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We have entered the Age of Interactivity,
connecting people and tools

                  Web 2.0, Social Media, and Unified Communication
                  Technologies have Changed Our World
                  •   Transforming the way people interact, and the companies
                      and way companies do business
                     Revolutionizing the way people seek product information
                      and engage in real-time
                      opinion sharing
                         Moving one-way information gathering to multi-way communication and
The Internet is           collaboration
   not only              Giving potential for every e-user to be heard
 transmitting
  news, it is        Proliferating communities, broad influence networks and
                      product champions
    affecting
      news

2
To date, physicians rely on both people and
tools to access health information
       People                  Tools




3
Virtually all US physicians are online today




                                                                       Number is up
                                                                        significantly
                                                                       from even 2
                                                                         years ago
                                                                               (9.9 hours)




        Average time online per week
            15.9 hours
                                       SOURCE: Manhattan Research, Taking the Pulse, 2009
4
Yet Physicians use a variety of sources
to stay informed about medicine

                                Media vehicles are
                                   now roughly
                                 60% Push and
                                    40% Pull;
                                utilizing personal,
                                  traditional and
                                 eMedia channels




Source: KRC Research




5
As such, promotion to physicians needs to
mirror the way they consume media
                                                                 Conventions
                                                    KOL                           Viral Mail
                                               Community
                                                                                               MOA Animations
                                                                        1
                                   In Office                24                   2
                                                23                                              3               Mobile Apps

                           Radio

                                      22                                                                   4
                  Direct
                  Mail                                                                                                            PDAs

                              21                                                                                   5

       Newspaper
                                                                                                                                     Podcasts/
                         20                                                                                             6            Webcasts




           TV
                     19                                                                                                       7
                                                                                                                                         eDetails




                         18
      eCommerce
                                                                                                                                     Sales Force




                              17
    Magazines/Journals
                                                                                                                              Social Networks


                                      16
                                      16
                      On Demand
                                                                                                                  Live
                     Programming
                                                                                                                  Support
                                                15
                                     Branded
                                      Games                                                            Search


                                                 eNewsletters                    Widgets
                                                                    Banner Ads




6
When online, physicians turn to search
engines most often

                                   Physician Websites Used in Research

                                                                                                       92%
90%
         81%
80%                      74%
                                                                                                       use Google
                                        65%
                                                                                                       **********
70%

                                                       59%
60%                                                                   55%                              13%
50%
                                                                                                       use Google Scholar

40%                                                                                  36%
                                                                                                          29%
30%

20%                                                                                                                      14%
                                                                                                                                        11%
10%

 0%
      Search Engines   General Health   Health.org   Drug-specific   Pharma Co.   Hospital or Clinic   Medical Device  Chat Rooms,   Video Websites
                         Websites       Websites       Websites       Websites       Websites            Websites     Message Boards




Source: Hall & Partners and Google Custom HCP Study, August 2009




 7
Physicians search most often to
       inquire about healthcare info
                                            Reasons for Conducting Online Research

                                                                   Patient
                                                    Drug/Treatments
                                                              Questions




       81%
                                            Specific drug information        77%
                                            Treatment side effects           68%
                                            Drug safety information          66%
                                            New medications                  64%
      of physicians go to                   Contraindications                59%
       Search engines,                      Medication in development        45%
       more often than                      Clinical trial information       45%
       any other online
           resource                                    Patient/
                                                       Conditions
                                             General condition information   75%
                                             Information for patients        61%
Source: Hall & Partners and Google Custom    Information to aid diagnosis    53%
HCP Study, August 2009



8
… and Physicians trust what they find from search



      88%      Search engines                                       77%       Rely more on
      have made looking for                                         search engines than in
      information online easier.                                    the past.



73%       Search engine                                               69%      Tend to use search
results tend to be                                                    engines throughout the
relevant to my query.                                                 research process.



                                                                    57%        Trust the
     60%     Search engines are                                     results listed in the
     my “go to” online source.                                      search engine results
                                                                    page.




 Source: Hall & Partners and Google Custom HCP Study, August 2009



 9
EU doctors are using portals
much more than US counterparts


         Physician Resource                      Europe   US
         Physicians’ Portals                        81    36     Half of European
         (Univadis, Doctors.net)
                                                               physicians also believe that
         Wikipedia                                  58    66     pharmaceutical companies can and
                                                               should offer digital services that can be
         HCP Online forums/                         57    59   integrated into their local primary and
         boards/communities
                                                                      secondary care services,
         Pharmaceutical company                     51    68
         websites
                                                                compared to only a
         Video portals                              24    30
                                                                  quarter of US
         Reading blogs                              14    14
                                                                    physicians

         Source: Kantar Health and Digitas Health, 2010




10
US Physicians use the internet more for literature
review and drug references




                                                                       Suggests that what
                                                                         big pharma has
                                                                        offered so far has
                                                                      been valued far less
                                                                      than other resources




     Source: Jupiter Research, US Online Physician Executive Survey




11
While online media usage is certainly
increasing, it’s not an “Either/Or” situation

             Physicians’ Usage of Offline & Online Media




     +20%             +9%             +26%             -15% -14%


Source: Manhattan Research Taking the Pulse v9.0, US
Numbers represent significant changes over two years



12
CMI data supports that theory – particularly the
importance of traditional media
              Most Important Sources of Info
                (10 Being Most Important)
       9
       8
       7
       6
       5
       4
       3
       2
       1
       0




                                Source: CMI’s ByDoctor® OnDemandsm 2009-2010




13
Physicians rely on traditional sources when
making important prescribing decisions




             KRC Research: http://www.krcresearch.com/pdfs/KRC_ReportPharmaceutical.pdf


14
…Additionally, they rely on multiple complimentary
channels for info delivery




      KRC Research: http://www.krcresearch.com/pdfs/KRC_ReportPharmaceutical.pdf




15
Physician Smartphone usage is also on the rise…


                 • 72% of US physicians now have
                    Smartphones1

                 • 80% of U.S. physicians who own a
                    Smartphone or PDA agree that their device
                    is essential to their practice, up from
                    65% in 2008
                 • Ads viewed on Smartphone typically have
                    higher CTR than those viewed on a PC2
                        − Internet Banner: 0.2% average
                        − Mobile Banner: 2.0 – 3.0% average

                  1 Manhattan Research
                  2 ABI Research, eMarketer




16
Physicians rely on Smartphones for quick and easy access
to information

                             Why do physicians use their Smartphones?
                                                                                             86%
                        Any Clinical Use                                                   81%
                                                                                     63%
           Drug Reference Database                                             53%
                                                                           50%
     Prescription Dosage Calculator                                  38%                         PCP
                                                                           49%                   Spec
                 Treatment Guidelines                             32%
                                                                         43%
           Clinical Medical reference                                   41%
                                                                        42%
         Checking Formulary Status                             27%
                                                                 31%
                       Product Updates                         27%
                                                            22%
       Reading Articles or Abstracts                         25%
                                                           22%
      Continuing Medical Education                        19%

                                              0        18        36        54
     Source: Manhattan Research – Taking the Pulse, 2008 – The Mobile Physician.      72    90      108


17
Smartphones and apps are quickly becoming
essential to a physician’s daily practice


                          • One-third access their
                            Smartphone during
                            patient consultations1
                          • As of April 2010, 27% of
                            healthcare apps were
                            geared towards HCPs2



                            1: MobiHealthNews, April 2010
                            2: Manhattan Research, Taking the Pulse




18
For clinicians, Smartphone apps offer an alternative to
more cumbersome IT formats




19
eCollaboration between physician and patient also
facilitates better health exchange




                                               Researchers found that the use of
                                               secure patient-physician
                                               messaging in any two-month period
                                               was associated with statistically
                                               significant improvements in
                                               HEDIS (Healthcare Effectiveness
                                               Data and Information Set)
                                                           - Kaiser Permanente, 2010




Source: Lightspeed Research, September, 2009



20
Physician adoption of basic EMR systems
has grown 42% since 2007



                                                                      At the end of 2009, 20.5% of office-based
                                                                       physicians had what the CDC termed a
                                                                       basic EMR system in place*
                                                                      Fully functional systems** still
                                                                       haven’t reached double-digit usage
                                                                       (currently
                                                                       around 6%)




 * Basic system" means one with a minimum of six certain functionalities
 ** Fully functional“ includes plus more, such as warnings of drug interactions or contraindications, medical history
 and follow-up, and orders for tests


Source: National Ambulatory Medical Care Survey, National Center for Health Statistics, Centers for Disease Control
and Prevention, released December 2009


21
Industry professionals believe social media will change
the way we engage with doctors




       Source: LinkedIn user poll, 2009




22
23
Pharma companies are “tweeting”



                              Companies share almost
                               anything—general news, job
                               postings, pipeline updates,
                               philanthropy efforts, even POV on
                               social media




                               Source: L2 and PHD Media, May 2010




24
And Pharma is exploring
the use of social media with HCPs


                   A few companies have already started to dip their
                   toes in the social media waters
                      For example, Medtronic has sponsored training
                       videos for surgeons on OrLive
                      Novartis runs a virtual physician advisory board
                       called the PCP Heartburn Advisory Board
                      AstraZeneca has partnered with the American
                       College of Gastroenterology to launch ACG GI
                       Circle, an online interactive community built for
                       ACG members




25
The majority of HCPs are willing to engage with
pharma in social networks

“I am interested in interacting with pharma, biotech and device
companies on HCP-only social networks.”

                                                          70%
                                                    Strongly agree
                                                          + agree


30%
Strongly
disagree
+ disagree



Source: Manhattan Research, Taking the Pulse v8.0




26
Physicians would use social media more if there
were established rules of engagement

                                     2010 Survey result:
                                     Would you be more
                                     likely to use social
                                     media for health if
                                     there were clear,
                                     established regulations
                                     & guidelines on how
                                     patient, doctors and
                                     healthcare companies
                                     can interact using
                                     them?




Source: pharmaphorum.com



27
And hospitals are engaging in social


                       All 14 hospitals listed on the 2010-2011
                        U.S. News Honor Roll are using social
                        media

                       78% of the larger Best Hospitals List are
                        also engaged on Facebook,Twitter and
                        other social media sites

                   Source: Social Media and the U.S. News Hospitals, JULY 28, 2010




28
Summary of findings
Multi-channel engagement is essential
    On average, more than three-quarters of consumers are using two or more channels to
     browse, research, and purchase products
    The Internet is no longer an add-on, it needs to be a core piece of the multichannel
     pharmaceutical media mix
    Smartphones and social media have given rise to immediate dissemination and sharing of
     information, but the information
     needs to fit the media
    As the use of Web 2.0 technology continues, HCPs direct influence on what the patient
     actually takes will diminish and shift towards other HCPs
    Because your customers are coming to merchants through multiple channels, it’s necessary
     to link those experiences and create a continuous conversation to avoid gaps where
     the sale could be lost
    The key is message consistency- you need to be saying the same thing no matter where you
     are to communicate the value proposition



29
It is so different than it
was
even
10
years ago




30
How has the pharma media model changed?
                From                             To
     Building consumer awareness   Maximizing the patient / physician
     and influencing physicians    dialogue

     Driving recommendations       Driving two-way conversations


     Science as a proof point      Science as a stimulus to dialogue


     Separate consumer &
                                   One world with two dialects
     HCP worlds

     Direct sales model            Relationship marketing model


     Advertising-driven            Marketing and publication-driven

     Supplying information         Supporting all parties through a
     leading to a transaction      transaction

31
So what is the “Optimal Media Mix?”



                       Developing the Optimal
                       Media Mix is a process
                       determined by measuring
                       the impact past decisions
                       had on all KPIs, which
                       provides the ability to
                       forecast the impact current
                       decisions will have across
                       KPIs over time




32
Traditional offline resources still have
 wide reach and impact…
Physicians use of resources and impact on professional decision making
                                                                80%
                                                                           • Offline resources
                                                                           • Online resources
                         someor highimpact)




                                                                                                                                                                                           Journals
                                                                                                                               Pharma Reps

                                                                 60                                                                                                     Printed references & textbooks

                                                                                                                                                         Search engines                          Information
                                              Relative Impact




                                                                                                                                                                                              from colleagues
                                                                                           Newspaper or on television
       (%of usersreporting




                                                                                                                                                            Online references & textbooks
                                                                 40                                                           Online news sources
                                                                                                                                                                  Online journals

                                                                                                                                           Physician-targeted portals                          CME

                                                                                      Online message boards                                          Disease specific websites
                                                                                       chat rooms, or blogs     Rx Product Web sites
                                                                                                                                                                             Online CME
                                                                 20
  Impact




                                                                                                                         Pharma
                                                                                         eDetailing                                                                            Online
                                                                                                                        corporate                                                                 Conferences
                                                                                                                        websites                                             conferences




                                                                  0
                                                                      20                              40                              60                                    80                                  100%

                                                                                                 Reach (%usingsourceat leastweekly)

                                                                Source: Manhattan Research, 2007 Study of Technology as a Complement to U.S. Detail Efforts

 33
Media mix best case scenario: A combination of
online and offline channels
 Strengths – Online                             Strengths – Offline
    Patient-tailored interventions                Access to larger patient base (not only
    Customized + dynamic content                   those online)
    Potential for frequent interactions           Access to larger base of support and
                                                    care givers (not only those online)
    Two-way communication
                                                   Interactions don’t depend on patients’
    Lower production costs                         actions or willingness to receive
    Low incremental costs                          information
    More viral potential                          Diversity of channels (print, mail, call
                                                    centers)
    Ability to link real-time with other Web
     content or applications
    Easy collection/analysis of data
    Continuous fine tuning possible
                                                      The choice of channel mix
    ROI can be measured at multiple touch
     points                                          should take into account the
                                                      tradeoff between content
                                                         richness and reach



34
Media Utilization and Preferences of Physicians: Trends in Engagement

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Media Utilization and Preferences of Physicians: Trends in Engagement

  • 1.
  • 2. We have entered the Age of Interactivity, connecting people and tools Web 2.0, Social Media, and Unified Communication Technologies have Changed Our World • Transforming the way people interact, and the companies and way companies do business  Revolutionizing the way people seek product information and engage in real-time opinion sharing  Moving one-way information gathering to multi-way communication and The Internet is collaboration not only  Giving potential for every e-user to be heard transmitting news, it is  Proliferating communities, broad influence networks and product champions affecting news 2
  • 3. To date, physicians rely on both people and tools to access health information People Tools 3
  • 4. Virtually all US physicians are online today Number is up significantly from even 2 years ago (9.9 hours) Average time online per week 15.9 hours SOURCE: Manhattan Research, Taking the Pulse, 2009 4
  • 5. Yet Physicians use a variety of sources to stay informed about medicine Media vehicles are now roughly 60% Push and 40% Pull; utilizing personal, traditional and eMedia channels Source: KRC Research 5
  • 6. As such, promotion to physicians needs to mirror the way they consume media Conventions KOL Viral Mail Community MOA Animations 1 In Office 24 2 23 3 Mobile Apps Radio 22 4 Direct Mail PDAs 21 5 Newspaper Podcasts/ 20 6 Webcasts TV 19 7 eDetails 18 eCommerce Sales Force 17 Magazines/Journals Social Networks 16 16 On Demand Live Programming Support 15 Branded Games Search eNewsletters Widgets Banner Ads 6
  • 7. When online, physicians turn to search engines most often Physician Websites Used in Research 92% 90% 81% 80% 74% use Google 65% ********** 70% 59% 60% 55% 13% 50% use Google Scholar 40% 36% 29% 30% 20% 14% 11% 10% 0% Search Engines General Health Health.org Drug-specific Pharma Co. Hospital or Clinic Medical Device Chat Rooms, Video Websites Websites Websites Websites Websites Websites Websites Message Boards Source: Hall & Partners and Google Custom HCP Study, August 2009 7
  • 8. Physicians search most often to inquire about healthcare info Reasons for Conducting Online Research Patient Drug/Treatments Questions 81% Specific drug information 77% Treatment side effects 68% Drug safety information 66% New medications 64% of physicians go to Contraindications 59% Search engines, Medication in development 45% more often than Clinical trial information 45% any other online resource Patient/ Conditions General condition information 75% Information for patients 61% Source: Hall & Partners and Google Custom Information to aid diagnosis 53% HCP Study, August 2009 8
  • 9. … and Physicians trust what they find from search 88% Search engines 77% Rely more on have made looking for search engines than in information online easier. the past. 73% Search engine 69% Tend to use search results tend to be engines throughout the relevant to my query. research process. 57% Trust the 60% Search engines are results listed in the my “go to” online source. search engine results page. Source: Hall & Partners and Google Custom HCP Study, August 2009 9
  • 10. EU doctors are using portals much more than US counterparts Physician Resource Europe US Physicians’ Portals 81 36 Half of European (Univadis, Doctors.net) physicians also believe that Wikipedia 58 66 pharmaceutical companies can and should offer digital services that can be HCP Online forums/ 57 59 integrated into their local primary and boards/communities secondary care services, Pharmaceutical company 51 68 websites compared to only a Video portals 24 30 quarter of US Reading blogs 14 14 physicians Source: Kantar Health and Digitas Health, 2010 10
  • 11. US Physicians use the internet more for literature review and drug references Suggests that what big pharma has offered so far has been valued far less than other resources Source: Jupiter Research, US Online Physician Executive Survey 11
  • 12. While online media usage is certainly increasing, it’s not an “Either/Or” situation Physicians’ Usage of Offline & Online Media +20% +9% +26% -15% -14% Source: Manhattan Research Taking the Pulse v9.0, US Numbers represent significant changes over two years 12
  • 13. CMI data supports that theory – particularly the importance of traditional media Most Important Sources of Info (10 Being Most Important) 9 8 7 6 5 4 3 2 1 0 Source: CMI’s ByDoctor® OnDemandsm 2009-2010 13
  • 14. Physicians rely on traditional sources when making important prescribing decisions KRC Research: http://www.krcresearch.com/pdfs/KRC_ReportPharmaceutical.pdf 14
  • 15. …Additionally, they rely on multiple complimentary channels for info delivery KRC Research: http://www.krcresearch.com/pdfs/KRC_ReportPharmaceutical.pdf 15
  • 16. Physician Smartphone usage is also on the rise… • 72% of US physicians now have Smartphones1 • 80% of U.S. physicians who own a Smartphone or PDA agree that their device is essential to their practice, up from 65% in 2008 • Ads viewed on Smartphone typically have higher CTR than those viewed on a PC2 − Internet Banner: 0.2% average − Mobile Banner: 2.0 – 3.0% average 1 Manhattan Research 2 ABI Research, eMarketer 16
  • 17. Physicians rely on Smartphones for quick and easy access to information Why do physicians use their Smartphones? 86% Any Clinical Use 81% 63% Drug Reference Database 53% 50% Prescription Dosage Calculator 38% PCP 49% Spec Treatment Guidelines 32% 43% Clinical Medical reference 41% 42% Checking Formulary Status 27% 31% Product Updates 27% 22% Reading Articles or Abstracts 25% 22% Continuing Medical Education 19% 0 18 36 54 Source: Manhattan Research – Taking the Pulse, 2008 – The Mobile Physician. 72 90 108 17
  • 18. Smartphones and apps are quickly becoming essential to a physician’s daily practice • One-third access their Smartphone during patient consultations1 • As of April 2010, 27% of healthcare apps were geared towards HCPs2 1: MobiHealthNews, April 2010 2: Manhattan Research, Taking the Pulse 18
  • 19. For clinicians, Smartphone apps offer an alternative to more cumbersome IT formats 19
  • 20. eCollaboration between physician and patient also facilitates better health exchange Researchers found that the use of secure patient-physician messaging in any two-month period was associated with statistically significant improvements in HEDIS (Healthcare Effectiveness Data and Information Set) - Kaiser Permanente, 2010 Source: Lightspeed Research, September, 2009 20
  • 21. Physician adoption of basic EMR systems has grown 42% since 2007  At the end of 2009, 20.5% of office-based physicians had what the CDC termed a basic EMR system in place*  Fully functional systems** still haven’t reached double-digit usage (currently around 6%) * Basic system" means one with a minimum of six certain functionalities ** Fully functional“ includes plus more, such as warnings of drug interactions or contraindications, medical history and follow-up, and orders for tests Source: National Ambulatory Medical Care Survey, National Center for Health Statistics, Centers for Disease Control and Prevention, released December 2009 21
  • 22. Industry professionals believe social media will change the way we engage with doctors Source: LinkedIn user poll, 2009 22
  • 23. 23
  • 24. Pharma companies are “tweeting”  Companies share almost anything—general news, job postings, pipeline updates, philanthropy efforts, even POV on social media Source: L2 and PHD Media, May 2010 24
  • 25. And Pharma is exploring the use of social media with HCPs A few companies have already started to dip their toes in the social media waters  For example, Medtronic has sponsored training videos for surgeons on OrLive  Novartis runs a virtual physician advisory board called the PCP Heartburn Advisory Board  AstraZeneca has partnered with the American College of Gastroenterology to launch ACG GI Circle, an online interactive community built for ACG members 25
  • 26. The majority of HCPs are willing to engage with pharma in social networks “I am interested in interacting with pharma, biotech and device companies on HCP-only social networks.” 70% Strongly agree + agree 30% Strongly disagree + disagree Source: Manhattan Research, Taking the Pulse v8.0 26
  • 27. Physicians would use social media more if there were established rules of engagement 2010 Survey result: Would you be more likely to use social media for health if there were clear, established regulations & guidelines on how patient, doctors and healthcare companies can interact using them? Source: pharmaphorum.com 27
  • 28. And hospitals are engaging in social  All 14 hospitals listed on the 2010-2011 U.S. News Honor Roll are using social media  78% of the larger Best Hospitals List are also engaged on Facebook,Twitter and other social media sites Source: Social Media and the U.S. News Hospitals, JULY 28, 2010 28
  • 29. Summary of findings Multi-channel engagement is essential  On average, more than three-quarters of consumers are using two or more channels to browse, research, and purchase products  The Internet is no longer an add-on, it needs to be a core piece of the multichannel pharmaceutical media mix  Smartphones and social media have given rise to immediate dissemination and sharing of information, but the information needs to fit the media  As the use of Web 2.0 technology continues, HCPs direct influence on what the patient actually takes will diminish and shift towards other HCPs  Because your customers are coming to merchants through multiple channels, it’s necessary to link those experiences and create a continuous conversation to avoid gaps where the sale could be lost  The key is message consistency- you need to be saying the same thing no matter where you are to communicate the value proposition 29
  • 30. It is so different than it was even 10 years ago 30
  • 31. How has the pharma media model changed? From To Building consumer awareness Maximizing the patient / physician and influencing physicians dialogue Driving recommendations Driving two-way conversations Science as a proof point Science as a stimulus to dialogue Separate consumer & One world with two dialects HCP worlds Direct sales model Relationship marketing model Advertising-driven Marketing and publication-driven Supplying information Supporting all parties through a leading to a transaction transaction 31
  • 32. So what is the “Optimal Media Mix?” Developing the Optimal Media Mix is a process determined by measuring the impact past decisions had on all KPIs, which provides the ability to forecast the impact current decisions will have across KPIs over time 32
  • 33. Traditional offline resources still have wide reach and impact… Physicians use of resources and impact on professional decision making 80% • Offline resources • Online resources someor highimpact) Journals Pharma Reps 60 Printed references & textbooks Search engines Information Relative Impact from colleagues Newspaper or on television (%of usersreporting Online references & textbooks 40 Online news sources Online journals Physician-targeted portals CME Online message boards Disease specific websites chat rooms, or blogs Rx Product Web sites Online CME 20 Impact Pharma eDetailing Online corporate Conferences websites conferences 0 20 40 60 80 100% Reach (%usingsourceat leastweekly) Source: Manhattan Research, 2007 Study of Technology as a Complement to U.S. Detail Efforts 33
  • 34. Media mix best case scenario: A combination of online and offline channels Strengths – Online Strengths – Offline  Patient-tailored interventions  Access to larger patient base (not only  Customized + dynamic content those online)  Potential for frequent interactions  Access to larger base of support and care givers (not only those online)  Two-way communication  Interactions don’t depend on patients’  Lower production costs actions or willingness to receive  Low incremental costs information  More viral potential  Diversity of channels (print, mail, call centers)  Ability to link real-time with other Web content or applications  Easy collection/analysis of data  Continuous fine tuning possible The choice of channel mix  ROI can be measured at multiple touch points should take into account the tradeoff between content richness and reach 34