Dr. Jason Hwang: The Innovator's Prescription
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The Innovator’s Prescription
Jason Hwang, MD, (20 minutes)

The co-author of The Innovator’s Prescription details how disruptive innovation may be the cure to our broken healthcare system.

• How decentralization leads to accessibility
• Futility of adding new technology to old business model
• 3 universal business models and why hospitals don’t work

• Social Media for Pharma - 4 SEATS LEFT (March 31, 2010)
• Ask about in-house workshops for e-patient strategy, social media compliance and metrics

This new, free 40-page guide for health marketers and communicators has just been released. In Using Twitter for e-Patient Communications you’ll get:

• Social Media for Pharma (Feb 23, 2009)
• Social Media ROI for Health Marketers (Feb 24, 2009)
• January e-Patient Connections Distance Learning & Briefing (By invitation only; limited to Kru alumni and clients)
  • Friday January 29, 2010 * 1pm EST * Dial-in info to be emailed

SAVE THE DATE: e-Patient Connections 2010!
=====================================
September 27-29, 2010, Philadelphia Hyatt Bellevue.

• Social Media for Pharma (Feb 23, 2009)
• Social Media ROI for Health Marketers (Feb 24, 2009)
• January e-Patient Connections Distance Learning & Briefing
  • Invitation only; e-Patient Connections alumni and Kru clients
  • Friday January 29, 2010 * 1pm EST * Dial-in info to be emailed

SAVE THE DATE: e-Patient Connections 2010!
=====================================
September 27-29, 2010, Philadelphia Hyatt Bellevue.

Imagine a social community site consisting only of your family, friends, and loved ones; where a person suffering from cancer or Parkinson’s Disease can gather a tight-knit support group in one location, offering a space to provide updates and commiserations, information and explanations, without the risk of that too-public feeling that sometimes accompanies large public sites like Facebook.

For many e-patients, the allure of connectivity is mitigated by a desire for privacy and respectful distance. Anyone who’s experienced a serious illness knows that the comfort of sympathy and condolences is balanced by the tedious duty of explaining, often over and over, what is going wrong, why it’s going wrong, and what’s going to happen.

CareFlash “Care Communities”

CareFlash, created by self-described “recovering CFO” Jay Drayer, attempts to address these concerns by offering patients private and secure social networks with features designed to make the relationship between patients, caregivers, and well-wishers as streamlined as possible. A simple e-mail based blog system allows patients to keep their network of supporters up to date, and integration with the iHelp Calendar lets everyone involved coordinate needed involvement and assistance, including visiting hours and errands.

The site also offers a wide variety of animated videos explaining the diagnosis and treatments of a number of diseases, ranging from hypertension to macular degeneration. The videos, which are produced by Blausen Medical, are offered in a number of languages, and have proved incredibly popular. “Many doctors tend to explain diagnoses and recommended courses of action using plastic models…white boards and brochures,” said Drayer. “This commonly leaves people with only a vague understanding of the associated diagnosis, anatomy, and treatment. It’s more common than I ever would expect that we hear from people that they never had a comprehensive grasp on their diagnosis until they viewed the associated treatment.”

New Solutions for New Demographics

These videos are just one of the appealing aspects of the site. Just as Blausen’s animations provide confused patients with a clearer understanding of their conditions, CareFlash offers a social space to a demographic profile that may not be comfortable with Facebook or Twitter. As Drayer says, “Participants in Care Communities tend to be most representative as being the parents and grandparents of the Facebook generation.” By granting users their own private mini-sites, with greater control over who is allowed access, users can bypass media-hyped worries about privacy, spam, and viruses.

CareFlash has also made in-roads into non-English speaking groups. Drayer attributes the popularity of his project among ESL families to the multilingual options offered by the site’s videos. These families may face challenges in getting explanations of complex healthcare concepts from primarily English-speaking hospital staff, and the site offers them an alternative.  Most of the videos are currently available in Spanish, Dutch, Hungarian and Arabic, and Drayer plans to expand user options to at least ten options by early 2011.  In addition, well over 10% of the site’s population is located in the eastern hemisphere.

Big Ideas, Small Scale

We can see from these cases that making small allowances in terms of user functionality, such as allowing private, tightly user-controlled communities, and offering multiple language options, can allow a site to bridge the gap between typically “wired” demographics and other groups.

Hopefully this appeal will continue as CareFlash expands. The site is currently monetized through advertisements and private-label Care Communities offered to various healthcare entities. Drayer has in mind a “rich development roadmap” for the future, including many features suggested by users.

How J&J Joined the Twittersphere
Marc Monseau, Johnson & Johnson
(14 minutes) watch video

You’ve overslept by fifteen minutes, and you have a killer headache. A couple of Aspirins take care of that. Grapefruit and yogurt for breakfast, a 20 minute jog, and then off to work. You’ve just gotten a promotion and a new office with a gorgeous view, so you’re feeling pretty good about your career. At the end of the day you catch an hour of T.V., hop on the bathroom scale, and hit the hay.

This is the raw data of your life, the cold hard facts of diet, exercise, and attitude that determine your wellbeing, and TheCarrot is dedicated to measuring it. TheCarrot is an online and mobile collection of trackers that collect and calculate data pertaining to a wide range of health concerns. If you’re looking to lose a little weight, plug in what you eat at each meal or log your workout routine. Feeling stressed? You can log and rate your general mood, your quality of sleep, even your job satisfaction. For users with more specialized concerns, there are specific trackers for diabetes, menopause, hypertension, and a sort of WebMD-lite which tracks various individual symptoms.

What distinguishes TheCarrot from similar sites is the focus on mobility and, perhaps more importantly, on a full integration of all the above-mentioned aspects into a gestalt look at wellbeing. The platform’s Iphone app allows users to log in their meals and activities as they happen, even inviting users to upload snapshots of their food into a database. While a seemingly small point to tout, entering the contents of a meal is much easier and salient on the subway ride home than it is hours later, racking your brains for if you had the risotto or the orzo.

The platform’s integration of every tracker into your daily report is similarly based on small, intuitive touches. How many times have you patted yourself on the back for jogging two miles, and rewarded yourself with an ice-cream sundae, or offset a diet with an afternoon sitting around on the couch? TheCarrot, by collecting up all of your lifestyle trackers into one collated chart, stresses the importance of all-around health and wellness.

As Douglas Trauner, CEO of TheCarrot’s parent company, Healthcare Analytic Services, puts it, “until now there wasn’t a mobile, one-stop option for all areas of [health] interest.” This all-in-one, integrated method is what really sets TheCarrot apart.

However, this emphasis on breadth of content may come at the expense of depth in any one area. While the nutrition tracker is admirably well fleshed-out, with a nice range of customization regarding what information shows up on your reports (ranging from a simple calorie count to detailed data on sodium, protein, and more) and a stocked pantry of over 20,000 pre-selectable food entries, other trackers are less comprehensive. It’s great to be able to hold your exercise regimen up side-by-side to your daily diet, but without even giving a broad estimate of the amount of calories burnt by each activity at various durations, the actual functionality is sadly limited.

Other areas of the platform are similarly bare-bones, sometimes in surprisingly fundamental ways. Some, such as Energy Level, Sex, and Job Satisfaction, are merely sliding scales ranging from Low Satisfaction/Energy/Libido to high-a totally subjective criteria that fails to offer much meaningful data. Sleep is structured similarly, with an entirely separate tracker set up for wake-up time. The result is a jumble of trackers ranging from comprehensive and useful, to somewhat confusing, to the useless and/or redundant.

The site and its Iphone companion have undergone a general upgrade since August of 2009, adding numerous features and trackers to its original configuration. While the platform as it is today is far from perfect, TheCarrot’s ambitious scope and convenient, mobile-friendly approach make it a fascinating experiment and a worthy (if flawed) eFitness contender.

One week ago the inaugural e-Patient Connections conference came to an end, and I must say I’m still decompressing and trying to make sense of it all. Many have done an excellent job summarizing the event and highlighting special sessions. To get content summaries you can:

• search Twitter for #ePatCon
• view slides at http://www.slideshare.net/KruResearch/presentations
• view photos at http://www.flickr.com/photos/epatient

and definitely read these blog posts Eric Brody, Steve Woodruff, Kerri Sparling, Ellen Hoenig Carlson, BioJobBlog, E-Patient Dave deBronkart.

The highlight for me was the Pecha Kucha session from Dr. Val Jones. Her “Tale of Two e-Patients,” is a great reminder that there is a right way to be empowered and engaged and a wrong way. I was glad I wasn’t moderating that session because I was choked up by the end of her 6 minutes and 40 seconds. Being an e-patient is about being actively engaged yourself; it doesn’t diminish the role or value of your physician.

My only real disappointment was the fact that I started losing my voice the day before the conference even began. I tried my best to mingle and chat Sunday and Monday nights, but each night I had to retreat early to the comfort of hot honey water. I knew having a voice was the most important thing, but felt like a rude host and wanted to spend time with my new friends.

Overall I think we accomplished our goal, which (again) was to bring together health communicators from different industries to compare and contrast the best ways to connect with empowered, digital patients. The term “connection” has a double meaning - connect with patients, but also connect with each other. What delighted me the most was the unpredictable ways connections were manifesting themselves at the conference. I learned from dozens and dozens of speakers and attendees. Some of my favorite moments:

Connections…

“e-Patient Dave deBronkart” publicly thanks Novartis for saving his life.

Yes, the personification of the e-patient movement teaches us that you can be pro-patient without being anti-pharma.

Connections…

From patient blogger Diane Bayer, “…after my talk I sat down in the back and this fellow with a pharma company…he told me he was really amazed by my talk because he has a six year old son who has been diagnosed with autism.  Then he proceeded to show me the pictures of his son…and my god…he looked just like my son!  This person had come for business reasons but then we connected in a very human way. ”

Yes, we are all caregivers, we are all patients; as e-Patient Dave boomed, “Your day will come!”

Connections…

Susannah Fox, from Pew Internet and Mark Bard, from Manhattan Research sharing perspectives on e-patient trends and publicly acknowledging that it’s great to be presenting together.

Yes, commercial and non-profit research can both shed light on the changes around us.

Connections…

There were several tweets and comments about what a great guy Paul Loebach is and how he offers a great face to the FDA. In the breakout sessions he offered some eye opening insights into why the FDA does and doesn’t do certain things.

Yes, even the FDA and pharma folks can connect and gain a better understanding of each other.

Connections…

Jim Currie from “N’Awlins” shouted to me as he was leaving the hotel, “Kevin, my goal is to go back and implement something that is worthy enough to get me invited back to present a case study at next year’s conference.”

Yes, we can inspire and learn from each other.

The challenge of producing a 2-day conference is nothing compared with the challenge of keeping the community alive beyond the walls of the Bellevue. Hopefully we’ve sparked something that will continue to grow and continue to benefit the patients and caregivers who we ultimately serve.

- Kevin

Almost all social media strategists recommend that companies and brands begin their journey into social media by “listening.” But how do you monitor the chatter on 180 million sites, including Twitter, the blogosphere, YouTube and Facebook? And more importantly how do you make sense of the aggregate data?

To answer these questions we used the most advanced, real-time social media listening platform available, ListenLogic. We monitored the social network activity for two competing insomnia products, Ambien and Lunesta, for the month of July, 2009.

Human analysts were used to train the listening platform how to disregard all the spam messages related to “get Ambien cheap” and how to determine if a comment could be considered positive or negative. While other listening platforms only achieve 60% accuracy on “sentiment analysis,” ListenLogic is able to achieve over 90% accuracy in this measure.

The questions we sought to answer were:

1)     What is the total number of comments for each of these brands?

2)     Does one brand have more social media activity than the other?

3)     Which sites generate the most chatter (eg, Twitter, Blogs)?

4)     Are there any people or sites that could be seen as key influencers in the online space?

5)     Overall, are people saying good or bad things about each brand?

6)     Is there a difference in the topics or issues that are being commented on for each brand?

7)     What do the some of the specific comments look like for each brand?

Here’s what we found…

Ambien beats Lunesta 7:1 in Share of Voice

After tracking 180 million websites and cleaning out the promotional chatter, we see that Lunesta had 764 total mentions and Ambien had 5265 mentions. Ambien has been on the market much longer than Lunesta, and in fact is now available as a generic, so it isn’t surprising that they may have more activity on the social networks. But the size of the gap is greater than expected especially given that the two products are roughly comparable in current sales. What would be interesting to see is if the total number of prescriptions for Ambien is seven times greater than for Lunesta-this is data I don’t have.

Twitter Accounts for the Majority of All Online Activity

The data clearly shows that Twitter by far carries more comments than any other social media platform.

Of the 5265 comments for Ambien:

• 3666 (70%) came from Twitter
• 226 (4%) came from ehealthme.com
• 89 (2%) came from bluelight.ru
• 78 (2%) came from community.babycenter.com
• other

Of the 764 comments related to Lunesta:

• 3666 (46%) came from Twitter
• 70 (9%) came from ehealthme.com
• 25 (3%) came from omgili.com
• 24 (3%) came from cafepharma.com
• other

What’s interesting is that after Twitter, there is then a divergence in terms of what other sites are most important in terms of volume. And we can see that for the month we looked at, a full 3% of Lunesta activity occurred on the pharmaceutical rep gossip site cafepharma.com.

No Patient Opinion Leaders Emerge

We dug deeper to try to identify who are the most influential bloggers and Twitterers but no clear pattern emerged. In this particular drug case, in this particular month, there was nobody that emerged high on the “influence scale.”

Ambien Has More Positive Sentiment Than Lunesta

Not only are there a lot more people talking about Ambien than Lunesta, what they are saying is more positive too.

Much of what people say about a brand is neither positive nor negative, so it’s just classified as “neutral.” There are far fewer neutral comments as a percent for Ambien, 41%, than there are for Lunesta which has 84% of all comments being neutral.

For Ambien, 36% of the chatter overall or just over 50% of the non-neutral chatter is positive.

For Lunesta about 4% of chatter overall, or 25% of the non-neutral chatter is positive, with 75% being negative.

Comments Reveal DTC Ad Confusion & Pregnancy Questions

When reviewing the comments for Ambien, many consumers are seeking additional information and clarification.  Common topics:

• Confusion by the Ambien TV commercial and all the side effects listed - with an ongoing debate over whether the ad announcer is saying “aggressively normal” or “more aggressive than normal”
• Confusion exists over the safety of taking Ambien while pregnant, with chatter focused on “new mommy” blogs.
• Others complain about the “Ambien Hangover.”
• 5%-7% of posts discussed “what I did on Ambien” including sleepwalking and unintentional communications.

With less volume, it was harder to pick up trends in comments for Lunesta. What was noted:

• Comments about Lunesta being less effective than Ambien
• Lunesta leading to feelings of depression
• And Lunesta reps (supposedly) chatting on blogs about how to push Lunesta to doctors

Conclusions

First, you must monitor. Our strongest recommendation is that every marketer use a listening platform to monitor social media comments. Marketers have long invested in 12 person focus groups or thousand person surveys; with social media monitoring, you can quickly and easily see the perceptions of a much wider cut of customers. In the case of Ambien you can literally listen in on over 60,000 comments per year!

Second, track macro results over time. With ongoing analysis you will be able to see:

• Is our total number of mentions going up or on the decline?
• Is our share of voice compared to our competition increasing or decreasing?
• Is our positive sentiment increasing or decreasing?
• Does a change in sentiment correlate to a new marketing strategy or tactic?

Third, review comments for actionable issues.
Not every comment or topic will require action, but using Ambien as the example, if a there is an ongoing debate over what the DTC ad announcer is actually saying, you have to wonder if many thousands of other viewers out there aren’t also unclear as to what is being said. This could easily be an issue not picked up by focus group panels, but is revealed when you can listen to 60,000 people.

Fourth, if you promote or engage on just one platform, make it Twitter. We suggest that brands can progress in social media first by listening, then by promoting (one way communication), then by truly engaging (dialogue and relationships). With limited time and budgets, this can seem like an awesome task (how do you respond to various blogs, user groups, YouTube comments, etc.). But we can see that Twitter accounts for the vast majority of user-generated comments. So if a brand is going to promote or engage, focusing on Twitter will cover most of the bases.

NOTE: For more information on the ListenLogic social media listening platform that was used in this study visit: www.ListenLogic.com.

Social Media Faceoff: Lipitor versus Crestor coming next!
Subscribe to the Kru Report at: http://www.kruresearch.com/subscribe

For most health consumers, Healthwise is the biggest brand they’ve never heard of. Even though Healthwise content is accessed over a 110 million times a year, it is accessed most often through online health publishers, health plans, hospitals and disease management companies. Even though this company is over 30 years old, they continue to find innovative new ways to support patient decision making. I spoke recently with Healthwise Founder, Don Kemper.

Kevin Kruse: Don, why did you start Healthwise. It was back in the 70s right?

Don Kemper: That’s right 1975.  During the time of the Vietnam war, I became an officer with the Commissioned Corps of the US public health service.  One day I went to a talk by Vern Wilson, Assistant Secretary for the US Department of Health and Human Services. He said “The greatest untapped resource in healthcare was the patient”. That just took hold of me and I decided that that was something I wanted to work on.

I had a baby at home at the time and somebody gave me the book by Doctor Spock on raising children. I started promoting the idea that we needed a Dr. Spock type book for the whole family that would guide people in how to take care of themselves… this led to the creation of Healthwise in 1975 and then later the Healthwise Handbook.

Kruse: Has the Healthwise mission changed since then?

Kemper: Well the mission hasn’t changed but the media changes. The mission has always been to help people make better health decisions. We did that initially through both the Healthwise handbook and workshop.  So we had a focus on education early on, just wasn’t as scalable as it is now on the Web.

Kruse: Healthwise online content is syndicated by most of the major health portals, how did you become an innovator with web technologies?

Kemper: We have a wind sculpture outside our building that’s devoted to our relentless innovation.  The base of it is solidly in the ground as is our mission which never changes, but that sculpture is always in motion and it means we are continually trying to find new ways to help people make better health decisions.

Kruse: Speaking of innovations, are you embracing social media?

Kemper: We certainly very supportive of the whole 2.0 movement and the social networks around health.  We think there are three sources of information that people need. They need to have information from their doctors, information that has a good solid evidence base, and then they need to hear from other people who have been in similar situations.

The piece that we focus on is the information that is really documented by medical research.  We are really trying to find the right ways to reach out to the 2.0 group, so that we can get those two sources of information collaborating on a more regular basis and I think that’s going to happen in many different ways.

Kruse: Tell me more about your “virtual conversations.”

Kemper: Many people learn best through personal interaction with other individuals and we also know that psychologists have developed a number of techniques like motivational interviewing.

We can now model these interactive conversations by using software developed by Jellyvision, the makers of the computer game called “You Don’t Know Jack”

So instead of having the very obnoxious Jack run the game show we use a very supportive voice and individual called Shelley that guides the person through this interactive conversation.

One type of conversation is around medical gaps mostly in chronic illness. For example the importance of the hemoglobin A1c test for monitoring and controlling your diabetes or the importance of aspirin to a person at risk for heart disease.

The other type of conversation is around wellness.  We don’t have a prescription exercise program, but we have the conversation that will help you make an exercise program work for you. It’s like having a twenty minute conversation with a psychologist around what is it going to take for you to be successful in your fitness program.

Kruse: Shifting to some business questions, how many employees do you have now? And you’re setup as a non-profit?

Kemper: We are a not-for-profit with 120 employees.

One advantage of being non profit is that nobody can come buy us, so that’s good. The not-for-profit approach allows us to play with everybody now because they aren’t concerned that their main competitor might buy us or take us over. We are now used by all ten of the ten largest health plans.

Kruse: What are you future plans for Healthwise?

Kemper: Our next big initiative that we are currently looking for funding and partners for is taking on the whole issue of late life care. We want to use interactive conversation technology to engage elders and their family care givers.  We have identified 26 critical moments in late life care ranging from the early days of just helping prevent falls to deciding when you stop driving, all the way to when do you need to move out of your home, when do you need to put in your advance directives, etc.

We think this will be a highly impactful program that will address what has got to be one of the biggest problems in American medicine; the program is called “Elder Talks.” I think it is going to be a one of our major legacies.

Kemper: Also we have 154 patient decision aids which is by far more than anybody else in the world. These guide the person through clinical treatment decisions like do I need the surgery, do I need this drug, do I need this test, etc.  We’ve had these for quite a while, but we are releasing a whole new generation of them.  The same topics but reformatted into a much more interactive and richer user experience.  Last year we had about 10 million uses of these decision aids, so that they are making a big difference.

Kruse: Great contributions, Don. Thank you.

Kemper: You bet.

Here’s a new video from Kru Research showing that the age of participatory medicine has begun.

Please share, forward, and RT. Enjoy!

Sources used for this video include:

• Kao, Helen, Rebecca Conant, Theresa Soriano, Wayne McCormick. “The Past, Present, and Future of House Calls.” Clinics in geriatric medicine 25(1): 19-34.
• Yawn, B., M.A. Goodwin, S.J. Zyzanski, K.C. Strange. “Time Use during Acute and Chronic Illness Visits to a Family Physician.” Family Practice 20(4):474-7.
• Ley, P., “Memory for medical information.” British Journal of Social and Clinical Psychology 18: 245-256.
• Rubin, Rita. “Doctors baffled by patients not taking prescriptions.” USA Today 29 March 2007.
• Ferguson T, Frydman G. “The first generation of e-patients.” BMJ 328 (7449): 1148–9.
• Herrick, Devon. “Web Replaces Doctors as Patients’ Top Health Information Source.” Health Care News 01 January 2009.
• Fox, Susannah, and Sydney Jones. “The Social Life of Health Information.” Pew Internet & American Life Project June 2009
• Fox, Susannah. “The Engaged E-Patient Population.” Pew Internet & American Life Project. August 2008.
• Goetz, Thomas. “Practicing Patients.” New York Times 23 March 2008.
• Keckly, Paul, and Laura L. Eselius. “2009 Deloitte Survey of Health Consumers.” Deloitte Center for Health Solutions. March 2009