THE DIGITAL HEALTH DEBATE Ci C

A REPORT ON HOW DOCTORS ENGAGE WITH DIGITAL TECHNOLOGY IN THE WORKPLACE

THE DIGITAL HEALTH DEBATE Ci

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CNOV 2015

Advances in digital technology have become ubiquitous within healthcare, bringing about breakthroughs in diagnosis, new treatment options and at the same time heralding the expansion of companies usually associated with technology into the market place.

Enter Google Health, Apple Health, and Microsoft HealthVault. These major players are accompanied by IBM with ‘Watson’, a new cognitive system that processes information more like a human than a computer. IBM claim Watson will be able to ‘see’ medical images once its advanced image analytics and cognitive capabilities are merged with a newly acquired medical imaging management platform.

The potential for these new and symbiotic relationships is vast and doctors are at the heart of it. As such, they are well placed to report from the front line on how digital advances are impacting healthcare quality and efficiency, and how these developments can potentially help them to make better patient care decisions. This report is a summary of findings from Cello Health Insight’s 2015 research survey of doctors across eight markets; including the UK, France, Germany, Italy, Spain, the US, China and Brazil. The research explores the ways in which doctors are interacting with digital communication channels and digital devices in the workplace – focusing on how they are using these to exchange information and communicate with peers, pharmaceutical sales representatives, and of course with their patients.

FOREWORD

THE DIGITAL HEALTH DEBATE 2015 | ©CELLO HEALTH INSIGHT

The research explores doctors’ perceptions of how smart technology such as apps and wearables can be used by patients to better manage their health.

The appendix section also includes our findings on doctors’ preferences when participating in research via a mobile app.

Throughout this report, consideration has been given as to what the survey findings mean for pharmaceutical marketing strategies. If you would like to know more about the specific relevance of this research to marketing, sales and business intelligence please get in touch.

For more information about the full extent of the survey research, please do not hesitate to contact us.

www.cellohealthinsight.com

8Markets

1,040certified doctors

PAUL MANNU Master Practitioner, Behavioural [email protected]

Online interviews with

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Contents

THE DIGITAL HEALTH DEBATE 2015 | ©CELLO HEALTH INSIGHT

Uptake of digital technology and online platforms• Access to digital devices• Communication via digital channels• Social media use in a professional

capacity

Influence of digital channels on prescribing• Comparison of information sources• Influence of social media on

treatment decisions• Rise in use of tablets for

representative visits

Impact of digital on the patient-doctor consultation• Researching conditions online• Self-diagnosis online• Patients presenting with

a named prescription

Potential for mobile apps and wearables to help the patient• Extent to which doctors are

recommending health apps• What doctors might

recommend apps for• Barriers to take-up of

apps and wearables

Key segments emerging from extent of sharing via digital channels• Defining user levels• Chain of influence

Appendix• Methodology• About Cello Health Insight• How doctors feel about participating

in surveys via mobile apps

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2

3

4

5

6

UPTAKE OF DIGITAL

TECHNOLOGY AND ONLINE PLATFORMS

1

ACCESS TO DIGITAL DEVICES

There is a growing trend for doctors to use digital technology to assist them in their work. Doctors use their smartphones and smart devices to access the web for a wide range of purposes – from communicating with their patients and peers, to finding information that will help them to diagnose or prescribe.

The smartphone has been widely adopted by doctors globally, and it has become a close companion from which they can obtain information. As connected devices offer easy access to the internet from any location via Wi-Fi and mobile networks, they are ideal for doctors on the move, especially for specialists.

Globally, our survey finds that 82% of doctors own or have access to a smartphone at work, and 77% of them report that they regularly use it at work for professional purposes. Of these, doctors in Brazil are the most likely to regularly use their smartphone (90%), followed by doctors in China at 85%. UK doctors follow at 82%, which is a higher number than in the other European countries surveyed – Italy 73%, France 73%, Spain 79% and Germany 68% – and higher than the US (73%).

Globally, 58% of doctors regularly search for work-related information using their tablet or smartphone. With 81% doing so in Brazil and 76% in China, this again puts them ahead of the curve.

There are some interesting differences in the number of doctors who agree with the following statement:

“I find my smartphone / tablet so much easier to use than my work desktop / laptop.”

Almost one third (32%) of all doctors in the survey agree with this statement. Doctors in emerging markets were much more likely to agree with this statement compared with those in Europe (67% vs. 22%).

In Brazil and China, the data suggests that doctors have embraced tablets and smartphones, which presents interesting opportunities for pharmaceutical companies to access them in their professional life.

The lower result for Europe, where smartphone use in the professional setting seems less advanced, is potentially due to the need for systems in Europe to link in with other local and national Health Electronic Reporting (HER) systems – something that is more difficult via a smartphone.

58of doctors regularly

search for work-related information on their handheld

THE DIGITAL HEALTH DEBATE 2015 | ©CELLO HEALTH INSIGHT | 01

82of doctors own

or have access to a smartphone

at work

COMMUNICATION VIA DIGITAL CHANNELS

02 | THE DIGITAL HEALTH DEBATE 2015 | ©CELLO HEALTH INSIGHT

The research explored the ways in which doctors are adopting digital channels into their preferred methods of communicating with peers, pharmaceutical sales representatives, and their patients.

Phone calls

Continue to be the primary channel of communication between doctors and patients across all markets. 89% of doctors reported talking on the phone to colleagues in the last month, with 84% talking to patients, and 45% to pharmaceutical sales representatives.

Email

A major channel of professional communication between doctors, with 88% surveyed having emailed their peers in the past month. 48% report having emailed patients in the last month, and 43% of doctors having used email to communicate with pharmaceutical sales representatives.

Text messaging

Widely used across all markets to communicate with colleagues. Globally, 68% of doctors use mobile texting to communicate with their peers. Almost one third (30%) use it to communicate with their patients, and 18% with pharmaceutical sales representatives. Use was particularly strong in Brazil and China (82%).

WhatsApp / WeChat

Embraced in China, Brazil and Italy for communicating with peers, patients and pharmaceutical sales representatives.

France and the US are far behind other countries in terms of using WhatsApp, or its equivalent – WeChat in China. Doctors in Southern European markets, China and Brazil are using these platforms to communicate with peers, patients and pharmaceutical sales representatives.

Only 2% of UK doctors and 4% of US doctors report using WhatsApp to communicate with patients in the previous month, compared to 87% in Brazil, 61% in Italy and 50% in China.

48report having

emailed a patient in the same period

88of doctors have

emailed their peers in the last month

43report having

emailed a pharma representative in the

same period


Web platforms

Offer an opportunity for a customised solution. Doctors are open to the idea of using dedicated web platforms to communicate directly with patients, with one third (33%) of doctors globally agreeing with the statement:

“If I could communicate with patients via a specialist doctor-patient website, it would be more time-efficient.”

Doctors in Brazil and China were even more likely to want to communicate in this way, with 47% and 67% respectively agreeing with the statement.

Skype

Has not taken off with doctors. While it is often seen as having great potential for the profession, less than 17% of doctors claim to have used the channel in the last month to communicate with their peers, and only 4% with patients or pharmaceutical sales representatives.

Social media

Has an increasingly important role to play in doctors’ peer-to-peer communications, but it is yet to take off for patient communication. 30% of doctors globally now claim to use consumer social media to communicate with their peers. However, only 8% claim to use it to communicate with patients and pharmaceutical sales representatives.

of doctors would like to communicate with

patients via a doctor-patient website

Digital channels most commonly used by doctors to communicate:

89%

88%

68%

31%

30%

25%

17%

3%

84%

48%

30%

15%

8%

7%

4%

1%

45%

43%

18%

12%

8%

5%

4%

1%

Phone calls

Communicating: with collegues with patients with pharma sales reps

Email

Text

WhatsApp

Consumersocial media

IM

Skype

WeChat

33

SOCIAL MEDIA USE IN A PROFESSIONAL CAPACITY


There is wide regional variation in social media use, which pharmaceutical companies will need to understand for their strategy development.

The three social media channels used most widely at work ‘in the last month’ for professional purposes are YouTube (28%), LinkedIn (24%) and Google+ (21%). In Brazil and China there is significant use of YouTube in comparison to the other countries in the survey. In Brazil, 50% of doctors report having used it for professional purposes ‘in the last month’, and 37% claim this in China.

1/2of global doctors use

Wikipedia at work

Wikipedia

By comparison, the online encyclopedia resource Wikipedia is used globally by about one half of doctors at work. 63% of doctors in Brazil and China, 53% of doctors in Europe, and 42% of doctors in the US report using it in the last month.

Use of consumer social media by doctors in a professional capacity (% of respondents):


IMPLICATIONSFOR PHARMAMARKETING:

Digital technology and online platforms are channels used by a significant proportion of doctors and each is a potential entry point for the promotion of a pharmaceutical asset.

Understanding doctors’ digital behaviours is vital for effective multi-channel marketing strategies. In particular, identifying the right message for the right person, through the right channel.

INFLUENCE OF DIGITAL

CHANNELS ON PRESCRIBING

2

COMPARISON OF INFORMATION SOURCES

While face-to-face information from peers, key opinion leaders (KOLs) and visits from pharmaceutical sales representatives are still all in the top four channels for trust and influencing doctors’ prescribing decisions, the use of some digital channels is increasing. The pharmaceutical sales representative still remains the preferred source of information – with 54% of doctors saying the representative is their preferred source.

27used a digital channel

to access company information

54of doctors prefer a

representative as their primary source of

information

However, the data suggests that digital offerings can be useful alongside the sales representative. More research is needed to help pharmaceutical brands understand what information is better communicated face-to-face and what works better sent digitally.

In terms of using digital channels to access pharmaceutical company information, only 27% of doctors surveyed had accessed a company website in the last 6 months, and 17% a branded product-related site.

Top 4 information sources:

Direct mail ads Medical advertising Direct email

Sponsored event F2F info from peers F2F with KOLs

Sales rep visit

Sales rep visit

Sales rep visit

Sales rep visit

F2F info from peers

F2F info from peers

F2F with KOLs

F2F with KOLsConference /

sponsored meetings

Conference /sponsored meetings

67% 65%Exposure to in past 6 months

Preferred sourceof pharma info

Most trusted source of pharma info

Most likely toinfluenceprescribing

64% 58%

54% 48% 42% 32%

48% 43% 34% 33%

38% 35% 27% 22%

1st 2nd 3rd 4th



Influence of social media on treatment decisions

35% of doctors globally agree with the statement that:

“Information from peers on Twitter will increasingly influence treatment decisions over the next one to two years.”

In contrast, only 16% agreed that information from pharmaceutical brands on Twitter would increase in influence over the same period.

Almost one quarter (24%) agreed that brand pages on Facebook will increase their influence on treatment decisions in the next one to two years, making this and other social media sites important access points for pharmaceutical companies to consider.

80of recent sales

discussions have involved paper-based materials

74of recent sales

discussions have involved a tablet

Rise in use of tablets for representative visits

Our research suggests that a shift is happening towards using tablets in visits from pharmaceutical sales representatives and that their use has caught up with the use of paper-based sales aids.

According to the research, 80% of recent sales discussions have involved paper-based materials, and 74% have involved a tablet. When it comes to preferred format, tablets win, but only just, at 46% compared to 43% for printed. However, in Brazil and China there is a strong preference for tablets (50% vs. 37% for paper-based materials).



The changing environment in terms of influences suggests that if pharma brands wish to maximise their presence they must indentify the optimal mix of face-to-face and digital channels. They also need to understand how both mediums work together in order to build relationships that will ultimately influence prescribing decisions.

IMPACT OF DIGITAL ON

THE PATIENT-DOCTOR

CONSULTATION

3

RESEARCHING CONDITIONS ONLINE

The patient-doctor consultation increasingly indicates that digital is acting as a significant catalyst for the democratisation of medicine, with patients having more influence over their treatment. In fact, one of the most interesting and striking pieces of data we collected was related to the influence of the patient.

With the wealth of information available online, it’s no surprise that patients are more informed than ever before when they arrive at a consultation with a doctor. Patients have a thirst for medical knowledge and currently 69% of doctors globally say that patients often look up their condition online prior to a consultation. Digital has been instrumental in patient empowerment, and doctors are accommodating this new behaviour rather than dismissing it.

Self-diagnosis online

Even more startling is the finding that 62% of doctors globally agree that patients often arrive having self-diagnosed from online research. Italian and Brazilian doctors agree with this trend more than other markets.

The majority (90%) of Brazilian doctors and 81% of Italian doctors agree that their patients look up conditions online, and 87% of Brazilian doctors and 71% of Italian doctors agree that their patients self-diagnose online.

62of doctors globally agree that patients often arrive

having self-diagnosed

69of doctors globally say

that patients often look up their condition online

prior to a consultation


40of patients will

specifically request named prescriptions

Patients presenting with a named prescription

40% of doctors globally agree that patients will often specifically request named prescriptions based on their own online diagnosis. This behaviour is more common in some markets, particularly in Italy (65%), and close to half of doctors in Brazil (47%), Spain (46%) and the US (45%) also report the trend. France and the UK both lag behind, with only 28% of UK doctors and 33% of French doctors claiming their patients ask for a named product.

This data highlights the ongoing increase in online searching from both the patients’ and doctors’ perspectives. Crucially, it reiterates the need for a strong online presence for pharmaceutical brands across a range of resources.

Digitally connected patients are clearly empowered by the information they find online and are the carriers of essential information into the consultation room. Pharmaceutical brands cannot ignore these websites and platforms, but must consider exactly how to engage with them.



The new development and the increasingly democratic relationship between doctor and patient is hugely important for pharma brands. If one patient mentions a brand to a doctor they might ignore it, but if 20 patients mention the same brand then their voices will start to have an impact.


POTENTIAL FOR MOBILE APPS AND

WEARABLES TO HELP THE

PATIENT

4

EXTENT TO WHICH DOCTORS ARE RECOMMENDING HEALTH APPS

With smartphone penetration increasing around the world, apps have become a key part of many people’s lives. According to published data1, there are some 165,000 consumer health apps available at present, but just 36 of them account for half of all downloads. This suggests that many are not being utilised at present, but that is likely to change.

Perhaps it’s no surprise that health apps are predicted to play a greater role in healthcare in the future, with 41% of doctors globally agreeing that:

“Mobile apps could be a game-changer to improving health outcomes in many of the patients I see.”

However only just over one third (36%) of doctors globally say they are likely to recommend a health app to their patients in the future. There are several reasons why doctors might shy away from recommending apps. It could be that there are too many apps to choose from, so it could be a case of information overload, or there may be concerns about evidence and efficacy. Serious apps will need the endorsement of doctors to gain traction.

What doctors might recommend apps for

According to our survey, globally, the top reasons that health apps would be recommended are for diet and weight loss, general health and fitness, and smoking cessation.

It is interesting that the situations in which doctors would recommend a mobile app are the more straightforward treatment areas and nothing specialist emerged. This may point to doctors lacking awareness of more specialist apps – as suggested by a recent BMJ survey2, where the greatest reason for non-use was that doctors just ‘didn’t think about it’.

1. IMS Institute for Healthcare Informatics. Patient Apps for Improved Healthcare: From Novelty to Mainstream. Oct. 2013

2. BMJ. The Ownership and Clinical Use of Smartphones by Doctors and Nurses in the UK: A Multicentre Survey Study. Oct. 2015

41of doctors globally

agree with the following statement: “Mobile apps

could be a game-changer to improving health

outcomes in many of the patients I see.”


Reasons doctors might recommend an app:

Diet & weight loss 70%

General health & fitnessactivity 65%

Health monitoring e.g. glucose levels, sleep, heart-rate 53%

Smoking cessation 49%

Compliance 45%

Patient support networks & information 37%

BARRIERS TO TAKE-UP OF APPS AND WEARABLES


The wearable tech market is estimated to be growing rapidly and will be at $20.6 billion by 2018. Based on this, we might expect a high rate of use, recommendations and enthusiasm. However, at present, ownership of wearable health technology such as fitness tracking bands among doctors themselves globally is less than one in ten (9%), with the US market highest at 15%.

Globally, only 6% of doctors regularly use their fitness tracking bands at work. In the US it’s slightly higher at 11%. The regular use of fitness tracking bands by doctors is non-existent in Germany (0%) and Brazil (0%), and negligible in Italy (1%) and Spain (1%). Doctors globally say they are almost as likely to recommend a wearable tech device to patients (33% would recommend in the future) as a health app (36% would recommend in the future).

Our survey highlights key concerns among doctors about the accessibility of health apps and wearable technology, and ultimately how effective they are in managing disease burden.

Almost one third (28%) of doctors surveyed said that the biggest barrier to them recommending health apps is that they don’t believe all patients own a smartphone.

The next highest concern at 14% is the consistency and accuracy of the data, with a further 11% of doctors concerned about the inability for the data collected to integrate with other healthcare operating systems, limiting their usefulness. 10% of doctors also think that doctors themselves currently lack the necessary time or skills to interpret the results accurately.

36of doctors would

recommend a mobile health app in the future

to their patients

33of doctors would

recommend a wearable tech device in the future

to their patients


IMPLICATIONSFOR PHARMA MARKETING:

Digital departments in pharma need to understand how to overcome logistical barriers before engaging or collaborating with digital initiatives.

Universality and integration are vital components to consider. Until health apps and wearable technology can be used for the majority of their patients and can integrate with existing hospital based electronic systems, they are unlikely to be widely used.

KEY SEGMENTS EMERGING

FROM EXTENT OF SHARING VIA DIGITAL CHANNELS

5

DEFINING USER LEVELS

The increasing use of digital communication tools has led to the emergence of ‘influencers’ – doctors who are proactive, high sharers of information online either via specialist websites for healthcare professionals, or via general consumer social media such as Facebook and Twitter. From our survey data we classify 42% of doctors globally as ‘influencers’, and these can be regarded as online KOLs.

They represent an opportunity for pharmaceutical companies in helping to generate noise and interest via digital channels, sharing information from a variety of sources including medical journals, product information / reviews, conferences / events and patient support web sites.

23% of doctors can be considered ‘engaged’, and are low to medium sharers of information, while 35% are passive ‘observers’ who only read information. However, in all cases, social media represents the perfect channel for sharing content – whether posting it proactively or receiving it passively.


of doctors globally are classified as ‘engaged’(being low to medium

sharers of information)

42of doctors globally are

classified as ‘influencers’ (online KOLs)

35of doctors globally are

passive ‘observers’ (they just read

information)

23

CHAIN OF INFLUENCE


On specialist websites:Medical journals 39%Product information / reviews 32%Specific therapy area 31%Conference / event 28%Patient support websites 24%Career development / training or new posts 24%Samples 24%

On consumer media:Patient support websites 16%Conference / event 16%Product information / reviews 14%Medical journals 14%Career development / training or new posts 12%Specific therapy area 10%Samples 9%

On specialist websites:Medical journals 56%Product information / reviews 50%Specific therapy area 50%Conference / event 41%Patient support websites 32%Career development / training or new Posts 31%Samples 31%

On consumer media:Patient support websites 20%Conference / event 20%Product information / reviews 17%Medical journals 16%Career development / training or new Posts 15%Specific therapy area 11%Samples 10%

Being shared:

Being read:

They may be small in number, but the ‘influencers’, or ‘digital KOLs’, are an important audience for any pharma company operating in today’s landscape. They represent a key target for a virtual ‘wisdom of the crowd’ approach.

Identifying them, understanding what they are sharing and developing strategies to provide them with the right information to share will maximise their potential as ‘virtual sales people’.

Listening to their conversations and understanding how they are steering the stream of debate can also provide an early warning system for potential problems.

Types of information being shared and read by doctors:


IMPLICATIONSFOR PHARMA MARKETING:

Pharma needs to ask whether they place as much emphasis on digital opinion leaders as they do on face-to-face experts at conferences. They also need to indentify whether the nature of the message communicated should be the same. News travels much faster in the digital space.

APPENDIX

6

Methodology 1,040 interviews were conducted across a range of primary and secondary physicians in eight markets between 10th and 31st July 2015. The markets covered were the US, the UK, France, Germany, Spain, Italy, China and Brazil.

Each interview was 15 minutes in length and was conducted online with panel provider M3 Global Research. All respondents were verified as being healthcare professionals. The final sample was un-weighted.

Fieldwork conducted by online panel provider M3 Global Research

Sample:

US n=330

Europe (UK, France,Germany, Italy, Spain) n=650

Emerging Markets(China & Brazil) n=60

Total n=1,040

About Cello Health Insight

Established in 1983, Cello Health Insight is the global marketing research arm of Cello Health, with offices in London, New York and Chicago.


HOW DOCTORS FEEL ABOUT PARTICIPATING IN SURVEYS VIA MOBILE APPS

The vast majority (88%) of doctors who took part in our global survey said that they would be happy to take part in mobile app surveys. Additionally, 80% of doctors said that they would be willing to participate in a market research study via an online community.

In order to understand doctors’ preferences when they are participating in research surveys via a mobile app, we conducted a short additional survey with a sub-sample of the respondents in the UK and US.

Although doctors the world over are notoriously short of time, the majority of respondents (60%) who answered our specific questions about mobile research indicate that they would be prepared to dedicate up to 15 minutes to complete a survey via their mobile phone. One quarter would only spend up to five minutes on a survey. The ability to complete a survey in stages is considered a benefit.

Although many doctors are already happy to complete surveys on mobile apps, more could be done to optimise the experience for respondents. 22% cite the need for a clear and simple design, and the same proportion note that surveys need to be optimised for mobiles and tablets.

Doctors have high expectations of survey design and execution. They expect researchers to make it easy for them to participate, and the research suggests that automated questions encourage completion of mobile surveys.

• 86% are prepared to use ‘slider’ answers

• 78% will watch video content• 71% will listen to other media• 69% will complete open text questions• While doctors may be happy to engage with video content, the survey reveals that very few have an appetite for content creation. Less than one half (48%) would complete an online diary, only 40% would upload images and less than one quarter (24%) would be prepared to upload a video of themselves talking to camera. The message for clients and market research companies is clear: keep it short and simple if you want to hold doctors’ attention.

Using mobile technology for surveys allows for ‘in the moment’ examination of the motivations and experiences of doctors, asking pertinent questions of their experiencing self rather than their remembering self. This is a great opportunity to gain in the moment insights. However surveys must be kept short, a 45 minute mobile survey would counteract the attraction of the medium.

80of doctors would be

willing to participate in a market research study via an online community

88of doctors in global

survery would be happy to take part in mobile

app surveys

60of doctors would be

prepared to dedicate up to 15 minutes to a survey

via their smartphone


Supplementary research


Documents

THE DIGITAL HEALTH DEBATE Ci C