR googles can than be used used by colleagues to attend virtually in the manner described above.

    T2: What are some of the most interesting and useful ways you’ve seen conference speakers and panelists share information to, or interact with, conference attendees? #HITsm

    Each and every slide should include the speakers Twitter handle, conference hashtag, and an explicit exhortation to share on Twitter. I now do this every time I speak. If you can get folks to type your twitter handle into the twitter client to tweet about your talk, they’ll often follow you too. Another thing I do is literally give the talk before the conference while recording the audio. Then I match the slides to the audio in iMovie and upload to Youtube. And then I include that URL on the slides too. The way audience members can tweet not just the slide, but a close approximation to the entire talk. Getting back to virtual reality, the next time I speak (about workflow, usually), I’ll live stream 360 video. I often periscope my presentations. If I use a fish lens I can set my phone on the podium and viewers can see both my slides and me. In a sense, 360 video is the ultimate fish eye lens! Folks can see my slides, me, and even swivel to observe activity in the audience.

    T3: What technology-based approaches can conference organizers and exhibitors use to create new or enhance existing opportunities for content identification, acquisition, and dissemination? #HITsm

    Technology-based? Virtual reality (see above) and smart buttons/smartbadges! BTW, there is a connection. These badges can sense where they are and the direction they point. So they could serve to knit together virtual and augmented realities of the health conference experience. Imagine, though your smart glasses, being about to see the “ghosts” of virtual attendees. And virtual attendees being able to see the “ghosts” of physicial attendees in their virtual world. And then being able to communicate!

    T4: How can those physically attending a conference and those ‘following along remotely’ originate, share and/or discuss conference-related content? #HITsm

    I think what I describe above goes miles toward allowing folks to not just follow along remotely, but rather to feel as if they are literally, physically present at the health conference.

    T5: What can conference organizers and exhibitors do to provide additional value to conference attendees and others AFTER the conference is over? #HITsm

    Access to slides, obviously. But I think the most important thing conference organizers and exhibitors to provide is a means to continue the networking conversation. Getting people to follow each other, wherever, on LinkedIn, Twitter, etc. Which is why the “social” part of #socialVR” is so important. Social platforms, like LinkedIn, Twitter, and Facebook, allow you to follow and friend. If you ever used Blab or Firetalk, the social group video platforms, you’ll recall that after you register interest in an event, you’ll get a notification it is about to go live. Whether in social VR or social none-VR, encouraging and supporting these communities is the most important thing to me as conference goer. Just as conferences host before and after conference tweet chats, I’d love to see them also host social virtual reality experiences.

    Bonus: What are some of worst examples of a conference organizer ‘dropping the ball’ that you’ve ever experienced or heard about? #HITsm

    I’ve been very lucky. I’ve never been to disaster of a conference. And I can’t, at the moment, think of any such in healthcare. However, most of the controversies I’ve heard about in the IT conference industry in general have been about representation and diversity.

    PSS Testimonials!

    From #HIMSS18

    From #VirtualMed18

    My Trip Report: Virtual Reality, Artificial Intelligence, and Workflow at #HIMSS18

    “We are your here!” said anchor and host Adam Johnson (@AJInsight on Twitter) during our interview on HIMSSTV (the first live segment, 9AM, March 6th).

    “Hereness”! It really is a word (noun: the state of being here in this place, according to the Webster Dictionary). I’ve been thinking about hereness a lot recently, ever since I started traveling to distant places and meeting distant people via virtual reality. For example, I watched the recent eclipse, with others, in real-time, via 360 video, wearing a VR headset, SIX TIMES, as it moved from Corvallis, Oregon, to a cruise ship off Florida. HIMSSTV is an important move toward making folks feel as if they are “here”, present at the center of action, at HIMSS18, at future HIMSS conferences, and in between!

    If I had to boil HIMSS18 down to a half a dozen takeaways, here they are… (keep in mind, I’m a quirky person with idiosyncratic, even obsessive tastes…)

    1. HIMSSTV is great!

    In our house we have the news on, in the background, most of the day. When I got back from HIMSS18, I replayed all 9 hours HIMSSTV on ROKU instead. Loved it!

    Action item: + Add Channel!

    2. There were a lot of virtual reality demos on the exhibit floor!

    Check out the photos on Twitter. The Virtual Reality Gets Real in Healthcare educational session at HIMSS18 emphasized that VR increasingly learns from, and adapts to, patients and clinicians. Costs keep dropping and the Star Trek holodeck is getting closer!

    By the way, during HIMSS18 I hosted two-hours-a-day of social virtual reality experience. Folks from all over North America and the world, some wearing VR headsets, hung out in a cool meeting space in a beautiful Park on top of a mountain, discussing health IT!

    Here is a tour of that space…

    And here is one reaction to participating.

    Action item: Join me in social virtual reality to chat about health IT!

    Workflow has arrived in health IT, big time!

    Workflow, and its technologies (workflow engines, graphical editors, workflow analytics…) have finally arrived in a big, big way. As an industrial engineer (basically a degree in workflow), who went to medical school, I’ve been evangelizing workflow technology in healthcare for almost three decades. Every year since HIMSS12 I’ve searched every single website of every single HIMSS exhibitor for workflow-related content, and then blog, tweet, livestream, and now host social virtual reality experiences, about it. Back then, believe it or not, hardly anyone even mentioned it. Now almost everyone has some sort of workflow story. This year my search query was: “workflow engine” OR “business process management” OR BPM OR RPA OR “robotic process automation” OR orchestration OR orchestrator. As a result I tweeted about over 200 exhibitors (peruse here, even if you don’t have a Twitter account).

    Action item: Apply my Litmus Test for Detecting Frozen EHR Workflow (which applies to healthcare software in general).

    Ai yai yai! AI!

    Don’t get me wrong. I love artificial intelligence. I have an MS in Intelligent Systems, met John McCarthy (who named AI), and attended lectures by Herbert Simon (sometimes called the father of AI). Also, see my pre-HIMSS17 series, including A guide to AI, machine learning and new workflow technologies at HIMSS17 Part 1: Machine learning and workflow. The key to getting useful results from AI and machine learning is to ask, show me the workflow! Show me, step-by-step, MY workflow, and how AI/ML applied at a specific step in MY workflow, increases something good, or decreases something bad. That said, I saw a lot of AI/ML startups taking about customer workflow, particularly in combination with robotic process automation tech.

    Action item: If someone tries to sell you an AI/machine learning solution, shout “Show Me The Workflow!”


    If you’re interested in workflow, draw it and show it to me. I’m genuinely interested. You can contact me via Twitter ( or my blog’s contact form. (

    If you’re interested in HIMSSTV, watch it!

    If your interested in all the above, including artificial intelligence and machine learning, book your hotel in Orlando for HIMSS19! Review proposals! Submit a proposal! Exhibit!)

    If you are interested in virtual reality, I have a really great book to recommend, it’s called Experience on Demand by @StanfordVR. It just came out. It’s about virtual reality from the point of view, not of a techie, but of a psychologist. It’s full of medically-relevant examples, from training to pain management. It’s about achieving hereness, through “presence”, the “illusion of non-mediation.” (My interpretation? Presence is the illusion that an illusion is not an illusion.) Since I was interviewed about virtual reality (and its connection to workflow) in the very first live HIMSSTV segment, watch it now! Please subscribe to my Youtube channel! I’ll post more segments from my social virtual reality experiences.

    I’m so excited about VR, I’ve been playing Johnny Appleseed, giving away (over four dozen!) inexpensive VR glasses on health IT social media.

    If I’ve run out, you can still get them on Amazon.

    Why I Don’t Follow You on Twitter

    How about a follow?

    Report this message sent 8 hours ago from ????????? Delete this message sent 8 hours ago from ?????????

    8h 8 hours ago

    Chuck Webster MD #HIMSS18 Social Media Ambassador

    I sometimes get this request. If we have met personally, in IRL, I sometimes acquiesce. However, unlike Facebook, Twitter is an asymmetrical interest graph, not a symmetrical social graph. Most of the people I follow are not in health IT and do not follow me. It is literally true that only about 10% percent of the 6K I follow, about 600, actually follow me back. While I think it is nice you follow me, I will not feel offended if you feel that since I choose not to follow you back, at least for now, that you chose to unfollow me. We both have our reasons and principles for who we follow, and I respect yours, and hope you understand mine.

    Delete this message sent 8 hours ago from Chuck Webster MD #HIMSS18 Social Media Ambassador

    8h 8 hours ago




    Report this message sent 8 hours ago from ????????? Delete this message sent 8 hours ago from ?????????

    8h 8 hours ago

    Chuck Webster MD #HIMSS18 Social Media Ambassador

    I’m sorry. I’m happy to explain further if you’ll direct me to that part of my DM that I did not make clear.

    Delete this message sent 8 hours ago from Chuck Webster MD #HIMSS18 Social Media Ambassador

    8h 8 hours ago



    No worries. Take care!

    Report this message sent 8 hours ago from ????????? Delete this message sent 8 hours ago from ?????????

    8h 8 hours ago

    Chuck Webster MD #HIMSS18 Social Media Ambassador

    You too!

    Delete this message sent 8 hours ago from Chuck Webster MD #HIMSS18 Social Media Ambassador

    8h 8 hours ago


    Snow Crash, Social Virtual Reality, The Metaverse, and #HIMSS18: A Science Fiction #HTreads Tweetchat

    [For the 2/27, 9:30PM EST #HTreads tweetchat…]

    Recently I innocently posted the following tweet, whose replies, and replies to replies, garnered between 700 and 1000 tweets (I lost count around 700, but the conversation refused to die!).

    I think it is really cool that so many health IT social media tweeps love science fiction so much. There’s even a science fiction meetup at the upcoming #HIMSS18 conference.

    So a #HTreads tweetchat about science fiction before #HIMSS18 seems appropriate. And, to be more specific, and dearer to my personal sci fi heart, I’d like to focus on one book, and it’s most cool high concept.

    Believe it or not, the most compelling idea and depiction of virtual reality was published a quarter of a century ago: Snow Crash, by Neal Stephenson. Not only is it on many lists of the top 100 science fiction novels of all time, it also appears in top 100 English language novels of all time. If you haven’t read Snow Crash (shame on you, especially if you claim to be a science fiction aficianodo), then at least take a couple minutes to skim this Wikipedia Snow Crash plot synopsis.

    One could go on and on about how well (or how not well) Snow Crash not only predicted social virtual reality, but its then future society (our current society, today). Snow Crash was not omniscient; it was compelling. Many of today’s 3d environments depicting real or imagined worlds were and are deeply influenced by Snow Crash. Snow Crash popularized “avatar.” Snow Crash influenced Google Earth, with which we are all familiar. Even Quake (and so, Doom and Duke Nuk’em) was loosely based on Snow Crash. People read Snow Crash, the product of the imagination of a science fiction writer, and then they created similar technologies and worlds, influenced by Snow Crash.

    Social virtual reality is about to take off in a big way. Especially when Ready Player One is released (set in my current hometown, Columbus, Ohio!).

    You can also dip your (virtual) little toe in social virtual reality during the upcoming #HIMSS18 conference. I am hosting three, two-hour social virtual reality events on Monday, Tuesday, and Wednesday, at 3PM-5PM PST. (For instructions, see A New Venue Two Hours Each Day During #HIMSS18: Social Virtual Reality!)

    Let my pull out five ideas from Snow Crash, to use as #HTreads questions/topics (all these are in the Wikipedia Snow Crash plot synopsis):

    Let’s start with the title: Snow Crash. Stephenson was inspired by what a Mac screen sometimes looked like when it crashed, sort of like static on a TV. I am also reminded of many sci fi and horror movies and TV shows in which snowy, static-y TV screens in indicate proximity of scary things or communication from the beyond.

    1. Can you think of any recent examples of TV or computer “Snow Crash” scenes (static-y visual white noise…)? (I can) #HTreads

    A central conceit, which at the time I thought was the weakest Snow Crash idea, because it didn’t jibe with what I thought I knew about computer science and neuroscience, was a virus that could jump from the digital world to the human biological world, through the computer screen. Ha! I thought this was ridiculous. But I kept reading, everything else was to bloody good. Besides, I think I sensed, Snow Crash was a bit of a parody, kind of like Hitchhikers Guide to the Galaxy, which was also full of lovely ridiculous stuff. Little did I know, at least metaphorically, of today’s systematic manipulation of public opinion via fake news.

    2. What do you think about the metaphor of fake news as a virus, traveling over digital social networks, leaping from human host to host? #HTreads

    Read this description of the “Metaverse”:

    “The Metaverse, a phrase coined by Stephenson as a successor to the Internet, constitutes Stephenson’s vision of how a virtual reality-based Internet might evolve in the near future. Resembling a massively multiplayer online game (MMO), the Metaverse is populated by user-controlled avatars as well as system daemons.”

    Note, the Metaverse is much more than just networked virtual reality:

    “The Metaverse is a collective virtual shared space, created by the convergence of virtually enhanced physical reality and physically persistent virtual space,including the sum of all virtual worlds, augmented reality, and the internet”

    3. How might a “Metaverse” virtual reality-based Internet, resembling a massively multi-player online game, affect digital health? The Internet of Health? What about the Social Virtual Reality of Health?

    Science fact: “Scientists have developed a brain-computer interface that reads the brain’s blood oxygen levels and enables communication by deciphering the thoughts of patients who are totally paralyzed and unable to talk.” (Paralyzed patients communicate thoughts via brain-computer interface)

    4. The Metaverse is much more than VR (“virtually enhanced physical reality AND physically persistent virtual space”) how might the Metaverse be used to help patients who are totally paralyzed and unable to talk cope?

    5. If you could write a science fiction novel that literally will change the world (just as Snow Crash began to do, 25 years ago), what would be it’s title? It’s scientific advance? The morale of your story?

    Thank you for being interested, with me, in the realization of a cool, influential, science fiction idea, the Metaverse, or what I call, in its baby form, social virtual reality. I hope you’ll join me in this infant Metaverse during #HIMSS18. Just show up and follow the instructions!