Brave New Digital World

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Pharma companies must be bold and confident in their deployment of electronic solutions or risk being left behind on the technological superhighway. Patients and physicians are migrating in droves toward Web- and mobile-based healthcare solutions. The overall number of e-health consumers who go online for health and medical information is steadily increasing; this market now stands at 157.5 million consumers. The latest version of Manhattan Research’s Cybercitizen Health study notes that since 2005, the number of patients using the Internet to research prescription drug information has doubled to 102.3 million. Similarly, the overall number of e-health consumers who go online for any health and medical information has also grown significantly over the past four years; this market now stands at 157.5 million consumers, or 1.6 times the number of e-health consumers in 2005. The Cybercitizen Health study has found that the major theme of the digital health landscape over the past four years is the increasing diversity of the overall patient media mix. Health-related social media, in particular, has flourished in recent years with the increased popularity of online patient communities, social networking, and health 2.0 applications. When faced with health and prescription drug decisions, the average consumer relies on a variety of channels and resources for information and support — decreasing advertisers’ ability to target a particular audience through any single media outlet. “The savvy marketer doesn’t look at marketing in terms of ‘online vs. offline’,” observes Mark Bard, president of Manhattan Research. “Today’s media consumption is so fragmented that brands need a well-connected, multichannel strategy to keep pace with the evolving consumer market. Additionally, marketers must tailor their brand strategies in accordance to the media preferences and behaviors of individual patient groups, as disease-type is a critical factor in how consumers seek out medical information.” Physicians have also embraced online delivery of information. According to Manhattan Research data, the importance of the Internet to physicians has been steadily increasing over the past decade. Virtually all physicians go online for professional purposes, and 88% of physicians report that the Internet is essential to their practice, while only a fifth of physicians felt this way in 2001. Physicians access online resources at multiple points throughout the day — almost three-quarters of physicians surveyed by Manhattan Research for the 2009 edition of its Taking the Pulse study use the Internet in between patient consultations, and a growing number are also referring to online information during an actual appointment. “The emergence of new media and technologies is quickly changing the pharmaceutical marketing landscape,” says Greg Barrett, VP, marketing, for Daiichi Sankyo. “With the availability of new communications tools, there will most likely also be a shift to accommodate and adjust to these new technologies.” Social Networking and Physicians According to Manhattan Research’s Taking the Pulse survey, the physician professional resource channel mix continues to steadily shift towards digital. Physicians are almost as likely to access clinical textbooks/references, continuing medical education (CME), journals, conferences, and news through online channels as they are through their offline counterparts. Additionally, three-quarters of physicians read professional or clinical e-mail newsletters on a regular basis. Mobile is one of the areas that realized the most significant growth over the past year — 64% of physicians own smart phones, and iPhone adoption in particular doubled between 2008 and 2009, according to data from Taking the Pulse. The multitude of emerging devices and applications is helping to drive the physician mobile market’s rapid growth; major players on which to keep an eye include Epocrates, Stat ICD-9, Skyscape, and ReachMD, the report notes. Peter Nalen of Compass Healthcare Communications agrees that the mobile marketing medium, unlike other “new” marketing tactics in pharma, is going to be driven by HCP audiences. He adds that the percentage of HCPs who have smart phones climbs to 79% for HCPs under the age of 45.5, and 100% of all residents have one. HCPs consume information from sources that they trust. Mr. Nalen says while mobile marketing is a “young” technology for the industry and there will be few significant widespread uses available in the next two to four years, there are some very promising applications for specific conditions and situations on the horizon. (For more information on “Mobile Marketing for Pharma,” please turn to page 16.) To Mr. Nalen’s point, analysts expect there to be an evolution in the next couple of years, resulting in a more mature and proficient physician audience, with the Internet becoming physicians’ primary professional resource. Mobile solutions, he says, will become even more indispensable to physicians as they start to expand the range activities they perform on these devices to include administrative tasks and patient monitoring. “By 2012, all physicians will walk around with a stethoscope and a smart mobile device, and there will be very few professional activities that physicians won’t be doing on their hand-helds,” predicts Monique Levy, senior director of research at Manhattan Research. “Physicians will be going online first for the majority of their professional needs and will be regularly pulling online resources into patient consultations.” All mobile all the time means, however, that marketers need to be careful in how they manage their physician lists, and the list’s value increases when there is an increase in responses to the communications. Buddy Scalera and Rima Nachshen of Qi, a CommonHealth company, urge marketers — as they engage their physician list and the physician’s level of trust grows — to resist the urge to abuse their physician list by bombarding them with annoying messages. With each communication sent, marketers are entering into an agreement, so it’s vital to be clear with messages. For example, if an engagement (like a survey) takes 10 minutes to complete, don’t say it will only take five minutes. Physicians will click the first time, but after that, the trust is gone. (For more Tips for Better Physician Recruitment, please turn to page 21.) Despite the overwhelming evidence of patient and physician acceptance of social networking, pharma remains reluctant to fully embrace the medium. In a recent report on e-pharma ROI, Eularis President Dr. Andrée Bates says that one of the obstacles to widespread adoption of social media as a marketing tool is that executives usually want to see the bottom-line results, and many of the approaches shown in social media are not always measured in those terms. “Executives are wondering, ‘what is this social media thing anyway?’, and I have seen many dismiss it as the latest fad that won’t go anywhere, so why bother?” Dr. Bates says. “The issue, of course, is that the figures are showing that it is not a fad and not going away.” Mr. Barrett agrees that social media is here to stay — the challenge for pharma remains how best to adapt to the shift in communications. “It’s vital to our patients and healthcare communities that we do engage [in social media] because we want to serve the best interests of physicians and their patients, while remaining compliant with the laws and regulations that govern such communication,” Mr. Barrett says. “It is a fast-evolving landscape that requires new resources and new skills to participate effectively. “The communications landscape has changed drastically in a short period of time, and we’ve reached a point where it’s not a matter of if we can effectively communicate, it’s that we have to reach the public where they are,” Mr. Barrett continues. “Data have shown that not only are consumers relying on social media methods as a source of health and medical information, but we’ve also seen almost two-thirds of physicians using online communities for social networking.” Data from Manhattan Research’s Taking the Pulse study shows a similar trend; according to the study, 39% of physicians communicate with patients through e-mail, instant messaging, or secure messaging services, with secure messaging services like RelayHealth and Medem showing growth in the past year. Consumers are extremely interested in connecting with doctors online, and physician acceptance is a major key to pushing this type of communication forward. According to the Manhattan Research study, virtually all U.S. physicians report that at least some of their patients bring health information they found online to an appointment, and more than two-thirds of physicians believe that this trend is a good thing. Additionally, the majority of physicians report they spend more time with a patient as a result of the information they brought in to discuss. “Patient-directed communications, online search and new media tools will continue, as they provide the ability to not only reach people where they are already spending time, but can do so with much more targeted communications than mass DTC magazine and television ads,” Mr. Barrett observes. “In short, we need to be where our customers are.” According to Boris Kushkuley and Shane Mayer of Qi, a CommonHealth company, as mobile devices become more advanced, consumers are finding new and interesting ways to integrate them into their lifestyles, The rise of a new generation of smart phones, including the iPhone, has made it possible for relatively nontechnical people to use their devices in ways that were previously relegated to the home computer. They say in the healthcare arena, marketers can leverage the power of mobility to integrate the idea of compliance into patients’ everyday lives, even while they’re on the go. For example, a medication calendar or symptom tracker can be an ideal tool for chronic conditions, since many conditions require compliance with daily medications with (almost) all of these drugs needing to be reordered. By thinking beyond the calendar., these devices can be used as a new rich media communication channel with the ability to deliver messaging directly to patients in an engaging, nonthreatening way. (For more information about Creating a Better Electronic Compliance Program, please turn to page 20.) Barclay Missen of Topin & Associates believes technological advances have the ability to revolutionize healthcare promotion. He specifically points to bar coding and its applications, which have a new twist, thanks to a new generation of technology. The standard linear one-dimensional (1-D) bar code — a symbol consisting of parallel lines, spaces, and numbers — is now joined by two-dimensional (2-D) coding, which employs geometric patterns of squares, hexagons, or other shapes. Mr. Missen explains that the 2-D code format isn’t just a graphic repackaging of an old technology for the sake of novelty; it also offers greater potential for usage. The possibilities for healthcare marketing and promotional materials are exciting. When marketing to healthcare professionals, 2-D bar codes could be incorporated into print materials to lead readers to a Website or enter them into a promotion. They could be used as a way to “hard link” objects in the real world at a trade show to additional product information online. (For more information related to how Next-Generation Bar Coding Can Revolutionize Health Care Promotion, please turn to page 22.) Open Exchange of Health Information According to a recent survey by the nonprofit eHealth Initiative (eHI), the exchange of health information electronically between physicians, hospitals, health plans, and patients has increased substantially in the last year, and is reducing the cost of care and positively impacting physicians. Physician practices that utilize health information exchange (HIE) reported a number of benefits resulting in a more time- and cost-efficient practice, including improved access to test results, decreased costs related to redundant tests and care for chronic-care patients, reduced medication errors, and reduced staff time spent on handling lab and radiology results and clerical administration and filing. “The survey shows the potential for health information exchange to improve efficiency and reduce healthcare costs nationwide,” observes Jennifer Covich, chief operating officer and interim CEO at eHI. The growth of HIE initiatives is expected to continue as the healthcare industry takes advantage of the $30 billion in funding set forth by the American Recovery and Reinvestment Act (ARRA) over the next year or so. “We need to take advantage of this moment in time, when health information technology and health information exchange enjoy broad support; we might not get another,” says Ms. Covich. Among the recommendations eHI has for the continued growth and improvement of HIE initiatives is to ensure that best practices, successful strategies, and lessons learned from failed initiatives are documented and widely shared. “One of the greatest challenges has been our ability to spread best practices in health information exchange,” says Ms. Covich. “Cost savings and improved quality of care need to be better documented, so we can replicate what works and help create a healthcare system that connects clinicians and providers.” Analysts from Ernst & Young note that the next great advance for improving patient health might result not from traditional drug discovery and development efforts, but from a renewed effort to systematically address the many factors that determine health outcomes. They say improving the health IT backbone of the healthcare system, for example, could bring about a better-informed basis for diagnosis, improved patient compliance, increased physician and pharmacist monitoring, and lower costs. Matt Johnson and Cory Shouse from AmerisourceBergen Specialty Group contend that the informatics challenge facing the pharmaceutical industry lies in the complexity of the supply chain. As the product moves from the distributor to the clinic or pharmacy and then to the patient, product data are created at each stop. Fortunately, companies that span the length of the supply chain have begun to piece the puzzle together, standardizing data collected at every point from manufacturer to patient. What was once a disjointed process can now be turned into a consolidated view of product movement. (To read more about Just-in-time Information, please turn to page 14.) Virtual R&D Analysts at PricewaterhouseCoopers predict that over the next decade, new technologies and the development of a virtual R&D process will improve our understanding of the underlying biology of the human body and its diseases, allowing researchers to better predict the effects of new drug candidates before they enter human beings. It discusses the fact that these changes could enable the shortening of the R&D process by up to two-thirds, as well as a dramatic reduction in attrition rates and a substantial reduction in the costs of clinical trials. Glenn Gormley, president of Daiichi Sankyo Pharma Development, believes that use of a virtual R&D model has the potential to become common practice. “The R&D process must evolve with technological changes, including the use of virtual models and adaptive clinical trials to increase efficiency,” Mr. Gormley notes. According to the PricewaterhouseCoopers report, Pharma 2020: Virtual R&D, with the advent of virtual patients, it will be possible to screen drug candidates in a digital representation of the human body that can be adjusted to reflect common genetic variations and disease traits, such as a weakened cardiovascular system. This will show whether a molecule interacts with any unwanted targets and produces any side effects, and in what circumstances it does so. Once robust computer models of the entire human body are available, much of the dosing and safety testing currently undertaken in the clinical environment could be conducted much earlier within discovery. “Modeling and simulation activities have made impressive contributions to the drug development process, allowing us to derive more data from a single experiment than ever before,” Mr. Gormley says. “Any new technology that can improve our understanding of the underlying biology of the human body and its diseases and allow researchers to better predict the effects of new drug candidates should be pursued.” Ron Waife of Waife & Associates warns that e-solutions need to be part of, or indeed lead, the design of a new means of clinical development. If companies do not re-imagine clinical development, they will fail to meet the challenges in a business environment of reduced financial resources. He contends that e-solutions that are no more than bridges between silos will not meet the needs of a rapidly changing clinical development environment; and strategies, pilots, and initial use of e-solutions are skipping over the hard work of operational change management, as most industry-specific IT innovations do. (To read more about What’s Missing in eSolutions, please turn to page 24.) Benefits, Drawbacks to EDC Use of electronic data capture (EDC) in clinical trials continues to grow. A recent survey by the eClinical Forum found that across the surveyed population, EDC is now used in 58% of clinical trials, compared with 13% in 2001, and 95% of respondents indicated that they have had experience with EDC during the last three years, versus 52% in 2001. In addition, 27% of respondents indicated that EDC is used in all of their current trials, up significantly from less than 1% in 2001. The survey also indicated that while users generally satisfied with EDC, opportunity for improvement exists. While 67% of those surveyed are satisfied with EDC, results also showed a shift away from EDC as a positive factor in a site’s decision to participate in a clinical trial. Almost half of respondents perceived an increase in workload when using EDC, double the number reported in the 2001 survey. The findings also reveal that there is still extensive duplication in data input, and that the use of paper case report forms (CRFs) alongside EDC has actually grown since 2001. Respondents identified speed of system response, cross-system standardization, resources available for data entry, and help desk support as among the most important opportunities for increasing user satisfaction with EDC. David Gemzik and Sean Cheng of Medidata Solutions say EDC is only one piece of the puzzle and that to enable an intelligent e-clinical process, sponsors require a closed-loop clinical trial system with complete end-to-end integration throughout the life cycle of the trial. With a suite of e-clinical tools, sponsors will be able to optimize the entire clinical process across the enterprise and gain significant competitive advantages in R&D. A true closed-loop clinical trial system allows dynamic information to flow bi-directionally in real time throughout the entire clinical trial process, from design and budgeting to execution and closure. The system must communicate with other enterprise solutions, including operational, manufacturing, finance, and accounting systems. (To read more about Why Sponsors Need an Integrated, Closed-Loop Clinical Process, please turn to page 18.) “As pharmaceutical technologies become more interdependent at the clinical research interface, the e-clinical paradigm needs to be revisited in order to respond to advances and external influences,” says Richard Perkins, president of the eClinical Forum. “Understanding investigational site personnel experiences with today’s technologies, and their perspectives on future requirements, is critical to delivering improved e-clinical solutions.” PharmaLinx LLC, publisher of the VIEW, welcomes ­comments about this article. E-mail us at feedback@pharmalinx.com. by Carolyn Gretton Today’s media consumption is so fragmented that brands need a well-connected, multichannel strategy to keep pace with the evolving consumer market. The R&D process must evolve with technological changes, including the use of virtual models and adaptive clinical trials to increase efficiency. The emergence of new media and technologies is quickly changing the pharmaceutical marketing landscape. Results of comScore’s third annual study, Online Marketing Effectiveness Benchmarks for the Pharmaceutical Industry, found that exposure to online media, including a brand’s Website and online ads, had a significant positive lift on a treatment’s awareness and favorability. The results also showed that visitation to a brand’s Website generated significant levels of incremental new patient starts and refills. The study, performed in conjunction with pharmaceutical marketing consultancy Evolution Road, evaluated the impact of vaous online marketing activities including banner ads, rich media, search marketing, and visits to a brand Website on a pharmaceutical brand’s awareness, favorability, and sales results among both patients and prospects. The study is based on comScore’s 1-million-person U.S. panel, for which online activity is passively observed, and survey data collected throughout the past several years. The study found that branded Websites were the most effective form of online pharmaceutical marketing, with existing patients increasing their refill rate by nearly 25% compared to those who did not visit the site. Patients who were new to a treatment increased 11.9% compared with non-visitors. Exposure and interaction with rich media advertisements also improved refill rate among existing patients with a 14% lift versus the control group. “Not only does a brand’s Website provide visitors with critically important information on the condition, treatment options, and the drug itself, but it is also one of the few environments where a brand can build a dynamic and recurring relationship with its patients,” says John Mangano, VP of marketing solutions for comScore. “However, it is important to realize that a brand’s Website is only one critical piece of a comprehensive marketing campaign that includes online display ads, search marketing, and offline marketing working in unison to raise awareness, educate consumers, and ultimately drive conversion.” The study also found that online advertising and branded Websites had a significant positive impact on awareness and favorability among patients and prospects. For prospects, exposure to an ad increased both aided and unaided brand awareness, with increases of 4.1% and 4.2%, respectively. Pharma Websites played the greatest role in increasing awareness and favorability among patients and prospects. Prospects exhibited an 18% increase in favorability after visiting a branded Website, while patients reported a 17.2% lift. Web Remains Key Element of Marketing Strategy Recommendations for Advancing Health Information Exchange Help define a clear role for health information exchange in “meaningful use.” Many initiatives are closely watching the debate on meaningful use. Given the landscape, initiatives should actively participate in this discussion and clarify the role of health information exchange, particularly how to ensure that providers will be able to access health information exchange initiatives anywhere in the country by 2015. Measure and document improvements in patient care, savings and value. With an increased emphasis on health information exchange, there is a need for better tracking and documentation of the value and benefits of health information exchange. Cost savings, improved efficiencies, and quality of care need to be better documented. Expand secure services to patients. An expansion of services affecting and targeting patients, particularly in the areas of access to and privacy of their health information, is needed. This will be driven in part by the new privacy and security provisions of ARRA, as well as the increasing need to provide a secure method for individuals to access their protected health information. Increase implementation assistance and related services to clinicians. Initiatives should continue to provide services to help support adoption and implementation among clinicians. Despite current efforts, this area continues to be a challenge, and is likely to increase as more and more clinicians move into health information technology. In addition, many initiatives are well-placed to be a key contributor to or coordinator of efforts to create the new regional extension centers that will support physicians and hospitals in becoming meaningful users. Source: eHealth Initiative, Migrating Toward Meaningful Use: The State of Health Information Exchange, a report based on eHI’s Sixth Annual Survey of Health Information Exchange. For more information, visit ehealthinitiative.org. Companies that span the length of the supply chain have begun to piece the puzzle together, standardizing data ­collected at every point from manufacturer to patient. What was a disjointed mess can now be turned into a ­consolidated view of product movement. Matt Johnson AmerisourceBergen Peter Nalen Compass HC Mobile applications can complement or enhance, brand’s other traditional media programs with a mobile call-to-action, such as a mobile ad, link to a site, video, applications, a keyword QR code, or a short code. David Gemzik Medidata Solutions With a suite of eClinical tools, sponsors will be able to optimize the entire clinical ­process across the enterprise and gain significant competitive advantages in R&D. Boris Kushkuley Qi, part of CommonHealth So much of our lives now exists on a digital plane, it’s important to understand how to connect online and offline retention tools…while ­maintaining appropriate ­regulatory compliance. The challenge is how to recruit and retain a solid panel of healthcare HCPs. And remember, it’s not about hitting them once with one message. Recruitment is about building an ongoing relationship. Buddy Scalera Qi, part of CommonHealth Barclay Missen Topin & Associates When marketing to healthcare professionals, 2-D bar codes could be ­incorporated into print materials to lead readers to a Web site or enter them into a promotion. Ronald Waife, MPH Waife & Associates E-solutions need to be part of, or lead, the design of a new means of clinical ­development. If we do not ­ re-imagine the process, we will fail to meet these challenges in a business environment of reduced financial resources.

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