Peer-reviewed publications in the era of social media--JHM 2.0.

Only 20 years ago, science from peer-reviewed journals was still distributed and consumed in the same fashion that evolved from the earliest days of medical science: in print at monthly or weekly intervals. The Internet radically accelerated this paradigm but left the essential processes intact - journals could publish the information and readers could read it more easily but the basic forums for interaction and discussion over the content remained the same. Enter Web 2.0 and the era of social media. Authors, editors, and readers can now interact easily with each other over the content in real time and across great distances. Social media may not have changed the way science is produced and reviewed but it is certainly changing how people consume and use the science. Some have suggested that social media activity around particular articles or journals may be a more important measure of impact than traditional measures of citation1 and others have suggested that Twitter activity in particular has changed both the speed and quality of discussion about new studies within the scientific community.2 In the face of these trends, the Journal of Hospital Medicine has decided to develop a bold strategy for leadership in this emerging area with an initial focus on increasing the Journal's activity and visibility on Twitter. As part of this initial focus, the Journal has successfully developed and implemented a protocol for use by authors to compose 2 Tweets describing their publications: the first announces the paper's publication (ex: “New evidence on white coats and risk for hospital acquired infections”) and the second promotes a key point from the article (ex: “Does the doctors' white coat spread hospital infection?”). These Tweets are encouraged (but not required) from the corresponding author for every article in every edition and the Journal's editorial staff works with individual authors to refine their message and maximize their impact. To help authors, we have developed several tips for effective tweeting (Figure 1). Figure 1 6 Tips for Effective Tweeting for JHM authors Even after just 1 year of this Twitter-focused strategy, we are already seeing noteworthy impact and have several lessons learned: 1) Authors can and will generate tweets for their papers. When we started asking authors to generate tweets for their papers, Twitter was relatively new and we were unsure if authors would be willing and able to participate. Since we started, we have noticed a steady increase in the number of author-generated tweets. Today, more than three-quarters of tweets per issue are author-generated. Anecdotal feedback has been very positive, and authors have expressed interest in the plan for tweeting as well as feedback on how well their tweets were written. If authors or institutions are on Twitter, we also encourage using the Twitter name or “handle” in the tweet, which serves as a way for others on Twitter to identify directly with the author or institution which often results in greater interest in a particular tweet. Of note, authors have no obligation to become regular users of Twitter or engage with followers of JHM's Twitter feed, but many find themselves following the journal's feed more closely (and responding to posts by other authors) once they have joined Twitter and tweeted about their own work via JHM. 2) #hashtags make it happen –Because Twitter is a very large crowd of people with diverse interest, it is important to target tweets to the groups that would be most interested in studies. Use of hashtags make it easy to index tweets. One of the major edits of author-generated tweets that we provide is to index the papers to the most popular hashtags. For example, medical education studies can be indexed under #meded which is a popular hashtag for clinician educators. Other important hashtags for hospitalists include #ptsafety, #readmissions, #healthpolicy, #healthcosts, or #infectiousdisease. To select hashtags, we have found the healthcare hashtag directory maintained by Symplur (http://www.symplur.com/healthcare-hashtags/) to be a helpful resource to figure out what the most popular ways to index tweets are and also to identify hashtags for areas that are less well known to hospitalists, like #histmedicine, which is for history of medicine. 3) High impact studies make a bigger impact on Twitter. For example, we observed a high number of retweets and comments about articles that were the most viewed studies on JHM online, referring to Project BOOST and the SHM Choosing Wisely Campaign. This is not surprising given the national focus on readmissions as well as cost-conscious care. Moreover, our experience is in line with observations that Twitter provides an additional source of page views and article downloads for medical journals3 and research that demonstrates that studies that are tweeted will eventually be cited more.4,5 4) Technology studies are adored by Twitter. Studies and research examining use of mobile health, smartphones, or social media draw a lot of attention on Twitter, particularly from other technophiles in healthcare who often use the #hscm “healthcare social media” hashtag.. Such studies often resonate with Twitter users who tend to be engaged in technology at a high level and interested in how to advance use of technology in the healthcare workplace. JHM's social media strategy has already been very successful in its early implementation; the JHM twitter feed has more than 600 followers. Although most authors submit their own tweets (71/117 or 61% of articles over the last year), JHM has also created social media roles for editors to fill in tweets when missing and ensure timely and consistent output from the JHM feed. We have also started a Facebook page with a rapidly growing number of followers and we continue to see our social media influences scores rise. In the next year we hope to develop a JHM blog with invited commentary as well as a process for unsolicited submissions from our readership. Increasingly, a journal's impact (small `i') is measured not only in the traditional metric of Impact Factor (a representation of the number of papers cited in a given journal publication year), but also by the journal's ability to disseminate knowledge and awareness of issues key to the field. Social media is a major element of the next phase of evidence dissemination, and JHM is pleased to be developing and growing its footprint in the digital world.