Personal Health Records and Relationship Marketing?

There is no relationship between the two. None possible with HIPAA. But there is something incredibly important happening, and though the tipping point is a ways off, the ever-increasing number of people with Electronic Personal Health Records is going to radically change how pharmaceutical marketers engage with patients.  

This thought has been stirring in my head since I went to ePharma Summit in February (some thoughts just have to bake longer than others). One of the best speakers there was from Microsoft and his topics was EHR and PHR. Besides reinforcing the inevitability of the conversion, especially with this new administration, he created a genuine sense of excitement. Not easy with a bunch of pharma marketers.

Two things about his presentation stick in my head: first, that Kaiser Permanente has a majority of its under-35 patients already online. Obviously, Kaiser is gigantic, and if they're on board with EHR, then everyone else is going to have to follow suit. In addition, there seems to be a real generational issue at work here — younger patients have grown up with the Internet as part of their lives, and are more conversant with its capabilities and perhaps less concerned about privacy issues.

Second, Microsoft and Google, the two leaders with their respective, Google Health and MSN HealthVault offerings, have agreed to have a shared cross-platform technology, thus no "Beta versus VHS" religious war delaying adoption.This has a lot of second-order implications as well. For Microsoft to agree to cooperate with Google, they have got to believe that the market is big enough for both of them. That's a big market. Also, Microsoft was built on the idea of a proprietary operating system, and what's being discussed here is essentially an online operating system for healthcare. For Microsoft to voluntarily partner in something like this with its archenemy Google is a radical shift in perspective.

What does this mean to pharma/biotech marketers? Well, in some ways we are cut out — forget ever proposing an online diary or customized experience. If you already have your own private Health Network going on, who wants to interact with some lame branded or clever unbranded site?This depends to some degree on what these private networks actually do, but overall, it doesn't look good for pharma marketers.

That is the negative. The positive is the acceleration of using the different digital media to stay engaged with your health. This bodes well for pharma to innovate and really compete for the patient's attention through online and phone center service. As one of many channels for communicating with patients, online is going to take a more and more central role. Patients are going to be increasingly comfortable with online health information, and if pharma can manage its offering relative to both the patients it serves and the content of the PHR systems, I suspect some really exciting opportunities are going to emerge — if we are alert and forward-thinking enough to seize them.

Transparency is going to be key.  The number-one issue people have with online health data is privacy. If there's even a whiff that games are being played with what is very, very personal data, the results could set back the change by years. Everyone who touches this new world has to be absolutely upfront, transparent, secure and straightforward. Pharma has lots of examples of this approach being taken in the offline world — think of Johnson & Johnson's response to the Tylenol situation in 1982. We have to adopt this approach going forward.

Ultimately, this is one of those "lead, follow or get out of the way" situations. Change is coming. For once, I hope pharma gets out in front of it.

It is, in fact, all in how you look at it

A fascinating article in AdAge recently on, of all things, data visualization has demonstrated what may be the next wave in building patient relationships online.

The article begins as follows: Today's consumer seems to have an insatiable appetite for information,
but until recently making sense of all of that raw data was too
daunting for most. Enter the new "visual scientists" who are turning
bits and bytes of data — once purely the domain of mathematicians and
coders — into stories for our digital age.

To put this a little differently, the idea here is that in any setting where there's a great deal of information, or a large number of items that constitute the whole, how that information is arranged and presented has an enormous impact on how clearly people understand what it all means. As an example, there has been a lot in the news about trillion-dollar stimulus packages. It's one thing to see that a trillion dollars is $1,000,000,000,000 dollars. It's another to see what it would look like as actual cash — think of a football field of money, stacked about eight feet high. It looks like this:


Incidentally, that tiny little object in the front left corner of the pile is a human being, drawn to scale.

As examples of this, the article goes on to introduce us to several online services and microsites where individual items or stories have been visually organized to better allow people to explore them, to understand them, and so on. A few examples:

The Hard Rock Cafe's Memorabilia site (warning — requires a quick download of Microsoft's free Silverlight utility)

The Oakland Crimespotting site

The San Francisco Museum of Modern Art ArtScope site

Using the SFMOMA site as an example, it's a display of the museum's entire collection online, in one big tiled display. Viewers can move a window over it, expanding any item they select in order to get a closer look. It's essentially a virtual visual file of the entire museum, right in front of your eyes. It gives the size and scope of the collection a whole new dimension, and is an outstanding way to explore, and see art you otherwise would probably have missed.

We have written before of the need patients have to engage, to be connected to one another, and to the brand. It's easy for, say, an MS patient to feel as if she is very alone in coping with her condition. There are online communities springing up, like, that create environments for communication. However, these communications are typically manifested as words and numbers. Not a lot of images.

What if a pharma company marketing an MS drug, say, Tysabri, created something like the ArtScope site for patients. Instead of a list of names, the site would feature a tiled group of pictures (or video — take a look at the Flickr Clock site) of fellow patients, which would then break down when clicked upon into individual profiles, histories and so on.

It's the same information. However, it's presented visually, and in a way that supports the patient's understanding of how enormous, diverse and yet similar this group is. This approach would knit patients together like nothing they've ever experienced, and would also powerfully position the brand as the foundation of the patient community.

As we said, it's all in how you look at it.

Google Trends, Robert Jarvik and Pharma Marketing

One of Ryan TrueHealth's constant themes is patient-centered marketing. Distilled down to its essence, this concept means that pharma marketing has to be based on a deep knowledge of the patient, rather than an explication of the features or capabilities of the drug. This strategy is absolutely common practice in other consumer-driven industries (if you've ever bought a car and then been surveyed about your experience the next day, you know what I mean) but pharma, as in so many things, is different.

It's simply not as easy in pharma to understand what your patients (and potential patients) are thinking, feeling and doing. First, there are a lot of factors that affect how a patient thinks or feels about his condition and the drugs for it. Some of these are connected to the drug, and some are not, but may be attributed to the drug anyway. Second, privacy is an issue — you can't simply start surveying, say, MS patients at random. And third, because gathering information is often such slow work, it's not easy to get a meaningful sample, and thus, meaningful data.

Enter Google. In a fascinating item in today's Wall Street Journal Health blog, there's a post about the use of Google search data, particularly Google Trends, to track potential outbreaks of disease. Specifically, in Canada, there was a correlation between Google searches for the term "listeria" and the reporting of an outbreak of the food-borne illness that eventually resulted in 20 fatalities.

The same technique might be applied to evaluating the effect of events on brands. Admittedly, it's a somewhat crude measure, but it's also one done across a vehicle that processes over a thousand searches per second, so if there's data to be mined, there's no better data set than Google.

As an example, let's consider the controversy last year over the use of Dr. Robert Jarvik as a spokesman for Lipitor. We blogged about this in the past — essentially, in case you've been living in the woods for the last year or so, Jarvik was hired, then fired, as Lipitor's televison spokesman when it was learned that he wasn't, for example, a cardiologist who actually saw patients. It was something of a scandal, and if you take a look at the relevant Google Trends report, the effect it had on search patterns was clear. There is a huge search spike the day Pfizer announced Jarvik had been terminated.

However, if you look at the trend results for "Lipitor" for the same time period, you see something different. There is a minor increase in searches for that term early in 2008, when the Jarvik story broke, but it's nowhere near as significant, it abates quickly, and search levels go back to their original level. Initially, at least, this seems to suggest that although there was interest in the Jarvik story, it wasn't generally connected with Lipitor itself.

Essentially, this is a kind of generalized version of the ComScore method of tracking audience behavior. ComScore's system relies of an enormous compensated panel that allows their Internet usage to be monitored, then extrapolated into conclusions about the behavior of the Internet audience as a whole. For example, if 7% of the ComScore panel visits eBay once a month, it's intepreted to mean that 7% of the Internet audience as a whole does.

ComScore has a much small sample, but much more rigorous tracking of behavior. Google's tracking, at least as far as we know, is much less sophisticated, but on the other hand, it's the result of the genuine searching behavior of the audience itself. Since the audience, and Google, are only getting larger, it will be interesting to see where all this goes, and what impact it has on how pharma companies study, and respond to, their patients' needs.

Not really, Seth

In his blog today, Seth Godin directly discusses, well, us. Here's what he wrote:

Drug companies have coined an acronym for the marketing they do that
bypasses doctors: DTC. Direct to consumer. Those happy face ads you see
in Readers Digest and other magazines, or the erectile dysfunction ads
during the Super Bowl.

What they are totally unprepared for, and what your organization may be unprepared for is Direct from consumer.

someone takes your medicine and gets sick, do you want to hear from
them, or would you rather have them blog about it or make a video?

Most drug company marketers instantly say, "we want to hear from them!"


Buisnessman at keyboard

Well, no. We want them to do both. It depends on how you define "sick."

If someone takes a pharma company's drug, and something goes seriously wrong — something that implicates the drug's safety, efficacy or both, after they discuss it with their physician, we want them to contact our clients. Serious problems aren't funny, and they' can be a lot more serious than a simply dissatisfied customer. If there's something going on out there, our clients want to know about it fast.

This is particularly true in light of this week's Supreme Court ruling against Wyeth, in which the Court held that FDA approval does not shield drug manufacturers for liability in patient lawsuits alleging inadequate warnings. Given this, wanting to know of problems patients are experiencing is just common sense.

By an enormous margin, however, "sick" usually means "side effects." 

For a lot of drugs, side effects simply come with the territory. Depending on the condition, there is no such thing as a drug without side effects, which can range from next to nothing to profound. When discussing side effects, even more than informing the drug's manufacturer, we want patients to inform each other.

The absolute backbone of any pharmaceutical company's brand is trust. The patient has to trust that the drug is safe, that it will does what it is supposed to, and that there will be no surprises, either good ones or bad ones. Every patient is informed in advance, beginning with the advertising, about possible side effects and reactions. This alone makes pharmaceutical marketing unique, and pharmaceutical companies uniquely responsible. How many times have you seen a magazine ad for a toy that mentioned a possible choking hazard? Pharma companies, because of the unique impact of their product, have a much higher threshold for transparency than consumer products companies. It's the basis of the trust between the drug company and the patient.

And ideally, that transparency extends to a discussion of side effects. It's extraordinarily helpful for a patient to know that others have experienced similar side effects, that they can be managed, or at least minimized, and that he or she isn't alone. So, ideally, patients will share their experiences with others, teach them and learn from them, and in doing that, strengthen the bond of trust that every patient taking a pharmaceutical product depends on.

What did you expect?

There was an interesting video piece in today's Predictably Irrational blog about the influence of expectations. This topic speaks particularly acutely, I think, to adherence. I won't rehash the whole piece here, but suffice to say that expectations matter.


We tend to think of adherence as the result of the creation of an ongoing relationship with the patient. This is definitely true, but it's also incomplete, because the relationship begins before the relationship begins, so to speak. What people expect has a profound impact on their experiences of what they actually get. Sometimes this expectation actually affects the clinical outcome itself. After all, healthcare expectations are closely tied to the patient's own sense of self, their health, and sometimes, profound changes in their lives.

A great deal of anyone's perception of anything is a function of expectations. They don't compare the experience with their pre-experience state; they compare it with their expectations. The business version of this is "underpromise and overdeliver." And the actual providers of healthcare — physicians, dentists, nurses — are well aware of the role of expectations, and use it all the time. Consider:

  • The placebo effect.
  • The dentist who, before giving you an injection, tells you that it's going to pinch a little bit. It actually hurts, and in a way that's nothing like pinch, but your expectation makes it quite manageable.
  • The physician whose wall is covered with diplomas, certificates, and other symbols that prime you to respect and listen to him.

The imagination, which is what expectations are based on, is an extraordinarily powerful thing. Based on a description, people will envision themselves going through some experience in the future. This concept, really, is the foundation of almost all sales, and of a great deal of marketing. You drink this beer, you get to date the beautiful girl. And so on.

Given this, what kind of messaging are you conveying to your patients prior to their experience of the drug? What are you conditioning them to expect? Are their additional things you're conditioning them to experience during the course of treatment? It's really a kind of game of conceptual follow-the-leader. The more consistently you can create expectations in advance of any kind of patient experience, the more you can manage the perception of the experience, the definition of what it means, and in some respects, the eventual outcome.