Medication Guide App

Mobile maze

By Christiane Truelove (chris.truelove@ubm.com)

Doctors love their smartphones, but do they love what pharma is providing them through mobile devices? The answer is mixed. The pharma industry is still struggling to find ways to be relevant in the mobile conversation, and experts say helping physicians provide information to patients, creating easy to use and efficient tools for the point of care, and ability to link these tools to the electronic medical records system are the best ways to do that. At the same time, pharma marketing teams have to change their thinking, get beyond the mindset of just providing another app in an already crowded field, and understand the challenges today’s physician faces in providing care. If there is an “easy” button, pharma has not found it yet.

“A lot of people are still dabbling when it comes to the physician and mobile and experimenting, with not many successes because they’re not really needs-focused,” says Will Reese of the digital agency Cadient Group. “At the end of the day, doctors are adopting mobile because they don’t have a lot of time. That time-saving aspect is hugely valuable to tap into from the doctor’s perspective. The marketers as they identify that need for saving time, they recognize that doctors, when you think mobile, are that omnivore and they are early adopters because they use smartphones and tablets and occasionally they’ll check in on the desktop. The solution has to be a lot more cross-channel from a mobile perspective as well as need to have a higher utility value than a lot of programs that they’ve done, less so on the marketing side, on the deep content side, much more on the practical value at point of need.”

One thing is clear: pharma does not have the option of overlooking mobile. According to a whitepaper done by the Digital Insights Group, “Are You Ready for the Mobile Physician?  Why Marketers Must Prepare for Digital  First…and  the Coming Age of Mobile First,” mobile continues to remain elusive to traditional pharma marketers.
Mark Bard, president of Digital Insights Group, says, “I don’t think there’s an easy thing, saying, ‘Do these five things on a checklist and you have a great physician mobile strategy.’”

He believes the impact of mobile on how physicians are practicing medicine is being severely underestimated. “It’s not a hype thing,” Bard told Med Ad News. “If you try to understand how physicians use these devices, let’s call them non-desktop, non-laptop – we’re really underestimating how those are impacting the way physicians get information. And then if you look at how do you sit down and plan for brand planning, and you’re thinking about 2014 strategy, mobile is not strictly speaking apps to mobilize the site. The argument being that if you thought about mobile the same way that physicians think about how mobile is important to them and how they practice medicine, there’s a pretty big disconnect between the two.”

DIG found polling physicians that in any use of a device to access medical information in one week, 90 percent of physicians reached for their smartphones; 75 percent went to their desktops; and 40 percent reached for their tablets.

And when it came to the primary device for accessing medical information, 65 percent of doctors used their smartphones, compared with 25 percent on the desktop and 15 percent using tablets. “It’s not only used to communicate, it’s a reference tool, it’s an e-mail tool, it’s a news tool,” Bard says. “Surprisingly, they are visiting news stories, they are looking at professional portals, they are using clinical apps, which is a whole other story.”

When looking at physicians’ top activities on their smartphones monthly, DIG found that 68 percent are accessing professional portals; 67 percent are communicating with colleagues; 58 percent are researching prescription options; 54 percent are accessing clinical apps; and 33 percent are accessing journals and magazines.

Physicians are “hunters and gatherers of bits of information throughout the course of their day,” says Martin O’Brien of Rosetta.

The industry has been scrambling to catch up digitally. “To a large extent, the industry was kind of a laggard in getting mobile-optimized Websites, your most basic raw offering,” O’Brien says. “And trying to look at a non-optimized Website on a mobile phone was an act of futility. Then you started to see Websites that were mobile optimized, and now you’re seeing a little bit more of strategic upfront focus on responsive design sites. We’ve already launched one or two of them for the industry. On what they’ve been offering versus what physicians really need, are things that are designed to operate optimally on the device they’re being rendered on.”

Just a few years ago, a company’s mobile strategy centered on getting a doctor to go to Epocrates, or creating an app to be downloaded off the brand Website, according to Bard.

“Now you’re in this much more strategic conversation, where it’s beyond the desktop, beyond the laptop, let’s call it browser based, and when we are talking about browsers, we’re looking at a larger screen size,” he says. “We get into tablets, phablets, everything that’s in that middle space, and we’re not going to know what those devices will be in one or two years. We have a smartwatch, there’s glasses, but if you look and say strategically, what does that mean, how is content now being served up.”

Paid search is a given – most brands are being served up in mobile search. “But when you start to think of display advertising, video advertising, and all of these things that are rapidly evolving in every other market outside of pharma, there are really some cool strategic questions pharma companies need to think about: how do you place your content, how do you place your advertising?” Bard says.

Merely making a desktop-optimized site usable on mobile it not enough. “That’s not really the question; the question is do you use a site differently on mobile than you do on a desktop or laptop?” Bard says. “How do you rethink that experience? American Airlines, for example, has a much different user experience on mobile than they do on browser.”

Zoe Dunn of Hale Advisors says physicians are looking for ways to integrate information both into the examination room and on their desktop. “They are feeling that having access to that information at point of care is more critical than ever, especially when they have limited time and resources to be good physicians with their patients,” she says.

Dunn begs her pharma clients to try and avoid solving all their mobile strategy problems with apps. “Personally, I have seen many of our clients go down that road and been disappointed,” she says. “In terms of the ROI, I feel it’s a tough thing to justify, in terms of what are the success indicators, what are we basing our success metrics on, it’s very hard to show success that is directly tied to what we all care about in the industry, which is selling product, from an app. And the argument that I make is that there are plenty of great apps out there, so why take the mentality of build it and they would come, when there are plenty of things that are already built and that people are already utilizing. And instead of providing one more app, why don’t you look to partner with an app that’s already successful, that’s already being utilized.”

Bard says, “The road of app strategies is littered with a lot of roadkill.”

One of the biggest problems is figuring out where an app should be used and when mobile Web is the best choice to access information.“We still do have some expectations of what an app delivers, and if you look at your own smartphone, you may have 80 or 100 apps, but we use about eight of them,” Bard says. “Those are core functionalities that we go back to again and again. I would argue that it’s the same thing with physicians.”

The clear market leaders in this arena are Epocrates and Medscape, Bard says, but there are outside-of-the-industry examples of where mobile Web is the preferred access point and the app itself will drive the user to the Web.

“I may use my American Airlines app, but depending on the functionality I’m using within the app, it’s going to take me to mobile Web, because that’s not an app functionality,” Bard says. “At one point do I simply start using mobile Web for American Airlines and the app functionality becomes nonexistent?”

According to Geoff McCleary, VP and director of Mobile Innovation at Digitas Health, the pharma and healthcare industries are in “a kind of a transition period of this value of apps for healthcare.

“We went from this ability for anybody in their garage to sit down and code an app, to actually now becoming pretty sophisticated pieces of software where now as marketers we see the huge value of integrating apps with our data services, and other information services and programs,” McCleary told Med Ad News. “So they’ve now taken the life of a much bigger thing, and when we get to those conversations with clients, does this make sense for you to build this, or to find a partner who’s already doing well in this space and work with them. And it’s an interesting conversation to have, it’s an interesting new dynamic. I figured at the end of the day, the patient aptitude or drive is there, to want an app pharma should figure out a way to provide one.”

But the question of how pharma should provide these apps is the challenge – the question is whether companies should build apps themselves or just buy them.

“And at some point, a lot of app makers and developers are going beyond active conversations with patients, they’re going into clinical trials with payers,” McCleary says. “So now we’ve got these apps that are not just service, customer service and support tools, they’re actually being looked at as a new class of therapeutics. Because they can drive measurable outcomes and can be used as treatment in conjunction with the pharmaceutical treatment to varying different degrees, all to the aid of increased healthcare.”

McCleary believes that the future of information consumption will be screen-agnostic.

“It’s driving communications and tools that are cloud based, that are more partner-driven and support-driven for the physician than focusing on specifically on ‘How do I promote this drug?’ he says. “Doctors are going to want tools and we already know based on research, doctors want to be able to see it across different screens. I think the driver right now is going to be the tablet because that adoption rate is catching up to smartphones. Our data saw that there is probably a little more activity in smartphone use between doctors and physicians than there is tablets, but I think that’s going to catch up and level out. But at the end of the day there are different tasks for different platforms. We need to provide our value across all of those mobile screens. And we’ve already seen value in things such as Google Glass, so it may not be tablet or smartphone in the future. So that in the future, it’s even more important to figure out, how to provide value for the physician based on the context of where they’re going to need that content in a kind of mobile setting.”

DIG’s findings concur – only 10 percent of the physicians queried say multiscreen access is not very important and more than half say multiscreen access is very important.

Ultimately, O’Brien believes that physicians are looking for pharma to provide more relevant apps that they can take and use on their own, to educate themselves, to support conversations with patients, to support ongoing adherence and optimize outcomes. “There is more of a hunger for utility across the board,” he says.

A conduit between physicians, patients
Dunn says physicians continue to place a high value on educational materials that they can pass along to the patient, to enable the patient to have better health outcomes.

“It’s no mystery to physicians that just giving them a pill is not going to solve their problems,” Dunn says. “It’s not the panacea for most therapeutic conditions, it’s a combination between lifestyle, diet, and medication. That’s often the solution for a particular health problem. They can prescribe the product, they can act as the patient comes in and sees them, but what they can’t help is the lifestyle and the diet. That’s really up to the patient, when they leave. And so tools that can be passed along to patients, in terms of patient education or even tools that might facilitate or enable that patient-physician dialog, are real opportunities for the industry.”

According to Digitas Health in its “Consumer Mobile Health Impact Assessment: How the Use of Mobile Impacts Disease Treatment and Therapy,” a study of mobile usage in health care while patients using more mobile devices (smartphones, tablets, etc.) are most proactive with their own care, it also indicated that those with limited mobile device access are twice as likely to be untreated.

The study found that brands that provide mobile tools for patients and physicians to use in the exam room can have a significant advantage over those that do not provide such interactive tools. Patients and their physicians are using mobile together, which is indicative of treatment behavior and decisions. In the exam room itself, more than one in three respondents reported that either they or their physician has used a mobile device at the point of care.

And physician use of mobile indicates increased patient use of mobile. Nearly 80 percent of mobile health users said they have accessed health information for their condition while in a healthcare setting; overall patient use of mobile in the physician’s office and pharmacy is 30 percent to 50 percent higher with users whose doctor has used mobile in the exam room.

The respondents also revealed that mobile in the exam room indicated switching behavior. Using their mobile in the exam room corresponds with users being 80 percent more likely to switch medications, and more than doubles the chance that they will ask for specific medications – compared to only 25 percent more likely when accessed in the waiting room alone.

“Our study has brought to light the potential significant influence that apps may have for the future of healthcare for prevention, treatment and management of most disease conditions,” McCleary says. “In fact, 100 percent of those accessing mobile in the exam room said that they would use an app, if recommended by their physician.

“The ability for app usage to affect repeat versus switching of medication is a signal to healthcare brands and marketers that we need to act quickly and be creative to tap into this unprecedented access to patients and physicians during the exam …or risk being locked out,” McCleary says. “We found that more than half [55 percent] of mhealth patients currently on a prescription drug were either planning on, or would consider, switching prescription medications in the next year.”

Digitas Health’s study indicated that digital tools are preferred over drugs as more – up to 90 percent – of patients and caregivers say they would take an app if their physician prescribed it. Nine out of 10 patients said they did, or would, use an app when recommended by a physician compared to industry data suggesting that only two-thirds of patients will fill a prescription that is written by a physician.

Come together
Many experts say one of the areas the industry needs to look at is how their apps integrate into electronic medical records or electronic health records.

“EHR is an interesting space right now,” McCleary says. “There are a lot of players and that marketplace is going through an alignment period of trying to come up with standards and processes that are going to work more ubiquitously across payer types and part organizations. No doubt mobile is a huge part of that. Everyone that we’ve talked to has some level of mobile play and consideration and as they get through this alignment period and come up with a solid approach about here’s how we’re bolting mobile or integrating mobile into our offering, or making an EHR a complete mobile-first solution, when we can start to see the additional levels of functionality and experience emerge where we can start to plug in patient apps and data and communication.

“I don’t think it’s wholly unreasonable to see a physician in the next year or so prescribe an app, a patient gets the app, completes the activity by performing the tasks, and all of that data goes back to the EHR for the physician to evaluate.”

But “Integration is the billion-dollar question,” Dunn says. “And we see this with all of these homegrown EMRs. Everyone wants to get into the EMR game but they really don’t know how to do it, but the problem is, until some of that gets standardized, there are like 400 EMR companies out there. How are you really, as an industry, going to work across this totally fragmented space?

“In integration, we’re a bit lagging, so it’s almost like we could be ahead of the curve by providing this information, by getting into this game, but where that information nets out, or how it’s really being utilized, we’re at the infancy, we still have a long way to go before that’s where we need it to be effective.”

O’Brien says EHRs are still a bumpy road for a lot of physicians, many of who have regrets over their first partnerships or EHR product chosen. Significant regrets stem from the fact that most EHR/EMR systems are not optimized for mobile. “From a usability perspective, it’s challenging,” O’Brien says. “As EHRs move in the direction of providing a similar responsive-design-type mode, a lot of the buzzwords we hear – outside of pharma, we work with some clients in the health information areas and we’re starting to see this movement towards interaoperability. Regional health information exchanges, locals uniting to provide state level, state level uniting to provide regional, so in the context of interoperability, I think that as pharma, within the specific drugs that we’re prescribing, and maybe the different types of information, that you’re really thinking about how that might port more easily into an EHR or maybe some custom applications inside the EHR, specific to your product offering.”

Considerations for pharma companies if they want to get into the EHR space is that need for more interoperability between systems, to really make these things functional and not redundant, replacing paperwork, and getting into more networked data.

“Inside of pharma, pharma is not responsible personally for your insurance information and things like that but the products we’re prescribing to you and how they relate to your personal access and information, and how they relate to the physician prescribing and using that product, if they are creating utilities that can plug and play inside of these other systems, that’s where they can add real value,” McCleary says.

Dunn says there are already platforms that gather health data that can be imported into an EHR, and provide an opportunity for pharma to have a voice in the exam room conversation with patients. For example, Dunn uses her Flexband with an app called Runtastic to gather data on how many miles run, heart rate, etc.

“If I was partnering with Runtastic, I would be able to get in the game there, and offer, ‘Hey if you’re trying to reduce your cholesterol or keep your blood pressure in check, and you’re looking for activities, we can help you. We can partner with you with these existing tools and support you and for more information about high cholesterol or high blood pressure, please feel free to visit us where we can give you the latest, greatest information and strategies to work better with your doctor and manage your condition,’” Dunn says.

Reese points out an offering from Epocrates as a good example to the industry of how data from differing sources can be packaged in a way to provide real-time value for physicians. The “Bugs and Drugs” app combines athenahealth’s data with Epocrates’ information to provide localized susceptibility data for infectious disease.

The app helps clinicians identify superbugs in areas their patients live by incorporating lab data sourced from more than 15 million patient records on athenahealth’s cloud-based EHR. Data include a list of bacteria observed in urine, blood, and skin for geolocated communities across the country; antibiotic drug options organized by organism susceptibility; and Epocrates dosing and contraindication content with a link to the complete monograph.

According to Kim Levy, VP, team lead, Strategic solutions, at Epocrates, the tool gives physicians support and data that previously were only available in the hospital setting. “It’s a very simple too, but it’s a very powerful tool,” she says. According to Levy, Epocrates has spoken about a lot of these kinds of tools with pharma partners, figuring out how Epocrates can help capture pharma data such as clinical trial results, and get it into the hands of practicing physicians.

“I was very intrigued by Bugs and Drugs,” Reese says. “It’s a very interesting model for marketers to take a look at and say, when we go back and look at our information, what insights data do we have, what outcomes data do we have, what tools do we have that could they be packaged in a friendly way to be able to be at the fingertips of the physician.”

Posted: December 2013


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