Peer‐reviewed publications in the era of social media—JHM 2.0

© 2014 Society of Hospital Medicine

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 citation,[1] 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 (JHM) has decided to develop a bold strategy for leadership in this emerging area, with an initial focus on increasing JHM's activity and visibility on Twitter.

As part of this initial focus, JHM has successfully developed and implemented a protocol for use by authors to compose 2 Tweets describing their publications: the first announces the article's publication (e.g., New evidence on white coats and risk for hospital‐acquired infections), and the second promotes a key point from the article (e.g., Does the doctor's white coat spread hospital infection?). These Tweets are encouraged (but not required) from the corresponding author for every article in every edition, and JHM'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 (Table 1).

Six Tips for Effective Tweeting for Journal of Hospital Medicine Authors
1. Make it short:The limit is 140 characters, but getting retweets requires additional room for others to add their 2 cents, so try to get it under 100 characters.
2. Make it simple: If your tweet includes complex terminology or analytic methods, it is not likely to get picked up. Make it easy to read for the lay public.
3. Make it clear: Your article may have several conclusions, but pick the most newsworthy for the general public. It is usually best to focus on the main finding.
4. Pose a question: Raise interest by piquing the curiosity of potential readers. A good question can motivate readers to click on your article to find the answer.
5. Add a hashtag: Hashtags index tweets on Twitter. It is best to pick 1 or 2 existing tags from the healthcare hashtag project that fit the focus of your article (http://www.symplur.com/healthcare‐hashtags).
6. Build your following: Include your Twitter handle to alert current/prospective followers of your publication.

Even after just 1 year of this Twitter‐focused strategy, we are already seeing noteworthy impact and have learned several lessons.


When we started asking authors to generate tweets for their articles, 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 and 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.


Because Twitter users are a very large crowd of people with diverse interests, it is important to target tweets to the groups that would be most interested in studies. The use of hashtags makes it easy to index tweets. One of the major edits of author‐generated tweets that we provide is to index the articles 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 (Upland, CA; http://www.symplur.com/healthcare‐hashtags) to be a helpful resource for figuring out what the most popular ways to index tweets are and also for identifying hashtags for areas that are less well known to hospitalists, such as #histmedicine, which is for the history of medicine.


We observed a high number of retweets and comments about articles that were the most viewed studies on JHM online, referring to Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) and the Society of Hospital Medicine's 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 journals[3] and research, which demonstrates that studies that are tweeted will eventually be cited more.[4, 5]


Studies and research examining the use of smartphones, apps, or social media in healthcare 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 are interested in how to advance the 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 >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 influence 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.


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