eMarketing and Mobile in 2012

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Lanre Ibitoye. Vice President, eyeforpharma

eMarketing and Mobile in 2012

30/1/2012
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Over the course of 2011, we’ve seen a distinct acceleration in the speed at which digital healthcare initiatives have gathered pace. Information and interaction is in abundance between healthcare providers and patients, driving pharma to understand how it fits into this new dynamic. Ahead of eyeforpharma’s eMarketing Europe event from the 27-28 March 2012, we present a summary of some of the key issues emerging as critical to the strategic direction for pharma.

Cast your mind back (if you can) to the early 90s when very little technology was truly ‘mobile’. Mobile phones were yet to become truly mainstream and music on the move still meant Walkmans or new and rather clunky compact disk players you could carry around; the iPod still being only a glimmer in Steve Jobs’ eye.

The world of 2011 is a very different one - we’re always ‘on’ as smartphones mean we’ve got a constant connection to the online world, which blurs the work / life boundaries. This creates enormous opportunities to engage with customers on the go, particularly in areas such as healthcare where there are complex stakeholder groups spanning patients, medical professionals, payers and the drug industry.

But before you dash in with exciting new apps and expensive mobile campaigns, it might be worth pausing to consider a few key lessons that emerged. Here are some of the case study highlights from eyeforpharma’s Mobile Strategies for Pharma 2011 event in early December, showing that pharma is definitely on the move.

Putting mobile at the heart of strategy
Simon Clough, Managing Director of Daiichi-Sankyo in the UK, outlined how mobile is now at the heart of the company strategy, aligned around the Japanese principle of Kaizen, or continual improvement. Recognising that collaboration, both internal and external, is the key to success in today’s healthcare market Daiichi adopted the use of iPads and iPhones for all employees as a faster, more collaborative engagement tool.

But it’s not about the technology per se, as Clough described exactly how they have integrated traditional processes into these mobile devices. Company information, values and processes are now all accessible through the iPad, in addition to networking tools such as chatter, an internal corporate version of Twitter that facilitates real time communication, and opportunities for learning and development.

Critically, the old CRM system has been replaced with one that integrates with the new mobile strategy, allowing direct integration of customer-facing activities and reducing a lot of manual process. Apps have been developed for many products as a way of quickly outlining their characteristics and capturing immediate feedback. In addition, Daiichi is partnering with non-pharma organisations that reflect its mobile strategy, such as O2 Health and Downing Street’s Behavioural Insights group, which employs technologies like nudge, which can be used for improving patient adherence to medicines.

Improving efficiency by being always on
Andreas Claus Kistner, Global Head of Commercial Operations & Solutions Architecture at Roche, expanded on the theme of improved efficiency through the application of mobile technology.

Reflecting on the ‘always on’ mentality and the fact that information is now available anywhere, Kistner described how some of the traditionally dead time can now be better utilised by the sales force. His research shows that the average rep spends one to two hours per day waiting to see doctors and over two hours managing admin from such visits. The quick start functionality of mobile devices and collaborative CRM opportunities can be used to make such time more efficient.

But Kistner also highlighted some critical success factors with such strategies. Offline access must always be available, as 3G coverage is not universal, and the system must be intuitive, simple to use and quick in order to be well adopted. It is also important to consider key issues such as data security and how the mobile device can interact with more static technology back at HQ.

And Roche has practised what it preaches, with a single country pilot study replacing the traditional rep PCs with iPads showing that such proposed efficiencies do translate into reality. It seems the reps involved are not missing their PCs at all!

Understand the reality, not the myth
There’s a lot of hype around about which smartphone technology is best, who is using mobile technology for what and where the market is heading. Ralf-Gordon Jahns, from research2guidance, outlined what he uncovered as the reality in a recent mHealth apps study:

* There are 34,000 apps on the market classified as “mHealth”.
* Around half of the app stores have mHealth as a dedicated category.
* Personal care apps prove the most popular downloads, typically using ‘freemium’ models where there is no upfront payment, * with apps generally focussing more on the patient / consumer than the doctor.
* 72% of US doctors are using a smartphone, with 95% of them already downloading medical apps (Europe is not too far behind).
* Monitoring solutions within chronic disease areas (e.g. diabetes, obesity and hypertension) are seen as the areas with the highest business potential.

However, be aware of how quickly things change – the figures above will no doubt be out of date even before you read this, so it’s important to understand where the market is moving. It is clear that healthcare providers are irreversibly bought into using mobile devices; the challenge is understanding what devices they will be using next year and how they want to use them.

Mobile can deliver real closed-loop marketing
Timothy White, Head of eMarketing at Novartis, explored the potential of mobile technology to deliver such immediate feedback as part of dynamic and interactive closed-loop marketing (CLM). The concept of CLM, delivering different messages to different customers through different channels for optimum impact, is not new, but the barriers to achieving this have, until recently, been high. Tools are now available for mobile devices to capture much more personalised information about the customer and bring a much more individualised interaction to them – bringing the value of such internal data capture right back to the external audience.

The result, when applied correctly in pilots by Novartis, is that pharma representatives can engage with doctors on a much more one-to-one basis, reacting to their specific needs and questions. So whilst the allure of the technology may wear off, its ability to implement engaging ‘pull’ marketing over didactic ‘push’ messaging never will. The key here is integration across systems and between different customer-facing personnel; or as White neatly summed up, “CLM without CRM integration is like a car without an engine.”

It’s about the customer, stupid!
Finally, Matt Thomas, Vice-President at Medtronic, presented a warning to not get too caught up in the excitement of hot ideas like apps – pause for a moment to consider whether your strategy is really customer focussed or just sating your own desires.

So even if you have what you think is a ‘killer app’, with a cleverly planned business strategy within a chronic disease area, be aware of the costs and potential returns. According to Thomas, whilst the average app now costs less than $100k to build (and some considerably less), on average only 5% of users are still using an app one month after downloading it. Perhaps it’s because of our short attention spans in the modern world, but perhaps it also comes back to planning the right solution that is useful for the end user in the longer term. Ultimately, if you can’t demonstrate the longevity of your proposition through understanding the ‘what’s in it for me’ factor, then don’t expect long term loyalty toward your mobile solution.

The good news is that the fast pace of the mobile world means you can test multiple propositions and find out which works, using the concept of ‘fail fast’. As Thomas succinctly puts it, “execute like the app is your only product,” working with the customer to refine and develop it into something of tangible value based on their feedback. Dynamic, ongoing outcomes-based research is the key to success in this space it seems.

The Healthcare 2020 vision of cross-stakeholder collaboration
The information revolution has intrinsically changed the way that stakeholders interact across healthcare. The patient is no longer the passive recipient of medical advice and information on their disease, nor is the doctor at the mercy of controlled detail aid messages – everyone has access to a wealth of data on different therapeutic areas and interventions through the web.

The vision for healthcare in 2020 is therefore no longer about controlled messages and defined pathways of interaction between stakeholders – it’s about accepting that every stakeholder is at the table and they are well informed, so the challenge becomes more about facilitating joint working for better health outcomes.

Effective communication is critical
Denise Silber is all too aware of the importance of effective communication, having founded the Doctors 2.0 & You annual conference to encourage sharing ideas around how doctors can communicate with other key stakeholders, including patients, using new technologies. Doctors are increasingly challenged by the informed patient who has spent time researching their symptoms and likely disease even before an official medical diagnosis. In Silber’s view, the role of the doctor then becomes much more about understanding how to communicate with each individual patient on even terms, working on “exercises to improve diagnosis, to improve how we speak with the patient to announce the diagnosis, to improve their understanding about the treatment, to see what information should be communicated during the early treatment. There are so many opportunities there.”

Silber recognises that social media has a part to play here in connecting healthcare providers with patients, but the proportion of people connecting in this way is still “very low” in her opinion. Far more advanced is the use of such communication channels for patient-to-patient interaction, through sites such as PatientsLikeMe, which now boasts a community of over 120,000 patients spanning over 1,000 different disease areas. The success of PatientsLikeMe is hinted at in its title, by linking together patients who have not only the same disease but also similar presentation its users can virtually interact with others who are facing similar challenges and asking the same questions about their diagnosis.

Accepting that the patient is in control
Whilst many healthcare providers and companies are grappling with the challenge of patients taking more control, one man is actively encouraged by it and sees a bright future for healthcare where the patient is the pivotal player. Mohammad Al-Ubaydli is the Founder of Patients Know Best (and a qualified doctor who is also a world-renowned expert on healthcare IT), a start-up that claims to have developed the world’s first ‘patient-controlled medical records system’, which is managed electronically. It’s an area where both large companies and healthcare institutions have struggled in the past, including most notably the failed £11.6bn NPfiT project in the UK.

Al-Ubaydli is passionate about the patient being in control, stating that “patients are already running healthcare systems - they are already the one telling one specialist what the other specialist said,” because the current patient records system is so poor at communicating between different practitioners. His philosophy is that by putting the patient in control of their medical record and allowing them to choose who interacts with it electronically a more accurate record of their treatment can be maintained, which can lead to more efficient processes, savings for healthcare systems and more productive outcomes for the patient.
He acknowledges concerns that doctors may have over patients having such ready access to their records, clarifying that “they are worried that if the patient looks at the medical records they are going to be unnecessarily anxious, or that they might be angry about what the medical professional will have said about them,” but is keen to point out that it is ultimately the patient’s data so they should be the owner. However, Al-Ubaydli does not see this as long-term problem, more a mindset hurdle to be overcome as we transition to patients managing their records. He points out that in France, for example, the patient carries their record with them between medical institutions and doctors have learned how to manage patients who are concerned by anything they do not understand.

Service provision, not drug sales, becomes the key
Both Silber and Al-Ubaydli see a crucial role for pharma in facilitating communication and interaction between other stakeholders in the healthcare continuum, becoming a service provider that delivers wellness, rather than simply a purveyor of medicines to treat illness.

In Silber’s view, this means taking the research mindset to medical communication, as “pharma invests in 2,000 compounds to get one that works, so why not try 100 different communication tools with a special budget for things that aren’t necessary going to work out in the hope that one will?” It’s something that Al-Ubaydli has already seen in practice, “some are paying for our software to be given to the patients as part of the medical trial or as part of trying to added value services to medical teams,” he clarifies.

Critically, initiatives such as value-based pricing, which reward pharma based on outcomes, will be a key driver of the new service provider mentality. When prescribing the right drug only becomes one component of whether the patient’s outcome is a good one, it becomes firmly in pharma’s interest to help manage the other components better, including age-old issues such as compliance. As Al-Ubaydli succinctly puts it, “pharmaceutical companies will have financial interests and incentives in making sure that the medicines are taken properly and they do produce an outcome for the patient.” And the solutions might not purely be technologically based, with Al-Ubaydli citing the example of pharma companies investing in providing nurse support to help supervise patients and ensure medicines are being taken as directed.

Further hints perhaps that pharma needs to adapt to a world focussed on overarching healthcare solutions, not just medicines.

Does social media have any place in the pharma industry?
There’s been a lot of discussion about social media and pharma in the last year, ironically much of it taking place on social media channels such as Twitter, so if you’re not an advocate you might well wonder what all the fuss is about.

In a nutshell, there appear to be two divergent camps; one that postulates that social media could be just the tonic pharma needs to building trust with healthcare providers and patients, a way to tackle some of those knotty PR issues we all know the industry faces, in addition to addressing disease-specific issues. The other camp argues that the kind of real time person-to-person communication offered by social media has no place in the heavily regulated pharma industry and offers, at best, little commercial benefit and, at worst, a risk of major legal challenges.

Let’s talk about adverse events
There is no doubt that there are two major “fear factors” hindering pharma’s involvement in social media. The first is the risk of erroneously engaging in product-based discussion with a patient, something which Bayer got slapped on the wrist for earlier this year with its errant messages on Twitter. However, the second, and perhaps more worrying aspect for pharma, is the prospect of managing a flurry of adverse event reports coming in through social media channels.

However, both of these challenges come down to having the right internal processes set-up and ensuring all internal stakeholders are clear of the rules and risk management steps. As one social media pioneer, Alex Butler (who launched the Psoriasis 360 campaign whilst at Janssen), puts it, “there has to be a process in place for pharmacovigilance; it has to be across the business and underpinned by rigorous process and a full understanding of decision making with regards to mitigating risk”. The Head of Digital Marketing at a leading pharma company, echoes Alex’s comments around rigorous process, stating “I have to make sure that any adverse events, wherever they are, are reported within 24 hours back into the system. It’s non-negotiable.”

The reality is that many pharma companies are already using social media channels and the world has not spun off its axis. Recent studies have also suggested that the volume of identifiable adverse events within these channels is far smaller than many expect.

So the real question might not be whether pharma can use social media, but whether there is any benefit in it doing so.

Measuring ROI for social media initiatives
When people talk about social media and the term “return-on-investment” (ROI) is mentioned, responses tend to vary from “you can’t measure the ROI of social media”, through “it only generates a return in the longer term” and typically via comments such as “the ROI of social media is about softer things than financial metrics, such as good PR”.

One can argue the pros and cons of each statement, but marketing generally operates on the principles of understanding whether something you have done is beneficial or not, so if you buy into the first statement then you had best leave social media alone. But there certainly seems to be a growing tide of recognition that social media can at least help pharma build trust with medics and the public. As Sven Awege, formerly of Eli Lilly France, points out, “even the tobacco industry is rated better than pharma and if the public perception is going to change, we need to engage all our stakeholders and I believe social media is part of the solution.”

Awege goes on to expand that “in digital, we think everything is measurable and meaningful”, but the real challenge may be in knowing what to measure. Traditional metrics around financial return are difficult to link back to specific social media initiatives, so he postulates that ROO (return-on-objectives), which are softer metrics, may be a better way to assess things in this realm. Gillian Tachibana, Director of eMedia/Social Media at Merck Serono is keen to point out that the lack of ROI on social media comes from “Bad planning, lacking research on target groups and influencers with regard to disease prevalence, not benchmarking what’s already out there, and thinking that Tweets or a FB page will instantaneously attract thousands of followers and fans.”

Whilst it’s clear that you need some objectives in place to assess whether your social media initiatives is working or not, Butler clarifies that the fast-moving nature of such campaigns mean that you might well need to flex these as you go along. “You need to start thinking about a perpetual project, as the internet is now about continual communication with people,” he proposes.

Which channel is best?
Assuming you secure internal approval for a social media initiative, it can be daunting to understand what the right channel is for your project. A lot of the focus recently has been on how pharma has (or has not) been using Facebook, but there are numerous other social media channels such as Twitter, YouTube, Google Plus and a number of online healthcare specific communities.

One phrase that is often used, and was reiterated by Awege, when it comes to channel selection is to “fish where the fish are”. Fundamentally, this means that if you’re seeking to engage with a certain target group of patients or clinicians then you should be identifying which social media channels they use and focussing your campaign around them, rather than fixating on a channel to begin with. However, it’s not quite as simple as that, because you also need to bear in mind why they are there.

Here, Facebook presents an interesting challenge for pharma, because whilst it is no doubt the most popular social networking site online, most people are not there seeking engagement on health related issues. As Butler puts it, “you join to connect with your friends and you might serendipitously come across things on Facebook for health.” None of this means that Facebook is useless as a tool for engaging on pharma or healthcare issues, it just means you need to be subtle about your engagement and make sure you’re not “bombarding people with services”, as Butler goes on to elaborate.

Certainly, some pharma companies have taken the plunge when it comes to engaging on Facebook, with Boehringer Ingelheim arguably leading the way with engaging competitions and broader content aimed at building stronger relationships with the public. Others, like Roche, have developed bespoke careers pages on Facebook, seeing the channel as a good medium for recruitment. Again, this reaffirms the basics of being clear on the objectives for the channel and focussing content around that. After all, can a single Facebook page really speak to investors, employees, job seekers, medical professionals, regulators, payers, patients and the public all together?

The future of eMarketing
It has been suggested that people will not be talking about ‘digital marketing’ in five years’ time. The same is almost certainly true of the term eMarketing, as online engagement becomes a key component of the general marketer’s armoury. But this change will not occur overnight and there will be stages of integration, driven by key developments. Who better than Alex Butler to shed some light on what’s coming up?

Big data and mobile engagement
As the wealth of information available online expands the challenge becomes not so much about finding it, but more about validating its accuracy and presenting it in a format that is useful. The concept of “big data” is therefore all about taking enormous datasets and utilising them for strategic initiatives, but don’t underestimate the scale of the challenge here. As Butler puts it, “every two days, we create as much data as we have from the dawn of civilisation to 2003, which is an incredible thought.”

One of the key “big data” areas of interest to pharma is the wealth of patient information that is springing up, whether it is through community sites like PatientsLikeMe or as a result of patient record initiatives like Al-Ubaydli’s PatientsKnowBest. There are clearly privacy aspects that must be managed, but the potential benefits for pharma and patients are clear, “we can use that data to help people understand development of drugs and our understanding of diseases; it can unlock an understanding of the patient experience on a scale that was unimaginable five years ago,” Butler explains.

There are also some exciting developments in the mobile space, particularly as it relates to search – an aspect that becomes critical for healthcare as more and more information comes online. The intelligent search functionality of Siri, now part of Apple, transforms search into a more personalised, intelligent process and away from the one-size-fits-all approach of Google. In addition, it works well though mobile devices such as the iPhone, but others are not far behind. “Microsoft has a good voice-activated search, for the Xbox platform and they aren’t far behind,” clarifies Butler, hinting that this could be an exciting and competitive space in the next five years.

Gamification within healthcare
Gamification has been one of the buzzwords of 2011 – the use of games to educate and get people involved. By making health issues fun and rewarding, Butler sees great potential for the pharma industry as “you can improve your relationship with the patient and do things for their health that you couldn’t do before,” for benefits on all sides. But again, the devil is in the detail, and developing games requires the same strategic focus as any other initiative. As Butler neatly puts it, “games are very expensive and difficult; just because it’s a game, doesn’t mean it’s fun - some games are terrible!”

When it comes to public health, games could also tackle one of the key issues that most initiatives face, namely that the “benefits” are long-term rather than immediate, something that doesn’t sit well with the short-term focus of human nature. For example, millions is spent on education around the benefits of smoking cessation, but the payback for an individual doing so is reduced risk of cancer at some point way in the future. Gamification can bridge that gap and deliver more immediate rewards, which do not even need to be financial – “it’s about being upgraded, hierarchy, position and so on,” describes Butler.

Whilst development of games within particular disease areas could clearly yield all-round benefits, particular if they deal with issues such as medicines compliance, they could also play a role in more general education around the business of pharma. Boehringer Ingelheim is developing a game called Syrum, which is best described as pharma meets Farmville, putting the player in the role of a pharma company developing and commercialising drugs. Expected to launch at eyeforpharma’s eMarketing Europe in late March, whether it is successful remains to be seen, but it could certainly help pharma tackle some of the PR issues around drug pricing by explaining what’s involved in bringing a medicine to market.

Integrated healthcare solutions
As excited as Butler is by the technological developments, he is also clear that success is driven by understanding people’s needs and not the technology itself. “If you forget about people and concentrate on the technology, you’ll go very wrong,” Butler explains, urging instead that pharma focusses on “what is happening in the world and how it will affect the way people manage their health and the way people communicate with your business.”

In addition, Butler knows from his own experience the importance of planning ahead and taking internal stakeholders with you, expanding that “strategy isn’t built by one person - it’s about where you think the world is going to be in three to five years’ time and how you are going to set your business up to move in that direction. That is cross-functional and integrated.” In essence, Butler has seen a number of ‘build it and they will come’ approaches that have failed because they didn’t properly understand the customer needs or garner sufficient internal support to be properly implemented and sustained.

The bottom line is that the way in which people engage online is constantly adapting – new technologies and ways to interact are springing up all the time. The key message for pharma is to not get too obsessed with this dynamic short-term maelstrom of change, but focus on the longer term fundamentals, such as the wealth of healthcare data being generated and an ever-increasing willingness for individuals to share their personal data if they see a benefit in return. The opportunity for pharma is therefore on helping to facilitate this information flow, linking it back to use of its medicines and reaffirming itself as a healthcare solutions provider for all-round benefit.

One thing is for sure – it’s going to be an exciting time to work in the pharma business in the next five years!

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