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Realistic innovation

When it comes to online strategy, today's novel technology is tomorrow's everyday resource

twisted_lightbulb Rapid and continued growth of the internet as a communications and media channel is widely accepted. In healthcare it has the potential to radically change the relationship between doctors, patients and third parties – such as pharma. However, given restrictions in Europe limiting the ability of pharma companies to engage consumers online, many executives are asking whether a digital consumer strategy is worth the risk.

In the early days of the web, terms such as e-health came to symbolise a larger philosophical movement, and discussions would often include scenarios in which all consumers would embrace the vast clinical knowledge available to them, upload their clinical history to an online health record on an ongoing basis and have the real-time capability to share that information with the doctors that best served their needs as consumers. Over a decade into the first generation of e-health, it is clear that the migration towards a fully-integrated digital health system will take a web generation, or two, to come to fruition. After all, in the healthcare industry, things move slower than in the outside world.

Sir Arthur C Clarke did an excellent job of summing up our ability to integrate technological change into strategic planning when he said: "In the short term, we tend to overestimate technology, and in the long term, we tend to underestimate technology".

This statement certainly rings true for Europe's digital pharma consumer strategies today. Digital media firms would like you to believe that nearly every consumer is on a social network constantly chatting about the latest issue with their health. Yet, there is little in the way of innovation in the 5- and 10-year plans of most pharmaceutical companies and, in all likelihood, the environment contemplated by these strategic marketers is not much different to the real world today.

Bifocal vision
It's hard to maintain focus on what is realistic and likely to have an impact in the near term and still consider the 'what if' in the future consumer landscape. Many pharma marketers, and their agency partners, gain enjoyment out of a pilot project or programme that is innovative today for a niche market – rather than planning a broad strategy for a future when consumers routinely use the tools and technologies that are in early stages of development today.

These two worlds are not in conflict. It is possible to experiment in the near term and evaluate new innovations and also take a longer view of the planning cycle to lay the foundation for the markets in 5–10 years.

There is significant benefit in laying the foundation and preparing for the time when consumers are more likely to rely on the internet than their GP as a medical resource. Clearly, the internet will never replace the actual healthcare delivery system. However, the impact of the online channel on clinical decision-making and care support must not be underestimated over the long term. Just as it has, in a short amount of time, turned upside down industries such as music, travel and entertainment, its long-term impact on healthcare will be dramatic. Preparing for that horizon must be part of today's strategic planning process of every serious pharmaceutical marketer. In other words, the short-term risks of learning through trial and error are nothing compared to the long-term strategic risks of maintaining the status quo and assuming the consumer market of 2020 will look anything like the market of 2010.

Back to the future
Often, talk of the digital future quickly becomes a consideration of what is possible down the road. Before thinking about what is next in the technology pipeline, it is worth a recap of developments over the past 10 years.

In many ways, despite all the talk of Health 2.0 and the next generation of online health, the first generation of e-health remains alive and well. Perhaps the best way to describe the first generation is using the word 'content'. Consumers were given access to an exponentially increasing array of medical resources online that were previously the domain of their doctor. The online health environment was all about the content and the ability to access and share that information – whether it was clinical news, clinical trial results, drug information from halfway around the world, or simply the ability to email information to a list of online friends.

It is important to note that two of the original reasons for using the internet for health remain the same. The most likely one is when a consumer has symptoms for a specific condition or disease and wants to learn more to assist in a personal differential diagnosis. The second is right after receiving a diagnosis from a GP, when people are likely to research targeted, disease-specific information online. In other words, the original draw to the internet – access to a vast medical library – remains a motivating force today.

As the first generation of e-health continued to build steam, terms such as user-generated content, community applications, social networking, and social media became the focus of attention. Content never disappeared. We were simply finding new ways to bring additional value to that information, make it easier to create, share and distribute, and provide consumers with tools to engage with other like-minded individuals online.

Content contribution
It could be argued that the current generation began in the latter part of the decade from 2000 to 2010, and will continue for many years to come. As mentioned, the current push is all about the early promise of the internet – establishing communities by connecting individuals and making the publication and dissemination of information and commentary as easy as starting up a PC. As the world quickly learned, average consumers were not learning how to program HTML pages or monitor a website in their spare time. For that reason, the first wave was largely a movement online of traditional publishing content and models.

Now that self-publishing and user-generated content have become normal online, with tools and applications making it easier to share content, the initial stage of editor-driven content has been multiplied many times over as a much larger audience of 'editors' has started to contribute its own content on every topic. Healthcare has been no exception, as consumers with conditions such as MS, diabetes, asthma and cancer have taken to the internet by the millions to publish their stories and give others a chance to connect with them. Millions of others have used their user-generated content to make clinical decisions.

The vital few
Before jumping into the world of Health 2.0, every pharma marketer must keep in mind that, like most systems in the real world, the 80/20 principle certainly applies in the world of online health conversations and community. For example, our latest research continues to show that less than 20 per cent of online health consumers in Europe are actually posting health content online. A larger audience may consume that information on a grander scale but the logic of the 'vital few' remains true. A much smaller audience of consumer opinion leaders emerges to voice views driven by a wide range of health experiences.

Often, there is a connection one or two degrees removed from a patient with a condition that motivates a blogger, poster, or consumer opinion leader to get involved in the first place.

Knowing that consumers are taking to the internet and posting comments and opinions about the latest medical news and treatment options is one thing; understanding how that content is being used is another. Data from a recent study by Manhattan Research reveals the link between age and the likelihood to rely on user-generated content online. Younger consumers, growing up in a world where online content and social networking streams are a primary influence, are much more likely than their older peers online to rely on the opinions of other consumers in the virtual space to make decisions in the real world.

This goes back to the point earlier about overestimating the impact near term and underestimating long term. Although the group most likely to engage in conversations, networking, and user content online is the least likely to be affected by a wide range of health conditions, given the correlation between age and many illnesses, this is a group that will clearly take their behavioural patterns and media consumption trends with them into the future. Therefore, to plan for a disease segment with an average age of 40 years down the road, look at consumers aged 30 years today to understand their media consumption, decision making, and use of technology.

Critical connectivity
Back in the early days of e-health, there were many presentations at conferences outlining how the digital channel would revolutionise healthcare delivery. The problem was that most of those presentations were out by about 20 years. Yes, there are consumers using a personal health record to track and manage their healthcare outcomes today, but they remain a niche market for numerous reasons. One big one being that their doctors are still in the process of embracing the concept of e-health. Until that happens on a large scale, a lot of the connectivity and care support applications will not have the critical support network to make these solutions cost effective on a larger scale.

It is not a matter of 'if', but 'when'. In addition to the ability to share and manage personal health information, the ability to 'digitise' the world of pharmacy will aid reduction of medical error as well as concordance. Outcomes, defined as cost benefit, will increasingly drive prescription choice.

That said, using data to demonstrate value has significant potential for the pharma industry to work with technology and healthcare system partners. Findiing new ways to boost concordance and adherence to proven medical regimens will reduce short-term costs and the number of interactions with the healthcare system. It will also significantly reduce long-term costs and demonstrably boost quality of life.

Rapid innovation
It is amazing to think how much has been achieved in such a short time. The first internet browser was introduced just 15 years ago and technology has evolved so fast in that time that we barely recognise the sites and applications that were considered "cutting edge" from that period. Fast-forward to the current market and consider examples such as Facebook amassing an audience of 150 million users in just five years. Compare that with the much longer time it took for use of the telephone to grow to a level of significance.

We successfully moved through a period of rapid innovation in the first era of online health and quickly entered the next generation that pushed power out to the patient. The online health market started with in-depth clinical content, evolved to include patients as part of the movement, and is quickly morphing into a world where interconnectivity and access to content on a global scale are a reality.

The key for the coming decade is to align the promise of innovation with the coming vision of a ubiquitous information and media channel that will become a larger part of everyday life than the 'traditional' healthcare delivery system ever could be for the average patient.

There are risks related to this continued shift to empowered consumers online. The European market will certainly experience growing pains, and mistakes on a company-by-company basis. However, the long-term goals of taking healthcare digital and making knowledge more transparent and relevant to the end user, hold the potential to boost personal responsibility, enhance decision making based on hard data and ultimately promote a healthcare delivery system that holds the patient, the doctor and pharma accountable. It will also need to provide the technology to make that content, conversation and care support flow together seamlessly.

The Author
Mark Bard is president of Manhattan Research
To comment on this article, email pme@pmlive.com

26th May 2009

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