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I've been watching the Twitter phenomenon in health care with interest. Indeed, what began as a surefire PR tactic has continued to morph as public opinion questions the value, even the ethical and legal implications, of Twitter in the operating room. Naturally, the market leaders have already begun to refocus — using Twitter as a hyper-targeting communication tool to keep family and referring physicians informed — rather than merely to obtain coverage on the local news. Still, the marketing implications are undeniable. As such, like all communication tactics, Twitter should be evaluated based on how well it fits the organization's brand and marketing objectives. As part of an integrated strategy, it may serve a provider's goals. As a one-off, fad/tactic, it’s apt to be a flash in the pan with little lasting impact.

Interestingly, the leaders are doing what they do best — lead. They are pioneers in the social marketing realm much as they are pioneers in most of what they do. A look at those who have made use of Twitter reads like a Who’s Who of health-care leaders: Henry Ford Hospital in Detroit, Barnes-Jewish Hospital in St. Louis, Mayo Clinic, Northwestern Memorial in Chicago, Johns Hopkins in Baltimore, Baylor University Medical Center in Dallas, Yale University in New Haven. The very use of this progressive medium has reinforced their brand reputations.

And they’re making headlines. Aurora Health Care of Wisconsin posted Tweets during knee surgery — generating commentary by Oprah Winfrey and coverage on Good Morning America. According to The Business Journal of Milwaukee, “Four days before the surgery, Aurora had 933 Twitter ‘followers.’ As of April 20, the system had 2,874.”

The New York Times recently reported on the video Web cast of a craniotomy conducted at Methodist University Hospital in Memphis. According to the article, hospitals are “seeking to attract or educate patients, entice donors, gain recognition and recruit or retain top doctors ... using Twitter from operating rooms, showing surgery on YouTube and having patients blog about their procedures.”

But, in the few short months since the first surgery found a Twitter following, progressive systems have already moved beyond the headlines to integrate the medium into their grander strategic plans. For the past several years, Milwaukee radio station WKLH-FM has held a 60-hour “Miracle Marathon” to raise money for Children’s Hospital of Wisconsin. This year, the hospital posted Tweets throughout the event — updating pledge results and embedding links to YouTube videos, to their Web site and to the radio’s Web site, where pledges could be made online. In 2 ½ days, they raised $1.3 million. That’s what I call integrated marketing!

So what’s the lesson for those who haven’t yet embraced this medium? There are a few:

Jump on board, quickly. The train has left the station but it isn’t too far down the track. Although the news value has already evaporated in larger media markets, every market is different. You can still be a leader in your own community by embracing some of the more progressive tactics available.

Be certain it fits a strategy. Twitter, YouTube, Facebook are merely tactics. And while their very use might still generate news, these tactics should be considered part of a larger strategy designed to meet an organization’s brand objectives. And reinforce its brand personality.

Don’t expect miracles. It’s estimated that only 5 percent of Internet users also use Twitter. And retention is dreadful. Fewer than 40 percent of those who sign up for a Twitter account are still using it a month later. This is but one tool in the toolbox. Used to supplement other efforts, it can make a big impact.

I’ll continue to follow the phenomenon, recommending it where appropriate to meet client goals. Tell me your successes and your disappointments — and I’ll tell you mine.