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Who Owns Adherence?

by Sanjay Pingle, President, Physicians Interactive

ePharma Summit_2014_Panelists

Recently, I had the pleasure of moderating a panel at the ePharma Summit in New York City entitled Hello, Your Customers Have Changed: Do You Know Who They Are, What They Need and How to Get Their Attention.

The panelists included top-tier presenters across different arenas of healthcare:

  • Jordan G. Safirstein, MD, FACC, FSCAL, Interventional Cardiologist
  • Sumit Dutta, MD, MBA, SVP & Chief Medical Officer, Catamaran
  • Randy Krakauer, MD, National Medical Director – Medicare, Aetna
  • Adam Pellegrini, Divisional VP, eHealth, Walgreen Co.
  • Alexander Grunewald , PhD, Corporate Strategy & Business Development, McKesson Corporation

The panelists spent a portion of our discussion wrestling with a seemingly simple question: “Who owns adherence?”

A traditional answer might point right back to the prescribing doctor.

But with the “sea change” occurring in healthcare, the decision of which drug to prescribe is no longer solely in the physician’s hands.  As Dr. Safirstein pointed out, doctors in the hospital setting are often unable to prescribe any off-formulary drugs. And as doctors move away from physician-led practices and aggregate within hospitals and health systems, other stakeholders need to take responsibility.

Panelists agreed that adherence is more likely to be achieved if payers do it in collaboration with physicians. Yet even if healthcare professionals have access to the type of data formulary committees and payers wield, they may not want it, because of its potential to negatively transform their relationships their patients. “I don’t want to deal with the finances of medicine,” Safirstein said.

The panelists explored pharma’s increased responsibility for outcomes. If they are promoting the efficacy of their products, they have a stake in the downstream real-world outcomes, which depend heavily on how well patients adhere to treatment. Dr. Safirstein suggested pharma is well-suited to be the adherence facilitator simply because they have the resources. With healthcare professionals strapped for time and reimbursements dropping, pharma may be best positioned to take on this role in the new healthcare environment.

The panel agreed that adherence has to be easy for the patient. One way to achieve that is to use incentives to drive adherence—but there are likely to be a variety of tools that work for different patient types in different scenarios, and this is where a care collaboration model may have tremendous value.

So, getting back to the simple question – who is it?

Who is now responsible for helping patients adhere to their treatment and medication regimens? The doctor? The pharma company? The payer?

Not one stakeholder has the entire view of the patient or the data. We all need to collaborate.




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mHealth Provides Opportunity for Worldwide Healthcare

Several pandemics and non-communicable diseases, such as HIV/AIDS and malaria in Africa, continue to plague developing regions all over of the world. Just as necessary as clean water and food, strong public actions are required to monitor these diseases and ensure each region has affordable, immediate access to healthcare, resources and equipment. And in rural and developing regions where basic infrastructures such as electricity and roads are inadequate, many underserved clinics are turning to mobile health, or mHealth. The worldwide trend of using mobile phones for health represents an unprecedented opportunity for improving public health in impoverished or hard-to-reach regions.

mHealth solutions are beginning to spring up all over developing regions in Africa, as mobile becomes a widely recognized, sustainable approach to healthcare. TRACnet in Rwanda, considered the first national mHealth system in Africa, is collecting, tracking and disseminating critical drug and patient information. By leveraging the strength of the existing mobile infrastructure – nearly 70 percent of people in the developing world have a mobile subscription – TRACnet connects to every health facility providing treatments related to HIV/AIDS, malaria, tuberculosis and other epidemics.

In Mali, the Pesinet agency uses mHealth to provide villagers with an affordable form of health insurance. In a region with one of the world’s highest child mortality rates, community health workers test children weekly for illness before entering the information into a custom-designed mobile app. Doctors retrieve the information on a digital database and assist health workers and families to arrange the necessary treatment options.

While each region presents its own unique challenges, worldwide mHealth programs are springing up as an answer to global healthcare. Communities with no electricity, plagued by HIV/AIDS or operating under threats of violence oftentimes suffer with limited to no access to the latest in medical research. Health eVillages, a worldwide mHealth program partially funded by Physicians Interactive (PI) and founded by our CEO and vice chairman, Donato Tramuto, donates medical reference materials on tablets and smartphones to clinics in developing regions. The program has already made a difference by offering clinical decision support resources to existing local organizations in Haiti, Uganda, Kenya, the U.S. and China.

While the current slate of mHealth projects and organizations are offering quick, affordable responses to illnesses or epidemics in developing regions, the future they are paving has an opportunity to change the state of healthcare worldwide. Advanced reporting lends insights to community data in regions where this type of tracking was previously unheard of, promising more preventative care and a deeper understanding of how diseases start and spread.

The need for accurate reporting systems is of the utmost importance to understanding the management of non-communicable or chronic diseases in arenas with limited resources. mHealth offers a sustainable solution to healthcare workers struggling to provide consistent, high-quality patient care in an area where chronic diseases such as heart disease, cancers, asthma, diabetes, osteoporosis and more account for more than 60 percent of all deaths and is by far the leading cause of mortality, according to the World Health Organization. Lasting medical conditions, while difficult to treat, also present a serious drain on local resources as patient care needs to be consistently monitored and can be expensive to treat.

While mHealth is still in its infancy, initiatives such as these that operate at a low cost in developing countries can help spur innovation and testing for mobile healthcare in all parts of the world. Unlike in developed areas, these organizations serve communities where both health insurance and preventative care are nearly unheard of. A large part of mHealth program costs therefore must include awareness and education-building projects about mHealth benefits, such as reduced healthcare costs and access to hard-to-reach, rural communities.

A sustainable economic model largely dictates which mHealth program will flourish or flounder. Many regional programs offer care at free or reduced rates that hardly cover program costs in order to extend care to low-income communities.

As mHealth organizations continue working on finding better technology solutions and funding, programs continue to make life-saving changes to developing communities worldwide. Fueled by third-party donations and funding, the mHealth movement is changing how communities gain essential access to medical care. The rise of mobile within healthcare has made having a cell phone in hand a life-saving resource for both professionals and consumers. As the use of mobile devices grows more prevalent at the point of care, there is a real opportunity to finally track regional diseases and improve patient care worldwide.

Sanjay Pingle is president of Physicians Interactive and has oversight of the combined pharma and eCommerce business. Prior to joining PI, he was co-founder and executive vice president of Medsite, a biotechnology and pharmaceutical marketing firm.


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Pharmaceutical Companies Need to Adopt New Strategies to Effectively Reach Prescribers

It is well documented that the Pharma industry is facing many challenges in 2012. Drug makers are losing exclusive patents on drugs that have matured, resulting in expected losses of revenue in the billions of dollars. As a result, companies are cutting costs and significantly reducing their sales forces. This creates the new challenge of reaching practices and hospitals with fewer face-to-face office visits.

In the last five years, the size of the sales rep force has shrunk by nearly 30 percent according to For 2012, Novartis announced it was reducing its U.S. staff by nearly 2,000, including 1,630 sales reps—approximately 1.6 percent of its worldwide staff. This trend of reducing pharma sales forces also reflects impatience among prescribers with the hard-sell from sales reps and tighter governmental regulations on what sales people can convey to the healthcare professionals (HCPs) they’re trying to educate and inform.

Successful companies are those that will transition effectively from being primarily sales-driven to service-driven using a multi-channel marketing approach to reaching physicians and other prescribers. A key focus is providing services that fit into providers’ increasingly busy daily workflow: at point of care, when they’re making diagnosis and treatment decisions and when they’re prescribing medications for their patients.

Companies on the forward edge are putting a heavy emphasis on digital in their commercial models – but how can mobile technologies assist pharmaceutical and biotech firms in this transition?

Here are a few examples:

Tablets to support the sales force – While sales forces are shrinking, they still play a vital role in educating prescribers on new medications. The Pharma industry, taking the lead of companies like GSK, is starting to incent sales reps based on quality of service versus amount of sales (Read more here in the WSJ). One of the tools that is helping in delivering better service is the tablet. Reps with an iPad can deliver more interactive and engaging product information, capture signatures for compliance and make the most of a few quick minutes with a doctor in the time that it would take a laptop computer to boot up.

Online and mobile drug sampling programs – Companies now have the ability to leverage PDMA compliant mobile apps and websites that allow physicians to request free product samples that they can distribute to their patients to gauge efficacy and assist with adherence. Because the internet never sleeps, physicians can do this no matter what shifts they are working, independent of time zone or location, 24 hours a day.

Direct-to-HCP mobile advertising – It used to be that most online and mobile advertisements for drugs were placed only in industry magazines, blogs and online communities geared toward healthcare professionals and general consumer websites. With emergence of mobile networks focused on healthcare such as Tomorrow Networks, this is changing. Tomorrow Networks is comprised of more than 50 medical apps. Pharma companies can now buy ad placements in mobile apps made exclusively for physicians and other healthcare professionals. A physician can be looking up treatment information at the point of care and see an ad for a medication that is relevant to their patient’s ailment. That’s incredibly powerful for the physician and advantageous for the advertiser.

mDetails – Physicians want to learn about the best drugs and treatments for their patients. mDetails are multimedia mobile product presentations that provide information about drugs in a way that allow physicians to absorb detailed information at their own pace—and in their own time. Because mDetails are distributed on smartphones – they let physicians fit pharma product education into ‘found time’ at any point during their day that’s convenient for them.
By employing a multi-channel approach and by helping healthcare professionals do their jobs better, instead of just selling to them, pharmaceutical companies can reach their target audiences and develop deeper value-based relationships. The aforementioned examples are just a few of the ways that pharmaceutical companies can leverage the ever-growing mobile channel; there are many more evolving every day.

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The benefits of mobile devices at the point of care outweigh the risks

The New York Times recently shared a post on its Bits blog about multitasking clinicians endangering patients’ lives, which has caused some buzz on the Internet lately. The article discusses a case study written by Dr. John Halamka for the Agency for Healthcare Research and Quality. In it, a medical resident was asked by an attending physician to put in an order to stop a patient’s anticoagulation treatment, which the resident began entering on her smartphone via a computerized order entry system.

That’s when something went terribly wrong.

According to the article:

“Before the resident could finish the order, her phone beeped with an incoming text. It was from a friend. She got lost in the text and failed to finish the order….”

“On the patient’s fourth day in the hospital… [he] was rushed into emergency open-heart surgery. Blood had filled the sack around the heart. He’d received too much blood thinner, but he survived.”

While any distraction to a clinician treating patients can add to the risk of medical errors, do the benefits of access to mobile clinical tools outweigh the hazards of having mobile devices at the point of care? I say: without a doubt. In a mobile usage survey conducted by Skyscape, 78 percent of pediatricians and 71 percent of oncologists credited their use of mobile clinical resources with reducing the risk of medical errors. So, physicians at least feel that having clinical decision support such as mobile apps at the point of care helps them make more confident decisions.

There is emerging hard evidence pointing to that fact as well. In a November 2011 article in EHRWatch, Dr. Robert Hitchcock discusses the high value of having clinical decision support at the point of care. He explains that prescribing medication can be a difficult task because of complex calculations. Hitchcock cites U.S. Pharmacopeia’s MEDMARX database records from 2006-2007 showing that more than 37 percent of harmful pediatric medication errors are caused by an improper dose or quantity. He also discusses research from the Agency for Healthcare Research and Quality, which found that 10 percent to 30 percent of medical errors are diagnosis errors. By having dosing calculators, differential diagnosis tools, clinical resources and lab guides with them at all times, clinicians are able to mitigate the risk of these types of errors.

It really all boils down to accountability and ethics. It is a fundamentally similar issue to that which I discussed in my last blog post about HIPAA Compliance. According to the 2011 HIMSS Mobile Technology Survey, 72 percent of institutions have no policy governing the use of smartphones and tablets. To ensure privacy and to prevent misuse of mobile devices at the point of care, it is imperative that institutions, large and small, set clear policies that must be agreed upon by all their employees. These policies may include a stipulation that while working with patients, clinicians must put their smartphones in “Airplane Mode” with the Wi-Fi turned on.

That way, the clinicians can access medical resources but cannot make calls or text. Ultimately, it’s all about doing what is right for the patients — and that means allowing clinicians to reference medical calculators, drug information, lab values, diagnostic tools and medical journal summaries at the point of care, in order to make more informed decisions for their patients.

For another interesting response to the NYT article that highlights a far greater distraction to clinicians, please see the following article from Better Health titled, “What Is Distracting Doctors More Than Electronic Devices?”

Sanjay Pingle is president of Skyscape and Physicians Interactive Holdings and has oversight of the combined Pharma and eCommerce business. Prior to joining PI, he was co-founder and executive vice president of Medsite, a biotechnology and pharmaceutical marketing firm that has been named a market leader by Forrester, Jupiter Research and Frost & Sullivan.

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Mobile-enabled, HIPAA-compliant

There’s no question that mobile apps have the potential to improve patient care. When physicians and other practitioners have the information and tools to diagnose and treat patients in any environment – in the office, by the bedside, even on the commute into work – they save time, make more confident decisions, reduce errors and provide the most value for their patients.

But the challenge remains: How do you allow and regulate the use of mobile devices and tablets, which often include cameras and recording capability, in a clinic, hospital or academic institution while protecting patient privacy and adhering to stringent Health Insurance Portability and Accountability Act (HIPAA) protocols? The answer is certainly not to ban or severely limit the use such devices, depriving clinicians of fast access to current information, medical alerts and updated formulary information. The solution is to set strict device policies and to educate your institution’s clinicians and students about the “do’s and don’ts” of mobile use in a clinical setting.

This may seem like a no-brainer, but according to the 2011 HIMSS Mobile Technology Survey, only 38 percent of respondents reported that their mobile use at work was regulated by any formal mobile technology policy. Such policies may include provisions that clinicians and students are expected to understand and follow HIPAA guidelines that personal health identifiers (PHIs) must be removed from patient data that HCPs collect on their mobile devices or that mobile devices must be password protected. Some educational institutions require students to put their phones on “airplane mode,” so that the students can access clinical information but are unable to receive or send text messages or make personal phone calls.

Hygiene is another issue to consider in a clinical setting. HCPs must avoid the use of smartphones when wearing contaminated gloves, wash their hands prior to using a device and avoid using smartphones in isolation and/or sterile rooms. These rules are often spelled out clearly within the device policy and are meant to protect the patients, but also clinicians and their families and friends who come in contact with these devices outside of the clinical setting. Having a clear and agreed upon mobile device policy is the first step in protecting patient privacy while allowing your clinicians and practitioners-in-training to do their jobs better and more efficiently.

Recently, the Academic Centers and Associations (ACA) group at my company, Skyscape, conducted a webinar on “HIPAA Compliance in Nursing Education using Mobile Devices” with a panel of faculty from across the United States. The webinar was attended by nearly 200 participants and included information about HIPAA, setting policies and educating students and clinicians about patient privacy and regulations.

Sanjay Pingle is president of Skyscape and Physicians Interactive Holdings and has oversight of the combined Pharma and eCommerce business. Prior to joining PI, he was co-founder and executive vice president of Medsite, a biotechnology and pharmaceutical marketing firm that has been named a market leader by Forrester, Jupiter Research and Frost & Sullivan.

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Consumers will drive mHealth adoption

By 2014, mobile Web traffic will have exceeded desktop traffic for the first time. This has truly profound implications, especially for anyone who delivers services or runs a business on the Internet.

In healthcare, where we will see this impact first and most profoundly is with the consumer. By 2015, more than 500 million smartphone users worldwide will have downloaded at least one mHealth app. And apps are only part of the story – the more complete mHealth picture includes wearable devices, systems for data capture and sharing, communication and apps.

But why is mobile different? Unlike fixed-location desktops or even laptop computers, mobile is different for two main reasons.

First – smartphones are highly personal devices that are with us all the time. For most people the phone is within arm’s reach 24/7. Second – smartphones are always on and almost always connected. There is no need to log on, boot up, etc.

This is important for the healthcare sector because it means we are removing barriers for consumers to be more informed and active in capturing, understanding, sharing and taking action on their health and wellness. mHealth helps consumers evolve from episodic ‘sick’ care to more continuous health and wellness management.

There are a few examples of how mHealth is already moving far beyond providing medical information on a mobile phone – companies like Jawbone, Fitbit and, on a more specialized basis, Zeo. All offer wearable devices that track various health-related statistics and report them in a user-friendly way via a mobile phone or Web hubs.

Another example is CareSpeak, a company that offers direct two-way communication between patients and caregivers. There are also a number of start-ups are developing similar approaches to measure things such as anxiety, diet, blood pressure, blood sugar and other key health measures – all designed for the consumer.

In the future, “mHealth 2.0” will usher in increased interoperability and integration between mobile devices and between consumers and providers. At first, this will mean the smartphone acts as a mobile health and wellness hub for the consumer. However, smartphones have the potential to succeed where patient health record’s failed. The second phase of “mHealth 2.0” will facilitate transfer of data between the consumer and their providers’ EHR, allowing healthcare providers to share information and more proactively deliver care. For healthcare, we envision a solution that drives compliance, monitors patient progress and triggers communication between provider and consumer, all through interoperable systems.

What should the industry do to take advantage of these opportunities? The most important thing is to prepare for a future where consumers (who should no longer be thought of simply as patients) have access to more information (their information). This will require healthcare companies build systems that both facilitate this and are prepared to receive and interpret the real-time data that’s being generated. The second area of potential is to empower consumers and providers by making the data actionable – think of simplified presentation layers, communications and analytics as places to start.

As mobile consumption continues to rise in healthcare, the smartphone in your pocket will become a low-cost, portable health and wellness hub that will empower consumer-driven care. Through the convergence of universal availability, mobility, connectivity, ease of use and low cost, consumers will take a more proactive role in their health, making mHealth a truly positive disruptive force in healthcare.

Sanjay Pingle is president of Skyscape and Physicians Interactive Holdings and has oversight of the combined Pharma and eCommerce business. Prior to joining PI, he was co-founder and executive vice president of Medsite, a biotechnology and pharmaceutical marketing firm that has been named a market leader by Forrester, Jupiter Research and Frost & Sullivan.

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No Need to Choose – How Digital Marketing and Pharmaceutical Sales Teams Can Work in Unison

How Digital Marketing and Pharmaceutical Sales Teams Can Work in UnisonHave you noticed that sometimes it seems good things come in 3’s? The iPhone is finally available on Verizon, Samsung has released the Galaxy Tab, and Apple sells 8-gazillion iPad 2s on its first weekend.

In our industry, the latest meme now spreading through the magazines and blogs can be summed up in three recent articles:

So what’s going on here? Is the rule of three working its random magic or are we at a tipping point?

We’re not going to rehash all of the reasons why digital technologies and channels are finally having the impact that many have predicted for more than 10 years. We instead would like to focus on how eMarketing and digital promotions can be used to support the traditional sales channel and actually empower pharma sales teams by making them more relevant and valuable to the HCPs they are calling on.

In other words, it’s not an either-or situation.

Here are a few examples of emerging technologies and approaches that can be deployed now to close the loop between digital and traditional sales and marketing approaches.
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Shifting Pharma Focus to Include Non-Physician Clinicians

Non-physician cliniciansAs physicians become increasingly overloaded, non-physician healthcare providers, such as nurse practitioners (NPs) and physician assistants (PAs), are stepping in to pick up the slack, often taking the place of physicians in primary care settings.

The physician shortage is not the result of just one factor, but many conditions occurring all at the same time. For instance, by 2019, an estimated 32 million more Americans will have health insurance than have it now1.  The more Americans that have insurance means more strain put on the healthcare system – and physicians.  Furthermore, the baby boomer generation is set to retire over the next few years including physicians. In fact, one-third of all active physicians are over 55-years old2.

The Health Resources and Services Administration (HRSA) predict a net shortage of 24,300 physicians in the US across all specialties by 2020.  Currently, 65 million Americans live in areas designated by the federal government as having a shortage of physicians.

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Enterprise Approach to Online Sampling Drives New and Recurring Sample Requests

As budgets are cut and sales teams minimized at pharmaceutical companies across the country, brands are finding it more challenging than ever to reach their customers. Online sampling allows eligible healthcare professionals (HCPs) to request samples via a web-based system, regardless of where they practice.

With 78 percent of HCPs interested in or already requesting samples online1, more and more pharma companies are following the trend of offering online sampling for their brand – and implementing across multiple brands. 

Enterprise-Wide eSampling

Many pharma companies are transitioning from brand-centric to HCP-centric in the online sampling world by initiating enterprise-wide eSampling campaigns – understanding that what is valuable for the HCP is valuable for pharma.  HCPs using eSampling systems now have a wider selection of brands to request from during each trip they make into the online sample closet.  This approach has proven to be highly successful for several reasons:

Repeat Use: Once inside the virtual sample closet, HCPs can select multiple medication samples at once, increasing crossover potential.  Also, when more brand selections are available to them, HCPs are more likely to place a sample request and return to the closet.

Expands Reach: eSampling provides drug samples to HCPs at a more optimal reach and frequency than that of sales representative visits alone.

Existing HCP Interest:  A recent study showed that the majority of HCPs are highly interested in eSampling services. In fact, the average HCP who uses eSampling averages approximately ten to twelve sample requests per brand each year.2

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Online Survey of Oncologists Shows Use of Mobile Helps Reduce Errors and Increases Patient Volumes

Oncologists responding to a survey by Skyscape —the leading provider of mobile healthcare information and apps— said the use of mobile devices helps them reduce medical errors and increase daily patient volume.

More than 45% reported that using mobile resources helped reduce medical errors. The Skyscape Drug Calculator, a mobile application, allows healthcare providers to ensure accurate dosing for their patients by automatically calculating formulas and cross-referencing other tools, all at the point of prescribing.

Nearly 82% of the oncologists surveyed said they consult a mobile device four or more times a day during normal office hours. These frequent mobile users reported using their Smartphone during patient consultations, in their private office, and with other medical professionals. Thirty five percent of this survey group believes that the mobile device creates efficiencies in their day-to-day workflow allowing them to increase their patient volumes.  Healthcare providers can find the information they are looking for more quickly, leading to shorter patient visits.

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