Monday, July 22, 2013
Learnings from ExL’s Digital Pharma China conference: are smartphones the Key Screen?
by James Avallone, Director, Physician Research
There are some digital marketing principles that seem to apply to physicians around the globe and others that are more country-specific. At ExL’s Digital Pharma China conference, which Manhattan Research execs attended and spoke at, the central idea of content as the most critical aspect of a digital marketing strategy certainly fell into the universal camp. Dr. Stanley Li, founder of the China physician focused website DXY, said as much in his presentation at the conference. However, it was his second tenant for digital marketing in China that was much more market-specific and eye-opening—he said that if content was the most important concept, having a strong mobile strategy was a close second.
Wednesday, April 24, 2013
Thoughts on Consumer Empowerment After TedMed
Image courtesy of TEDMED
As those of you who have attended TedMed know, this gathering and event is a full immersion four day experience that inspires new ideas and feelings, infuses new knowledge and challenges assumptions. I will not attempt to summarize what I took away from the conference, or list speakers and vendors that were striking; Twitter does that very well. What I’d like to start here is a dialogue about patient empowerment; a topic that came up continuously at the conference.
We’re at the very beginning of our 2013 consumer research cycle now, which means we’re looking at emerging questions and trends in the market, especially discordant ones.
Patient or consumer empowerment is once again on most of our client’s minds with the following kinds of questions in our inquiry email inbox:
- How are consumers changing given the ACA and the mandate for universal health insurance coverage?
- How are empowered consumers ‘shopping’ for health services? Is this just a function of higher out-of-pocket spending or a broader trend? What’s more important quality, cost, ratings etc.
- How is mobile and social driving consumerism and what can pharma do about it?
- How are mass merchants disrupting care delivery?
- Which services and tools should pharma be investing in in 2013?
Through questions like these and other discussions with clients, it’s clear that the prevailing assumption is that consumer empowerment with regard to health is thriving. Indeed, our studies have shown several indicators that consumers are involved in their care; just not to the extent that most assume.
In our upcoming research, we plan to tackle the following key questions:
- For which medical decisions or activities are consumers taking a more active role than two years ago? What are the drivers and outcomes of these behaviors?
- Which challenges are consumers struggling with most when it comes to dealing with their care, and which solutions are promising?
- How will ACOs, EHRs, and a focus on outcomes among other macro health trends impact consumer choice, participation and satisfaction with care?
- How are consumers participating in for-pay and payer-supported models of care and how is empowerment different across these different payment models?
Jay Walker, the superstar chairman of TedMed, elegantly navigated the attendees through the conference, showcasing books from his personal library from time to time (The Walker Library of the History of Human Imagination). These original books, hundreds of years old, showed how medical thinking has evolved over the ages. From a historical perspective we clearly live in an unprecedented age of consumer or personal empowerment in the medical realm. From an innovation and product development point of view, however, its critically important to get the nuances of this empowerment clear to continue to make the advances we all want to see.
Please take a few moments to tell me your thoughts on consumer empowerment and what kinds of questions you’d like to see answered on this topic.
Posted by Monique Levy, Vice President of Research
Friday, April 19, 2013
Better Diabetes Care Through Data and Technology?
Many of us know someone affected by diabetes. According to the American Diabetes Association, there are 25.8 million people with diabetes and another 79 million people with prediabetes in the US alone. In addition to diabetes, many of these individuals have to deal with co-morbid conditions and complications such as heart disease, hypertension, kidney disease, and nerve damage.
There are many diabetes medications on the market, yet patients still have trouble seeing the full benefits of these therapies due to medication non-adherence and the lack of effectiveness of some of these medications for specific sub-populations.
Aside from the variety of medications available, several tech-based solutions have been offered to help diabetic patients with their care management, including those addressing the problem of non-adherence. As pharma looks to move their value proposition “beyond the pill”, Sanofi-aventis (in partnership with Luminary Labs) appears to be leading the way by sponsoring an annual innovation competition, Data Design Diabetes Challenge, to encourage competing companies to create data-driven solutions to help improve diabetes care.
The finalists for this year’s competition were announced yesterday. They are an impressive lot focused on adherence, virtual coaching / education, healthcare analytics, insulin medication analysis, and meal recommendations.
But how have past participants fared? Have they succeed in surviving an increasingly crowded digital health market, and are they actually improving outcomes?
I did some digging and only found 2 companies (out of 10 past semi-finalists over the past 2 annual competitions) that are still making noise and have tangible momentum. One of these companies, Wellframe, has pivoted away from a focus on diabetic care:
Ginger.io (2011 winner) – “behavioral analytics platform that turns smartphone data into health insights.” Status: Received $8.2 M in total funding, most notably a $6.5 M Series A round led by Khosla Ventures in December 2012. Includes a more general focus to many more therapeutic areas beyond diabetes.
Wellframe (2011 semi-finalist) – “using mobile technology and artificial intelligence to translate clinical protocols into personalized, adaptive to-do lists, made available to patients from their mobile device and ensconced in a vigilant system.” Status: Received seed funding from Rock Health (Rock Health invests $100,000 in each of its participating companies) in October 2012. Pivoted to cardiac rehab focus, completed pilot program with Brigham and Women’s Hospital.
Without sounding short-sighted, the competing companies had so much promise, but why is there so little success? According to a recent multi-study review conducted by The Cochrane Collaboration, tech based solutions have limited effectiveness at actually improving outcomes in diabetes patients: overall, participants saw a reduction in HbA1C levels of 0.2%, with a more significant drop of 0.5% in the mobile phone subgroup. The study also mentions no “adequate evidence for improving depression, health-related quality of life or weight.”
Patients are self-tracking and sharing health data with their physicians. According to Manhattan Research’s recently released Taking the Pulse® 2013 study, 70% of physicians report that at least one of their patients has shared self-tracked data. However, most of this is still done using old-fashioned pen and paper or spreadsheets and current self-tracking tools just may add to the burden of an already complicated life for diabetic patients, as Thomas Goetz notes in his recent article “The Diabetic’s Paradox”.
There are, of course, other solutions outside of the Data Design Diabetes Challenge. It is only a matter of time before innovators can take advantage of this self-tracking activity and transform it into meaningful care that is actually used by and useful to patients. The focus of these innovators should be on overall outcomes that matter to patients like quality of life and disease progression, not just surrogate outcomes like HbA1C and blood glucose levels. These companies should make human-centered design a central part of their development process, and drive true healthcare value along with innovation. The stakes are high for the lives of diabetic patients around the world.
Posted by Shawn Dimantha, Principal Analyst
Thursday, April 4, 2013
Electronic health self-tracking discoveries
Image courtesy of iMedicalApps.com
I’m just coming to the end of writing a report on health self-tracking, which hits on many of my passion points in health. Writing reports can be quite grueling at mR, as we follow a rigorous hypothesis testing approach and continuously test frameworks we design against reality and the data. The hypotheses we formulate are ambitious – in this case the goal was to define the remote care landscape, evaluate how advanced electronic health self-tracking is and put some context around the buzz in the market around this topic. Getting to this almost final point is bitter sweet: there’s huge pleasure in figuring something out, and a little fatigue that comes at the end of a creative cycle.
Here are a few things I discovered and conceptualized:
- Electronic health self-tracking (EHS) is quite prevalent, given the broader market is only recently getting set up to support this activity through electronic health records and practice models that focus on outcomes.
- Self-trackers track primarily to share, not just for self-knowledge.
- Sharing with providers happens with good old fashioned paper, either written by hand or printed, and electronic sharing is in the low single digits.
- Physicians are big believers in self-tracking: they think it helps outcomes, believe patient self-tracked data (i.e., don’t need sensors that by pass human error) and recommend self-tracking to patients. Still, pay-for-performance incentives, better technology and better integration of data in EHRs will help drive wider adoption.
- The distinctions between electronic health self-tracking, remote monitoring and telehealth have to do with the relative control stakeholders have on the capture, storage and sharing of data, the degree of out-of-pocket vs. payer reimbursement, and the regularity of sharing and personal/dedicated devices and communication channels used, to name a few.
- Lastly, as we all know, this market is growing rapidly.
The full report will be released mid-April but the physician piece of the market was released with Taking the Pulse® U.S. 2013 this week.
Posted by Monique Levy, Vice President of Research
Thursday, March 28, 2013
NFC in Healthcare: Early Developments
Image courtesy of Qolpac
Can we get one step closer to the internet of things with the growth of near-field communication (NFC)? NFC is a technology that has been in development over the past couple of decades, and allows for the wireless transmission of data over very short distances (4 cm or less). Data transmission can even be conducted between a NFC device and an unpowered NFC tag that can be placed on any pretty much any object. NFC is prevalent in Japan and South Korea, but has made little headway in the US until recently. Google and Samsung have rolled out NFC capabilities on some of their recent smartphone offerings, and tout it as a benefit over the NFC-less iPhones. All the recent buzz has been about NFC revolutionizing contactless payments, though the technology has struggled to gain mainstream appeal with consumers due mostly to trust issues.
Perhaps NFC can find traction in the healthcare world?
Hospitals have been using bar codes for years to help with standardization of medication delivery, and a GS1 sponsored McKinsey study claims that adopting a global standard across the entire healthcare supply chain will save 22-43,000 lives and avert 0.7 to 1.4 million patient disabilities. Some major hospitals are starting to investigate NFC tags as an alternative method to add a life-saving layer of information. Brigham & Women’s Hospital (BWH) has started testing an NFC RFID system to help with administration of medication at a patient’s bedside. Doctors or nurses use a Google Nexus 7 tablet to interpret and confirm passive NFC RFID tags on medications. BWH has been using bar codes since 2005, but cites difficulties in making a proper scan and the time required to establish a Bluetooth connection as reasons for looking to NFC as a solution.
Medication compliance and remote monitoring have also been large issues in the healthcare world. Qolpac has focused on the use of smart-packaged (NFC tagged) medications to help with patient medication compliance and monitoring. Impak Health has developed medication monitoring and post discharge management solutions that record and communicate patient metrics (e.g. heart rates and sleep quality) using NFC technology. Gentag has started to develop disposable NFC “smart skin patches” to help transmit glucose, UV, pressure and biomarker data to NFC enabled smartphones.
While NFC is not yet as pervasive as other wireless technologies in the healthcare world, it will likely carve out a sizeable niche as more smartphones and other connected devices incorporate the technology over the next few years and as incentives such as CMS meaningful use stage 2 align with technology adoption.
Posted by Principal Analyst Shawn Dimantha
Friday, March 15, 2013
Increasing convergence of electronic health records and mobile platforms for patient engagement: How can pharma benefit?
Photo courtesy of eClinicalWorks®
It was unsurprising to hear eClinicalWorks’ recent announcement to invest $25 Million in a mobile-based patient engagement initiative aimed to improve communication between the 70,000+ physicians using their electronic health record (EHR) and the 8 million consumers registered to the company’s electronic patient portal. Their first free mobile app called healow will be available later this month for both iOS and Android platform users. It facilitates secure, private two-way communication between providers and patients and provides users with immediate access to their health records. The app also enables patients to securely message their providers, view records for family members, request medication refills and to view lab results. It is more than likely that other EHR providers will follow suit in developing similar mobile applications that aim to foster better health outcomes.
On the other hand, primary medical app developers seeking to gain patient users, face an uphill battle trying to differentiate their products among the tens of thousands of disease state management tools that are freely available on both smartphone platforms. Even more challenging for such companies is the development of a scalable monetization model following a build and launch first philosophy. Companies such as Ubiqi health who have focused on individual chronic disease states such as migraine aim to monetize de-identified patient data by partnering with third parties. The value of data sporadically generated by patient app users to pharmaceutical stakeholders is yet to be determined. Medivo provides a free stand-alone service to both providers and patients whereby they can receive access to their lab results. Their business model is built around targeted advertising for pharmaceutical companies that may be looking to identify patients based on their lab results e.g. patients with type 2 diabetes not at A1C goal. However this platform like Ubiqi is not integrated fully with an EHR and the scalability of such a specific advertising model is limited.
Interestingly, with the availability of clearer FDA guidance surrounding mobile app medical devices, some developers are successfully gaining FDA 510(K) device designations. Wellaho recently gained 510(K) class II medical device designation for their proprietary personalized outpatient management system. Wellaho is a physician-directed, web and mobile-based platform that allows providers to manage and monitor patients between office visits in a secure, HIPAA compliant environment. At the same time it enables patients to access their medical information, monitor their condition, stream relevant educational materials and connect securely to their healthcare team. Wellaho claims that the self-education aspect of their platform is integral to the business model. In my opinion, accessing patients and providers through a dynamic chronic disease management system at critical junctures in shared decision-making and self-education make perfect sense. As pharma seeks to emerge “Beyond the pill” by providing value added services for patients and physicians in order to improve health outcomes, these developments illustrate a compelling venue for pharmaceutical companies to focus mobile advertising at critical points in health and wellness journey.
Disclosure: The author has no interest in any of the companies mentioned in this article
Posted by Aafia Chaudhry, MD , Senior Consultant
Friday, March 8, 2013
Ideas from ePharma Summit 2013
Photo courtesy of Bridging the Gap
My head is still buzzing after a wonderful three days at ePharma Summit here in NYC. Congratulations to the chair, Paul Ivans, and IIR for putting it together.
Here are interesting ideas I walked away with:
Patient accountability. Knowledge about physician accountability and payment reform is starting to sink in across the market, with some pharmas of course much more advanced than others when it comes to adapting to new market conditions. What is missing from this conversation is how patients will be motivated to cooperate with an ACO’s goals or what it will take for patients to meaningfully engage with portals. Health behavior modification is notoriously difficult so players working on enhancing patient portals, or helping connect ‘retail’ self-care to EHRs deserve more attention.
Physician backlash to loss of autonomy. There is general consensus that physicians will be losing some degree of choice and control with integrated networks and becoming ‘employees’. Interestingly, a couple of attendees shared with me their view that they expect some kind of backlash to this trend given the general traits and expectations of physicians driving a more independent approach to their profession.
Pharma organization needs to adapt. Along with rethinking the customer, pharma’s classical sales, multi-channel, brand and IT teams will have to change. Clearly many pharmas already have market access groups and innovation teams, however, cross functional teams that can take on end to end new service opportunities are more likely to succeed than the classical siloed approach.
Big data mess. I didn’t get a clear sense of urgency around Big Data. There were a couple of good presentations around this topic but it centered on big data with analytics, in other words data to drive better sales. Outcomes data and opportunities around using all the data that self-tracking and electronic health records will generate was sorely missing.
Posted by Monique Levy, Vice President of Research
Monday, February 11, 2013
Being Difficult for the Sake of it: Making the case for a non-iPad tablet
Image courtesy of abcnews.com
The Microsoft Surface Windows 8 Pro went on sale this past weekend and represents the first interesting player in the physician tablet landscape that does not have a giant apple on its back. Up until this point, the physician tablet scene has consisted of the iPad and a bunch of other background players. Kind of like this, this or this.
The Windows Pro 8 is the second tablet of the Microsoft Surface brand, which first released the Surface Windows RT in October. While the first version was interesting, it did not have a clear value proposition for a physician over any other device on the market—except for improving your tablet-aided breakdancing. However, this new version has the potential to make the HCP tablet landscape at least a little bit spicier:
- It has a more natural/native keyboard: Taking the Pulse® U.S. 2012 revealed that one of the barriers to using a tablet during the workday is how difficult it is to type on it. This is a real problem, as these keyboard difficulties make tablets less efficient than desktops/laptops and create a ceiling in terms of the activities that physicians will consider performing on their tablet. The Microsoft Surface has a snap on keyboard which is a more native attachment than what other tablets boasts and could be a solution to this problem.
- Same interface and OS as a PC: The previously released Surface RT tablet had the same interface as a Microsoft laptop but still had a different operating system. The Surface Pro bridges that gap and operates with the same operating system that a PC laptop could have - Windows 8. This could streamline a number of issues surrounding EHR use on tablets; allowing for a much better user experience than what many physicians have been reporting when accessing their EHR via an iPad. Additionally, many of the Windows 8 desktops/laptops are incorporating a touchscreen interface, which could make this an even more seamless transition.
- Non-iPads still have a puncher’s chance at some market share: Data from last year indicated that while physician tablet adoption surged (and by tablet I pretty much mean iPad), the professional profile of tablets had not yet fully emerged. While this is probably just due to a steep learning curve for professional integration, it is also possible that the current tablets on the market have certain flaws/inefficiencies that could make them vulnerable to a new player on the market.
Just to be clear: Am I saying that the Microsoft Surface can dethrone the iPad as the go-to tablet among physicians? Nope, that seems very unlikely—at least not in the short-to-midterm. The Surface is a pretty expensive device (starting at $899) for starters and U.S. physicians tend to be very Apple-centric in their purchasing behavior. However, the Surface could easily nab second place in the market by wooing a physician segment that is more interested in their digital practices being tablet-centered.
Posted by James Avallone, Principal Analyst
Friday, January 25, 2013
CES 2013: Digital Health Takes Center Stage
Healthcare, in particular digital health, took center stage at this year’s CES. Two full conference tracks, Fitness+Tech and Digital Health Summit, were dedicated to the industry. Technology companies, large and small, pharma, insurance companies and providers were all in the mix:
Health and wellness vs. clinical/therapeutic
One major distinction in the digital health market that panelists at this year’s Digital Health Summit made is between health and wellness, and clinical / therapeutic focused technology. This is normally the line drawn between whether a technology is regulated by the FDA: a clinically focused technology will often make medical claims, while a health/wellness technology will not. Pharma is naturally most interested in the clinically focused apps, though major companies like Sanofi-aventis have applications in both categories. Sanofi has two applications focused on diabetic patients: 1) GoMeals helps patients make healthier eating choices, and 2) iBGStar, the blood glucose monitor that can plug into an iPhone and track readings (technology developed by AgaMatrix). Though health and wellness technologies get all the press, in particular FitBit and Nike+ FuelBand, devices that track your activity throughout the day. Sonny Vu, co-founder of AgaMatrix, launched a very successful campaign on Indiegogo to crowd fund his company Misfit Wearables. Misfit Wearables is launching a very elegant quarter sized device that tracks all types of activity (running, swimming, cycling), first shipments should be available in Q1 2013.
Payers come to the rescue?
Tech startups and pharma are not the only stakeholders getting in the digital health game. Health insurance companies are also sticking their foot in, and tellingly the main sponsor of the Digital Health Summit was UnitedHealth Group. These companies have a lot vested in the success of technology to improve patient outcomes and reduce costs. UnitedHealth Group partnered with Comcast to deliver a reality TV show on demand to prediabetic patients with the goal of preventing diabetes onset through weight reduction. Companies like Aetna (iTriage, CarePass) and Blue Cross Blue Shield (Blue365 program, a Groupon copycat for health and wellness purchases) have developed and acquired applications to help their members more proactively manage their health. Health care insurance companies are becoming health care technology companies out of necessity, as stricter provisions of the Affordable Care Act kick into place.
Telecom companies jumping on board
Even major telecom companies are finally starting to join in, as they try to push for the “consumerization” of healthcare. Dr. Paul Jacobs, CEO of Qualcomm, announced in his pre-show keynote a partnership with the X Prize Foundation to launch a contest to create a medical tricorder device – “a tool capable of capturing key health metrics and diagnosing a set of 15 diseases” (yes, inspiration for the tricorder comes from Star Trek). Nokia is also partnering with the X Prize Foundation to launch a companion contest to create the sensors that will be paired with this device. Verizon, General Electric and Tenet Healthcare announced a partnership with the Clinton Global Initiative to launch the Clinton Health Matters Initiative, a partnership with a mission to build a platform “to help people make small lifestyle changes that will improve their health in big ways.”
Can digital health cross the chasm?
Right now digital health seems to be a focus mainly for tech / fitness obsessed early adopters, and we shall see in the next few years whether digital health will gain broader mainstream adoption. The power of digital health did not quite hit me until I actually used one of these technologies. On the last day of CES I was walking around the mostly empty exhibit floor and was lucky enough to find a representative from AliveCor, Kathryn (who is the founder’s daughter and a member of the research team). AliveCor’s main product Heart Monitor is a $199 FDA approved technology that allows you to turn your iPhone into an ultraportable ECG machine. With the blessing of Kathryn, I put my hands on the two leads behind the AliveCor iPhone on display, and within seconds my ECG popped on the screen. I saw a slightly irregular rhythm read out, and she assured me that it must have been a misreading, but I knew inside that it was my amazement at the potential of this technology and many others to truly revolutionize healthcare.
Posted by Shawn Dimantha, Principal Analyst
Thursday, January 24, 2013
CES 2013: Screens, Screens, Screens….and Sensors!
At this year’s International CES, I had the privilege of seeing in action many of the latest technologies that will hit the market in the next few years. There were a few key trends I saw that may signal new digital paradigms in the near future:
- Flexible screens - The most interesting screen news comes out of Corning Glass and Samsung - working flexible screen prototypes. I have seen conceptual designs before, but not working prototypes. Very impressive, and potentially game changing if the technology is priced right. In fact healthcare applications were quite prominently featured in the Corning Glass demo presentation. Devices with flexible screens could be on the market as soon as early 2014.
- Screen size fragmentation– Only three years ago the iPad’s launch had us talking about the differences between smartphones and tablets. Now these distinctions are blurred by the emergence of multiple types of connected devices: 20” Ultra HD resolution tablets from Panasonic, 3G/4G digital cameras from Samsung, Intel’s Ultrabook campaign to redesign the laptop form factor, 5-6” phablets from Huawei, and even “connected” household appliances.
- Primary screen vs. second screen – The terminology of “primary screen” and “second screen” was heavily used throughout the conference. Industry leaders claimed that the primary screen used to be the TV and the second screen used to be the tablet/smartphone. But now they claim the roles have reversed. Search and discovery is often initiated on smaller devices such as the smartphone or tablet, and continued on larger fixed devices like smart TVs. Google’s multiscreen study seems to confirm this shift in screen roles. Smartphones are even being used as interfaces for other devices. Though another type of “screen”, the heads up display with augmented reality projections may compete for our attention with the expected release of Google Project Glass later this year. Sergey Brin was recently spotted on a NYC subway train wearing the glasses, and a series of Google-sponsored hackathons over the next couple of weeks may hint at future uses for the Google Glass platform.
- Sensors, everywhere – Sensors are now in smartphones, toothbrushes and forks. The technology to measure our environment through these devices and communicate results to the cloud is becoming so inexpensive that we may soon see a proliferation of sensor technology in many objects and tools in our lives, the long-awaited emergence of the “internet of things”. Sensors are not only limited to objects and devices, but also can be placed on our bodies. Sensors have been used for years in the hospital setting, but are now migrating to consumer wearable devices, adhesive patches, and clothing that can help patients self-manage care or fitness nuts quantify their workouts. Major mobile communications and technology companies like Verizon and Qualcomm are partnering with medical device companies to enable the integration of data across connected medical devices in the cloud. This data that can be delivered to patients and healthcare providers for better care management. The point of care is not a fixed location anymore, but travels with the patient outside of the healthcare provider setting.
Posted by Shawn Dimantha, Principal Analyst