A Twitter Holiday: Sun, Sand, Surf, Smartphones, Short URLs, Social MEdia, and EMR Workflow Systems

Short Link: http://j.mp/4ogmwT

You will notice something new at the beginning of each post to this blog: “Short Link:” followed by a short and somewhat cryptic URL (http://j.mp/4ogmwT). If you click on it (try it!) you simply end back where you started, on this same page.

What’s the point? Short URLs, or short links, are used in SMS messages and Twitter tweets, which are a maximum of 140 characters long. At eighteen characters, the short link leaves 122 for the trenchant, piquant, pithy, and necessarily concise tweets about what you are doing or thinking.

Why am I doing this? In fact I’ve avoided Twitter for the same reasons I initially avoided blogging. The phrases “self-indulgent,” “banal,” and “navel-gazing” came to mind. For example, the following study found that 40.55% of tweets are “pointless babble.”

Then last February I registered (so my Twitter handle is ). While Twitter was new (to me, it’s been around since 2006) if it turned out to be important I wanted to be *the* of out estimated 613 Charles Websters in the US to have that account, not or .

A use for Twitter that immediately made sense to me was real-time microblogging of a live event for folks who cannot attend. So I sent 40 tweets in 60 minutes at Dr. Gonzalzle’s presentation “Workflow Management EMR Systems and the Primary Care Physician” at the HIMSS conference in Chicago last April. Fun to do once but exhausting (lots of typos too), and I don’t attend enough such events to merit further investigation (or so I thought at the time).

Your Personal Twitter Timeline as a Thought Stream

I continued to read about business uses for Twitter. Then I had lunch with someone very knowledgeable about Web who used to agree with me about the apparent pointlessness of Twitter, but who now has 240 “followers.”

Dave: I’ve got 240 followers on Twitter.

You’ve got 240 followers on Twitter?!

Dave: That’s what I said.

What do you tweet about?

Dave: Thought of the day, interesting quotes, links to interesting articles, that sort of thing.

That’s nice, but why bother?

Dave: It’s fun, some interesting people follow my tweets and I follow them too. And folks are clicking through to my other Web sites.

Oh! (Hmmm…web traffic…maybe I was a bit hasty!)

Thought of the day…thought stream…Twitter recently changed the question above its tweet submission box from “What are you doing?” to “What’s happening?”, encompassing more interesting material than “Having breakfast.”

Then I read about research (“Study Reveals Two Types of Twitter Users” and “Is it Really About Me? Message Content in Social Awareness Streams”) that divided Twitter users as Meformers versus Informers, “two different types of ‘content camps’: a majority of users focus on the ‘self’, while a smaller set of users are driven more by sharing information.” That second set of users sound a lot like me (or at least how I like to think of myself).

Coincidently, at the same time I read about Twitter Informers, I stumbled across a list of WordPress plugins that help coordinate Twitter and WordPress. I realized that I could use my tweets to generate content on this blog (scroll down to the bottom of the right-hand margin on this blog). Since each new tweet causes the oldest tweet to disappear, I’ve “archived” a set of tweets to the end of this post so I can refer to them below.

During my recent holiday vacation I wasn’t going to have access to my laptop at the beach. I faced writing two posts and scheduling them to be published automatically on vacation. I will tell you the truth. That felt like work. And I write this blog because it is fun. Was there a way for me to conveniently submit material to this blog from my smartphone? It would give me something to do while soaking in the rays.

I then began to think about my Twitter account as a convenient mobile extension to this blog. The fact that it would *only* allow me to submit 140 characters at a time was almost a relief (I do go overboard). It was almost an enforced “stop working so hard.” Just have fun exploring something new and if what I post is self-indulgent, so what, it will just be lost in the noise and eventually disappear in a massive haystack of other inconsequential tweets.

Then the snow storm hit DC just before my wife was about to fly down to Key West and the best real-time news (compared to cable and even the Web) I could get about DC travel conditions was Twitter. I tracked the key words “DC”, “DCA” (Reagan National Airport), and “snow” plus the hash tag “#snowpocalypse”. Here was a source of real-time news alerts that was really useful.

Huh. I was impressed.

In the meantime, sitting at the beach, I’m reading about different Twitter applications, culture, and uses. Eventually I began to think of my own tweets as resembling the email reminders I already send myself.

Using just the email subject line, I often send myself emails with subject lines starting with “remind think about…”, “remind what is connection between X and Y?”, “remind blog post idea: …” and “remind cell photo pretty sunset at piedmont park” (with attached image). Sometimes I include a Web URL in the email body. When I get back to my office or laptop I sort my emails in outlook and go back and data mine this “thought stream” (wasn’t I thinking about X a few months ago, ha! here’s the link I was looking for).

While an email subject line can hold more than 140 characters, it is similar to a tweet: telegraphic, no formatting, targeted audience. So I decided to conduct an experiment. For the next two weeks, over the recent holidays, I resolved to not touch my laptop. I’d just use my smartphone to access the Web and update this blog. I would post once or twice a day, and while I’d try to be an Informer, I’d give into a Meformer urge once in a while, just so I could understand that inclination.

It was fun. I “meformed” a bit more than I intended: vacation photos, a bit of doggerel when bored, an obscure reference to Michael Keaton’s character in the Night Shift. Hey, I was on vacation. But I also found some interesting content on the Web that I wished to remind myself to explore and possibly post about later (and didn’t mind if anyone else eavesdropped).

If I go back over my recent tweets they appear to fall into one or more three categories:

• Informer-style Branded Content: Comments, quotes, and links related to the EMR workflow systems that will likely continue. (13 tweets: green bullets)
• Informer-style Unbranded Content: Such as material related to Twitter itself. It’s the new thing that I am currently learning about, thinking about, and excited to share. This content will likely wax and then wane, to be replaced about whatever intrigues me next. (7 tweets: blue bullets)
• Meformer-style Content: Of most interest mostly to me, a relative or a friend. (3 tweets: red bullets)

Plus a more recent short that spans all three categories: Branded Informer (mention of EncounterPRO), Unbranded Informer (look, I can tweet a video!), and plain ‘ol Meformer (“It’s cold here in Atlanta!”).

URL Shortening Services

Oh. So why am I putting URL short links my blog pages and those of our product website? So I can tweet them. So you can too. For example, coincident with publishing this blog post I “Blog post: Twitter Holiday: Sun, Sand, Surf, Smartphones, Short URLS, Social Media, and Pediatric EMR Workflow Systems http://j.mp/4ogmwT” More and more people surf the Web on their cell phones and communicate using Twitter. If you want to tweet one of my blog posts or our product pages, just copy and paste the Short Link into your tweet.

On the other hand, you could go to the trouble of creating your own short links at one of the many free URL shortening services. Why did I choose j.mp? If you look back over my tweets (below) you may notice that I tried different URL shortening services: http://bit.ly (favored by Twitter), http://multiurl.com (enables tweeting more than one URL, each with a description), and http://j.mp (two characters shorter than bit.ly, but also belongs to bit.ly). I chose j.mp because it results in an exceptionally short URL (18 characters) and because it belongs to bit.ly, a Twitter partner and therefore not likely to go away soon.

Conclusion

That’s how and why I started twittering. Is Twitter the greatest thing since sliced bread? I don’t know. I recently read that national and international use of Twitter from the desktop Web browsers is flat lining, but that smartphone access continues to grow. This is consistent with my experience; I didn’t see the point of Twitter until I realized what I could conveniently use it to do things from my smartphone.

Right now, Twitter is a way for me to interact with my blog in both real time (the direct feed) and to publicly, but informally, archive ideas for future posts. Sort of miniature trailers for potential longer attractions to come. Therefore many of my future tweets will be about the same subjects I address here in the blog: EMR workflow systems, their usability, and the extraordinary potential for applying business process management techniques to improving healthcare processes.

Since I’ll be attending HIMSS here in Atlanta March 1-4, maybe I’ll try to live blog that from my smartphone. I can bump my live feed of tweets to the top of this blog’s right-hand column (replacing the photo of  our kickbikes) so it will be hard to ignore. Check back then (even if you aren’t a regular reader).

Also, (surprise!) sometimes I just don’t know when to stop writing. Since brevity is the soul of wit, maybe Twitter can teach me to be (t)wittier. I just don’t know. But I am interested in finding out.

If you are interested in finding out too, or interested in some of the same subjects as I am (EMRs, workflow, usability, cognitive science, kickbiking, and, for the moment, Twitter), and you have a Twitter account, I hope you’ll follow me (I’ll likely follow you right back). If you don’t have a twitter account, head over to get one: free!

Tweet you later!

Archive of Recent Tweets as of Date of this Post, Color-coded by Category (Green •: Branded “Informer,” Blue •: Unbranded “Informer,” and Red •: “Meformer”)

(from newer to older…)

Wishing I was in Key West……tweeting from the beach…

· End Key West Twitter Holiday 🙁 Is my wife wearing a cruise ship for a hat? http://www.twitpic.com/wcxn4 Will I continue to tweet? Que Sera Sera!

· Test: Shortest URL shortener? Which links work? http://en.wikipedia.org/wiki/URL_shortening http://j.mp/8XKXlo http://www.j.mp/8XKXlo j.mp/8XKXlo

· Wanna no y I have a Twitter acct? To tweet things. See, I got ideas coming at me all day. I couldn’t fight’em off if I wanted Happy New Year

· Blog post idea: recent article care coordination gap » EMR workflow systems = EMR care coordination systems http://j.mp/5n0E1d Pediatric EHR

· MSFT”use [workflow] model to interpret behavior [and to] reason…how to optimize the business process” http://j.mp/6ntnVa Pediatric EMR EHR

· MSFT”which individuals are contributing work to which business process…to understand costs and workloads” Pediatric EMR http://j.mp/6ntnVa

· http://twitpic.com/vc8nv Mobile Office: subject usable EMR workflow, locale beach, 1999 technology PALM VII–readable in direct sunlight!

· MSFT”Workflow models can be used to gain insight into the flow of work through an organization” Pediatric EMR http://www.multiurl.com/l/0Oi

· Microsoft “Benefits that a workflow model can bring are insight, monitoring, and optimization.” Pediatric EMR http://www.multiurl.com/l/0Oi

· There once was a tweet, a bit of a cheat, that did not obsess, or even address, the author’s central conceit http://bit.ly/6dkU7o Merry XMas

· Cycle time from 80 to 30 minutes, improved bottom line and patient satisfaction http://bit.ly/8NeKZn quote EncounterPRO pediatric EMR user??

· Watch http://ehrworkflow.com for new EMR / EHR workflow and usability pediatric, subspecialty, family medicine, OB/gyn. content…developing

· Read about pediatric EMR workflow systems at https://wareflo.com/pediatric-emr-workflow

· Groupware versus Workflow http://bit.ly/8nzRQd need both clinical groupware http://bit.ly/57uxWG and pediatric EMR WfSs http://bit.ly/6DeFlE

· “Products designed to…reflect…work patterns of physicians…reduce EHR implementation difficulties” http://bit.ly/8WoBp2 arg 4 EMR WfSs!

· http://twitpic.com/u7qfw – Arrived in Key West. Here’s the view out the window. (Grin!)

· Merry Christmas and Happy New Year from Key West! http://bit.ly/602CpE Check out my “Twelve Days of EMR Beta Testing” http://bit.ly/83b6Uv

· Idea: Complex Event Processing http://bit.ly/8YltPT and Pediatric EMR Workflow Systems, user-defined events trigger automated workflows

· I’ll try to be more of a Twitter Informer than Meformer. Read about social awareness streams at http://www.bit.ly/PUcvD and http://www.bit.ly/3JEtPb

· …worked like a charm!

· Going on vacation, want to post ruminations from the beach, installed Twitter Tools for WordPress, let’s post a test tweet to my blog…

· Audience member caught up with me, is your system enterprise ready, what do you mean? Handle multiple specialty workflows, absolutely!

· That’s it for ed sessions today. Nw to find a coffee house, get online, and do some work. Thnks fr following my twitter updates this morning

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Bill Blazejowski (Michael Keaton’s character in Night Shift)

“Wanna know why I carry this tape recorder? To tape things. See, I’m an idea man Chuck. I got ideas coming at me all day…I couldn’t even fight them off if I wanted. Wait a second…hold the phone. Hold the phone!

[Speaking into the phone]

Idea to eliminate garbage. Editable paper. You eat it, it’s gone. You eat it, it’s outta here. No more garbage.”