Healthcare marketing did not exist prior to 1970. Marketing was "product oriented," prior to the 70's. Health care is something everyone needed and one decided to use the services or not (Thomas, 2020), if they could afford it, or allowed to use or not. Certain areas the country used local health peopled, midwives, doctors or tribal healers. Health care is a service, it is a consumed and mot produced (Thomas, 2020). Electronic sources of marketing in health care have influenced consumers' choices in health care providers, hospitals, clinics, etc. with the increase if information sharing, comparisons of services on the internet and social media. (Thomas, 2020). This exchange of information may be positive or negative Information. These platforms were and continue to be a main factor in marketing the Affordable Care Act of 2010.

Digital marketing is essential in the current competitive health care marketplace (Ameen, 2022). The digital marketing strategy that each health organization and provider should implement a mutli-media approach with the consumer/patients as the primary focus. Ensure the healthcare/provider website is optimized by investing in Search Engine Optimization (SEO).Educational and engagement channels should be built and update frequently on the chosen social media. Facebook should be included in the social media profile as it is favored by and use buy more consumers/patients greater than 65. This is the population that is the largest consumer of healthcare service. (Beckers, 2022). As of January 2020, Facebook had over 2.45 billion users worldwide. Most providers simply use Facebook, Twitter, and YouTube. All of which are easily accessible with most personal digital devices used today, which is another strategy for successful marketing, Mobile Friendly. Cell phones, tablets, etc. are in everyone's possession. Ease of access to informational content that is pertinent to the consumers' needs is equally as important. Adapt and use recent technology that consumers already use to manage their health information will also be a satisfier. The pandemic played a huge role in the increased use of digital technology and social media in health care. The increase in virtual health care visits rose from 15% in 2018 to 28% in 2020 (DeLoitte, 2020)

With any marketing strategy that includes social media and the internet, there are opportunities, challenges and ethical considerations when it comes to health care and health information sharing. According to the American Hospital Association Society for Healthcare Strategy and Marketing Development (SHSMD), social media provides an opportunity for health care providers and staff to connect with the community, patients and their families in a manner that fosters information and knowledge to be shares outside of the walls of the hospital. The community is already using social media and it is an excellent way to provide true information and from the experts. An example of the use of social media is to hold short videos provided by providers, specialist to present factual and true information to the community about relevant disease states and proper management and collaboration with the providers in the community. Q&A session virtually add a human and a personal factor to the exchange of information.

Challenges exist with health care organization's or provider's use of social media. The big questions are, to what extend will social media be used? Will there be an opportunity for the community/patients/families, etc. to send in questions, comments, concerns and complaints and who will monitor and manage the site and respond to patient experience related inquiries. An example of how to overcome some of the challenges with social media presence of a hospital with a forum for patient experience related areas of the organizations website is creating patient advocacy staff to read, review and work on responses with quality staff, clinical staff, administrative staff, public relations staff and other hospital leaders that could address the concerns and assist with crafting a response in a timely manner to the patient, community, etc. This fosters trust and builds a relationship with the community. (Becker's, 2022)

Ethically, organizations and providers with social media presence must consider incentives for referrals to one provider or hospital, protecting the confidentiality and security of patient health information, HIPAA, violations. Other ethical consideration to use extreme caution with pictures, videos and commentary regarding patients and providers. There is room for HIPAA violations. Organizations should develop policies and procedures to speak to what behaviors are ethically appropriate for providers of health care and to protect patients first but also the providers, employees and organizations (Thomas, 2020).