Special Feature: Mobile in the hospital

 

 

As private practices close and the number of doctors joining rep-restricted hospital-based and integrated delivery networks of healthcare increases, pharma needs to look at the advantages of mobile marketing to “detail” these hospital-based professionals.

 

 

The sun has truly set on the traditional detail visit as the number of no-see physicians continues to grow. However, there is a gateway to doctors that exists in their pockets – their smartphones. Healthcare advertising agencies and their pharma clients are striving to reach physicians through these mobile screens, using advances in geotargeting and other technologies to “be” where the doctor is.

In July 2015, experts at Accenture noted that only 37 percent of physicians were independent in 2013, down from 57 percent in 2000, and they predicted by the end of 2016, only 33 percent, or 1 in 3, would still be in independent practices.

With that decline of independent practice physicians has come an increase in physicians who refuse to see pharma sales reps. ZS Associates reported that in 2016, 44 percent of physicians are considered accessible in 2016, compared to 47 percent in 2015, 51 percent in 2014, 55 percent in 2013, and 65 percent in 2012.

Additionally, 18 percent of physicians severely limit access to the number of reps allowed to visit them while access to another 38 percent is moderately restricted. Physicians who severely limited access only saw less than 30 percent of the reps who called on them, while those with moderately restricted access saw 31 percent to 70 percent. Compare this with 2008, where almost 80 percent of physicians were rep accessible, ZS Associates says.

Pharma has come to quickly realize how important digital has become to reaching its stakeholders. According to pharmaceutical executives surveyed by Accenture, nearly one in four direct sales force interactions have been replaced with digital interactions for targeting doctors, providers, payers and patients. Eighty three percent of the executives surveyed by Accenture said they intend to increase digital and multichannel interactions. But increasingly, digital means mobile, as the prevalence of mobile usage in daily life continues to grow.

“We’re telling clients to be aware of how their specific brand fits into the healthcare system and prescribing habits, because when we see why physicians are moving into health systems rather than private practice, we’re seeing a little bigger skew with younger physicians,” says Chris Humphreys, VP, strategic planning and innovation at Intouch Solutions. “There’s more stability there, and there’s decreased burden from the administrative parts of private practice that they don’t have to deal with any more. But when they get into that setting, you get these no-see clinics or reduction in pharma visibility to those physicians. It can be actually difficult.”

Dave Traini, senior VP, creative director at Sentrix Health Communications, characterizes the new health system groups as “organized customers.”

“That’s something at Sentrix that we’ve focused a lot on, in terms of reaching these organized customers and understanding how they’re different,” Traini says. “And if you can understand how they’re different, then you can think from a mobile perspective in terms of how to reach them.

“And I think to boil it down, organized customers, what they’re really looking for, of course they want better patient outcomes, they want more efficiency, they want more efficient processes, and they want enhanced quality of care.”

What Traini says he has found different about hospital systems is the concept of “key influencers.”

Because all health systems are different, “It’s hard to make broad generalizations but a lot of them are organized top down,” Traini told Med Ad News. “If you can target the people who have influence, whether it’s formulary, or if you need to communicate something about guidelines or getting the hospital system to endorse a new drug, or a new technology, or a change in clinical pathways, or get information out about a safety issue, you can target those key influencers within a hospital.

“And there is a potential that they will communicate from the top down out to all the people who are in that system practicing,” he continues. “So in some ways you can be smarter about how you try to communicate just going through those key influencers as opposed to spending your time trying to target every single physician who may not be treating how much of what your brand treats.”

Traini calls these influencers “decentralized decision makers,” who he believes are going to become more common in hospitals.

“In some ways the power is being taken away from the independent physician,” he says. “It depends on which therapeutic category we’re talking about, but there are protocols that in some ways are going to be decided upon by the health system. And there are some ways that you’ll have to get communications out, if you have a closed system, where they don’t allow reps in. You can try to get in through those top channels and they can disseminate the information for you, if it’s deemed valuable to them.”

 

The doctor is “in” (your phone)

Spend a lot of time in any hospital, and you will notice everyone in a white coat or jacket has a smartphone in their hand. Kantar Media reported in October 2015 that four in five physicians – 84 percent – use a smartphone for work reasons, and 51 percent use both a smartphone and tablet for work. Additionally, 93 percent of physicians use a smartphone in some manner, either professional or personal – up from 88 percent during 2014, according to Kantar experts.

“It’s interesting that the biggest maker of white coats now for physicians, there is actually now a pocket that is actually large enough to hold a tablet so that they can walk around and have their tablet in their pocket,” Traini says. “I think that’s just indicative of how tablets and mobile usage is in a hospital system. I think the statistic we see is that about 60 percent of our doctors who get e-mails read them on mobile now.”

He adds that many of these physicians do not even have offices, where they get to sit down and review records on a desktop computer.

So what are physicians using on their smartphones? According to JP Medved, posting at the Capterra Medical Software blog in April 2015, the best medical apps for physicians are ePocrates, UpToDate, Doximity, Read by QxMed, NEJM This Week, Isabel, Figure 1 – Medical Images, DynaMed Mobile, Medscape, and Virtual Practice for Doctors. While most of the apps on this list are medical reference databases or sites, Isabel is a free mobile-based EMR.

“One other statistic that I’ll point out is that something like more than 80 percent of doctors use iPhones, whereas 30 percent of the general population is on iPhones,” Traini says. “They’re much more on an iPhone platform and they also tend to adapt new versions of the iPhone quicker than the general population. So doctors are faster adapters and they are much more on an Apple platform. It’s just something to take note of.”

For pharma marketers, the growth in physician mobile usage means when creating content and websites, the strategy must be “mobile first.”

According to Chris Cullman, senior VP, engagement strategy at Ogilvy CommonHealth Worldwide, just a few years ago he recalls having conversations with clients over whether it was worthwhile to optimize their websites for mobile, “and clearly, that change has happened.”

“The majority of our audiences, both in the consumer and HCP spaces, were starting to see the tipover, with 60 percent of engagement coming from mobile platforms,” Cullman told Med Ad News.

Consumer audiences do not have a very high tolerance for sites that they can not access from their mobile devices, and Cullman added, “It’s very much the same for our healthcare professional audiences, whether or not they’re using a mobile device for just-in-time information in the middle of the day, for a reference, or they’re using their phones in their homes in the evenings, even consuming some video content.”

 

Content remains key

When it comes to content, Jim Mackie, partner at Greater Than One, notes that it has to work harder across different touchpoints. The hectic workpace of physicians also means that this content can not be an interruption to their routine.

“So with mobile, the biggest change is that it has to have thoughtful content that works within a thoughtful content strategy, the customer experience, the user experiences, how they find things becomes important,” Mackie says. “You also have to think about the mobile interface and touchpoint, in terms of how they’re using it, things like mobile voice search, AI with mobile voice search, social media and its impact, how people discover information, the whole discovery side in search, and understanding search intent.”

Michael Spitz, VP Strategy, Klick Health, says using smartphones to reach physicians makes sense because of the phone’s capabilities of distilling the content that they want. “Your smartphone or tablet knows an awful lot about you already,” he says. “It knows who you are, it knows where you are, it’s already got your own preferences in there. So by doing this kind of profiling and compiling it with a mobile device that’s got patients, physicians, and caregivers on the go, it’s going to be revolutionary new way of researching health information and turn digital health into an active service, very much like all the services consumers are used to.”

Pamela Pinta, partner at Greater Than One, says mapping out the content strategy is just the first step. “In this world today, we need a lot more content,” Pinta says. “You need to create it, you need to curate it, and that is going to be very different for pharma, they’re not used to the level of content that’s going to be needed in this kind of mobile social world.”

But again, it’s not enough to have plenty of content if the physician is not seeing it. Agencies and their clients are trying to get the content to where the physicians already are.

“One of the things that we’ve been doing a lot of is geotargeting and geosensing around certain institutions, we’re really hypertargeting where they are,” Pinta says. “We’re not asking them to come to Websites anymore to find certain things, we’re serving up content in the places that we know they are. They’re busy, they have a lot going one, we don’t want to have them get on a quest to get the information anymore.”

Cullman says providing support to physicians during the mobile search experience is important, particularly when the physicians are asking questions.

“The desktop still offers a huge opportunity for the pharmaceutical brand and the healthcare brand, but I still think when it comes to nonpersonal communication to go to a physician or reaching out to them with a call to action, the smartphone is the critical cornerstone to that communication strategy – in particular search, targeted communication, geolocation, which the phone is especially adept at, and also making sure we provide an architecture to reach out and have correspondence with them,” Cullman says. “I think these are all critical aspects to what that engagement model looks like moving forward.”

According to Humphreys, part of creating relevant content for the hospital physician is understanding the restrictions these doctors are under. Not only do they have less freedom in prescribing choices under formulary restrictions, they have to understand and adhere to the treatment guidelines of that hospital or health system.

“But also, those physicians are held to different quality metrics, whether it’s different compensation and performance packages based on quality, or patient satisfaction,” Humphreys says. “Oftentimes you have to communicate the larger suite or features of a product rather than just the clinical benefits. How can this help that physician with patient satisfaction, or how can this brand fit into quality metrics that they’re being held to within the health system?”

In many ways when creating content, “it’s not looking at these hospital-based physicians too differently than we would non-hospital-based physicians because it’s digital,” Spitz told Med Ad News.

“That’s the great part of doing digital marketing, in that we can transcend that no-access boundary because these physicians who are in hospital setting and within large physician groups, from a digital vantage point and in terms of a digital fingerprint, are quite similar and often identical to their compatriots who are in this single-office setting,” Spitz says.

When hospital-based physicians go online, “They’re visiting very much the same Websites and platforms where we do many of our contextual ads and placements as the physicians who are in single offices,” Spitz notes. “So even though that they’re consolidating, even though they are less accessible to reps, a lot of the behaviors don’t really change when they get consolidated, and when they put the sign on the door that they don’t really want to see sales reps, they’re still going to many of the platforms and many of the sites where we are placing our ads.

“And these sites and our ad placements are very mindful of the fact that most of them how have smartphones and tablets as well.”
Agencies and their clients must now think of how they can provide value with their content.

“We’re in the relationship business rather than the information blasting business,” Spitz says. “I think that’s becoming increasingly important and it’s becoming increasingly feasible with the impressive digital technology at our fingertips.”

This means the pharma industry can get away from “buying an e-mail list and blasting a bunch of physicians to really understanding their digital fingerprint, tracking them throughout the continuum of the relationship, using the data back end to really learn their preferences and kind of grow together in that relationship, and extend a relationship with the brand to provide continuous value rather than using them as a traditional audience that we just shoot a bunch of content to,” Spitz states.

 

Avoid the apps, go for the bots

Even just a few years ago, when it came developing programs for mobile messaging, pharma marketers were looking to create their own apps. The hope was that physicians would download them and use them.

That is not the case these days. In fact, agencies are trying to steer their clients away from creating their own apps as part of a mobile marketing strategy.

“I believe every brand when considering an app needs to ask themselves the question, what value am I going to be giving to the user?” Cullman says.

With finite budgets, marketers really need to consider whether it’s effective to create an app and try and compel physicians to download it, install it, learn to use it, and actually use it more than once.

“Each step along the way has a tremendous amount of atrophy built into it, even if you’re performing optimally,” Cullman comments. “If you’re going to spend the marketing dollar to drive a physician to an app store to make that selection of an application and download your application, I would challenge every brand to ask themselves, is that dollar better spent in search, in nonpersonal communication, in some other form of targeted communication.

“Many of the brands we work with are looking for some form of an awareness message, more to let the physicians know that there is a value to interacting with the brand. Can you deliver that value inside of an app? Can you do it repeatedly, and give that physician the sense of whimsy or excitement that they get from opening a lot of these other applications on their phone? Remember, you’re competing for attention and space – both memory space on the phone and share of voice. If you can’t answer that question with a lot of confidence, I’d say you might want to consider your app strategy and using something else, whether or not it’s working with another app inside that space to make sure you have a share of voice from an advertising perspective.”

Of the more than 165,000 healthcare consumer qualified apps selected for review from the Apple iOS and Google app platforms in an IMS Institute for Healthcare Informatics 2015 study, only 36 of them accounted for nearly half of all downloads, “and most of them have limited to no functionality,” according to Spitz.

“From a pharma marketing view, there is almost nothing that you can meaningfully do most of the time to really get the ROI that justifies the exercise in the first place,” Spitz says. “Apps have gone from the holy grail of digital health and pharma marketing to just kind of a shrug and bare silence at best. We don’t dismiss them all together, we feel that apps do have their time and their place, if they’re strategically right in terms of the brand and what it wants to do.

“There are a lot of unbranded opportunities that have been fulfilled for pharma in the app space, but getting the busy physician to download them and use them even more than once is something of a challenge. So in lieu of developing a costly app, and the keeping your fingers crossed that the professionals are actually going to use them more than once we instead gear more towards these non-personal promotion and relationship management style programs that use more of an omnichannel approach.”

This approach can reach the physician from multiple angles throughout the course of a day “in a way that’s actually relevant to their practice, providing value to their practice in terms of them understanding their patients better and provide the right treatment for the right patient at the right time in the right way, rather than spending a lot of time and money developing an app that has questionable value,” Spitz says.

Traini says when it came to hospital-based physicians in “closed’ systems, pharma initially found apps appealing because surveys indicated that doctors would use tools as long as there is value there.

“So I think when apps first came out, everyone was rushing, it was like, oh, we can do anything on an app, and doctors are going to download and use it,” Traini says. “I think now, clients and from the agency side, we’re really looking at things, and saying what is the value to the customer, what is the value to the patient, and just trying to be smarter about how we’re building mobile technology or mobile tactics.”

According to Spitz, “the good news there is that clients have come to realize that the app hype has kind of burned itself out.”

Now what a lot of Klick’s clients are asking about are bots, he told Med Ad News.

“At Klick we’re actually researching them, we’re working with clients on actually trying to make them happen,” Spitz comment. “We’re mindful of keeping them compliant, keeping our clients’ faith, but at the same time entering a new and exciting space which we really think is not only going to change the face of marketing, but the face of digital and how we interact with services and each other. Bots are a really big deal we think and we’re just dipping our toes into their potential.”

Traditionally, search works by relying on the user to do the heavy lifting.

“If you go to Google and type in, ‘I’ve got a headache,’ you get a bunch of links and some metadata that pop up on the results page,” Spitz says. “And now you have to get someone to sift through all those results and then if you’re lucky, you get to a Website. And then when you’re at the Website, you have to search through the Website for the information that you’re looking for. And oftentimes one Website leads to another Website leading to another Website that leads to another page. You’re clicking and reading and clicking and reading, and you’re searching and working hard to get the information that you need.”

Bots take in the info you are looking for, asking a series of questions to refine your results. “You know the game 20 Questions?” Spitz says. “A bot kind of works the same way. Based upon the answer to the last question they gave you, it’s increasingly narrowed down your search. It provides a service to you without you having to go and dig for it.

“And in healthcare, that’s mindblowing, because [bots will affect] everything from symptom management to making recommendations for treatments to sending you information to share with your doctor to providing downloadable assets and education. Instead of patients and professionals and even caregivers having to go look for this stuff, they’ll be adding questions into a box and this artificial intelligence will be narrowing down their query to the point where it can provide the information, the product, or service that they’re looking for, without the user having to keep searching and searching and reading and reading.”

Spitz says the role that pharma can play with these bots is to create contextually relevant information that the bots will provide based upon the personalized input of the user.

 

EMRs and EHRs

One place physicians are “going” to on their phones, especially in hospitals, are patients’ electronic medical records and electronic health records. Agency experts say there are opportunities for pharma to share relevant content there.

“What you have to be cognizant of there, it’s the quality of engagement and what they’re doing at the time that they’re accessing an EHR or an EMR,” Mackie says. “There’s an opportunity to be very targeted and oftentimes with the different platforms, if there’s an advertising/media opportunity there you can be very targeted but you also have to be extremely thoughtful of your message and how it’s relevant.”

Pinta says there are a still a lot of challenges with the platforms themselves, from an engagement perspective. “I think what we’re trying to understand now is by the time they get to that EHR, they’ve made their decision already and are we really going to change it with some type of banner ad, because there is not a lot of room for content,” she says. “They’re not as sophisticated yet with some of these platforms.”

Mackie and Pinta say Greater Than One has talked with many EHR and EMR providers about coordinating to create a better platform, and has done some advertising programs on EHRs/EMRs for clients. “We have done advertising on EMRs, the big thing there is the content actually has to fit the context,” Mackie says. “This means what is the doctor actually trying to achieve in that context, where he’s already written a script and he’s trying to do something else. You’re not going to be able to interrupt, it’s not a great opportunity for interruption-style marketing. It’s a great opportunity to get a simple message, if the content is relevant to the context of what the physician is doing.”

According to Traini, one thing EHRs can do is allow search-through lists that mine the EHRs and claims data. “A lot of those most useful tactics are in the realm of patient identification and screeners,” he says. “Can you give the doctor a population screening tool that can help them identify at-risk patients for something? Is there way some mobile diabetes management tool helps the patient track their glucose? Maybe it’s sent to the doctor in some way through mobile technology.”

Ultimately, just about every pharma marketer has to believe in the power of mobile.

“The secret truth, the real truth, is that mobile is here and it’s understood, it’s everyone’s remote control for life, including physicians,” Mackie says. “So there’s no need to convince anyone that mobile is needed, its just implicit in what we do. But the big implication and the real challenge is that when you think of how people are accessing content, it’s more and varied types of content. How much content can you afford to support?”

Pinta says it’s easy to convince clients of how integrated mobile just about everywhere. “The best way to challenge any clients who doesn’t believe in mobile is to have them sit in a room for one hour and take their phone away,” she says. “They’ll start twitching in 20 minutes!”