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Sanofi and Microsoft: Tech Innovation Meets Medical Insight

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Based on an article by Danielle Baron, “Medical Meets Machine.” BozidarJovicevic will be speaking at eyeforpharma Philadelphia 2018.By Bozidar Jovicevic, VP, Global Head Digital Medicines, Sanofi and Professor Iain Buchan, Director of Healthcare Research, Microsoft.

In his book The Tipping Point, Malcolm Gladwell writes about that magic moment when “an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.”

Those in the know say that the use of technology in medicine is currently at that tipping point. With the potential to fundamentally change the practice of medicine over the next decade, this will also transform how pharmaceutical companies interact with and support healthcare professionals.

Healthcare is currently “low-resolution,” says Professor Iain Buchan, newly-appointed Director of Healthcare Research for Microsoft in the UK and Professor of Public Health Informatics at Manchester University.

We know a lot about patients when things go wrong, when they come into the clinic and details are taken, we get a snapshot in time.

At higher resolution, the view extends across the patient journey, tapping into the rhythms of life. A very important rhythm is medication behavior, about which very little is truly known.”

He says that in a more connected and predictive world, we will look at therapeutics within the context of biology, behaviors and environments. “We are on the verge of a really interesting journey for clinical therapeutics and patient experience, which will allow us to have high definition healthcare. This will treat the patient journey and not just the stops along the way.”

For example, stratification will become ever more accurate with advancing biological knowledge leading to more precise care when coupled with technological advances, such as AI and personalization. Buchan explains that complex models of patients and as much as individual behaviors when it comes to treating an illness.

With such pervasive technology, transparency will come to the fore. “Today, if I go to my GP or look online for treatment options, it is hard to see how uncertain those options are. It may be that current evidence can’t determine whether treatment A or B is best for me.

In this equipoise situation, the most transparent answer from the doctor, or the algorithm I consult before making the appointment, is: Don’t know: Would you like to enter a study to discover the best treatment in this situation, helping patients like you? The very nature of the consultation needs to change, and the right AI could underpin this evolution.” admits Buchan.

He continues by explaining that this connectivity will expose the “invisible” individual pharmacology of each patient, including the timing of medicines, and the “meta-medication” of lifestyle factors such as diet, alcohol, physical activity and sleep patterns.

“This will lead to a more purposeful connection between physician and patient. We are moving towards a world where personal health data and algorithms provide a view of the road ahead for your health, whereas old-style medical records were more of a rear-view mirror of healthcare,” forecasts Buchan.

“We know a lot about patients when things go wrong.”

“If patients donate data to be learned from, healthcare systems have a duty to harness those data for better therapeutic understanding and development. Separate systems for post-marketing surveillance, clinical trials and prescribing quality management, etc. are wasteful—they need to merge into ‘bigger brains’ at the core of health systems.”

It’s clear this goes much deeper than the average patient support program. These algorithms will become an inherent part of any new therapy, meaning the success of a drug will not simply be down to the molecule, he asserts. “It is wasteful to support medication adherence in diabetes, for example, without using the same patient contacts to influence diet and physical activity.” These algorithm-drug combinations could potentially show up different subgroups of people who need a different type of therapy, so the boundaries between drug development and discovery may blur.

Unsurprisingly, this type of intelligent medicine means the physician’s role will change irrevocably, with a collaborative effort needed across tech, pharma and medicine.

“As patients get more insights into what is happening in the body from recent medications and behaviors, feedback loops are created, which could lead to better outcomes. However, this kind of disruptive observation will also pose challenges in trial design for researchers and regulators.”

Physicians and patients will interact differently, and across all channels, says Buchan. “Trust is central. Trust not only in preserving patient privacy but also in making fullest use of personal data for the healthcare choices that can and should be computed.”

All this heralds a dramatic change in how pharma communicates with key stakeholders—patients, health care professionals, and regulators.

Bozidar Jovicevic, VP, Global Head Digital Medicines, at Sanofi, is emphatic when he says the traditional sales channels used by pharma are evaporating.

“The number one commercial channel for years and decades has been sales reps, visiting physicians and influencing them to prescribe drugs. Pharma companies use many other channels, but that has been the most impactful channel for years. That channel is slowly dying, for two reasons. Doctors are either closing their doors to sales reps or else limiting the visit to just two minutes– you have sales reps driving around in their cars with a price per visit being between $300-500 and maybe making five sales calls per day. That adds up to spending just ten minutes with physicians each day, which is really not impactful.”

All this heralds a dramatic change in how pharma communicates with key stakeholders—patients, health care professionals, and regulators.

The question for pharma is what are they going to do about it? They need new ways of promoting drugs and engaging with physicians, and ultimately a brand new channel through which they can reach them.

Jovicevic does not hesitate. “We know that the doctors are increasingly spending time online to stay up to date. In Europe, 63% of physicians spend more than six hours online each week, in order to stay up to date on developments in their fields. Physicians are spending time online and they are closing their doors to pharma offline.”

Yet he freely admits that pharma is “notoriously bad” for engaging with physicians online in a meaningful and sustained way. “In the online world, it is easy for physicians to stop engaging at any point if it is not meaningful or relevant to them. In other words, if pharma is not relevant to them in the first 10 seconds, all they need to do is close the tab/window. It takes one click.

“For physicians, one problem they face is the overwhelming amount of content available. They are finding it difficult if not impossible to stay up to date due to the vast proliferation of data and the escalating number of trials published each year. This is one issue where pharma can be helpful.”

Ultimately, he says, it is about adding value to physicians and building goodwill. “This could be providing education—it means talking about something not necessarily to do with their drugs, but this will then build up goodwill and form a relationship and get permission to talk about their products, what I call ‘permission-based marketing’.

Pharma has to shift its online approach from an unwelcome pest to a welcome guest.”

Another problem for pharma when engaging with physicians in a multichannel world, is their lack of expertise in this area, according to Jovicevic; “In the pharma world there is a very small number of solid digital marketeers, people who understand online engagement, analytics, traffic, conversions, psychology, etc. There is also a lack of digital leaders who both have skills and can lead the digital transformation.”

”Pharma has to shift its online approach from an ‘unwelcome pest to a welcome guest’ by providing value to physicians,” says Jovicevic.

This is further compounded by pharma’s largely legacy-driven approach to product development in IT, he warns.

“Most IT platforms need to be common (one platform customized for each country but still one platform) and cloud-based. Pharma needs to adopt agile processes and leave the waterfall behind. On top of this, the top 20 countries in a big pharma organization may use five different CRM systems, so it is very difficult to harmonize and create a global, digital multichannel strategy. When you add to that building of many non-common online platforms each country is building its own apps, developing its own engagement platforms for physicians.” According to Jovicevic, organizations need to create special innovation teams or groups, which enjoy their own relatively high level of autonomy. These should be fundamentally separate from the rest of the organization—he even recommends a separate building. Executive sponsorship is key—without this, the innovation will continue to fall foul of mid-management overthinking.

A centralized legal and compliance team devoted to digital issues should also be established.

The example that companies should follow in terms of centralizing their different digital content offerings is already out there—a little site called Facebook. Jovicevic laughs: “When you log into Facebook everything is there, not separate apps for each country—it is all accessible with the one password and it adapts to your own needs.”

When it comes to content, ultimately it is about finding the “white space.” Pharma must analyze the online content and platforms that physicians are already using and then use this to find another opportunity. One clear opportunity lies in the aggregation of content—by collecting and curating the vast swathes of online content already out there, this would make it easier for the individual physicians to digest.

Jovicevic would know about aggregating content—he was central in pioneering the first global eCongress platform for medical e-conferences while at Novartis. This gathered the best content from the huge number of medical conferences held each year and hosted it on a platform called VivindaTV that he says looks like “the Netflix of medical conferences.” It included the latest breaking abstracts, videos in real-time, chat forums (in development), all personalized to the doctor’s interests and/specialty. “This was of huge value to physicians and is a good example of finding the white space (confirmed by NPS score of 71 from physicians using the platform).”

Another key element is not to “over-engineer” the innovation. It is Jovicevic’s belief that in large pharma companies, or any heavily regulated industry, innovation “breaks” at middle management level, and also legal and compliance. A long process of de-risking as the innovative project moves through a large corporation means the resulting success might be so minor that it is ultimately inconsequential, he says.

“Large companies are designed to execute proven business models—they know their stuff. They know how to sell, how to produce, how to talk to customers. Innovation works very differently—you are searching for a business model, you are testing. Companies need to build a prototype, test, tweak, and try again.”

SEVEN SALIENT STRATEGIES:

  1. Learn more about the patient journey and medication behaviors
  2. Use AI to change the nature of the consultation and create a more purposeful physician/patient interaction
  3. Connect medication adherence to diet and physical activity
  4. Make online engagement with physicians relevant and meaningful
  5. Adopt agile IT processes to harmonize a global, digital multichannel strategy
  6. Create innovation teams with more autonomy
  7. Have a centralized legal and compliance team dedicated to IT issues
Bozidar Jovicevik VP, Global Head Digital Medicines, Sanofi

Bozidar Jovicevik has served as Regional Europe Brand Director for Novartis Switzerland, Senior Global Product Director and Global Head of Medical Affairs for Novartis, and is currently Vice President, Global Head Digital Medicines for Sanofi. He will be speaking at eyeforpharma Philadelphia 2018 on ‘How to Gain Competitive Advantage With a More Holistic Solution Around Your Product.”

Iain Buchan Director of Healthcare Research, Microsoft

Iain Buchan has been a rheumatological doctor for the National Health System (NHS) in the UK, a research associate at the University of Cambridge, and Special Registrar in Public Health at the NHS. He is currently Director of Healthcare Research for Microsoft Research and Professor of Public Health Informatis and Director at the University of Manchester.

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