HealthEd Blog

Joe knows innovation. Do you?

I'm at the e-Patient Connections conference in Philadelphia this morning, and Joe Shields from Pfizer has the floor. He's talking about his new role at the pharma giant as director of worldwide innovation, a lofty title that he admits makes him a bit sheepish. But the position gives Shields what he calls a "license for disruption": a mandate to identify cutting-edge ideas and technologies that can help Pfizer become a more patient-centric company.

And he's looking for a certain kind of help.

"I don't really need an ad agency right now," Shields says. "I think the problem is more complex, and I need a different set of people, a different set of solutions."

He tells the audience—which includes some of those very ad agencies, along with patient advocates, healthcare media companies, and his pharma colleagues—that he is setting an innovation agenda for the next 6 months ... and he wants all of us to send him an e-mail with our suggestions, ideas, and advice.

Because Shields is asking, and because I can use the power of blogging to fast-forward several hours into the future, here are a few innovations that I'm pretty sure will make an impression on me today:

• Mobile integration: Connecting cell phones to disease-monitoring tools, such as glucose monitors, may become an easy way for pharma companies to get “beyond the pill” in the near future. I have a feeling that Brian Dolan from mobihealthnews will tell us that mobile operators abroad, including Orange and Airtel, have already joined the mobile health movement. Pfizer’s gravity should be more than strong enough to attract a US wireless carrier, enabling the launch of a monitoring partnership that would ensure patient adherence and probably save lives. (And when Shields is done brokering that deal, I would of course invite him to read more about mobile opportunities in pharma on the HealthEd blog)
  
  
• Mining online conversations: My peers at ListenLogic truly recognize the wealth of data that can be mined from patient conversations in the social media. It wouldn't surprise me if founder Mark Langsfeld shares a powerful graph with conversations about Victoza plotted next to actual prescription data ... a graph in which the volume of “switch”-oriented Victoza conversations accurately predicts the growth curve of Victoza. Shields should pursue development of a corporatewide social media listening program that proactively seeks to bring analysis of Web conversations directly to brand teams and patient marketers
   
• Social tools: If Shields does tap into the power of online conversations, then he also needs to provide some conversation starters: namely, sharable info bites from Pfizer Web properties. He should give a close look to share>>send>>save, a simple yet elegant widget recently launched by Intouch Solutions. Wendy Blackburn from Intouch will almost certainly explain how the tool provides a DDMAC-friendly approach for brands seeking to enable content sharing on their Web sites. Pfizer has both the breadth and the depth in its portfolio to pilot share>>send>>save across multiple disease categories and learn whether “safe” patient sharing can drive corporate business objectives

Shields' brief presentation is coming to a close now, and I can already hear the gears turning at nearby tables. He has created a buzzworthy challenge that deserves much more thought: Where should patient marketers innovate first?

What will you tell Joe?

Jeff Greene
Director of Strategic Services
HealthEd

 

Vote for the HealthEd SXSW Panel!

We are excited for the opportunity to present at the first-ever Health Track at SXSW^® Interactive 2011 conference. Now we need your help. Please vote for our proposed panel, The Customer Experience System & How Patients Learn. Just visit the SXSW PanelPicker, leave a comment, and vote "thumbs up."

What’s a customer experience system? It's an evolutionary approach to online healthcare “marketing” with the goal of creating patient experiences that enhance learning and promote self-efficacy—the ability to manage one’s own care.

HealthEd is particularly interested in customer experience systems because we are building our own system through our subsidiary, HealthEd On Demand. Yet our interest is much broader, as our teams seek to understand how educational approaches can drive better patient outcomes.

SXSW Interactive is the nation’s leading digital and innovation festival, held annually in Austin, Texas. It would be an honor to present, and we appreciate your vote. The SXSW PanelPicker closes August 27!

9 Great Health Track Panels

When you’re at the PanelPicker, please be sure to vote for these other health track panels. We’re happy to recommend them, and we wish their presenters good luck:

–     Minority Report: Social Media for Decreasing Health Disparities
Aimee Roundtree, Univeristy of Houston–Downtown
Key learning: What are best practices for using social and mobile media to increase health literacy, patient education, and activation in minority communities?

 –     Yelping Health Professionals: Patients, Providers & Digital Rights
Keely Kolmes, PsyD, clinical psychologist
Key learning: Are there ways for owners of confidential services to respond to consumer feedback or act on their own behalf without violating legal and ethical standards?

–     Creative Alternatives: What if We Reinvented Healthcare Today?
Robert Fabricant, frog design
Key learning: What would a new/better experience look and feel like, and what role can designers play in creating that experience?

–     Crowd Sourcing Cancer
Alicia Staley, The Staley Foundation
Key learning: Why would anyone want to "crowd source" a cancer-related question or issue?

–     Your Computer Is the Next Wonder Drug
Jonathan Richman, Bridge Worldwide
Key learning: What advances in technology will completely change the way we manage and track our health and how we share that information with others?

–     The New Frontier of Social CRM in Healthcare
Earl Whipple, AstraZeneca
Key learning: How is social customer relationship management in healthcare different from social CRM for other industries?

–     Why Consumers Feel Compelled to Talk About Drugs
Andrew Levitt, HealthTalker
Key learning: Why does pharma need to pay attention to this consumer communication channel?

–     Treating Chronic Disease: New Media and Lifestyle Change
David Ormesher, closerlook, inc.
Key learning: Can we delay the onset of—or reverse the effects of—chronic illness through lifestyle change?

–     Why Nurses Are Vital In Emerging Technology
Phil Baumann, CareVocate LLC
Key learning: How are devices like iPad, iPhone, Android products being used in healthcare?

Jeff Greene
Director of Strategic Services
HealthEd

What social media can tell us about the patient journey

Those of you who attended our presentation this morning at EXL Digital Pharma West can view our slides courtesy of SlideShare:

ExL Digital Pharma West Presentation June 2010

If you weren't able to attend, here are some key takeaways:

• Quantitative measures of pharma buzz can be misleading
• Using qualitative analysis can provide a robust alternative, particularly when findings are put into the context of the patient journey
• The patient journey has far-reaching usefulness for brands: It can provide the building blocks for all phases of a consumer marketing program
• Key intervention points we found along the rheumatoid arthritis journey included Diagnosis, Transition to Engagement, Treatment Initiation, and Moving Forward Through Setbacks
• Pharma brands can use social media conversations to create their own journeys and identify key intervention points, educational needs, and marketing implications along the way

Jeff Greene
Director of Strategic Services
HealthEd

How Can Oncology Healthcare Providers Facilitate a Discussion with Patients About a Taboo Topic?

No, not sexuality and intimacy. I am referring to financial distress and its impact on patient nonadherence to a treatment plan. 

The high price of cancer treatment takes its toll on cancer patients. The corollary to this statement is that the current unemployment rate and the number of people without health insurance is unacceptable. While it is not a novel topic to address, I was struck by a recent survey of cancer patients, caregivers, and oncology social workers. The survey indicated that more than two-thirds of patients with major financial hardships suffer depression and anxiety, nearly one-third of patients delay filling prescriptions, and nearly one-quarter skip doses of their medication. The mounting financial pressures patients face have placed undue strain on patients' ability to follow recommended treatment plans and focus on recovery. Only a third of patients in this survey turned to an oncology social worker for assistance, yet most patients reported stress related to the financial burden of cancer care.
 
Are we in touch with the severity of this issue? Imagine choosing which essential expenses you cut back on—food or your cancer treatment. That is what nearly half of the patients reported in the survey. How does one focus on health when constantly worrying about paying bills and having enough left over to afford groceries? That is what 75% of the patients reported.

Are we in touch with the issue of nonadherence for oncology patients?

When one speaks with oncologists and oncology nurses, one finds a growing number of healthcare providers who have made a mind-set shift and recognize that cancer patients are not as adherent to treatment plans as previously thought. With this change in thinking comes a referral to oncology social workers and other staff who can help patients address the barriers they face. The number of oral oncolytics approved in the past 10 years has added another financial burden to the patient, especially the patient receiving Medicare. The need for financial resource assistance has grown, as has the need for emotional counseling related to the financial stress. However, only half of the patients surveyed are comfortable discussing financial matters with their healthcare provider. The patients may fear receiving substandard care, being offered different treatment options, or receiving less attention from their heathcare provider if they admit to financial hardships. Providers may hesitate to initiate a discussion based on a preconceived notion that a patient is facing financial hard times. And financial stress is only one barrier to nonadherence. The stress toll mounts for cancer patients, complicating their overall cancer care and recovery.
 
Making financial assessment a routine component of patients' visits may direct them to receive the counseling they need. The National Comprehensive Cancer Network (NCCN) has developed clinical practice guidelines regarding distress management. Within the guidelines is the Distress Management Screening Tool, a validated resource that can help patients identify their degree of distress and the source of that stressor. It is a visual, user-friendly tool administered to patients by their healthcare provider. This tool can help explore and uncover 5 areas of distress a cancer patient may be experiencing—practical, family, emotional, spiritual/religious, and physical. If a patient is not able to articulate the extent of distress or the root of the stress, this tool can facilitate both assessment and discussion of the patient’s worries. This is the first step in referring patients to the appropriate healthcare provider and finding effective resources. 

Ide Mills, LCSW
SVP, Health Education
Encore, a HealthEd company

Shifting American Attitudes, Part I: Consumer Trends for the Pharmaceutical Industry

At the DTC National Conference 2010 in Washington, DC, in March, Ogilvy (Chicago) and online community research leader CommuniSpace presented findings from joint research on shifting American attitudes. Their white paper, titled “Eyes Wide Open, Wallet Half Shut,” served up 10 key themes shaping America’s “new” mind-set as the country emerges from recession. It also presented significant implications and posed a serious warning for marketers: don't overlook fundamental shifts in consumer thinking.

In this vein, HealthEd explores how these general shifts might play out in more specific attitudes toward the pharmaceutical industry, healthcare, and the broader issue of health itself. This blog, the first in a series, reflects on 2 of the broader consumer trends. In hopes that our perspective on these trends spurs deeper thinking among industry leaders, we welcome your comments.

Trust Lost in Recession
The research presented in the white paper found that in the wake of the recession, trust of large institutions has plummeted. In fact, consumers' circle of trust has narrowed and includes few outside self and close family, with the local community being the furthest it extends. Sadly, pharmaceutical companies count among the large institutions that fall outside the diminished circle of trust, deepening the underlying distrust of the industry that was already a challenge. Further, the wrenching healthcare debate caught up almost everyone and joined the recession-fueled distrust of big institutions to intensify previous attitudes toward the pharmaceutical industry.

As an industry, we must do more, and do better, to make a positive impression. Give Humana’s Horsepower Challenge a try in your local community to demonstrate for yourself how we can build goodwill and trust for our industry. While you’re at it, think about how your patient communications help your brand and help lift the industry. How are you helping the cause?

Stronger Self-reliance
The flip side of narrowing trust, self-reliance is on a significant upswing. And we take the white paper’s observations one step further here as well. In our view, the Internet has liberated the self-reliance trend, especially when it comes to making decisions about health. Patients know about the Internet, they look there more and more for their own answers, and they fill in the gaps—ironically with the industry notably absent from the direct discourse. In the vacuum, patients have turned to one another, having formed communities (Twit2Fit, dLife, or cancercompass.com) around broad health topics, as well as more specific conditions (www.abc-survivors.net/stories/chondrosarcoma, transplantcafe.com, www.epilepsy.com).

Invariably, patients discuss pharmaceutical products they are using. How many of us in the industry care what they are saying? We should. Although few will give credence to the one patient who tells us her medication made her see ghosts, most patients make significantly less fantastical statements that others will (and do) pay attention to.

While these communities are not “local” in the traditional sense, they do provide common ground where people with common health experiences can feel at home with one another. Think of these comunities as pseudo-local, formed by consumers relying on themselves. And oh, by the way, that puts these communities inside the circle of trust.

Implication for the Pharmaceutical Industry
Our industry must find ways to speak through more trusted channels like these. Over the past few years, we've all heard how pharmaceutical leaders have developed “patient strategy” as an important driver of business results for their brands. By now, most recognize a concept known as the “empowered patient” and have given that patient more mind space and focus in their marketing efforts.

As we think it through, this does not necessarily lead to DTC marketing. In fact, it mostly takes the form of very specific, often personal or intimate, communications driven by deep insights about condition, treatment, and the clinical setting where patients interact with the healthcare system.

George Fencl
Director, Strategic Services - CRM
HealthEd

DTC National: A Storm of Opportunity

I came to DTC National 2010 in Washington expecting to hear about best practices in television advertising, the vital role that print still plays in the marketing mix, and the benefits of portals like WebMD.

Instead, DTC National feels more like a hybrid of ePharma, the Pharmaceutical Relationship Marketing Congress, and a NAMI convention.

Speakers have detailed the intricacies of database-focused marketing, opportunities in social media and word-of-mouth, and the need for partnerships with advocacy groups. In fact, the high winds blowing newspapers around outside of the JW Marriott here may be symbolic. 

Exit: pharma’s past. Enter: a digitally-influenced, behaviorally-focused, and surprisingly optimistic future.

Sir Martin Sorrell, the voluble chief executive of WPP, one of the world’s largest marketing services companies, kicked off the proceedings with a reflection on US healthcare reform. He raised the issue that passage of the healthcare bill has a strong upside for pharma: 30 million new consumers joining the healthcare system.

(This could explain why 66% of the DTC audience voted their “approval” of healthcare reform during an audience-response survey earlier in the day.)

However, Sorrell noted, these previously uncovered consumers will be different than those whom pharma marketers have been pursuing to date. He said they are more likely to be poorer, less educated, younger, non-white, foreign-born, and possessing lower health literacy.

“They learn by watching and listening, not by reading,” Sorrell said, first suggesting that television will continue to be a viable approach, then later noting advances in mobile technology will offer another strong vehicle.

Regardless, Sorrell said: “Healthcare marketers will have to work much harder to reach them.”

Some more highlights:

• Actor/director Joe Pantoliano provided an intimate look at his struggle with depression. Successful yet suicidal in the mid 2000s, Pantoliano (“Ralphie” from The Sopranos) got help and later created No Kidding, Me Too, an advocacy group that aims to “shine the light of Hollywood fame onto the dark corners of diseases like depression.” He echoed comments made earlier in the conference by former Vermont Gov. Howard Dean that trending diseases such as obesity may in fact stem from emotional responses to depression. Pantoliano encouraged pharma to help consumers understand the positive benefits treatments can bring, and use their media leverage to continue encouraging diagnosis and treatment
• Michael McCaughan, of Provision Policy, questioned whether the value of pharma brands in the post-recession, post-blockbuster world is in the molecule itself or in the support system created around it. Confirming what many in health education and digital healthcare have assumed, McCaughan said there will be many government dollars available for interventions that lead to better health outcomes. The catch: “You’ve got to be able to show proof”
• Dolly Judge, formerly of Pfizer and now with Hill & Knowlton, was asked what the future held for pharma. Her response: “Compliance, compliance, compliance”
• John Kamp of the Coalition for Healthcare Communication, an industry lobbying group, added that the New York City Health and Hospital Corporation is looking for ways to ensure patients adhere to prescribed treatments, as a way to control spiraling healthcare costs
• Amy Cowan, Google’s industry lead for healthcare, shared data showing higher consumer interest in search ads that carry additional risk language. Bayer’s Yaz brand piloted the new ads on Google, where click-through rates were measurably higher than for ads that ran before 14 manufacturers received FDA warning letters last spring. In some cases, the new ad formats with risk language saw click-through lifts as high as 20%, Cowan said
• Mark Miller of Epsilon shared results from a wide-ranging survey the agency conducted to shed light on consumer behaviors in the social media. The most compelling finding: Healthcare conversations are taking place on message boards in much greater volume than on any other social media venue. 49% of respondents said they used message boards to discuss health issues online; only 20% of respondents selected the next-closest venues
• The Great Recession appears to have ended in the marketing services industry. Several agency speakers, including Sorrell, remarked that revenues have recovered in 2010…although he noted downward pricing pressures will continue to hurt big-ticket items (read: print, TV) and support more nimble approaches (read: digital)

Jeff Greene
Director of Strategic Services
HealthEd

HealthEd wears red for women's heart disease awareness

To show support for women’s heart disease, the American Heart Association and the US Department of Health and Human Services have sponsored today’s National Wear Red Day.  The national movement helps send the message "Heart disease doesn't care what you wear—it's the number one killer of women." You can see how our staff members at the HealthEd have joined the movement and worn red today.

As we wear red and show our support for women's heart disease awareness, I remember the many women—and men—with heart disease who have shared their stories with HealthEd to help us develop our patient education programs. In particular, I remember a special group of women who were heart attack survivors. Despite the emotions stirred up by their memories of the event, the women courageously came together to share their insights and wisdom. They wanted to help HealthEd develop educational programs that would be personally relevant, actionable, and easy to understand. To help promote heart health and wellness, the women spoke about helping other women to: 

• Shift their beliefs from "This is my fate and destiny" to "I have the power to take control of my heart health"
• Listen to their bodies and recognize symptoms they should report to a doctor
• Strengthen their communication skills with healthcare providers and advocate for high-quality healthcare
• Know the numbers that matter for their hearts: blood pressure, LDL cholesterol, blood sugar (if they are at risk for diabetes), and weight
• Believe the small steps they take to stay healthy can make a big difference in their lives

HealthEd thanks these women and the many others who have helped influence what we do and what we believe in. And we are proud to be part of National Wear Red Day.

There are many Web resources where you can learn more about National Wear Red Day.

Susan Eno Collins, MS, CHES, RD

SVP, Health Education Research and Development

HealthEd

FDA Social Media Hearings, Day 2

The FDA social media hearings continued Friday with a focus on adverse event (AE) reporting. It’s a critical issue for FDA to consider, because pharma manufacturers have identified AEs as a barrier to opening two-way conversations on the Web. The logic says that if patients could talk directly to pharma, pharma would be overwhelmed with reporting responsibilities (assuming drug-company employees could identify which “events” required reporting).

Yet data emerged this morning that challenged the logic. Notably, a Nielsen analysis (PDF) of consumer health comments from the Web found that only 1 of 500 (or .002%) randomly sampled posts fit all 4 of FDA’s required criteria for reporting. Only 11% of posts, explained Nielsen’s Melissa Davies, had an identifiable reporter (eg, not just an anonymous screen name). Only 1% of posts mentioned a true AE.

Further, Davies testified, it took about a week to analyze the 500 posts, drawing a few nods from the FDA panel—perhaps a signal that online monitoring might not be too great a burden for manufacturers to bear.

Several presenters panned FDA’s Medwatch program, which lets patients visit a Web site to self-report an AE. For one thing, the Medwatch Web site collects only a small percentage of total AEs, according to PatientsLikeMe CEO James Allen Heywood. He had a few more things to say: “Medwatch is hostile … and written in a language that patients don’t understand.” Heywood’s critique points to the need to consider health literacy in any debate on the role of social media in healthcare.

Finally there’s a subtheme I want to mention, one that has quietly simmered during these hearings. The historical focal point of healthcare—the doctor—appears to be blurring. Meanwhile, the healthcare consumer is sharpening into bright focus, energized by the free flow of online information and perhaps a sense of frustration with the medical establishment.

Understandably, the establishment is uneasy. When Bill Drummy of Heartbeat Digital finished a thoughtful proposal for a direct-to-FDA social media reporting plan for patients, FDA panelist Gerald Dal Pan, MD, asked: “Where is the physician in all of this?”

A compelling question. If more patients could answer it, perhaps they wouldn’t be turning so often to their peers in the social media.

Jeff Greene
Director of Strategic Services
HealthEd Group

FDA Social Media Hearings, Wrap-Up Day 1

So much to talk about after day 1 of the FDA hearings on social media. I’ll be providing additional analysis and wrap-up after I get back to HealthEd from DC, and checking www.fdasm.com for complete coverage. For now, some initial takeaways:

Best Idea
The FDA may have saved the best for last. Google, which gave the final presentation, unveiled proposed search ads (PDF) with a new “risk line” it said would address concerns about fair balance. Rumors at the networking events afterward suggested the FDA found Google’s proposal favorable.

Biggest Need
In presentation after presentation, the FDA panelists requested “more data” about consumer behaviors on the Web. If pharma companies can’t prove that patients actually will click on links to view fair balance information, for example, I wonder if the FDA will ever approve a one-click-away rule. The agency will accept feedback and public response on this and other social media issues until the end of February 2010. 

Most Consensus
Nearly every presenter said that pharma manufacturers should not be liable for policing the whole Internet and that content they don’t create, influence, or pay for should not fall under FDA regulation.

Boldest Statement
Aside from John Mack, of Pharma Marketing News, imploring Google to “tear down Sidewiki,” Elizabeth Forminard, from Johnson & Johnson, said there was no regulatory basis for the FDA to control user-generated content. Her sentiment was echoed, but never stated so boldly and clearly.

Biggest Surprise
Social media may hold its greatest promise as a support and learning tool for patients trying to stick to their prescriptions … yet little mention was made of adherence at all. Either speakers were concerned about discussing this topic with the FDA, or the industry sees marketing acquisition—not overcoming barriers to safe treatment—as the goal of social media.

My Favorite Quote
The team from Wego Health, a self-described portal for health activists, asked community members their opinion about whether pharma should participate in social media. One member recounted seeing a response to her message posted by an employee of Allergan: “It made it seem like we aren’t just yelling into the air.”

Jeff Greene
Director of Strategic Services
HealthEd Group

FDA Social Media Hearings, Day 1

The much-awaited FDA social media hearings kicked off today. For some outside the industry, the hearings appear little more than a push by pharma companies to promote their drugs through yet another channel.

Those of us who live and breathe patient communications know so much more is at stake.

Michele Sharp, Senior Director of U.S. Regulatory Affairs, Eli Lilly and Company, outlined a major barrier to improving patients’ medical knowledge this morning: “Currently, numerous unregulated sources are significantly contributing to the body of healthcare information on the Web with what is often inaccurate, incomplete, or imbalanced information.”

She singled out Google’s new Sidewiki to make her point. The new Sidewiki lets users who install it attach comments to any Web page—as if they were part of the page’s content. When other Sidewiki viewers visit the page, all comments appear … even if some are patently false.

If the FDA provides appropriate guidance, Sharp continued, “The pharmaceutical industry could more effectively balance and otherwise address these concerns with regulated content and help patients achieve better outcomes.”

Better outcomes. If there were one ultimate win-win-win for patients, the healthcare industry, and government, that single phrase would define it. I’m a big proponent of empowering consumers to say what they choose on the Web. Yet when health outcomes are at stake, those able to provide accurate, information while adhering to principles of health literacy must have their say as well.

There is much testimony to follow, from numerous stakeholders with diverse interests. It will be interesting to see if the industry outsiders got it right, or if better outcomes and improved patient communications are truly the objective of this week’s gathering.

Jeff Greene
Director of Strategic Services
HealthEd Group