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Getting Closer to Customers: Mobility Revolution in Pharmaceuticals
• Cognizant 20-20 InsightsGetting Closer to Customers:Mobility Revolution in Pharmaceuticals Executive Summary focus on patients over the years. The situation is accentuated by the specific nature of the The mobile revolution has irrevocably changed the pharmaceutical industry. Consider the following: way the world communicates. The initial contours of this change were felt in the social dimension, where communication barriers between individu- • A huge amount of money is spent on inventing very few products, with perhaps one major als were eased. Over time, fueled by fertile minds, drug launched every couple of years or so. the contours extended to the business dimension, where greater effectiveness was achieved • Consumers are not the decision-makers, and by establishing a personal connection with it’s very hard to directly reach them. customers, which hitherto was almost impossible • Reaching the influencers is increasingly in some industry segments, such as pharmaceu- difficult, with more oversight by regulators. ticals. Payers are increasingly exerting decisive influence over the success of the product. This paper looks at how the mobile revolution is transforming the pharmaceutical industry by • Ethical concerns surround how drugs are enabling a consumer-to-industry connection. It tested in clinical and pre-clinical stages. proceeds to give a glimpse of the transforma- • Over-the-shoulder regulatory supervision tion by discussing three real-life examples and exists in almost all activities. concludes with a discussion on future trends and challenges. Pharmaceutical products reach consumers mostly through their prescribing physician. The Industry Challenges commercial focus has been predominantly on Pharmaceuticals companies are in the business figuring out how to encourage physicians to of offering products that save lives and enhance prescribe more of their products. It is estimated quality of life. Undeniably, the innovations of phar- that $19 billion is spent by pharmaceuticals maceuticals have helped millions of people lead companies on drug promotion in the U.S., alone.1 dignified lives. Our healthy future is predicated on Several key applications have been built by all our ability to access required medicinal products. pharmaceuticals companies to try to understand With increasing preference for generics over physician prescribing patterns, ways to ethi- branded drugs, the pharmaceutical industry is cally influence prescribers, types of marketing facing severe revenue pressure. This, coupled campaigns targeting select prescribers in select with other industry forces like managing payers territories, etc. Similarly, applications that and regulatory authorities, has diluted the monitor drug safety, help with drug discovery cognizant 20-20 insights | november 2011
and track interactions with regulators have also engage with physicians. Manhattan Researchbeen built. However, it would be surprising to find estimates that about 81% of physicians willany application that directly talks about consum- own smartphone devices by 2012.6 This mobileers and their opinion of the product, partly due revolution has come as a silver lining, offeringto the peculiar nature of the industry. Building new ways to engage with physicians. New mobilitya better understanding of customer sentiments applications target not only the traditional salesand consumer experiences with any pharmaceu- force but also the patient community by offeringtical product has been made very difficult by the wellness-based, informative applications.lack of direct customer access. The onset of socialmedia, coupled with emerging channels, has Emerging channels such as Web portals andintroduced a welcome change in this direction. mobile devices enable consumers with the latest information about pharmaceutical products.Social media and emerging channels for interac- Social networks empower consumers by formingtion have opened pathways for better connec- a community. Offering opinions and hearingtions to both patients and physicians. According advice from more experienced consumers is nowto recent estimates, Facebook has more than a reality. This can improve or mar the chances of500 million subscribers, and Twitter recently sur- success for pharmaceutical products. With everypassed 190 million users (who tweet 65 million passing day, the increasing consumer influencetimes per day).2 Mining from social networking on pharmaceuticals is felt.sites, one can get a wealth of information, fromrecruiting for clinical trials, to figuring out active In his classic work on Web 2.0,7 Tim O’Reillyphysicians and their preferences. Pharmaceuti- observes with great foresight that harnessingcal companies are conscious of the emergence collective intelligence is about “users themselvesof new power centers and the gravity shifts. For deciding what is important for them rather thanmore effective connections with their consumer a few people in a back room deciding what iscommunity, these companies are supporting important for users.” Of course, the context ofbrand Web sites, which provide a host of informa- this remark was that of Web page rankings, buttion about the product. One of the most success- we can see the extension of this thought mani-ful instances is Novartis’s Glivec Web sites,3 which festing itself in the form of “harnessing collectingprovide a lot of useful consumer information. intelligence” elsewhere. In the context of the pharmaceutical industry, we see the followingThe Mobile Revolution: uses for collective intelligence:The Pharma ImpactTectonic shifts in technology innovations open up • Payer community: Direct evidence from consumers on their perception of the efficacyinnovative avenues to capitalize on these changes of pharmaceutical products.and improve human life. Ubiquitous, affordable,easy-to-use mobile devices are probably the most • Pharmaceutical: The ability to hear thesignificant technology innovation to occur in the customer voice directly and gain valuablepast few years. “Hyper-connection” is the order of insights from it.the day, and the trend is irreversible. Unimagined • Consumers: The ability to influence the futurepossibilities are now on the verge of realization, of pharmaceutical products.due to the wide prevalence of mobile devices andformation of virtual communities. With interest- The mobile revolution has given power to theing research happening in the areas of location- average Joe to generate opinions and increaseaware 4 and context-aware5 mobile applications, his social networking possibilities. This increase inpharmaceuticals companies will be able to touch social networking traffic requires elastic storagethe lives of their consumers in novel and fruitful and processing capabilities. Cloud solutionsways. provide the right kind of infrastructure for intel- ligence generation. One can see the link betweenAccess to physicians for pharmaceuticals sales mobile applications, social networks and cloudexecutives is increasingly becoming a challenge. solutions. There are interesting applicationsPhysicians are shifting to more convenient that pharmaceuticals can create for monitoringchannels for interaction such as the Web, which health conditions via an implanted device and aoffers the flexibility of being available anytime physician’s mobile device, which can change thewith the most recently updated information. contour of care beyond the known boundaries ofPharmaceuticals are forced to find new ways to today. cognizant 20-20 insights 2
Mobile App for Consumer-Physician-Payer Connection Consumer This app enables a channel of Higher customer satisfaction will positively interaction, aimed at customer care. influence the payer, resulting in more business for pharmaceuticals. Physician PayerFigure 1We studied the popular applications developed advances, pharmaceuticals are experimentingby pharmaceuticals that are targeted toward with novel mobile applications that can notify theconsumers. In parallel, we also looked at the inter- physician about the consumer’s health instanta-esting mobile applications available in the public neously. This application enables the physiciandomain pertaining to healthcare. With these, to work even when he is not in the office. Such awe identified the broad themes and picked out capability transcends the constraints of time andmobility applications in which these themes were space, demonstrating customer care practicallywell-expressed. We will describe three such appli- anytime, anywhere. Figure 1 illustrates how thecations that are illustrative of the technology and application fits in the pharmaceutical-consumer-domain trends. physician chain.Three Real-Life Examples The simplified flow of this application is depictedPharmaceuticals are motivated by the desire to in Figure 2.improve consumer health and well-being. Themobile revolution has enabled computing power Automatic Transmission of Alertsin mobile devices, and pharmaceuticals are taking from Consumers to Care Providersadvantage of that to improve consumer health.The examples below are linked by this commontheme: how to use the mobile revolution toimprove consumer satisfaction and enable higherquality of life. We will see how each of these Implanted Transmissionsmanifests this theme in innovative ways. Device DatabaseRemote Patient MonitoringThe market for medical devices is growing briskly. AlertsMarket size for medical devices in the U.S. was Generatorabout $94.9 billion in 2010.8 Medical devices arecapable of automatically transmitting the healthconditions of the consumer to the physician, Mobile Push Apps Notificationwho uses this information to assess the patient’s Serverhealth. Currently, this is mostly being done bylogging on to a Web site and viewing the transmis-sions or using hard copies, both of which generallyintroduce a time lag. Exploiting the technological Figure 2 cognizant 20-20 insights 3
The Salubris Ecosystem REST End Users Calls iPhone/iPad Web Services Rx (prescription details) Care Provider Android Web Application Logs into wellness application and provisions device to patients Blackberry Multitenant Provisioning ETL Analytic Insight Warehouse 1. Correlation between exercise and mood level 2. Analytics between blood glucose vs.stress 3. ..... EMR Google/MS HV Health Info ExchangeFigure 3Salubris: A Wellness Framework Such a correlation will help in establishingWellness — whose responsibility is it? The consum- evidence of whether the drug worked as expected.ers? Pharmaceuticals? Physicians? Ultimately, It is of invaluable help for the payer community,wellness is the consumer’s responsibility, and theentire ecosystem can and should help the con- Correlation of Vitals to Symptomssumer achieve it. The seed idea of the Salubris Blood Glucose Tracker Graph Blood Glucose Valueplatform is using mobility technology to empowerpatients to take charge of their wellness and, in 40the process, generate real-world evidence to help 30 < 30both pharmaceuticals and the payer community. 20 10 JFM AM J JAS ONDSalubris provides the ability to set medicationschedules and alerts, capture food consump- BMI Tracker Graphtion and exercise patterns and record vitals and 21.91 BMI Value 21.9symptoms. It also offers hooks for connecting to 21.89 21.88 < 30social networks such as Twitter and Facebook. 21.87Salubris provides learning materials to motivate 21.86 JFM AMJ JAS ONDcustomers to understand their conditions scien-tifically. The architecture is depicted in Figure 3. Vision Appetite Increasing IncreasingAs the consumer records information about hisor her dietary patterns, exercise, symptoms and JFM AMJ JAS OND JFM AMJ JAS ONDmedication compliance, the data is sent to the < 30 < 30back-end server, from which the consumer canopt to store it in an electronic health record Thirsty Feeling Urge for Urinationformat. What is of interest is the ability to mine Increasing Increasingthe data for aggregated trends from the server.For example, a trend analysis can be drawn upfor a particular age group for body mass index JFM AMJ JAS OND JFM AMJ JAS OND(BMI) and blood glucose values over a year’s < 30 < 30time against reported symptoms of appetite,feeling of thirst, urge for urination and vision(see Figure 4). Figure 4 cognizant 20-20 insights 4
as well; for instance, it will be possible to relate for physicians, accounting for 41% of their mobilea symptom — say, the worsening of eyesight for usage.8 Web sites like WebMD provide very gooda diabetes patient — to lack of compliance with a information; however, accessing this informationprescribed drug. This is an exciting possibility for from mobile browsers is not always an enjoyableall: consumers to manage their health, payers for experience.evidence and pharmaceuticals firms for whetherthe drug benefits are realized. Pharmaceutical companies are creating summa- ries from their educational information in easy-to-Reincarnation of Information Dissemination use native mobile applications. The various typesWeb Sites as Consumable Mobile Apps of information, such as 3-D diagrams, news, jour-The need to access important, timely, concise nals, calculators, etc., are subscription-controlledand relevant medical information is extremely and available in different languages for end users.important for both physicians and consumers. A Search is an essential feature in applications ofrecent study by Manhattan Research shows that this nature. The flow diagram in Figure 5 illus-accessing clinical or medical information is one of trates the contours of this application.the top three most-used mobile medical functionsRealizing Information Portlets as Mobile Apps Country Users Various Structural Content Language Subscription Library Hub Translation ControlFigure 5Content Managed as Capsules Journals iPad/iPhone/iPod Risk Calculators Managed Content Windows Phone Forums Backbone Health Videos Android Care ContactsFigure 6Figure 6 provides an expanded view of the content Crystal-Balling the Futuremanaged. Today, pharmaceuticals companies monitor onlineNative mobile features of touch, location and sites for opinion and brand perception. In theimaging functions are put to creative use in these not-too-distant future, brand perception will beapplications. This will result in an innovative, created and shared from mobile channels, as well.immersive and more satisfying user experience We expect new applications from pharmaceuticalsand will serve as an enticement to use mobile companies offering an innovative and engagingchannels for accessing information. experience that facilitates the generation and cognizant 20-20 insights 5
sharing of the customer voice. Applications of Mobile channels offer the best passage for phar-this nature will have wellness management func- maceuticals companies to gain an understandingtionality enabling consumers to take charge of of the consumer. This trend will strengthen overtheir health and well-being. the next few years. The consumer is the common interest for the ecosystem of pharmaceuticals,Managed care is on the verge of transformation. care providers and payers; we are set to witnessAlerts that are indicative of serious conditions the launch of well-amalgamated, innovativeemanating from implanted devices will be instan- mobile applications covering all dimensions fromtaneously routed to a mobile application, which the consumer perspective.will be specifically designed to handle this type ofsituation. The physician who is using the mobile By way of caution, we must add that there areapplication will immediately arrange for the right some genuine concerns that one needs to addresscare for the consumer. to make the mobile experience an irreversible reality:Mobile devices will emerge as the single systemof record for the consumer. The consumer will be • Security concerns related to the wireless trans-able to walk into a physician office and just hand mission of data. It is important to safeguardover his device, which will contain information on consumer interests and ensure that dataall the details of his or her eating habits, exercise sharing happens with informed consent.patterns, symptoms, medical history, etc. Thephysician will simply pull out the required infor- • Portability of mobile applications across mobile devices and the need for the evolutionmation and correlate it with the verbal observa- of widely accepted standards.tions of the consumers. This will enable bettertargeted care and ultimately prove beneficial for • Regulatory concerns around the best level ofall parties. engagement with consumers.Mobile devices are more ubiquitous in developing • Controlling the proliferation of apps, as well as creating a mechanism to find and design themarkets than in developed markets. Users in most worthwhile ones and rate them as such.emerging markets are more comfortable with andenthusiastic about using mobile devices.9 Though There are concerted efforts to address the abovethis appears seemingly simple, it has profound concerns. We are sure they will be addressedimplications for pharmaceuticals companies. in the near future and that the full potency ofWhere traditionally it has been difficult to gain the mobile revolution will be within reach ofan understanding of consumers, it can now be consumers. Some suggestions for future work inmuch more easily achieved in emerging markets, this direction are:given the eagerness to use and penetration ofthe mobile devices. Thus, using mobile channels, • Architect applications to evaluate the effec- tiveness of the mobility channel.emerging markets can be understood much betterthan developed markets. Pharmaceutical innova- • Monitor regulatory guidelines on pharmaceuti-tions in customer understanding are more likely cal and consumer interactions, as they greatlyto emerge from developing countries, and we can influence pharmaceutical sales.10 Regulators’expect new mobile applications targeted to local interests are closely aligned to that of themarkets. consumer, so it’s vital to create innovative applications designed for greater transpar-Conclusion and Future Work ency with regulators.The above are some examples where we are • Use powerful capabilities in mobile devicesclosely involved. These hand-picked examples such as photography and location awarenessillustrate the alignment efforts of pharmaceu- for creating applications that will help thoseticals companies with their customers. There who may be in urgent need for care.are a lot of applications in Apple’s iStore thatoffer health-related services, from tracking • Repurpose innovations in educational and retail-oriented mobile applications for phar-one’s dietary behavior, to registering symptoms, maceutical customers.to physician/consumer educational materials. cognizant 20-20 insights 6
Footnotes1 Wikipedia pharmaceutical industry definition. http://en.wikipedia.org/wiki/Pharmaceutical_industry2 Cliff Mintz, “Social Media’s Impact on Clinical Trials Enrollment,” Life Science Leader, November 2010. http://www.lifescienceleader.com/index.php?option=com_jambozine&layout=article&view=page&aid= 41363 Novartis Glivec Web site. http://www.glivec.com/index.jsp4 Jonna Häkkilä and Jani Mäntyjärvi, “Developing Design Guidelines for Context-Aware Mobile Applica- tions,” Proceedings of the 3rd International Conference on Mobile Technology, Applications & Systems, 2006.5 Stefan Saroiu and Alec Wolman, “Enabling New Mobile Applications with Location Proofs,” Proceedings of the 10th Workshop on Mobile Computing Systems and Applications, 2009.6 Manhattan Research. http://www.manhattanresearch.com/7 Tim O’Reilly, “What is Web 2.0?” O’Reilly, Sept. 30, 2005. http://oreilly.com/web2/archive/what-is-web-20.html8 MarketResearch Web site. http://www.marketresearch.com9 “Measuring the Information Society: The ICT Development Index,” International Telecommunication Union, 2009.10 Stefan Stremersch and Aurelie Lemmens, “Sales Growth of New Pharmaceuticals Across the Globe: The Role of Regulatory Regimes,” Marketing Science, Vol 28, No. 4, July 2009, pp 690-708.About the AuthorRaghuraman Krishnamurthy is a Chief Architect in Cognizant’s Life Sciences Business Unit’s TechnologyConsulting Group. Raghu’s core skills include enterprise architecture, social media, SOA, mobility appli-cations and convergence of technologies. He has worked with several major pharmaceuticals in envi-sioning and leading transformational initiatives. He has presented papers at numerous conferences andwas recently named a senior member of the prestigious Association of Computing Machinery (ACM).Raghu holds a master’s degree from the Indian Institute of Technology, Mumbai, and is a TOGAF-certifiedenterprise architect. He can be reached at Raghuraman.firstname.lastname@example.org.Saikumar Jagannathan is a Chief Architect and heads Cognizant’s Life Sciences Business Unit’sTechnology Consulting Group. Sai is very passionate about technology and the life sciences industry.His views and advice are frequently sought after by major pharmaceuticals. Sai’s recent areas of focusare cloud computing and mobility and its transformational potential in the pharmaceutical space.Sai is a TOGAF certified enterprise architect and specializes in building enterprise views of applica-tions, large-scale architectures and performance tuning. Sai actively works on strategizing the latesttechnology advances for possible business benefits for clients and prospects. He can be reached atSaikumar.email@example.com.AcknowledgmentsThe authors would like to express their thanks to Srivatsan Nagaraja, Senior Vice President in Cogni-zant’s Life Sciences Practice, for his thoughtful comments and insights. We express our gratitude toSairamkumar Jayaraman, Vice President in Cognizant’s Life Sciences Practice, for constantly supportingus and encouraging us to think ahead. Our thanks are due to Dr. Elby Nash, Director of Cognizant’s LifeSciences Practice, for several stimulating discussions that influenced our perspective.Content used in this white paper was originally presented at the IEEE’s Tenth International Conferenceon Mobile Business and published on the IEEE’s portal, http://www.computer.org/portal/web/csdl/doi/10.1109/ICMB.2011.28. It is reprinted with the permission of the IEEE. cognizant 20-20 insights 7