Investing in the physician-patient relationship
For years pharma has wrestled with the question of how to engage with physicians more effectively. Answering that question requires that a more fundamental question be answered first: what do physicians really need and is this something that pharma can provide?
Broadly, healthcare professionals (HCPs) want their patients to be as healthy and satisfied with their care as possible. More specifically, at the point of care HCPs want more productive, informed, efficient and pleasant interactions with their patients. The factors conspiring against this ideal have been well documented. Patients aren’t always very articulate about their symptoms, don’t always take their medications as prescribed and struggle to follow the diet and lifestyle recommendations their HCPs make. On the other hand, physicians have less time and attention to give to patients, feel less confident that their prescribed solutions will be appropriately followed and have less autonomy when it comes to making treatment decisions due to changes in the payer environment.
If there is an overarching physician need, it’s related to enhancing the physician–patient relationship by helping doctors be more efficient and patients be more aware. If pharma wants to engage with physicians more effectively, this is a good place to start.
It would be naïve to think there’s a single silver bullet solution to address these challenges. However, advancements in the development and application of technology provide opportunities to significantly improve the relationship between physicians and their patients. And because HCPs and patients generally don’t have the expertise or resources to implement these new technologies, an opportunity exists for outside experts. Successful enablers of better physician–patient relationships stand to gain the goodwill, business and loyalty of both patients and physicians.
For decades, pharma has done much to contribute to the health and well-being of patients. But today much of what ails individuals—and therefore vexes HCPs—can’t be addressed solely with a pill, injection, device or procedure. The needs are broader, and the individuals and companies leading the way toward improved point-of-care experience are coming from all corners of the healthcare industry—and from outside as well, not just from the traditional biopharma and medical device companies.
Can pharma play a role in this new world? If so, pharma leadership needs to start with a better understanding of the role of these innovators in enhancing the physician–patient relationship and then determine how and where it can contribute.
Saving everyone’s precious time
Dr. Lyle Berkowitz
Dr. Lyle Berkowitz is a wired physician at Northwestern Memorial Hospital who has been recognized for his leadership in medical informatics by the Mayo Clinic, Healthspottr and HealthLeaders Media magazine. “We don’t have a shortage of physicians,” Dr. Berkowitz says. “We have a shortage of physicians’ time.”
Dr. Berkowitz has been writing for years about the relationship between the practice of medicine and the advancement of technology. Innovation with Information Technologies in Healthcare, published in 2012 and co-edited by Dr. Berkowitz, highlights real-life cases in which technology has been applied to improve quality, efficiency, financial health and patients’ experiences in today’s healthcare system.
Dr. Berkowitz and his colleagues at healthfinch created a software tool to simplify the prescription refill process and reduce physician workload.
In addition to studying and writing about healthcare and technology, Dr. Berkowitz has led the creation of technological solutions that positively affect the point-of-care experience. For example, recognizing that the refill process can be an excruciatingly annoying one for physicians, office staff and patients alike, Dr. Berkowitz and his colleagues at healthfinch1 created RefillWizard, a software tool to simplify the prescription refill process. Physicians appreciate that the reduction in their refill workload allows them to get back to focusing on patient care.
Uncovering the clues in chronic symptoms
One mobile app designed to help patients and their HCPs better identify patterns in their symptoms, daily activities and treatments is called Tummy Trends2 (created by Takeda Pharmaceuticals U.S.A., Inc.). It’s focused on the symptoms and activities typically related to irritable bowel syndrome and constipation. Tummy Trends is free to download at the iTunes App Store, easy to use, confidential and meant to help people with gastrointestinal conditions rather than to promote a particular product.
Lina Nudera, Associate Director at Takeda Pharmaceuticals U.S.A., Inc., explains how they saw the opportunity. “It can be difficult and often embarrassing to talk to your physician about these [gastrointestinal] conditions. The previous tools were paper based—inconvenient to carry around, easy to forget when you have an appointment and not as private as patients would prefer. It became clear that a mobile app could solve these problems and help benefit patients.”
Tummy Trends is a mobile app designed to help patients and their HCPs better identify patterns in their symptoms, daily activities and treatments.
The advantages for the patient include the ease of use in tracking and observing trends with such things as bowel movements, symptoms, treatments, diet and other relevant factors. For the physician, there’s self-reported data about severity, symptoms and timing, with the added ability for patients to send their data to their physicians in an e-mail report, making face-to-face appointment time more efficient and meaningful.
Most important, it’s successful. There have been thousands of downloads, enabling Takeda to develop closer ties to HCPs by helping them to enrich their physician–patient relationship. And researchers at Medical Economics included Tummy Trends in their latest list of top ten apps physicians recommend to their patients.
Alerting patients and HCPs to life-threatening events before they happen
Solutions that allow patients to contact emergency staff and request help in the case of a critical health event have existed for years. physIQ3 is taking the critical alert paradigm from a reactive mode to a proactive one. Its remote patient monitoring system is based on applying predictive analytics to data being collected about the patient, so it can detect a worsening condition before it results in an avoidable hospitalization. According to physIQ CEO Gary Conkright, “Clinicians caring for the chronically ill believe they could prevent most 30-day readmission if they had a few days warning of an exacerbation that will ultimately lead to an acute hospitalization. Using predictive analytics on a personalized basis, versus a population “big data” view, provides the sensitivity and specificity needed to provide real clinical value.”
A wearable sensor tracks vital signs in congestive heart failure (CHF) patients and transmits the data via smartphone to physIQ’s data center, where predictive analytical tools identify abnormalities. Those patients who veer from their own “normal” baseline are flagged and healthcare staff are alerted.
Early detection of an exacerbation is not only useful information to the clinician but the patient as well. Providing a feedback loop to the patient that links a non-compliance incident, like not taking a medication, to a worsening condition is a powerful tool for reinforcing clinically helpful behavior.
CHF sends more than one million patients to the hospital annually, one quarter of whom will return within 30 days. In addition to the stress on clinicians and the distress patients and their loved ones experience as a result of these hospitalizations, the costs associated with these admissions total in excess of $12 billion. physIQ believes its system will reduce the number of acute hospitalizations—and the financial impact they have—significantly.
Making behavior change more fashionable
Sonny Vu has a background in the healthcare industry (he developed the first glucose meter for the iPhone®), but his new company, Misfit Wearables4, is as much about fashion as it is about health. Misfit offers a wireless biometric fitness device called Shine. It’s wearable in the sense that it looks like a cool accessory, but it’s also a tool that tracks sleep, exercise and other metrics. Shine links to the iPhone and has a battery life of up to six months.
Misfit Wearables has created a wireless biometric fitness called Shine. As a cool accessory, it tracks sleep, exercise and other metrics.
Mr. Vu sees the technology as the easy part. “There are lots of sensors out there. But how do you get people to use them? We focused on three factors that would improve the desirability. We made the design timeless, not trendy. The price point, at $99, is affordable. And the longer battery life of up to six months adds to the appeal.” Although the first iteration is just for personal use, Mr. Vu and the staff at Misfit Wearables see many kinds of applications in the future, including tracking chronic care patients, measuring employee productivity and earning discounts on health insurance. The product is evidence of what he calls the “consumer era of healthcare.”
Pulling it all together
From a traditional pharma perspective, these technology solutions are clearly innovative and intellectually interesting, but largely irrelevant. They are not connected to the complexity or business model of getting a molecule to market. And that’s the important distinction. In the traditional pharma business model, the center of the universe is developing and selling a product.
A customer-centric perspective, however, focuses on, well, the customer. The brand that becomes an expert in discovering what pharma’s most important customer—the physician-needs and wants, and then turns around and helps meet that need, will have built itself a valuable foundation for a long-term relationship. And this is why technology that enhances the physician–patient relationship is relevant. This offers an opportunity for pharma to demonstrate a material commitment to holistically addressing its customers’ needs.
It’s important to reiterate that most of the newest technology-based healthcare solutions have not been developed by pharma. Most came from entrepreneurs trying to solve a healthcare problem, usually centered on physician efficiency or patient quality of life. And yet, no one is in a better position to know and understand the needs and challenges of physicians and their relationships with their patients than pharma. With this knowledge comes the opportunity to introduce relevant, valuable technologies to strengthen the relationship.
Physicians understand that pharma is principally in the business of inventing and selling pharmaceutical products, but they are beginning to expect more from their relationship with pharma. The way for pharma to earn the respect and loyalty of physicians is by helping them address their own fundamental concern: the physician–patient relationship.
By focusing on the needs of physicians and patients and exploring ways to use technology to support that relationship, pharma will find the answer to its own need for better physician engagement.
Dr. Lyle Berkowitz is the Associate Chief Medical Officer of Innovation for Northwestern Memorial Hospital, Founder and Director of the Szollosi Healthcare Innovation Program (SHIP), President of Back 9 Healthcare Consulting and the Founder and Chairman of healthfinch, a healthcare software company making “Doctor Happiness Tools.” In 2008, HealthLeaders Media magazine named Dr. Berkowitz one of the nation's top “individuals who are making a difference in today's complex healthcare world.” In 2009, Healthspottr chose him as one of the “Future Health Top 100. In 2010, his “Change Doctor” blog was voted one of the "Top 50 Healthcare IT Blogs”, and he was a winner of the Mayo Clinic's Center for Innovation's iSpot Competition for “Ideas that Will Transform Healthcare”. In 2011 and 2012, he was named one of the Top 25 Clinical Informaticians in the country by Modern Healthcare magazine.
Lina Nudera is Associate Director at Takeda Pharmaceuticals U.S.A., Inc. She recently earned the Trailblazer Brand Champion award in the gastrointestinal category from PM360 magazine. At Takeda, Ms. Nudera has driven all aspects of brand management, including strategic planning, direct and indirect physician promotion, KOL/thought leader development and patient support and promotion. She has developed and implemented strategies utilizing both online and offline tactics and has significant experience with in-pharmacy and in-office programs and developing disease education and branded/promotional programs. Ms. Nudera has extensive knowledge of diabetes, metabolic disorders and cardiovascular and gastroenterology-related disease states.
Sonny X. Vu is Founder of Misfit Wearables, makers of highly wearable computing products, including Shine, an elegant activity monitor (Red Dot and A' Design Awards). Mr. Vu also founded AgaMatrix, makers of the world's first iPhone-connected hardware medical device (Red Dot and GOOD Design Awards), and built it from a two-person start-up to shipping 15+ FDA-cleared medical device products, and 1B+ biosensors, 3M+ glucose meters for diabetics. He worked at Microsoft Research on machine learning/linguistic technologies. He studied math at UIUC and linguistics (PhD) under Noam Chomsky at MIT. Mr. Vu knows a number of languages and is a patron of good product design. He believes an era of wearable computing is coming soon where UX design will be geared toward glanceable displays and non-visual modalities.
Gary Conkright is CEO of physIQ, which brings advanced predictive analytics technology to the healthcare industry to enable personalized and proactive heath management. physIQ believes that society’s capacity to accumulate and aggregate data has greatly surpassed its ability to make sense of it all. Its solution is to use “machine learning” or “smart” software technology to reduce the data into the clinically significant and actionable intelligence the healthcare industry needs to produce better outcomes at a reduced cost. Leveraging their success in the industrial equipment health monitoring industry, they intend to have the same impact in healthcare.
A version of this article appeared in the October 2013 issue of DTC Perspectives magazine.