NASHVILLE—What do patients and consumers expect from hospitals with presences on Twitter and Facebook? How should hospitals be developing their brands online to build trust, respect and a reputation for attentiveness? And what does a hospital do when a patient friends a doctor or nurse or asks for clinical advice via a Facebook wall?

The social media team from Aurora Health Care in Wisconsin dived into these thorny questions and more during a fascinating session Thursday at the Premier Breakthroughs Conference on that holy grail of the 2010s for hospitals and other businesses: building a successful social media platform that genuinely connects with customers while maintaining needed boundaries.

As the editor of an e-newsletter, I was curious to learn how hospitals are adapting to this fast-changing communication structure, which offers great opportunities but also tremendous pitfalls to HIPAA-compliant organizations. At Aurora, much of their outreach, from what I gathered, is directed at women, who often lead the health care team in their families and like to use social media to connect with their families, friends or their local hospital. Men, on the other hand, generally use social media only to click to the latest sports or news headline, according to Aurora's research and a quick analysis of my own habits.

According to Cindy Moon-Mogush, Aurora's vice president of internal communications, hospitals need to begin by spotlighting information and news that builds trust and respect. For instance, 90 percent of women are more likely to trust an online brand with a charitable reputation, so for nonprofit hospitals, it's imperative to promote charitable and community-based efforts prominently on the homepage.

For hospitals with Facebook pages and Twitter feeds, it's highly important to answer posted questions quickly and in a friendly fashion, Jamey Sheils, Aurora's director of social media and digital communications, said, noting that people now expect almost real-time responses from their social media connections. Of course, the frighteningly open world of social media comes with its own perils for HIPAA-complaint institutions, and Aurora Health Care is mindful of those challenges. So while Aurora responds to every Facebook post or Twitter request publicly, so other patients note their attentiveness, it moves the conversation to private channels after the initial contact.

"We take the conversation offline, but we leave it out there to show we're listening," Shiels said. "People expect you to respond." Overall, Aurora has only deleted a single post from its Facebook wall; the offending post "was just so weird and out there," Shiels said.

The health system also stresses to customers that its website and social media tools are meant to inform, not give medical advice. That means offering access to over 3,000 internal web pages, but also politely telling patients who ask for clinical advice via Twitter or Facebook to reach out to their physicians via more conventional means of communication.

Evidently, not all hospitals have such strict boundaries around social media, because one attendee asked if doctors and nurses are allowed to friend patients. As it happens, Aurora is in the middle of developing a social media policy that will instruct doctors and nurses not to accept friend requests or pursue online, clinical conversations with patients outside of Aurora's social media umbrella.

"We're conservative about this," Moon-Mogush said. "Some doctors are really out there in this space on Facebook. For us, that's too much risk."