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2/ 14/13 #hpm - Healthcare Soc ial Me dia Transcr i pt hashtags.symplur.com/healthcar e-ha shtag-transc ript.php?hashtag=hpm&fdate =02-13-2013&shour=18&smin=0&t date= 02-13-2013&thour=19&t min=15&ss ec =0… 1/22 #hpm transcript Healthcare Social Media Transcript From: Wed Feb 13 18:00:00 PST 2013 To: Wed Feb 13 19:15:00 PST 2013 change time period Who were the influencers during this time period? #hpm analytics Conne cting the dots in healthcare social media: Healthcare Conference - Tweet Chats - Healthcare Analytics What is #hpm? KnowYourWishes Ditto MT @aliciabloom: for the next hour, i'll be in #hpm chat. so you can expect lots of #hospice & #palliative care tweets from me. Wed F eb 13 18:01:0 7 PST 2013  aliciabloom welcome to #hpm tweetchat! let's get started with some introductions. . . Wed F eb 13 18:01:0 8 PST 2013  hospice_mktg Hi! It 's Emily Barry with Tr anscend Hospice Marketing Group. #hpm Wed F eb 13 18:01:5 6 PST 2013  KnowYourWishes LJ Van Scoy, MD. Pulmona ry/critical care doc. Int erest in EOL i n the ICU. Author of Last Wish-st ories to inspire a pea ceful passing #hpm Wed F eb 13 18:02:3 4 PST 2013  SWChelsea06 Hi @aliciabloom & @KnowYourWishes- This is Che lsea, LISW f rom eFuneral b ack for more @eFuneral #hpm Wed F eb 13 18:02:4 3 PST 2013  Kamiyamay Hpm in motion. Lurking mostly. #hpm Wed F eb 13 18:02:5 1 PST 2013  aliciabloom welcome @hospice_mktg and @knowyourwishes! great t o have yo u both here #hpm Wed F eb 13 18:02:5 2 PST 2013  

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#hpm transcript

Healthcare Social Media Transcript

From: Wed Feb 13 18:00:00 PST 2013

To: Wed Feb 13 19:15:00 PST 2013

change time period 

Who were the influencers during this time period? #hpm analytics

Connecting the dots in healthcare social media: Healthcare Conference - Tweet Chats - Healthcare Analytics

What is #hpm?

KnowYourWishes Ditto MT @aliciabloom: for the next hour, i'll be in #hpm chat. so you can expect lotsof #hospice & #palliative care tweets from me.

Wed Feb 13 18:01:07 PST 2013 

aliciabloomwelcome to #hpm tweetchat! let's get started with some introductions. . .

Wed Feb 13 18:01:08 PST 2013 

hospice_mktg Hi! It's Emily Barry with Transcend Hospice Marketing Group. #hpm

Wed Feb 13 18:01:56 PST 2013 

KnowYourWishes LJ Van Scoy, MD. Pulmonary/critical care doc. Interest in EOL in the ICU. Author ofLast Wish-stories to inspire a peaceful passing #hpm

Wed Feb 13 18:02:34 PST 2013 

SWChelsea06Hi @aliciabloom & @KnowYourWishes- This is Chelsea, LISW from eFuneral backfor more @eFuneral #hpm

Wed Feb 13 18:02:43 PST 2013 

Kamiyamay Hpm in motion. Lurking mostly. #hpm

Wed Feb 13 18:02:51 PST 2013 

aliciabloom welcome @hospice_mktg and @knowyourwishes! great to have you both here #hpm

Wed Feb 13 18:02:52 PST 2013 

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ctsinclair Hello everyone! Will be joining #hpm chat from the air in a little bit. Coughing kidsand screaming babies say hello!

Wed Feb 13 18:03:23 PST 2013 

aliciabloom @Kamiyamay glad to have you lurking, hopefully you can join in a bit! #hpm

Wed Feb 13 18:03:57 PST 2013 

TheBiopsy Roheet here! Lurking at #hpm chat. There seems to be a lot of Twitter chats going ontonight!

Wed Feb 13 18:04:08 PST 2013 

NursSciWatch RT @abbrody: New York Area Hospitals introduce the palliative care bundle, achecklist for identifying and providing care #hpm http://t. ...

Wed Feb 13 18:04:44 PST 2013 

hospice_mktg Hopefully it's not a long flight @ctsinclair ... coughing kids and screaming babies in aconfined space can't be pretty for long! #hpm

Wed Feb 13 18:04:44 PST 2013 

aliciabloom welcome @TheBiopsy! feel free to join in the discussion #hpm

Wed Feb 13 18:04:45 PST 2013 

moyecome RT @hollyby: MT @ScrippsHealth: Discover how Scripps hopes to help@SanDiegoHospice patients and staff... http://t.co/ud4cX1mY. #hpm #ho ...

Wed Feb 13 18:04:47 PST 2013 

KnowYourWishes @TheBiopsy Hi Roheet. Great name for a medical blog! #hpm

Wed Feb 13 18:04:56 PST 2013 

ctsinclair Intro: Christian Sinclair, National Hospice Medical director for Gentiva, frequent flyer.Editor for @Pallimed #hpm

Wed Feb 13 18:05:30 PST 2013 

TheBiopsy @KnowYourWishes Why, thank you! #hpm

Wed Feb 13 18:05:54 PST 2013 

TexasKidDoc Joining today from the cardiology call room. Let's see how long I can last in here...#Hpm

Wed Feb 13 18:05:58 PST 2013 

NursSciWatch RT @DianeEMeier: For Some Caregivers, the Trauma Lingers http://t.co/x3ocr3Jd#palliative #hpm esp. if patient gets care in ICU or hosp ...

Wed Feb 13 18:06:06 PST 2013 

aliciabloom hey @ctsinclair! #hpm

Wed Feb 13 18:06:09 PST 2013 

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ctsinclair Airplane doors are closed. Gotta turn off my phone but will join you soon. See yatweeps. #hpm

Wed Feb 13 18:06:25 PST 2013 

Kamiyamay @aliciabloom safety first. :-) know it will be A great hour. #hpm

Wed Feb 13 18:06:34 PST 2013 

KnowYourWishes@TexasKidDoc Good luck with that!! #hpm

Wed Feb 13 18:06:35 PST 2013 

TexasKidDoc Current pediatric resident going into nicu and #pedpc #Hpm

Wed Feb 13 18:06:46 PST 2013 

aliciabloom @TexasKidDoc hopefully long enough to join us for chat! #hpm

Wed Feb 13 18:06:57 PST 2013 

NursSciWatch RT @nurse2103: Suffering Assessment: A Review of Available Instruments for Use

in Palliative Care http://t.co/r0rquHaS #hpmWed Feb 13 18:07:18 PST 2013 

CSlaterMD Hello there, internist, first time here, really lurking and learning #hpm

Wed Feb 13 18:08:52 PST 2013 

KnowYourWishes @CSlaterMD Welcome! #hpm

Wed Feb 13 18:09:22 PST 2013 

nursefriendly Yes :( but there is also #hpm #dmsa #addictionchat #premeded that started at 9pm :)

#ivchatWed Feb 13 18:09:37 PST 2013 

aliciabloom T1- Dr. @JoanMTeno just published an important study on utilization of hospice.Read a great summary here: http://t.co/V2besrqt #hpm

Wed Feb 13 18:09:50 PST 2013 

TexasKidDoc Wanted to share "hospice!? What good would that do!? That's for when you have 2wks to live!"convo I had recently w/ peeps who get it #Hpm

Wed Feb 13 18:09:59 PST 2013 

aliciabloom @CSlaterMD welcome! great to have you here. please join in the discussion! #hpmWed Feb 13 18:10:14 PST 2013 

marlenatang Hello #hpm. ER doctor from California here

Wed Feb 13 18:10:46 PST 2013 

aliciabloom @marlenatang welcome! glad to have you join us. #hpm

Wed Feb 13 18:11:16 PST 2013 

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nursefriendly Hello Everyone, Andrew Lopez, RN from New Jersey #hpm

Wed Feb 13 18:11:17 PST 2013 

CSlaterMD @KnowYourWishes @aliciabloom TYVM! Already see some friendly faces!@nursefriendly @Kamiyamay #hpm

Wed Feb 13 18:11:29 PST 2013 

aliciabloom T1- give a read to the LA Times summary and share some initial reactions. . . #hpmWed Feb 13 18:11:37 PST 2013 

hospice_mktg The @JoanMTeno study has gotten great coverage. Hopefully it will be a catalyst forchange in #hospice and #eol care. #hpm

Wed Feb 13 18:12:15 PST 2013 

mdTalk Airplane doors are closed. http://t.co/Wwuq2Sa1 Gotta turn off my phone but will joinyou soon. See ya tweeps. #hpm

Wed Feb 13 18:12:55 PST 2013 

MerynFry RT @DianeEMeier: For Some Caregivers, the Trauma Lingers http://t.co/x3ocr3Jd#palliative #hpm esp. if patient gets care in ICU or hosp ...

Wed Feb 13 18:13:23 PST 2013 

nursefriendly T1 Not surprising that many patients endure aggressive therapies in their last days,even though they would prefer otherwise. #hpm

Wed Feb 13 18:13:44 PST 2013 

nursefriendly T1 Have to wonder how many of these #patients have made their wishes known, hadliving wills, #advancedirectives #hpm

Wed Feb 13 18:14:19 PST 2013 

aliciabloom T1- an increase in hospice utilization seems promising, when you see the shorterlengths of stay, it's eye opening #hpm

Wed Feb 13 18:14:37 PST 2013 

hospice_mktg "latest research suggests patients' wishes may not be getting through to familymembers &physicians who help guide patients' eol." #hpm

Wed Feb 13 18:14:42 PST 2013 

TexasKidDoc T2 - very interesting it's not two divergent paths #Hpm

Wed Feb 13 18:14:51 PST 2013 

nursefriendly T1 When #patients #families #caregivers are on the same page, informed of optionsincluding #hospice, #doctors will listen. #hpm

Wed Feb 13 18:14:56 PST 2013 

KnowYourWishes T1 Haven't poured through paper in detail yet but % seems low - 29% die in ICU.Granted i have very biased experience being ICU doc. #hpm

Wed Feb 13 18:15:45 PST 2013 

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hospice_mktg Agree w/ @nursefriendly ... people need to clearly communicate their wishes for careand support early and often #hpm

Wed Feb 13 18:15:51 PST 2013 

nursefriendly T1 The fact the are "Enduring aggressive treatment" indicates a strong need ofeducation, shortcoming with doctors explaining options #hpm

Wed Feb 13 18:16:10 PST 2013 

hospice_mktg RT @nursefriendly: T1 When #patients #families #caregivers are on same pg,informed of options inc #hospice, #doctors will listen. #hpm

Wed Feb 13 18:16:27 PST 2013 

nursefriendly T1 Brings up the question, when is the right time to discuss less aggressivetherapies. Will they be mentioned routinely? #hpm

Wed Feb 13 18:17:00 PST 2013 

AnnoyingTris RT @TexasKidDocT2 - very interesting it's not two divergent paths #Hpmhttp://t.co/WHPNF8jg

Wed Feb 13 18:17:02 PST 2013 

CSlaterMD Is it a HIPAA prob or a communication prob? @hospice_mktg "latest researchsuggests patients' wishes may not be getting thru... #hpm

Wed Feb 13 18:17:10 PST 2013 

aliciabloom T1- hospitals often move patients out of ICU to general medical floors beforeimminent death; may account for low % of deaths there #hpm

Wed Feb 13 18:17:12 PST 2013 

KnowYourWishes T1 "Disruptive moves" interesting measurement. Like it. Would like to know % ofpeople who went from hospice to ER/hospital/ICU. #hpm

Wed Feb 13 18:17:22 PST 2013 

SWChelsea06 A pt today who refused to complete living will and Health Care Power of Attorney-frustrating- kept saying- "They'll know what I want." #hpm

Wed Feb 13 18:17:29 PST 2013 

nursefriendly T1 Has been my experience that #hospice #palliative are almost exclusively offeredin oncology, or at #patient #family request #hpm

Wed Feb 13 18:17:39 PST 2013 

aliciabloom @CSlaterMD I suspect it's a communication problem #hpm

Wed Feb 13 18:17:49 PST 2013 

buendia65 RT @AAHPM: AMA Issues 5 Patient Safety Guidelines http://t.co/bhXCBDxO via@sharethis #hpm

Wed Feb 13 18:17:52 PST 2013 

KnowYourWishes @aliciabloom excellent point #hpm

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Wed Feb 13 18:17:53 PST 2013 

nursefriendly T1 If a #patient #family #caregiver does not bring up #hospice #palliative options,when will it be brought up, will it at all? #hpm

Wed Feb 13 18:18:24 PST 2013 

hospice_mktg A comm problem on many fronts RT @aliciabloom: @CSlaterMD I suspect its acommunication problem #hpm

Wed Feb 13 18:18:31 PST 2013 

CSlaterMD @aliciabloom its true, been a while for me now but used to almost be like real estate,the ICU beds #hpm

Wed Feb 13 18:18:41 PST 2013 

KnowYourWishes Agree. in my experience HIPPA less of issue in #eol realm RT @aliciabloom:@CSlaterMD I suspect it's a communication problem #hpm

Wed Feb 13 18:19:21 PST 2013 

nursefriendly @SWChelsea06 Can see how #patients would not want to approach it in a crisis,

must be done long before, but isn't usually. #hpmWed Feb 13 18:19:29 PST 2013 

PracticalWisdom Patients wishes not be honored: Discussed #greatchallenges http://t.co/EeeAgVfK@TEDMED @CSlaterMD @hospice_mktg #HPM

Wed Feb 13 18:20:05 PST 2013 

hospice_mktg Patients and families need to know they have a choice when it comes to #hospice,#palliative care. They can choose even if doc hasn't #hpm

Wed Feb 13 18:20:12 PST 2013 

ReginaHolliday RT @PracticalWisdom: Patients wishes not be honored: Discussed#greatchallenges http://t.co/EeeAgVfK @TEDMED @CSlaterMD @hospice_mktg#HPM

Wed Feb 13 18:20:55 PST 2013 

CSlaterMD @PracticalWisdom @TEDMED @hospice_mktg Lisa, TY. amazing u are. #hpm

Wed Feb 13 18:21:17 PST 2013 

hospice_mktg Even if patients have shared their wishes, families many not agree and followthrough #hpm

Wed Feb 13 18:21:18 PST 2013 

aliciabloom T1- i think we're often quick to blame clinicians for not starting the conversations, butwe need families to be receptive #hpm

Wed Feb 13 18:21:19 PST 2013 

ReginaHolliday @nursefriendly @SWChelsea06 I was just on @MyDirectives today updating mine :)#hpm

Wed Feb 13 18:21:41 PST 2013 

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KnowYourWishes TRIPLE RT @aliciabloom: T1- we're often quick to blame clinicians for not startingthe conversations, need families to be receptive #hpm

Wed Feb 13 18:22:17 PST 2013 

ReginaHolliday @aliciabloom the problem is a default assumption that we don't want to talk. #hpm

Wed Feb 13 18:22:18 PST 2013 

KnowYourWishesT1 Clinicians afraid to 'upset' patient perhaps reason for avoidance #hpm

Wed Feb 13 18:22:48 PST 2013 

SWChelsea06 @ReginaHolliday @nursefriendly @MyDirectives Great Resource! I've never seenthat #hpm

Wed Feb 13 18:22:48 PST 2013 

nursefriendly @ReginaHolliday Hello Regina :) It is not a topic people like to think about, muchless do something about. #hpm

Wed Feb 13 18:22:51 PST 2013 

nursefriendly See that every day :( RT @hospice_mktg: Even if patients have shared their wishes,families many not agree and follow through #hpm

Wed Feb 13 18:23:24 PST 2013 

ReginaHolliday @hospice_mktg hence why you need a strong advocate and a clear directive, andsupportive provider if possible. #hpm

Wed Feb 13 18:23:24 PST 2013 

hospice_mktg RT @KnowYourWishes: T1 Clinicians afraid to upset patient perhaps reason foravoidance / also don't want to give up pt's hope #hpm

Wed Feb 13 18:23:36 PST 2013 

aliciabloom @ReginaHolliday don't think that's always a barrier. as a palliative care clinician, ican say that many stop conversation as it starts #hpm

Wed Feb 13 18:23:42 PST 2013 

CSlaterMD @ReginaHolliday @aliciabloom HC is still one directional. need to dissolve thesilence and start talking about it. guilty as charged #hpm

Wed Feb 13 18:23:49 PST 2013 

PracticalWisdom Is it too late to jump in? I'm working but saw this important topic. #HPM

Wed Feb 13 18:23:52 PST 2013 

PracticalWisdom RT @ReginaHolliday: @hospice_mktg hence why you need a strong advocate anda clear directive, and supportive provider if possible. #HPM

Wed Feb 13 18:24:01 PST 2013 

aliciabloom T1- there are many reasons the conversations don't happen, but patients/familiesneed to be empowered to speak up! #hpm

Wed Feb 13 18:24:33 PST 2013 

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aliciabloom @PracticalWisdom no, it's never too late. we're discussing Joan Teno's newlypublished study. #hpm

Wed Feb 13 18:24:55 PST 2013 

nursefriendly Many are gunshy yes. RT @KnowYourWishes: T1 Clinicians afraid to upset patientperhaps reason for avoidance #hpm

Wed Feb 13 18:25:11 PST 2013 

thanec RT @abbrody: New York Area Hospitals introduce the palliative care bundle, achecklist for identifying and providing care #hpm http://t. ...

Wed Feb 13 18:25:21 PST 2013 

ReginaHolliday @SWChelsea06 @nursefriendly @MyDirectives is really cool! Emails your careteam :) Great for folks like me with no spouse. #hpm

Wed Feb 13 18:25:26 PST 2013 

Sarah_Hewko RT @abbrody: New York Area Hospitals introduce the palliative care bundle, achecklist for identifying and providing care #hpm http://t. ...

Wed Feb 13 18:26:15 PST 2013 

KnowYourWishes Fam needs 2 b open, trusting of clinicians' http://t.co/GqBnnwsO ICU, often met wsuspicion, anger (from grief) which makes convos hard #hpm

Wed Feb 13 18:26:29 PST 2013 

nursefriendly @aliciabloom T1 Where are families supposed to learn about #palliative #hospiceas options is their providers don't every bring up? #hpm

Wed Feb 13 18:26:41 PST 2013 

ReginaHolliday @aliciabloom I am not talking case by case, but a cul tural presumption Re: LettingGo/ Atul Gawande #hpm

Wed Feb 13 18:27:11 PST 2013 

aliciabloom @nursefriendly it's not about asking for those things specifically, but it's asking aboutoptions & speaking up re: values/preferences #hpm

Wed Feb 13 18:27:29 PST 2013 

nursefriendly @ReginaHolliday Never heard of it before @mydirectives will need to check it out :)#hpm

Wed Feb 13 18:27:31 PST 2013 

PracticalWisdom @aliciabloom Dr. Joan Teno http://t.co/JnSQswZ0 is gives practical insight in the@TEDMED @YOUTube #HPM

Wed Feb 13 18:27:43 PST 2013 

ctsinclair RT @aliciabloom: T1- were often quick to blame clinicians for not starting theconversations, need families to be receptive #hpm

Wed Feb 13 18:27:57 PST 2013 

aliciabloom @ReginaHolliday i'm very familiar & agree there are some larger cultural issues, but

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at the end of the day it is the case by case #hpm

Wed Feb 13 18:28:11 PST 2013 

ctsinclair Can someone RT the first topic? #hpm

Wed Feb 13 18:28:13 PST 2013 

TexasKidDoc It's even nice while it lasted - have an admission to do! Enjoy the rest of the chatguys! #Hpm

Wed Feb 13 18:28:20 PST 2013 

nursefriendly @aliciabloom T1 Doctors are already notorious about not explaining all options forsurgery, treatments, can't see many including EOL #hpm

Wed Feb 13 18:29:06 PST 2013 

PracticalWisdom T1: Dr. Joan Teno Quote "If you don't make a plan you've made a Decision."http://t.co/EeeAgVfK #HPM

Wed Feb 13 18:29:36 PST 2013 

aliciabloom@nursefriendly it's not just about EoL though, and we've got to stop making just

about that. it's much bigger than that. #hpmWed Feb 13 18:29:50 PST 2013 

hospice_mktg @nursefriendly @aliciabloom Hopefully local hospices are educating theircommunities, phys and referrers about hospice care, svs avail #hpm

Wed Feb 13 18:29:55 PST 2013 

aliciabloom @ctsinclair we're talking about Joan Teno's recently published study. i sent a link toan LA Times summary. #hpm

Wed Feb 13 18:30:11 PST 2013 

nursefriendly @aliciabloom Elaborate please . . . #hpm

Wed Feb 13 18:31:04 PST 2013 

marlenatang @KnowYourWishes Yes, and in the ER, shock and disbelief of the whole situation#hpm

Wed Feb 13 18:31:13 PST 2013 

ctsinclair T1: In an era of more patient empowerment, there is usually a bias towards askingabout what more can be done, not about should we act #hpm

Wed Feb 13 18:31:22 PST 2013 

KnowYourWishes T1 Studies show pts prefer to talk about #eol and ADs in attorneys office. Pts do NOTwant to talk about it w/ docs (wish i had cite) #hpm

Wed Feb 13 18:31:32 PST 2013 

ctsinclair What surprised me is that 40% of patients 30 days before death had no homeservices. #hpm

Wed Feb 13 18:31:51 PST 2013 

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nursefriendly @hospice_mktg You would like to think so, yet how many doctor seek outinformation on #hospice #palliative care, CEUs? #hpm

Wed Feb 13 18:32:10 PST 2013 

ctsinclair T1: I would imagine there would be patient and family needs that could beaddressed during that time. #hpm

Wed Feb 13 18:32:16 PST 2013 

PracticalWisdomT1: "If you don't make that plan you will see aggressive Life Sustaining Treatment."Dr. Joan Teno Quote http://t.co/EeeAgVfK #HPM

Wed Feb 13 18:33:04 PST 2013 

CSlaterMD but what plan arises from that "decision?" @PracticalWisdom T1: Dr. Joan TenoQuote "If you don't make a plan you've made a Decision" #hpm

Wed Feb 13 18:33:05 PST 2013 

aliciabloom @nursefriendly it's not just about getting people to hospice. more people areenrolling, but late. need discussions WAY upstream. #hpm

Wed Feb 13 18:33:09 PST 2013 

aliciabloom RT @ctsinclair: What surprised me is that 40% of patients 30 days before death hadno home services. #hpm

Wed Feb 13 18:33:24 PST 2013 

KnowYourWishes @CSlaterMD @PracticalWisdom Full, aggressive intervention is the "no decision"decision #hpm

Wed Feb 13 18:33:42 PST 2013 

aliciabloom T1- i believe people are not accessing as much routine health care. coming to thehospital much sicker, creating challenging situations #hpm

Wed Feb 13 18:34:11 PST 2013 

nursefriendly @aliciabloom Agreed, #hospice #palliative care options need to be introduced intothe discussion long before need arises. #hpm

Wed Feb 13 18:34:37 PST 2013 

CSlaterMD @KnowYourWishes Got it , thanks. no plan sets full press in motion #hpm

Wed Feb 13 18:34:49 PST 2013 

hospice_mktg RT @aliciabloom: @nursefriendly not just abt getting ppl to hospice. more ppl areenrolling, but late. need discussions WAY upstream. #hpm

Wed Feb 13 18:34:52 PST 2013 

ctsinclair FYI Dr. Joan Teno is on Twitter @JoanMTeno #hpm

Wed Feb 13 18:34:56 PST 2013 

KnowYourWishes T1 lost my follow up tweet to my attorneys office tweet-- but essentially, need to moveconvo out of attorney office #hpm

Wed Feb 13 18:35:05 PST 2013 

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Kamiyamay @KnowYourWishes u R right. Seen some bad outcomes. How do we make better#hpm

Wed Feb 13 18:35:10 PST 2013 

chadreilly Very true! @aliciabloom MT: it's not just about EoL though, and we've got to stopmaking just about that. it's much bigger than that. #hpm

Wed Feb 13 18:35:17 PST 2013 

aliciabloom @nursefriendly we shouldn't be talking about it that way. we should be talking aboutdisease trajectory, QoL, values & preferences. #hpm

Wed Feb 13 18:35:28 PST 2013 

KnowYourWishes @Kamiyamay Conversations outside of emergency setting is only way to give TIMEfor the decisions to be made thoughtfully #hpm

Wed Feb 13 18:35:48 PST 2013 

aliciabloom T1- advance directive conversations do NOT belong in an attorney's office. icompletely agree, @knowyourwishes. #hpm

Wed Feb 13 18:36:01 PST 2013 

ctsinclair RT @KnowYourWishes Full, aggressive intervention is the "no decision" decision#hpm "The default of the system" #hpm

Wed Feb 13 18:36:12 PST 2013 

Kamiyamay RT @chadreilly: Very true! @aliciabloom MT: not just about EoL weve got to stopmaking just about that. its much bigger than that. #hpm

Wed Feb 13 18:36:15 PST 2013 

chadreilly RT @ctsinclair: What surprised me is that 40% of patients 30 days before death had

no home services. #hpmWed Feb 13 18:36:20 PST 2013 

ReginaHolliday RT @aliciabloom: T1- advance directive conversations do NOT belong in anattorney's office. i completely agree, @knowyourwishes. #hpm

Wed Feb 13 18:36:39 PST 2013 

hospice_mktg Yes, need to be talking about goals of care, QoL ... that's a good way to begin theconvo #hpm

Wed Feb 13 18:36:43 PST 2013 

aliciabloom T1- we need to have realistic conversations about disease trajectory from time ofdiagnosis & then routinely to inform decision making #hpm

Wed Feb 13 18:36:53 PST 2013 

ctsinclair RT @aliciabloom: we should be talking about disease trajectory, QoL, values &preferences. "Much more empowering, validating" #hpm

Wed Feb 13 18:36:58 PST 2013 

RT @ctsinclair: RT @KnowYourWishes Full, aggressive intervention is the "no

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ReginaHolliday decision" decision #hpm "The default of the system" #hpm

Wed Feb 13 18:37:09 PST 2013 

KnowYourWishes Outcome based discussions RT @hospice_mktg: Yes, need to be talking aboutgoals of care, QoL ... that's a good way to begin the convo #hpm

Wed Feb 13 18:37:12 PST 2013 

Kamiyamay@KnowYourWishes UR right. I have been called to too many extinctions on wkd. Notgood way at all #hpm

Wed Feb 13 18:37:33 PST 2013 

KnowYourWishes Need to incorporate outcomes of tx, duration and meaningful quality of life #hpm

Wed Feb 13 18:37:45 PST 2013 

Kamiyamay Yikes extubations. RT @Kamiyamay: @KnowYourWishes UR right. I have beencalled to too many extinctions on wkd. Not good way at all #hpm

Wed Feb 13 18:38:23 PST 2013 

marlenatang @ctsinclair The system also makes it hard to send a patient home from ED with sameday hospice services rather than admit. #hpm

Wed Feb 13 18:38:38 PST 2013 

aliciabloom @ctsinclair i think it's more empowering. patients & families feel like they're in controlof their lives, not just making hard choices #hpm

Wed Feb 13 18:39:11 PST 2013 

CSlaterMD @Kamiyamay was wondering what u meant! :-) #hpm

Wed Feb 13 18:39:16 PST 2013 

nathangradisher Dr Sinclair-- Thank you for the fyi “@ctsinclair: FYI Dr. Joan Teno is on Twitter@JoanMTeno #hpm”

Wed Feb 13 18:39:21 PST 2013 

KnowYourWishes YES. ER needs resources RT @marlenatang: @ctsinclair hard 2 send a pt homefrom ED with same day hospice services rather than admit. #hpm

Wed Feb 13 18:39:34 PST 2013 

PracticalWisdom T1:@JAMA=Dr.Teno http://t.co/yItLhxlXConcern:Both ICU use &% HC transitions+last month of life. #HPm

Wed Feb 13 18:39:40 PST 2013 

marlenatang @ctsinclair once admitted, ball starts rolling if no inpt PC service. Often left with admitas default for pts with few resources #hpm

Wed Feb 13 18:39:46 PST 2013 

Kamiyamay @ReginaHolliday we need a new default a better way. Early advocacy! #hpm

Wed Feb 13 18:39:48 PST 2013 

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aliciabloom i think we need more stories like this out there: http://t.co/DwqGGf9V #hpm

Wed Feb 13 18:40:04 PST 2013 

ReginaHolliday @aliciabloom saw a great presentation by med. director at our hospice ondementiaas infancy in reverse #hpm non clinical folks need a guide

Wed Feb 13 18:40:11 PST 2013 

ctsinclair I really like the page near the end of Caring Conversations (@PracBioethics) about

trajectories: http://t.co/ZMORJuyB #hpmWed Feb 13 18:40:15 PST 2013 

Kamiyamay @CSlaterMD using phone :-) #hpm

Wed Feb 13 18:40:19 PST 2013 

ctsinclair @marlenatang Agree that hospice admission from the ED is tough, but notimpossible with good collaboration between orgs. #hpm

Wed Feb 13 18:40:41 PST 2013 

ReginaHolliday RT @Kamiyamay: @ReginaHolliday we need a new default a better way. Earlyadvocacy! #hpm

Wed Feb 13 18:40:41 PST 2013 

KnowYourWishes RT @aliciabloom: i think we need more stories like this out there:http://t.co/DwqGGf9V #hpm

Wed Feb 13 18:40:43 PST 2013 

CSlaterMD agree! RT @Kamiyamay: @ReginaHolliday we need a new default a better way.Early advocacy! #hpm

Wed Feb 13 18:40:50 PST 2013 

chadreilly Yes! Care decisions are fluid, not a constant “@aliciabloom: T1- we need to haverealistic conversations about disease trajectory... #hpm

Wed Feb 13 18:41:04 PST 2013 

hospice_mktg YES! RT @aliciabloom: i think we need more stories like this out there:http://t.co/bvqoExsY #hpm

Wed Feb 13 18:41:04 PST 2013 

aliciabloom @KnowYourWishes @marlenatang if you can find a good #hospice partner in thecommunity, then d/c home w/ services from ED are possible #hpm

Wed Feb 13 18:41:12 PST 2013 

PracticalWisdom T1: Dr. Teno shared that Hospitals are Very complex Places when you are very Sickhard to advocate for yourself. Need An Advocate. #HPm

Wed Feb 13 18:41:21 PST 2013 

ctsinclair @marlenatang Agree, the default for a sick patient in the ED is 'admit & treat' or'Admit & observe' #hpm

Wed Feb 13 18:41:45 PST 2013 

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KnowYourWishes Only if ER docs willing MT @aliciabloom: @marlenatang if can find a good partner incommunity, then d/c home w/ services from ED possib #hpm

Wed Feb 13 18:42:23 PST 2013 

napernurse RT @PracticalWisdom: Patients wishes not be honored: Discussed#greatchallenges http://t.co/EeeAgVfK @TEDMED @CSlaterMD @hospice_mktg#HPM

Wed Feb 13 18:42:49 PST 2013 

Kamiyamay @PracticalWisdom so true Lisa. Once very ill I asked sign advance directives. Lghospital. 6 hrs later said none avail to discuss #hpm

Wed Feb 13 18:42:50 PST 2013 

ctsinclair RT @PracticalWisdom: T1: @JoanMTeno shared 'Hospitals are complex placeswhen sick; hard to advocate for yourself. Need an advocate.' #hpm

Wed Feb 13 18:42:56 PST 2013 

ReginaHolliday @PracticalWisdom Hospitals are a very scary rollercoaster when you are dying.#hpm

Wed Feb 13 18:43:02 PST 2013 

RHR_Chat T1 @PracticalWisdom Issue whether hospital advocate is really there for riskmanagement. IMHO, need impartial advocate (maybe family) #HPM

Wed Feb 13 18:43:06 PST 2013 

aliciabloom T1- i'd like to spend the rest of chat talking about another news story today, so pleaseshare any final thoughts. . . #hpm

Wed Feb 13 18:43:41 PST 2013 

ctsinclair RT @ReginaHolliday: Hospitals are a very scary rollercoaster when you are dying"And a new culture that can intimidate the uninitiated" #hpm

Wed Feb 13 18:44:04 PST 2013 

Kamiyamay @ReginaHolliday dschg from ER and icu. Been there. Those ER docs luv to seehpm nurse come in. #hpm

Wed Feb 13 18:44:06 PST 2013 

Kamiyamay @RHR_Chat studying that. Takin coursework. #hpm

Wed Feb 13 18:44:40 PST 2013 

PracticalWisdom Dr. Teno "It's really important 4 you ask your Health care Providers to help you makea plan on how your Wishes are to be honored." #HPm

Wed Feb 13 18:45:33 PST 2013 

ctsinclair T1: Would love to see anthropological documentaries on hospitals to help patientsand families understand medical culture #hpm

Wed Feb 13 18:46:00 PST 2013 

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PracticalWisdom Agree. That's why HP & Proxy can help RT @ReginaHolliday: @PracticalWisdomHospitals are a very scary rollercoaster when you are dying. #HPm

Wed Feb 13 18:46:21 PST 2013 

MDelaCalzada MT @ScrippsHealth Discover how Scripps hopes 2 help @SanDiegoHospicepts/staff, following Hospice's intent 2 close http://t.co/FSQOYo0i  #hpm

Wed Feb 13 18:46:27 PST 2013 

Amer_Acad_PedsRT @nursefriendly: Wednesday #Healthcare #Tweetchats (ET) 8p #IVchat 9p#Premeded #HPM #DSMA #AddictionChat #DPTStudent #nurseup #rnchat ...

Wed Feb 13 18:46:39 PST 2013 

SWChelsea06 @PracticalWisdom I agree- I think that Living Will and Power of Attorney forms arefull of jargon and confusing #hpm

Wed Feb 13 18:46:58 PST 2013 

aliciabloom @PracticalWisdom even more than that, important patients talk WITH family abouttheir wishes. ul timately, family must carry them out. #hpm

Wed Feb 13 18:47:04 PST 2013 

Kamiyamay @PracticalWisdom excellent. Must make sure all have documentation. That hospitaletc have documented. Important as knowing allergies. #hpm

Wed Feb 13 18:47:22 PST 2013 

Kamiyamay MT @aliciabloom: @PracticalWisdom even more than that, important patients talkWITH family about wishes. family must carry them out. #hpm

Wed Feb 13 18:48:01 PST 2013 

PracticalWisdom I didn't say MT @SWChelsea06: @PracticalWisdom I think that Living WillPower ofAttorney forms are full of jargon and confusing #HPm

Wed Feb 13 18:48:23 PST 2013 

aliciabloom T2- i'd like to spend the last few minutes of chat talking about a sad story that hit thenews today. . . #hpm

Wed Feb 13 18:48:25 PST 2013 

Kathy_Brandt #hpm need people to name a surrogate not focus on living will. Join #speak4mehttp://t.co/46PWo3JT

Wed Feb 13 18:49:27 PST 2013 

SWChelsea06@aliciabloom I encourage my patients and families to give out several copies of theirdirectives http://t.co/cFO9AYQp #hpm

Wed Feb 13 18:49:44 PST 2013 

CSlaterMD @ctsinclair fascinating idea. an anthropologic study of the culture of the hospital.Truly is a microcosm. would shed crazy insight #hpm

Wed Feb 13 18:49:58 PST 2013 

KnowYourWishes 100% agree RT @Kathy_Brandt: #hpm need people to name a surrogate not focuson living will. Join #speak4me http://t.co/3rBuAbdn

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Wed Feb 13 18:50:00 PST 2013 

ctsinclair Types of Adv Dir simplified: Living Will=Strong suggestions; Power ofAttorney=Decision maker; DNR&POLST=Physician Order #hpm

Wed Feb 13 18:50:09 PST 2013 

aliciabloom T2- today we learned that SanDiego Hospice is closing, as they fell victim toMedicare audit. News story here: http://t.co/C5kR7oyv #hpm

Wed Feb 13 18:50:27 PST 2013 

RHR_Chat TY for info Kathy RT @Kathy_Brandt #hpm need people to name a surrogate notfocus on living will. Join#speak4me http://t.co/zH7PrjC0

Wed Feb 13 18:50:30 PST 2013 

hospice_mktg Very sad news today about @sandiegohospice #hpm

Wed Feb 13 18:50:35 PST 2013 

KnowYourWishes Living will and advance directive not useful in isolation. Need surrogate whounderstands what was meant by it. #hpm

Wed Feb 13 18:50:49 PST 2013 

PracticalWisdom Alicia, @SandiegoHopsice News. This is terribly Sad. I know so many of us Holdthem in High Regard. @aliciabloom #HPm

Wed Feb 13 18:51:04 PST 2013 

aliciabloom @ctsinclair well done in less than 140 characters! #hpm

Wed Feb 13 18:51:12 PST 2013 

ctsinclair @CSlaterMD would need it to be easily translated into helping patients and families

understand, not just academic understanding. #hpmWed Feb 13 18:51:17 PST 2013 

Kathy_Brandt #hpm who will be @TEDMED? @NHDD is the same week. Let's plan some activitiesto get people talking about #acp #speak4me

Wed Feb 13 18:51:28 PST 2013 

Kamiyamay T2 when I read earlier today it evoked a strong emotion. Both mine and pts tweeting.#hpm

Wed Feb 13 18:51:31 PST 2013 

NCHomeCareTim RT @Kathy_Brandt: #hpm who will be @TEDMED? @NHDD is the same week. Let'splan some activities to get people talking about #acp #speak4me

Wed Feb 13 18:51:51 PST 2013 

ctsinclair T2: I am very saddened to hear about SD Hospice closing. For those who don't knowSDH is one of USA's premiere hospices #hpm

Wed Feb 13 18:51:56 PST 2013 

CSlaterMD @ctsinclair yes, I imagine prime time viewers not grand rounds :) #hpm

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Wed Feb 13 18:52:05 PST 2013 

AHHCNC RT @Kathy_Brandt: #hpm who will be @TEDMED? @NHDD is the same week. Let'splan some activities to get people talking about #acp #speak4me

Wed Feb 13 18:52:05 PST 2013 

PracticalWisdom RT @ctsinclair: T2: I am very saddened to hear about SD Hospice closing. For thosewho dont know SDH is one of USAs premiere hospices #HPm

Wed Feb 13 18:52:20 PST 2013 

ctsinclair I had my first #hospice experience at @ SDHospice. A lot of great leaders in thehospice field have trained there. Great teachers #hpm

Wed Feb 13 18:52:35 PST 2013 

RHR_Chat RT @Kathy_Brandt: #hpm who will be @TEDMED? @NHDD is the same week. Let'splan some activities to get people talking about #acp #speak4me

Wed Feb 13 18:52:48 PST 2013 

Kathy_Brandt “@KnowYourWishes: Need surrogate who understands what was meant by it. #hpm”

Absolutely! #speak4meWed Feb 13 18:52:49 PST 2013 

CSlaterMD RT @ctsinclair: T2: I am very saddened to hear about SD Hospice closing. For thosewho dont know SDH is one of USAs premiere hospices #hpm

Wed Feb 13 18:52:51 PST 2013 

PracticalWisdom Agree @sandiegohospice Best Practice~Creative~Great Blog~Great Social MediaExample for #HCSM. @ctsinclair #HPm

Wed Feb 13 18:53:36 PST 2013 

ctsinclair SD Hospice (like other hospices) was hit hard by Medicare fines. Complex issues,but really needs long form discussion. #hpm

Wed Feb 13 18:54:21 PST 2013 

KnowYourWishes @Kathy_Brandt Here is resource i created to help POAs understand how to interpretAdvance directives #hpm http://t.co/bZ2hmNgO

Wed Feb 13 18:54:22 PST 2013 

ctsinclair @PracticalWisdom Yes SD Hospice has been a pioneer in health care social mediafor hospice. #hpm

Wed Feb 13 18:54:55 PST 2013 

aliciabloom T2- i think what happened to San Diego Hospice could happen to any hospiceprovider in the US. #hpm

Wed Feb 13 18:56:02 PST 2013 

RHR_Chat @RHR_Chat: @PracticalWisdom Realistically, where do patients go? Home? Whowill be with them? @ctsinclair #hpm

Wed Feb 13 18:56:24 PST 2013 

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PracticalWisdom So are there Trainings/Conferences to learn more about Lessons learned Re:@SanDiegoHospice ? @ctsinclair #HPm

Wed Feb 13 18:56:31 PST 2013 

ctsinclair RT @PracticalWisdom: @sandiegohospice Best Practice~Creative~GreatBlog~Great Social Media Example for #HCSM #hpm

Wed Feb 13 18:56:33 PST 2013 

aliciabloom T2- the every changing and increasingly strict Medicare regulations around thehospice benefit present challenges #hpm

Wed Feb 13 18:56:44 PST 2013 

HeartHouseHosp RT @KnowYourWishes: @Kathy_Brandt Here is resource i created to help POAsunderstand how to interpret Advance directives #hpm http://t.c ...

Wed Feb 13 18:56:46 PST 2013 

RHR_Chat @RHR_Chat: @ctsinclair Where do we think most ppl get info? Forms fromhospitals? http://t.co/hoyUk3pk? #hpm

Wed Feb 13 18:56:52 PST 2013 

Kathy_Brandt IOM Committee EOL 1st mtg is next week. http://t.co/BADLkXUx #hospice #HPM whois going/testifying?

Wed Feb 13 18:57:09 PST 2013 

RHR_Chat @RHR_Chat: @aliciabloomVery true, ALicia. But hard topic to bring up@PracticalWisdom #hpm

Wed Feb 13 18:57:14 PST 2013 

Kamiyamay @ctsinclair I hope as we move forward good balances injustice. Many losing care or

lots of shuffling. Lessons for all #hpmWed Feb 13 18:57:32 PST 2013 

ctsinclair @Kathy_Brandt Would love for you to join in Tweet chat #hpm

Wed Feb 13 18:57:49 PST 2013 

PracticalWisdom Thank you. RT @Kathy_Brandt: IOM Committee EOL 1st mtg is next week.http://t.co/uWmw5lzs #hospice #HPM who is going/testifying? #HPm

Wed Feb 13 18:57:49 PST 2013 

ctsinclair@RHR_Chat Good question. I'm not sure. #hpm

Wed Feb 13 18:58:11 PST 2013 

RHR_Chat @RHR_Chat: @PracticalWisdom We all know best to make "wishes" when not verysick in hospital #hpm

Wed Feb 13 18:58:17 PST 2013 

Kathy_Brandt “@ctsinclair: @Kathy_Brandt Would love for you to join in Tweet chat #hpm” I listenmore than join. Tonight just jumped in. Sorry!

Wed Feb 13 18:58:35 PST 2013 

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ctsinclair @Kamiyamay @aliciabloom I imagine this will spark a lot of discussion of theMedicare Hospice Benefit and prognostic guidelines #hpm

Wed Feb 13 18:58:38 PST 2013 

aliciabloom @Kathy_Brandt we'd love to have you join in. . .anytime! #hpm

Wed Feb 13 18:59:12 PST 2013 

RHR_Chat @RHR_Chat: @Kamiyamay Cool. Let me know what you decide/learn #hpm

Wed Feb 13 18:59:13 PST 2013 

ctsinclair @Kamiyamay I'm hopeful that all the patients and staff can find a p lace to be safe.#hpm

Wed Feb 13 18:59:20 PST 2013 

PracticalWisdom Kathy were you talking about the #greatchallenges @TEDMED End of LifeDiscussion? @Kathy_Brandt #HPm

Wed Feb 13 18:59:29 PST 2013 

ctsinclair @Kathy_Brandt You are always welcome! #hpm

Wed Feb 13 18:59:36 PST 2013 

aliciabloom @ctsinclair i think that's needed, but i also think we have to be careful not to make itharder for patients to access the care. #hpm

Wed Feb 13 18:59:55 PST 2013 

RHR_Chat @PracticalWisdom We all know best to make "wishes" when not very sick in hospi tal#hpm

Wed Feb 13 18:59:58 PST 2013 

Kamiyamay @ctsinclair fun y wAs talking wi th an cc gaps surveyor about when chat started.Wishing best 4 all #hpm

Wed Feb 13 19:00:24 PST 2013 

PracticalWisdom Kathy or were you talking about http://t.co/3nkrINWm Day @Kathy_Brandt #HPm

Wed Feb 13 19:00:33 PST 2013 

PracticalWisdom Also Changes as our Health Changes too. RT@ RHR_Chat @PracticalWisdom Weall know best to make "wishes" when not very sick in hospi tal #HPm

Wed Feb 13 19:01:14 PST 2013 

RHR_Chat @PracticalWisdom Realistically, where do patients go? Home? Who will be withthem? @ctsinclair #hpm

Wed Feb 13 19:01:14 PST 2013 

Kamiyamay RT @Kamiyamay: @ctsinclair fun y wAs talking wi th an cc gaps surveyor about whenchat started. Wishing best 4 all Sorry CHAPS #hpm

Wed Feb 13 19:01:34 PST 2013 

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ctsinclair @RHR_Chat They will be offered choices of other hospices in the area. #hpm

Wed Feb 13 19:01:54 PST 2013 

PracticalWisdom EXCELLENT Chat. Thank you for our Topic, Folks who jumped in, Flexibility, ETC.@aliciabloom #HPm

Wed Feb 13 19:01:57 PST 2013 

RHR_Chat @Kamiyamay Cool. Let me know what you decide/learn #hpmWed Feb 13 19:02:16 PST 2013 

aliciabloom the hour has flown by & it was a lively discussion! thank you all for participating.please share final thoughts & join us next week. #hpm

Wed Feb 13 19:02:29 PST 2013 

Kamiyamay @RHR_Chat tough question. Will more faith based communities become involved?#hpm

Wed Feb 13 19:02:29 PST 2013 

PracticalWisdom Thank you Christian RT @PracticalWisdom: EXCELLENT Chat. Thank you for ourTopic, Folks who jumped in, Flexibility, ETC. @aliciabloom #HPm

Wed Feb 13 19:02:30 PST 2013 

ctsinclair RT @aliciabloom: we have to be careful not to make it harder for patients to accessthe care. "Yes, and receive full benefit" #hpm

Wed Feb 13 19:02:49 PST 2013 

RHR_Chat @ctsinclair I'd like to see too #hpm

Wed Feb 13 19:03:15 PST 2013 

Kamiyamay @RHR_Chat got it. Sorry typos all. I am a keyboard person. Flexing my mobi lemuscle :-) #hpm

Wed Feb 13 19:03:24 PST 2013 

ctsinclair RT @Kamiyamay: @RHR_Chat tough question. Will more faith based communitiesbecome involved? "Potentially, but that is safetynet" #hpm

Wed Feb 13 19:03:27 PST 2013 

PracticalWisdom Hey you Guys lets give a hand to Alicia. It's not easy to Moderate a Tweet Chat.Takes Time, Talent & Skill! @aliciabloom #HPm

Wed Feb 13 19:03:42 PST 2013 

aliciabloom @RHR_Chat they may go home, if appropriate, with another hospice service or betransferred to another inpatient hospice setting. #hpm

Wed Feb 13 19:03:59 PST 2013 

ctsinclair @aliciabloom Great job hosting tonight! Good conversation. I had my plane matetake a picture of my doing tweetchat from the plane. #hpm

Wed Feb 13 19:04:04 PST 2013 

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hashtags.symplur.com/healthcare-ha shtag-transcript.php?hashtag=hpm&fdate=02-13-2013&shour=18&smin=0&tdate=02-13-2013&thour=19&tmin=15&ssec=… 2

aliciabloom @PracticalWisdom thanks, Lisa #hpm

Wed Feb 13 19:04:40 PST 2013 

ctsinclair @Kamiyamay I just like to think it of as chicken scratch doctor handwriting.Eventually I can figure it out! #hpm

Wed Feb 13 19:04:40 PST 2013 

KnowYourWishes Goodnight #hpm. Been lurking the last few min. Great convo. Thanks @aliciabloom!#hpm

Wed Feb 13 19:04:42 PST 2013 

CSlaterMD @aliciabloom ty for discussion. learned a lot. thanks for sharing #hpm

Wed Feb 13 19:04:47 PST 2013 

PracticalWisdom MT @ctsinclair: I had 1st #hospice experience @SandiegoHospice # great leadersin the hospice field have trained there. Great teachers #HPm

Wed Feb 13 19:05:03 PST 2013 

Kamiyamay RT @ctsinclair: @aliciabloom Great job hosting tonight! Good conversation.(Applause) tough topics good convo #hpm

Wed Feb 13 19:05:05 PST 2013 

aliciabloom @ctsinclair awesome! we should chronicle all the places we participate from #hpm

Wed Feb 13 19:05:14 PST 2013 

ctsinclair @aliciabloom they have 400-500 patients on service, mostly at home, since theyclosed their inpatient unit #hpm

Wed Feb 13 19:05:26 PST 2013 

RHR_Chat @ctsinclair @kamiyamay And California is very unfriendly in #hc system lately. Ielack of docs #hpm

Wed Feb 13 19:05:30 PST 2013 

PracticalWisdom RT @Kamiyamay: RT @ctsinclair: @aliciabloom Great job hosting tonight! Goodconversation. (Applause) tough topics good convo #HPm

Wed Feb 13 19:05:36 PST 2013 

RHR_Chat @PracticalWisdom Realistically, where do patients go? Home? Who will be with

them? @ctsinclair #hpmWed Feb 13 19:06:13 PST 2013 

PracticalWisdom Have you had a chance to see #greatchallenges @TEDMED End of LIfe?http://t.co/EeeAgVfK @ctsinclair #HPm

Wed Feb 13 19:06:27 PST 2013 

ctsinclair RT @aliciabloom: @ctsinclair awesome! we should chronicle all the places weparticipate from #hpm

Wed Feb 13 19:06:38 PST 2013 

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RHR_Chat @ctsinclair Where do we think most ppl get info? Forms from hospitals?http://t.co/hoyUk3pk? #hpm

Wed Feb 13 19:06:47 PST 2013 

Kamiyamay RT @aliciabloom: @ctsinclair awesome! we should chronicle all the places weparticipate from #hpm

Wed Feb 13 19:06:53 PST 2013 

PracticalWisdom @ctsinclair Answered RT @RHR_Chat: @PracticalWisdom Realistically, where dopatients go? Home? Who will be wi th them? @ctsinclair #HPm

Wed Feb 13 19:07:32 PST 2013 

Robert_Fried @SDHospice closure a tragedy with global implications. We need radical reform inway Medicare views #hospice and #eol care. #hpm

Wed Feb 13 19:08:11 PST 2013 

Kamiyamay @RHR_Chat chronicles. I've done Hpm in cow pasture in an RV poor peeps. Two ofthem. Where there is a soul we go! #hpm

Wed Feb 13 19:08:14 PST 2013 

RHR_Chat @PracticalWisdom @ctsinclair Mist of my clients are at home. #hpm

Wed Feb 13 19:08:35 PST 2013 

nurse2103 RT @ctsinclair: I really like the page near the end of Caring Conversations(@PracBioethics) about trajectories: http://t.co/ZMORJuyB #hpm

Wed Feb 13 19:11:12 PST 2013 

PracticalWisdom CORRECTION: DR. Joan Teno used the term Proxy or Surrogate Decision Maker. I

made a mistake Said Hospital Advocate. Sorry 4 Confusion. #HPmWed Feb 13 19:13:17 PST 2013