“This house believes patient care will be enhanced through pharma’s involvement in social media“. So read the title of the debate I was invited to take part in at the PIPA Annual Conference 2010 on 5th July.

I was especially excited to take part in this debate, not only because of the opportunity to participate alongside an excellent panel of experts on the subjects of pharmaceutical companies, social media and regulatory affairs – Andrew Spong, Klynn Alibocus, and Sam Temple-Scotton. Even more so because the debate was hosted by PIPA, the Pharmaceutical Information and Pharmacovigilance Association.

In their own words, ‘PIPA is the professional organisation for individuals who are involved in the provision and management of information and those involved in the fulfillment of regulatory requirements relating to drug safety‘. In other words, the debate was hosted by regulatory, medical information and pharmacovigilence professionals. The fact that such an organisation placed this important topic on its Annual Conference agenda is an indicator that the questions being asked by pharma about how to engage through emerging two-way channels such as social media are being taken seriously.

At Creation Healthcare, one of the most enjoyable, if sometimes challenging aspects of our work is when we get to bring together internal stakeholders from across a pharmaceutical company – communicators, marketers, legal and medical colleagues, to develop healthcare engagement strategies embracing emerging channels. And from my experiences of this I know that amongst visionary pharmaceutical companies it is possible for these colleagues to strategise proactively together to achieve real health outcomes through innovative use of social media and other emerging channels.

Sarah Dunnett, Senior Medical Affairs Manager at Baxter Healthcare and PIPA President, chaired the debate and asked for a pre-debate vote. 42 conference delegates agreed with the motion (albeit some with caveats) whilst 21 disagreed, to at least some extent.

Not one to miss the opportunity to encourage healthy discussion about healthcare and social media, Andrew Spong kicked off the debate, playing devil’s advocate as he argued against the motion and highlighted some favourite objections including adverse event reports.

I followed with a brief outline of seven examples of pharma’s involvement in social media, outlining how each example demonstrated the potential for enhancing patient care. I included some of my favourite examples such as Johnson & Johnson’s Health Channel on Youtube, UCB’s partnership with PatientsLikeMe, Boehringer Ingelheim’s sponsorship of a Tudiabetes video, and AstraZeneca’s engagement with healthcare professionals through doctors.net.uk.

Sam Temple-Scotton then supported the case against the motion and pointed out that pharma is struggling to keep up with the level of change in digital channels.

Finally Klynn Alibocus made some excellent points about the breadth of ways in which pharmaceutical companies can enhance patient care through social media, drawing the debate away from marketing to consider other areas including clinical trials recruitment.

In the discussion that followed between the panel and PIPA delegates, some key issues were debated including trust, transparency, responsibility, stakeholder partnerships, business process change, and resourcing. Many of the most challenging issues were raised and debated. From my perspective, there was general agreement about points including:

• Pharma is generally mistrusted and this makes social media engagement difficult; but social media might play a role in enhancing trust through transparency
• Given the amount of discussion taking place by patients using social media about health issues, pharma has a responsibility to get involved
• Regulatory constraints make it difficult, but not impossible, to plan proactive engagement
• Avoiding adverse events reports by not listening to social media conversations is not the answer
• Successful social media engagement may require changes to the way pharma operates

Finally, a post-debate vote revealed the extent to which we had convinced PIPA delegates: after all the discussion, just 39 delegates agreed to any extent with the motion – a reduction of 3 – whilst 23 disagreed. On the face of it, it appeared we had done more to convince pharmacovigilence colleagues not to support pharma’s role in social media! But all in all I believe the debate was healthy, timely and relevant and I hope will encourage some of the PIPA delegates to take a proactive approach to working through some of the challenges with colleagues in their businesses. I am still reassured that 63% of pharmacovigilence professionals believe pharma’s role in social media will enhance patient care.

I understand that a more comprehensive report on the debate will be published in PIPA’s journal, PIPELINE. In the mean time, feel free to tweet me with your comments at @EngagementStrat.

If you live or work in Japan, or have visited the country, you will know it is a nation of contrasts. This is as true when it comes to online healthcare communication as anywhere else.

On the one hand, much of Japan’s healthcare communication is highly conservative. Yet in the midst of this, some Japanese pharmaceutical companies are becoming world leaders in developing patient-focused corporate websites.

Whilst the corporate websites of many pharmaceutical companies outside of Japan are primarily focused on content for investors and media, Eisai Co, Japan’s fifth-largest pharmaceutical company, has developed a highly consumer-centric website. In a regulated environment, direct-to-consumer marketing by pharmaceutical companies can be a sensitive subject, but for Hiroshi Kaihatsu, Manager, Business Strategy & Planning at Eisai, focusing on the consumer was essential.

“We must use the right words and terminology for consumers”, said Mr Kaihatsu at Marketing Excellence Japan 2010 last month. “This is not the same language we use for physicians.”

For Mr Kaihatsu and his team, the key to this was the development of an imaginary ‘persona’ around whom the website could be built. Following an extensive consumer research process, the persona was defined as an ‘ordinary’ lady; a healthy mother, the key family influencer. Her father has senile dementia; her mother has osteoporosis. She is fashionable, teaches flower arranging, and is 46 years old.

Eisai’s research process explored the magazines the persona reads, and the way she uses the Internet. Consumer interviews revealed that she checks the Internet for health information, although she is not a specialist in medical terminology. She likes to use the Internet to find out things she wants to know. Her favourite search engine, according to Eisai’s Japanese consumer research, is Yahoo!.

Eisai’s consumer persona features prominently on the website home page

The result of Eisai’s persona development is http://eisai.jp, featuring images of the persona around whom the website has been designed and a unique ‘Wellness Finder’ which was inspired by Amazon to direct consumers to relevant content based on their website activity.

Whilst the whole website experience has been designed with the consumer in mind, the home page’s Wellness Finder is a particularly innovative health information tool using consumer-centric language. On first appearing, the tool suggests a range of health-related terms such as ‘pain’, ‘stomach’, ‘pain’, ‘shoulder’, ‘fatigue’ or ‘osteoporosis’.

Eisai’s unique Wellness Finder tool

When a consumer clicks on a term, a series of related words is displayed. So for example, clicking on a term such as ‘pain’ updates the Wellness Finder to show words that will help narrow down a search for information, such as ‘neck’, ‘throat’, ‘stomach’. A further click on ‘stomach’ narrows down suggestions further and offers terms including ‘nausea’.

The Wellness Finder constructs relevant search terms through a simple process

With each click, the selected search term is added to a search query to return relevant information from the Eisai website.

Placing the Wellness Finder health information tool at the centre of user functionality has resulted in a website that is able to provide relevant health information to consumers easily and intuitively.

Eisai’s Wellness Finder’s provides relevant content based on simple user selections

What can others learn from Eisai’s website and Mr Kaihatsu’s experience? Getting the right information in a relevant way to consumers is a challenge that many pharmaceutical companies have yet to overcome. For Eisai, there was certainly a lot of work to achieve the new consumer-focused website. The work of mining and indexing the extensive content using specialist tools, and planning and designing the user experience around the persona, were only possible because of a culture that focuses on serving the consumer. As Mr Kaihatsu put it when describing Eisai’s 365-days-a-year call centre operation:

“Our call centre operates 365 days a year. Why? Because our patients don’t have a holiday from being a patient.”

Whilst Eisai’s corporate website does not cater for every health stakeholder – it is in fact just one of thirty websites operated by Eisai in Japan, including a search-based clinical website for doctors – its place at http://eisai.jp reflects the value placed by Eisai on putting the patient at the heart of its online communications.

If you would like to develop a strategy for engaging consumers in a relevant way about health matters, Creation Healthcare can help. Contact us in Tokyo or London to find out how.

At the recent Marketing Excellence Japan 2010 conference, I caught up with some of the pharmaceutical company speakers and asked them about the unique aspects of pharmaceutical marketing in the Japanese healthcare environment.

In this video interview, Brent McCain, Head of Marketing Excellence for sanofi-aventis K.K in Japan, and Gabrielle Pastore, Managed Markets Brand Director with AstraZeneca, share some of their experiences in the Japanese market.

Outlining the importance of Japan for a global pharmaceutical company, Gabrielle Pastore points out that Japan is the second-largest market in the world for pharmaceutical companies, and it continues to grow.

Pastore says there is an opportunity to bring Western market research techniques such as unique focus groups to Japan, to understand what drives prescribing. But she says that bringing new ideas can be challenging:

“Japan is an island, and they are very happy with the way they do things here. To bring ideas and change is a significant challenge.”

Brent McCain highlights the enormous number of Japanese patients who are not only accessing the Internet, but also creating content. He says that this provides a real opportunity for pharmaceutical companies to carry out market research, and also points out that this means changing the perception of the role of the Internet in pharmaceutical marketing:

“The role of the Internet is going to become a little bit different from what we thought before… it’s going to be a lot more about learning from social media and the Internet than it is about getting our message out to customers …that’s where we’re going to get insights.”

Creation Healthcare’s new Tokyo office opens 1st July 2010. Contact us if you would like to speak with a specialist about healthcare engagement in Japan or globally.

In my previous article I suggested that a social media policy was an essential basis for engaging with people online. Without it your ability to react to problems (or opportunities) that arise will be severely impacted. You won’t have the trained people in place, nor the process for escalation or the guidelines for response.

Having a social media policy in place not only sets up your company for engaging with people online but when you make it (or a version of it) available to the public its puts in place the parameters and expectations for discussion. After all, how you deal with the issues you encounter could make or break the success of your engagement strategies.

But does it make a difference for day to day, non crisis, engagement if you have a social media policy or not? I’ve had a look at various pharmaceutical sites to see first if they have a published social media policy and second, how successful does their digital engagement appear to be.

YouTube

By far the most successful pharmaceutical company channel on YouTube is Johnson & Johnson’s Health Channel. With over 270 videos they have the most content and perhaps not surprisingly therefore the most views.

One factor in generating YouTube views is the number of subscribers to a channel. Whilst not all the pharmaceutical channels reviewed showed their number of subscribers, Johnson & Johnson’s channel was far ahead of all those that did with 2,200 subscribers. It is worth noting that Johnson & Johnson has a clear policy on its channel homepage and it allows comments on its video posts. It could therefore be suggested that a regular flow of content, offered to an engaged and listened to audience is the route to successful engagement. The only other channel which appeared to allow comments was Boehringer Ingelheim’s. It is fair to say that neither had many comments but Johnson & Johnson’s had the most and had posted responses.

YouTube channels reviewed:

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Twitter

Following the suggestions in my first article about employees being given the freedom to speak in their own social media profiles it is no surprise that many senior names from the pharmaceutical industry are on Twitter. I think it is fair to say that the most talked about of these are in communication roles which is again no surprise. Perhaps interestingly, of the profiles reviewed not everyone referenced their employer or stated whether the views expressed were their own. Roche’s Sabine Kostevc gives the clearest disclaimer in her profile stating that “All tweets are my own and do not necessarily represent my employer’s view”.  To see if a social media policy makes a difference to the level of engagement it is perhaps better to look at official brand profiles on Twitter.

Of the 17 pharma Twitter profiles I reviewed, only two made direct or indirect references to their social media policy – @roche_com and @vertexpharma. Interestingly Vertex were only conducting a test at the time to see the viability of using Twitter yet they conscientiously created a Twitter Policy and linked directly to it from their profile – a very user focused and sensible thing to do rather than direct only to a corporate homepage or media page as all others do. In the short time since my review, Vertex has just relaunched their Twitter activity so it would appear they felt the trial was a success.

Roche has recently come in for some praise for their Twitter activity. With over 3500 followers, a presence on 307 lists and having sent 788 tweets since Feb 2009, TwitterGrader.com gives their profile a score of 99.8 out of 100. It would be hard to say that is simply because they have a disclaimer on their Twitter profile page but what it does suggest is that the existence of the disclaimer shows that the Twitter activity is well considered and that there is a framework for people to operate in. Based on the @Roche_com tweets  and the level of interaction with fellow Twitter users I would say this offers an increased level of freedom to engage people and build a trusted voice.

Facebook

A review of the corporate pages on Facebook shows a greater number of disclaimers and policies around what is and what is not permitted. As to whether this encourages more fans or not is hard to define, as the numbers across each pharmaceutical company’s page varies and the intentions of the pages also are not the same. However only Johnson & Johnson’s page has any form of engagement with its audience – who have commented, shared and liked various posts made by Johnson & Johnson. They state in their disclaimer that “While community members can make comments, we reserve the right to remove those that are off-topic, abusive or that are spam. Product questions should be put to our companies”. As you will see on their page there is a healthy amount of conversation, and not all of it positive towards Johnson & Johnson.

I assert that Johnson & Johnson have confidence in their policy and that it is has buy-in from across the organisation. The level of fear about what might be said would appear to be at a comfortable enough level to allow some freedom to speak. This makes them seem more real – like a person – and after all this is social media remember. I also suggest it allows a certain amount of conversation to go on under their control and in a place where they can directly respond, which is a positive thing.

Interestingly Sanofi-Aventis have the most detailed disclaimer on their Sanofi-Aventis Voices Facebook page. Given their recent experiences with negative comments it is perhaps no surprise. However this issue has not gone away yet and the majority of comments from their followers have been removed. The disclaimer is doing its job in policing the site, but the strategy has not done its job to deal effectively with the issue. A social media strategy is not about just one channel and as yet Sanofi-Aventis seem to have their activities on hold because they did not have the means in place to handle this issue appropriately online.

This review is by no means exhaustive but I do believe it shows that the existence of a social media policy does allow greater levels of engagement with the audience. I think it is no surprise that where participation has been thought through in advance – at least enough to post a disclaimer – then those running the channel have a greater level of confidence and freedom to engage the public.

Social media success and failure are closely linked to the level of engagement that you have with people. The engagement aspect is what shifts it from another form of broadcast media to a channel that can build trust, add value and make a difference to the people you serve. Avoiding the engagement can have exactly the opposite effect.

A little less than a year ago, I was collating a few ad-hoc statistics about the way that the Internet was being used to share private health information. At that time I particularly examined diabetes, a condition which when I was growing up was very personal, private, and a topic which people tended to avoid talking about in public.

However, as I started searching it was immediately apparent that the ‘social web’ has enabled and empowered people to now find peers and support networks which have significantly changed the way people relate to one another about personal health matters. There were literally thousands of photos, groups, discussions, and questions.

So when I was recently asked to begin preparing a new presentation about current online health consumer trends, I thought I might revisit some of those previous statistics to see what rate of change has occurred in the past 10 months. Once again, it was interesting to see how people share about their health online;

• Examining photos tagged with ‘diabetes’ as a key word, there has been an increase of 39% in just 10 months; with a total of over 57,000 photos now on the website Flickr.com
• Discussion groups in Yahoo! saw an increase of 13% to 3400
• Average views of the Wikipedia page about ‘diabetes’ have risen by more than 20%

It is no surprise that consumers are increasingly turning to the Internet for information about their own health, or the health of someone close to them.

The ITU says that 1 in 4 people of the entire world population are now online; 3 in 4 citizens of the developed world. Additionally, research conducted in 2008 showed that from 2004 the increase in usage of the Internet for Health is 30% on average – even higher for younger generations.

Of the 3 in 4 people of the developed world that use the Internet, it seems that more than 80% searched online for health information, according to one study of people in the United States.

Perhaps more importantly, when those people find online health information more than 60% said that this online health information affected a decision about how to treat and illness or condition. In this way patients are increasingly empowered with knowledge that would once have been very difficult to obtain.

Yet it is not only ‘patients’ and consumers that are now actively searching the Internet for connections and information. 95% of Physicians in the European Union are using the Internet for professional use; 74% obtaining medical information online. Nearly half of Physicians in the European Union recommend websites to their patients, for condition awareness, patient support, lifestyle change, compliance, treatment information, communities and more.

We are witnessing a substantial change in the forces which affect the provision of healthcare.

This brief slideshow presents some of these key trends and technology changes. Click the fullscreen button to read it more clearly, and feel free to download or share this resource;

There is no doubt that the pharmaceutical and healthcare industry is embracing and also seeking to understand the meaning of healthcare engagement in a digital world.

On the 15th April 2010, communicators from a number of Europe-based organisations came together at the London Hilton to ‘deep-dive’ into the strategies and lessons obtained through the winners of the 2010 Healthcare Engagement Strategy Awards, announced earlier this year. You may wish to view slides and an e-book from this seminar.

Representatives of Johnson & Johnson, Benenden Healthcare Society, Langland, Napp Pharmaceuticals, the NHS, Systagentix, the MHRA, Pfizer, Doctors.net.uk, BMJ Publishing Group, Bupa, PSL Group, Boehringer Ingelheim, and Creation Healthcare all shared best practice knowledge with each other through group discussion and breakout groups; also examining some of the practical considerations of two-way engagement.

A key theme for 2010, recurring in the group’s observations, is the changing needs and expectations of empowered patients, consumers and healthcare professionals who use the Internet with an interest in health.

As Burak Borahan of Systagenix put it, “Empowering patients is going to become more fundamental for healthcare in general, and also connecting and bridging that gap between healthcare and physicians, and using online as a channel for doing that.”

John Pugh of Boehringer Ingelheim explains that the ‘future’ of healthcare engagement is actually happening right now, because “Across the whole spectrum of stakeholders, whether that be hospitals or payers or patient groups – the focus is very much on engagement and upon sharing, learning, talking, dialogue, and creating this fantastic ecosystem of connections, and really learning from each other. I think engagement is only going to get better, and better, and better.”

Empowered patients means a paradigm shift for the way services are funded. Ryan Edwards of the NHS made the point that “Increasingly they [patients] will have a real sway in the way that healthcare is delivered, and ultimately, the money will be attached to the patient. If they’re not happy with their healthcare choices, they’ll have a range of providers to choose from so I think it will mean that we will all have to sharpen up our engagement we have with people. Because if they are not happy, they’ll move.”

For Andrew Widger of Pfizer the real opportunity is about understanding how and when it is appropriate to engage; “It’s evident that our customers are engaging in this area. There are networks of healthcare professionals, there are also networks of patients; we just have to find the most appropriate way of engaging with those audiences and delivering the right message, but really being mindful that this is about engagement – and that is a two-way street. It’s not just about getting our marketing out to them, but it is about listening, taking their feedback, engaging them in the process of working towards better health outcomes.”

Please enjoy the following video where several of these participants explain what they found most valuable about the day, continuing on to explain how they see healthcare engagement for 2010.

As increasing numbers of healthcare companies and government organizations turn to dedicated social networks to engage healthcare professionals, business models for interacting with doctors are changing. But can these networks really improve outcomes for healthcare companies, and what is the future for the pharma rep?

Len Starnes, Digital Marketing & Sales Manager at Bayer Schering pharma in Berlin, says that he has been looking at the growth of dedicated physician networks, and he is convinced that these are the places where the healthcare industry should engage professionals. He says:

“I’m personally convinced that [dedicated physician networks] will play a very significant role in the way that the industry engages the profession in the future. If you look at the phenomenon globally, the numbers of doctors that are using networks, and if you look at behaviours and expectations of young doctors, they are all using social networks in some way and will expect to continue to use networks professionally.

“That poses the question, ‘are these platforms more suitable platforms for the industry to engage?’ And I’m absolutely convinced that they are.”

Doctors.net.uk

When it comes to connecting doctors to each other, to other health stakeholders, and to the Internet, Doctors.net.uk was amongst the first and is today one of the largest and most active networks of doctors in the world.

Formed in 1998 (the same year that Creation Healthcare started out), Doctors.net.uk has grown to over 170,000 members. All of these are GMC-authenticated UK doctors, of whom over 60,000 actively use Doctors.net.uk every month, and over 35,000 every day.  In 2009, Doctors.net.uk saw record levels of doctor engagement, with 25 million web sessions during the year.

In this video we explore how Doctors.net.uk has changed the landscape for engaging doctors online, with Doctors.net.uk’s Head of Pharma, Carwyn Jones

What do doctors do there?

Interaction between doctors is an important component of Doctors.net.uk, with an average of 907 visits per member to the social network’s forum during 2009.

The network is also seeing an increase in access to multimedia such as podcasts. In the final quarter of 2009, more than one in eight members accessed podcast interviews from medical conferences.

Opportunities for engaging doctors include medical education, eDetailing, and market research surveys, all of which doctors readily engage with, thanks to one or two innovative approached by Doctors.net.uk.

Members receive eSR (electronic Surfing Rewards) when they complete market research surveys. These can then be exchanged for merchandise or vouchers. Taking part in market research can earn a member between £5 and £80, and Doctors.net.uk says that last year over £1,000,000 in eSR points were earned by its members.

A product webcast, sponsored by medical equipment manufacturer GE Healthcare (source: Doctors.net.uk)

Why does this matter to healthcare companies?

If you are in a pharmaceutical or medical devices company and you want to inform doctors about a new product, then you will be aware of how difficult it can be to engage doctors. In a recent online poll by Doctors.net.uk, members were asked “When a drug is launched what is the most trusted source of information?” Only 6 (1%) of 571 respondents identifed “Pharma company sponsored fact sheet” as the most trusted source.

Whilst this figure can at best only be said to be representative of Doctors.net.uk members, it provides a clue that perhaps there are better ways of engaging healthcare professionals than traditional fact sheets.

In another member survey, the majority (58%) of 1,000 respondents named Doctors.net.uk as their preferred channel for receiving information about pharmaceutical products and medical devices, ahead of ‘local meetings’, ‘by reps’, and ‘conferences’.

Another important insight from member surveys is the level of trust that doctors place in Doctors.net.uk. Asked about the most trusted sources for health information, respondents named ‘medical publishers’ first, followed by Doctors.net.uk ahead of journals and the Department of Health, and with the pharmaceutical industry in last place.

This lack of trust amongst doctors will not be news to many in the the pharmaceutical industry, who understand the challenges that the industry has in gaining the trust of either healthcare consumers or professionals. Dedicated doctors’ networks like Doctors.net.uk provide an opportunity to engage through a trusted platform.

According to Doctors.net.uk, when AstraZeneca targeted doctors through Doctors.net.uk with an eDetail campaign in 2009 for their Symbicort SMART asthma management product, 6,425 GPs engaged with the campaign, and 71% said that they would increase their prescribing of Sybicort SMART.

AstraZeneca Symbicort SMART case study on Doctors.net.uk (source: Doctors.net.uk)

A platform for engagement

I spoke with Carwyn Jones, Doctors.net.uk’s Head of Pharmaceutical Sales and Marketing, at Healthcare Engagement Strategy 2010 in London earlier this month, and I asked him what makes Doctors.net.uk so successful.

He said that the 35,000 unique Doctors every day participate because of Doctors.net.uk’s core values: Trust and transparency about interaction with doctors; independence; and collaboration – allowing doctors to collaborate with each other to improve their clinical practice.

Carwyn said that there are over twenty different services that doctors can use on Doctors.net.uk, and the way individual doctors use these varies by speciality. He said that the most popular services are continuing medical education, forums, the email service, medical news, journals and conference highlights.

I asked Carwyn about why commercial healthcare companies work with Doctors.net.uk. He explained why their sponsors engage with an existing and active network of doctors:

“The commercial sponsors that we work with have understood that there are a large number of doctors on a trusted network, that they can use to collaborate with and communicate to these doctors.

“With any online strategy, one of the key things is content, however even more important is engagement. Many companies have fallen foul of the ‘build it and they will come’ philosphy that says ‘if we build it, then surely many of our customers will come’ and that doesn’t happen.”

Carwyn does not claim Doctors.net.uk to be the ‘silver bullet’ of healthcare professional engagement, though. He says that when it comes to healthcare sales, nothing beats a real, face to face interaction by a rep with a doctor:

“Rep interaction is still the most powerful thing. Face to face interaction, I think, still beats an online interaction, but the costs and the resources that go behind the sales force are huge so companies are looking at other ways of getting that access.”

Earlier this month, hundreds of business leaders and communicators in healthcare met in Paris for the first Health 2.0 Europe conference. Some may have been asking themselves whether Europe really needed yet another conference about digital engagement in healthcare, but it soon became clear that Health 2.0 was unlike any other healthcare engagement conference in Europe to date.

Denise Silber introduces the pharmaceutical panel at Health 2.0 Europe in Paris.

To European delegates, the conference’s US roots were evident in what was a packed agenda of fast-moving, if sometimes awkward, stage performances. Matthew Holt, Inda Subaiya and Europe’s own Denise Silber co-hosted presenters and panel sessions, and added their own insights and reactions to each day’s events.

For those still wondering what Health 2.0 is all about, Matthew Holt kicked off conference with a definition in just four points and set the pace for fast-moving presentations, stating that Health 2.0 is characterised by:

1. Personalised search
2. Communities
3. Intelligent tools
4. Integration of data with content

Pfizer’s Sylvie St Laurent speaks at Health 2.0 Europe in Paris, about
Pfizer’s private public partnership model for improving clinical trial
recruitment through social media.

Delegates were asked both at the start of the conference whether they believe that Health 2.0 services in Europe will be different to the US, and the majority of participants said they do. After two days of Health 2.0 presentations and discussions, the same question was asked at the end of the conference and again the majority of participants felt that Health 2.0 services in Europe will be different to those in the US.

For those of us working in healthcare engagement internationally, this was no surprise at all – Europe has a unique healthcare and cultural landscape, with its own challenges and opportunities for healthcare engagement. It is very different from the US not only because it exists in a different regulatory environment, but because it has a different approach to innovation.

Take for example Doctors.net.uk, the world’s first major social network for doctors which was set up in 1998 in the UK, years ahead of US equivalent Sermo which was founded eight years later. Health 2.0 Europe conference allowed delegates to see both of these alongside the likes of the British Medical Journal’s doc2doc network.

Overall, an incredibly broad range of topics was covered at the conference, although none in any real depth. For speakers, innovation was a must. I supported my own brief presentation of Pfizer’s Real Danger digital strategy with series of simultaneous tweets linking to other campaign resources.

I explain that the Pfizer ‘Real Danger’ digital engagement campaign
was about more than a man vomiting a rat, at Health 2.0 Europe in Paris.

For me, conference highlights (selected from live tweets I sent during the conference) included:

• Pfizer says MyHealthRecords is available for iPad
• Pew Internet’s Susannah Fox (@SusannahFox) says that patients with chronic disease are more likely to engage online
• PatientsLikeMe‘s Jamie Heywood presents their pharma interface and shows the correlation between drug use, efficacy and safety
• iWantGreatCare‘s Neil Bacon shows a real-time dashboard analysing patient reviews of doctors & clinics
• Miguel Cabrer gives an excellent medting.com demonstration of clinical case collaboration amongst healthcare professionals, including integrated language translation
• British Medical Journal’s David Payne shows their international healthcare professional community doc2doc.
• World Health Organization highlight health divide between poor & wealthy
• Paul Hodgkin demonstrates patient review site patientopinion.org.uk “Your story can change the NHS”.
• Bupa’s Annabel Bentley (@doctorblogs) brings a timely reminder that “Remember what we’re looking for here is better health outcomes for patients” and later goes on to give an example: “At Bupa we believe that intelligent use of healthcare data will help reduce cost of healthcare”
• And my last tweet, after 68% of respondents said they still think Health 2.0 will be different in Europe to the US:  Europe WILL be different from the US because it IS!!! One size does not fit ALL location / culture / language / regulatory…

An increasing number of pharmaceutical and healthcare companies are venturing into social media, whilst still many hesitate. Are the ones who have started right to proactively participate or are the ones waiting right to be cautious? A common concern voiced by both groups is the lack of direction from the regulatory bodies. Whilst I understand that all industries have their rules, I question if this is really a reason to not be actively engaging customers and patients online?

It may help if you consider social media as just a buzz word(s) for people contacting you online. What’s being said is not necessarily anything new and processes for handling enquiries, complaints and even adverse events should already be in place.

What is needed is an effective social media policy. First for internal use and then second for the public. In both instances this will establish the boundaries and expectations. It will state what you will and won’t be engaging about and how you will be doing it.

What goes into an internal social media policy?

Starting with an internal policy will set the ground rules for your organisation and employees. Everyone should be very aware that everything said online can be monitored and that company policies on harassment, ethics, disclosure of information and company loyalty apply in and out of the workplace. An update to your existing communications policies should suffice. What you allow your staff to say in emails and on the phone should be no different than what they would be allowed to say online.

Get internal buy-in and use the knowledge of your staff

The internet is used by people in their everyday lives, so use the experience of your employees to define policies and best practices. What you want to achieve is not a list of what can and can’t be done but instead a definition of what is expected of people.

Bring together teams from different areas of your business and brainstorm scenarios. Let them decide which areas of social media are most relevant to their existing work i.e. customer services takes on social media monitoring. You will be amazed at how perceived problems can disappear. These teams should meet regularly to update each other, to discuss issues that have risen and to revise policy. Adopting this procedure will give you a social media policy that is in-line with your corporate values, has buy-in from your staff and brings you closer to your customers.

Who should be responsible for Social Media?

As much as possible it is best to let those departments who currently speak directly with the public and media carry out your social media activity. They will already be trained to handle all manner of enquiries and know how to escalate issues internally. You should not be frightened of what you might hear or get asked in social media. Review your internal processes and if you find a scenario you couldn’t deal with then look to fix that rather than try to hide from it. As many brands outside of healthcare (Taco Bell, Dell, Ford, Nestle) have found out you can’t stop an issue that the public want to talk about. Worst still, the more you try to stop it the worst it can get as Sanofi-Aventis experienced as a result of a Facebook page that wasn’t even theirs. You need processes and people in place ready to respond promptly without looking around for guidance.

The benefits of freedom to speak

That is not to say that people in other roles have no place in your company’s online engagement. If you want to build relationships and trust with communities then it is your people that will do this. As Dennis Urbaniak (VP US Diabetes, Sanofi-Aventis) pointed out in his recent interview about Sanofi-Aventis’s experiences with social media, it is important that ‘all teams learn how to engage in the space – rather than have just a company voice – as it provides a more personal contribution’.  So give them the training and guidelines for using the tools. Let them know when they can and cannot use your company logo and when they should state that their views are their own and not that of the company. Then make sure that the process of escalation for managing issues and crisis is readily available and well publicised within the company.

Dealing with problems

Any corporate initiative or marketing campaign should have its strategy defined before anything starts. The same applies when using social media. It is all very well having a Twitter and Facebook page but what happens when there is a problem there or the next big thing comes along? It would be right to remember that first and foremost this is a strategic communication activity.  Dennis Urbaniak goes on to suggest that a central hub of information – most likely a blog on your own URL – is an essential foundation to your online engagement strategy. Johnson & Johnson are a good illustration of the value of this approach. Their blog http://jnjbtw.com/ is authored by various members of their senior communication team, some of whom (like Marc Monseau) in turn have a sizable following on Twitter where they mention their blog posts amongst other tweets (Twitter messages).

This hub gives you a controlled platform from which to publicise your social media policies, post your opinions and respond to comments left by the public. From here it is then possible to venture out on to other platforms and social networking sites, with well trained and confident employees who can communicate safe in the knowledge that you have the systems in place to deal with all eventualities.

In the second part of this article I will be looking at whether the presence of a social media policy has any impact on the success of your engagement strategies.

Perhaps you noticed some of the confusion about return on investment (ROI) for social media and online initiatives in the past year. Certainly there has been a lot of conversation online and offline about what this actually is.

In fact ROI is not at all complicated, nor does it need commentators to re-define and interpret what it may mean; it is already a series of mathematically precise business metrics, perhaps best simplified as something like:

ROI = (GAIN – COST) / COST

Consequently, the range of descriptive spin which has been introduced in recent times to try and communicate the actual value of social media to the business is bewildering. Here are just a few that have been mentioned in the context of the healthcare industry;

• Return on investment – Just focus on the investment part at this stage, as it is a learning process where we don’t know what to expect.
• Return on ignorance – What if we don’t, what if we miss out?
• Return on influence – We just need to have a persuasive presence online.
• Return on interest – Think of it as an area of interest.

Some have even gone as far as changing the acronym altogether;

• Return on connections – It’s not about the money, just how many friends we have
• Return on hassle…

There are probably more. However, in the world of business ROI hasn’t changed at all.

Tangible ROI in health care and business

The ‘I’ in ROI means ‘investment’, which is usually in the form of capital (or resources which require capital). It figures therefore that the output returned (the ‘R’) also needs to be in these same units. A financial value is required.

Indeed one Pharmaceutical Brand Director made this point very strongly at an ‘e’-Pharma conference in the US earlier this year, which paraphrased goes like this:

“…you marketing types think that ROI is something that you can determine from your web analytics, but in the real-world of pharmaceuticals any measurement about website visitors is three levels down from true business ROI. Has there been an increase in prescriptions? Has there been an increase in sales? Let’s call it for what it is; we are a product manufacturing business, and we have to sell products.”

So the idea of ‘visitors’, or ‘hits’, or ‘time on site’ or conversion is not really helping to answer the big business principles – unless it is tied to a financial indicator. Even so, many well-meaning companies and agencies continue to derive new metrics to try and define online or social ROI. Some have even successfully integrated these metrics within their CRM systems. However these measurement indicators may truthfully only show the ‘potential for return’, but do not actually translate to the ‘actual revenue return’ that will be generated.

Nonetheless, there are many organisations for which ROI cannot be determined in terms of sales and revenue. Non-profit patient advocacy organisations are one example. Pharmaceutical patient safety campaigns are another. That said, there will usually be business objectives which are themselves tangible and measurable. In the case of a non-profit patient advocacy organisation, it may be the ability to secure funding.

Likewise in regulated areas such as medical devices, or prescription only medicine, or surgical supplies. Activities online by these companies often have no direct measurable correlation between the expenditure and the financial bottom line of the business.

Indeed for health care in general, determining ROI from channels like Social Media may seem even more intangible than for other industry sectors.

Case Study: TuDiabetes and The Diabetes Hands Foundation

In a recent interview with Manny Hernandez of the online patient group TuDiabetes, we discussed this at length. TuDiabetes, EsTuDiabetes, and the Diabetes Hands Foundation have received critical acclaim from industry observers, and from other patient advocacy groups who are keen to imitate the great engagement achieved online and offline.

After discussing some of the notable campaigns, which won TuDiabetes an award for Best Patient Community, we started to go deeper into the organisational objectives, and how well the initiatives served in meeting the big picture needs.

Manny explained:

“…in the past we were turned down on funding and sponsorship because we didn’t have quantitative data.”

As Chairman of the Board for the Diabetes Hands Foundation, as well as the founder, Manny naturally expects results from the good work they are doing. Results which do not include revenue, or even membership growth; but tangible benefit to people whose lives are touched by diabetes. In their own words they have a vision to

“…actively promote positive and proactive actions to stay healthy while living with diabetes.”

Changing behaviour is not the most ‘tangible’ of business objectives, and certainly does not fall into the typical paradigm of ROI. Yet this is also one of the most common objectives mentioned by the health care and pharmaceutical clients that Creation Healthcare provides strategy and research for.

When the BigBlueTest ran, the goal was to educate and to increase participation. In hindsight, it was recognised that collecting solid data is critical for building a case for the next phase funding, but that collecting mountains of data alone is useless without the right questions and the right measurement at the point of setting the strategy. Learning from the past, Manny knows that the 2010 version of the online/offline event will be even better.

Another popular campaign – Making Sense of Diabetes – was funded by Boehringer Ingelheim, a company that did not at that time offer any products specifically for Diabetes sufferers, although had a pipeline of oral antidiabetic products in clinical development. The ROI for Boehringer Ingelheim through such an exercise is massively intangible. Clearly there is brand association in a new therapy area, there is goodwill, there is support of public awareness – but no clear link to product sales and true ROI. Success can be construed through non-financial indicators, those with which marketing and communications teams are already very familiar. Fortunately, we live in a age where every online action is measurable, unlike the days of the traditional printed piece and television.

This is an important point in setting expectation. The expectation for a CSR initiative is very different than for a product launch. So at this level we have to be content with ‘potential value’ as a measure of success, or tie the success to well-targeted brand exposure associated with behavioural indicators such as ‘Opportunities to see’, or ‘Visits’ and so on.

As it happens, Manny did feel somewhat disappointed with the actual ‘views’ of the YouTube final compiled video, with approximately 4,360 as this article is written. However in terms of influence, this video is literally changing the thinking of patient groups all over Europe, and certainly giving pharmaceutical companies something to think about too. Although this is anecdotal, and once again less possible to measure quantitatively.

So how is the Diabetes Hands Foundation going to obtain their form of non-financial ROI in the future? Well, an exciting development proposed by the Boston Children’s Hospital is potentially going to close the loop and provide the kind of quantifiable evidence of changed patient outcomes that they need.

tuAnalyze is an application in Beta testing, which will allow members to enter, track and optionally share their haemoglobin A1c data. The potential exists to map this data by geography, or to find trends which lead to healthier behaviour for members. Importantly, members are able to opt into the level of personal health record sharing that they are comfortable with, leading to different but equally valuable research outcomes.

Manny explained his respect for research oriented institutions like PatientsLikeMe;

“I have always been a long-time admirer of the Heywood brothers because they have been really leading the way in this space. They gained access to data which respects patient choices and preferences.”

He understands the need to commercialize such operations and for industry to accept this new form of patient information, and says that for the Diabetes Hands Foundation it is actually not an option;

“It was important to us from the beginning that our network was run as a non-profit.”

So in the near future, the Diabetes Hands Foundation will have their own meaningful measurement which enables them to tangibly determine how effective their online networking efforts and awareness campaigns are in changing the perception and management of the diabetes condition. You can look forward to Part II of my conversation with Manny in the coming weeks.

Assigning value to intangible organisational objectives

In any case, every measurable action can be assigned a ‘value’; If it is someone signing up to a newsletter, how much money would have needed to be spent to find a contact, phone them, and ‘opt-in’ them to achieve the same outcome. Whilst not ROI, it is a meaningful indicator that has more persuasion with a Board than simple visits.

If it is someone contacting you through a form instead of a phone call, what is the reduction in resource overhead by not needing a person to be permanently there?

There are some simple pointers for all organisations that are unable to directly measure ROI through sales or revenue;

1. Start by setting the strategy
   • What do you want to accomplish?
   • What is the current baseline
2. Make sure there is a measurable ‘action’ at the end of the predetermined online journey
3. Make sure that any action has a ‘potential’ value
   • It may be based on cutting expenses
   • It may be based on projected funding
   • It may be based on the individual
4. Keep measuring and learning; Discovery is a continuous improvement methodology.

If you would like to take some time strategically planning how to determine and measure the level to which your organisational objectives are being met online, why not call us now and set up an informal meeting?