The topic of social media return-on-investment (ROI) continues to be popular as innovators look to justify their efforts and laggards look for excuses. Compared to more tried-and-true marketing campaigns, the return on investment involved with social media can be hard to quantify.

Think Interval has contributed to the conversation with their white-paper, “Yes We Can: Measuring Marketing Performance for Hospitals and Health Systems.” It reassures health-care companies that while setting up consistent and useful measurement standards can be a difficult and time-intensive project, establishing a system of gauging marketing results in a Social Media (SM) environment is not only possible but crucial. They recommend a three-tiered system of “Marketing Performance Measurements.”

Financial Metrics provide the traditional ROI. How much money has your campaign brought in versus how much it cost? Financial metrics, if you have them, are the easiest to draw conclusions from, but getting them can be difficult, often requiring customer and patient actions to be tracked over long periods of time.

Action Metrics lack the bottom-line punch of financial metrics, but still deliverable measurable, concrete results. For example, a hospital offering a free booklet on the risks of arthritis can measure the number of requests for the information. Often these actions can be roughly equated with a financial outcome. Any campaign that can’t efficiently provide a financial metric should take care to track as many actionable angles as possible.

Attitudinal Metrics simply measure the attitudes and opinions of a selected audience. These could be the results of surveys, polls, focus groups, interviews, or even anecdotes. While these can be a useful gauge of what people are saying about you, it is important to keep in mind that attitudes often do not correlate with behavior. As a result, attitudinal metrics are usually the least useful of the three.

With definitions of what you can measure in hand, the paper goes on to discuss how to measure the success (or lack thereof) of a campaign. The first step, the micro-level, is concerned with figuring out how to measure the results of specific marketing activities. To quote the paper, “your goal is to answer the question ‘Did this campaign work?’ with a definitive ‘Yes, and here’s the evidence to back it up.’” The report offers a fairly detailed run-down of what you should be measuring as results vs. actions, and how exactly you should look at these results. First, define what actions you will be taking. An action can be anything, the paper says, from a simple one-sheet brochure to an expensive television spot. If your metric is your end-goal, then try to include as many activities in this metric as possible. Open-houses, phone reminders, promotional websites-it all counts.

Make sure to set an objective (for example, “200 new appointments this month”) and take note of your current baseline (”75 new appointments last month”) to compare the results of your campaign to (”225 new appointments”). Make sure to look into the relative results of previous attempts to boost the same or similar branches of your organization, and make sure the source of your metrics and whose responsibility each aspect of the campaign falls to are also noted.

We’ve written in the past that at Kru we think social media ROI needs to be based on the purpose of your social media efforts. For example, using social media to “listen” is akin to conducting a focus group, and proving ROI isn’t necessary or practical. But if your goal is to get them to buy your product, or visit your website, then hard ROI metrics are possible and should be pursued.

Kru Research used the ListenLogic social media monitoring platform to monitor social media comments and measure sentiment for two cholesterol lowering drugs, Lipitor and Crestor, for one month (August 2009). An influence ranking of 5+ was used to reduce the amount of spam and irrelevant posts.

The questions we sought to answer were:

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

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

3)      What is the overall sentiment score for each brand?

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

Share of Voice: Lipitor beats Crestor 2.3 to 1

After tracking 180 million websites and cleaning out the promotional chatter, we see that market class leader Lipitor had 695 total mentions and Crestor had 302 mentions. Lipitor has been on the market longer than Crestor, and is considered the best selling drug in the world, so it isn’t surprising that it has more activity on the social networks.

Little Difference in Sentiment-Mostly Neutral

When you look at all the conversations and comments about Lipitor and Crestor the vast majority, about 94%, is labeled “Neutral.” This is because most mentions picked up by listening platforms has to do with general corporate news, lawsuits, and investor related articles that mention the blockbuster drugs as part of their description of Pfizer and AstraZeneca. When you look only at health related comments, the picture changes.

Lipitor’s positive sentiment was approximately 9% versus Crestor’s 1%. Negative sentiment was 27% for Lipitor and 18% for Crestor.

Another way to look at sentiment is the ratio of positive to negative comments. Using this approach Lipitor scores .33 to .05 positive to negative sentiment.

Comment Cloud Analysis

The cloud tags shown below reflect that the brand names are being used in a variety of discussions that go far beyond the management of cholesterol.

Websites with Most Activity

Using a 5+ influence rating corrects for a lot of irrelevant chatter that happens on Twitter. However, both products unfortunately have most of their social comments happening on pharma gossip site CafePharma. Major sites that these chole

Of the 695 comments for Lipitor:

• 46 (7%) came from CafePharma.com
• 36 (5%) came from wikio.com
• 22 (3%) came from medhelp.org
• 18 (3%) came from Boards.webmd.com
• 13 (2%) came from weightwatchers.com
• 11 (2%) came from Twitter.com
• 10 (1%) came from blogspot.com
• 9 (1%) came from diabetesdaily.com
• other

Of the 302 comments related to Crestor:

• 17 (6%) came from CafePharma.com
• 12 (4%) came from medhelp.org
• 11 (4%) came from technologyquestions.com
• 10 (3%) came from wikio.com
• 7 (2%) came from Boards.webmd.com
• 6 (2%) came from blogspot.com
• 5 (2%) came from weightwatchers.com
• 5 (2%) came from diabetesforums.com
• 4 (1%) came from Twitter.com

Previously I applauded the efforts of Novartis to embrace social media with the launch of CML Earth, their online community for people with chronic myeloid leukemia. When I reviewed the site I signed up as a member, and yesterday I received this email that shows they just don’t get it (yellow number citations are mine).

Novartis, it’s about personality, authenticity, being a real person who can be trusted! So what’s my problem with this email? Let me count the ways…

1) Subject Line — It’s not terrible, and they get points for being direct. But it’s very “me” centered, generic, and doesn’t provide a compelling reason to open the email.

2) From e-Mail Address — You’ve got to be kidding me. The mail actually comes from “DoNotReply”? I can’t imagine a less personal or caring address. In fact, in this day and age it’s downright offensive.

3) Salutation — This form email is inserting the member name into the greeting which is good. At first the “Dear” preface seemed a bit formal to me, but the average age of someone with CML is mid-60’s so probably appropriate to be a bit more formal in this email.

4) Body Copy — This is admittedly nitpicky but the paragraph block is too long and uses some passive voice which should be minimized.

5) Call to Action — Still impersonal but it’s good they actually have a call to action and remind the reader of the total number of members in the community.

6) Signature — Formal and impersonal. Yuck.

7) Footer — “Please do not reply.” Doesn’t that give you a warm and fuzzy feeling?

“Hey, it’s easy to take pot shots from the cheap seats,” you might say. Well, let me show you how this email should have been crafted.

First, there should be one or more patient leaders who actively lead the community. The monthly emails should come from them, not from a Novartis employee or a “DoNotReply” automated message. I’ll use my own name as the community leader for the example below. A rewrite might look like:

From: Kevin.Kruse@cmlearth.com

Subject: You can now add Caregivers to CML Earth

Hi <FirstName>,

I’m sure you know that CML Earth lets those of us with chronic myeloid leukemia connect with one another online. There are over 2,000 members in the community and I personally have made friends with people from all around the world. But of course we also know that CML affects our family, friends and other “Caregivers.”

The good news is that CML Earth is now open to Caregivers as well. Their stories, experiences and participation with our group will certainly inspire, educate and support all of us.

Please invite your loved ones to join CML Earth by forwarding this email or sending them this link:
http://www.cmlearth.com/welcome

And please log back in to CML Earth yourself to connect and encourage our new members.

Let me know if you have any questions or suggestions for how we can make our CML Earth community even stronger.

Sincerely,

Kevin Kruse

See the difference? Feel the difference?

What is a shame is that Novartis is a great company and Gleevac is a real miracle drug. I know the Gleevac team truly cares about the CML community. Unfortunately, the team managing CML Earth seems to be ignorant of social media, community culture, and maybe even copy-writing which led to an amateurish and probably ineffective email.

What do you think?

Advertising maven, Roy Williams, has been speaking about Society’s 40-year Pendulum since at least 2003. Grounded in the generational theories of Strauss and Howe, Roy Williams has been accurately predicting the changing behaviors of consumers for some time. 2009 was the first complete year of a “new” Civic minded generation (which transitioned since 2003 from an Idealist perspective). We now reject hype the way the baby boomers rejected conformity.

Key takeaways:

1) Authenticity is paramount — “Keepin’ it real” has replaced “being cool”

2) Networks are valued — Belonging has replaced winning

3) We trust our friends — Word of mouth has replaced mass media (WOM always the most powerful form of marketing, and Web 2.0 has eliminated friction and increased the velocity of messages)

Does your marketing and health communications reflect all this? Hopefully you’ve already made the shift; after all, you’ve had the previous six years to figure it out.

But if you need further inspiration, look no further than Madonna (the pop-star, not the Mother of Jesus). She is now in her 50’s and she isn’t the same artist/performer that she was early in her career. Her debut album in the 1980’s was self-titled, full of Ego and she became known as the “Material Girl.” Generations change their views as they progress–as we age–and Madonna today is known for her spirituality, Ray of Light album, and efforts to adopt children from Malawi.

You work in the most noble of professions; you are working for better health. Your drug, or hospital, or health publication, or non-profit is a valuable resource to patients; you are part of their health team. Does your marketing reflect all this? Does the “we” generation understand what you have to contribute?

For the past five years, obesity has been the number one health risk in America, the root cause of over 400,000 deaths annually and a nearly $123 billion burden on the economy. With 66% of the U.S. population overweight and an astonishing 32% obese, the issue is a constant concern for millions of people seeking to either prevent or eliminate their own weight issues.

Ethicon Endo-Surgery’s “Realize” adjustable gastric band, is a weight-loss device that is surgically placed around the stomach to limit food intake. Realize marketers have turned to YouTube as one of its primary marketing tools.

Featuring tutorials, customer testimonials and expert views, Realize’s YouTube Channel has received over 32,000 views since it’s inception late this June. The channel’s video tags feature a canny mix of specific and general terms, including “lose weight,” “bariatric surgery” and even rival product “lapband” promoting a diverse and broad flow of traffic.

This YouTube push, conceived without a specific ROI in mind, is just one of several online and social media publicity campaigns for the surgery, which is increasingly being touted as not only a way to combat obesity, but some forms of diabetes as well. There is a Facebook fan club with around 400 members and an online support group for customers that deliver recipes, fitness plans, and an opportunity to communicate with other members.

[...Realize's YouTube Channel has received over 32,000 views since it's inception late this June.]

However, on YouTube, Ethicon has turned off its social media features. The videos on their channel do not allow ratings or comments, nor does their Facebook page, hobbling the entire “social” aspect of social media and possibly raising skeptical eyebrows among casual browsers.

Furthermore, while a Discovery Health documentary hosted on the channel does feature information from real surgeons and other doctors, this content isn’t featured prominently. The channel’s “From the Experts” section only has testimony from a psychologist, a dietician, and an insurance expert-hardly the expertise most patients are likely to look to first. Previous research from Kru and others has shown that trust is a key variable to a health consumer actually taking action or talking to their own physician, and an onscreen real doctor would actually move Ethicon a lot closer to their goals.

YouTube videos garner massive viewership and the site has emerged as one of the most popular search engines on the Internet. Ethicon Endo-Surgery is wise to have launched this channel and the video on it are well produced. A person considering a gastric band certainly does want to hear from others who have gone through the procedure, so the prominent display of patient testimonials was also smart.

However, physicians continue to be a trusted advisor on health issues and those videos should be increased in terms of quantity and prominence. Lastly, Ethicon would be wise to enable the social features on their social platforms. Although fearful of negative comments, pharma will soon realize that negative comments only increases the credibility of the content in the eyes of the potential customers.

“Don’t worry. They have never dropped a potential protector… yet.”

A young marketing director, a middle-aged health communicator, and a college student are gripped in the talons of a trio of giant falcons. This isn’t the start of a bizarre bar-joke, it’s a scene from Fard Johnmar’s web-comic “The Path of the Blue Eye,” a tale focusing on the dimension-hopping Specto Laurus and his vendetta against the evil Davos.

But the mystical back-story and six cryptic pillars of wisdom isn’t just the latest graphical novel. It’s the background for an ambitious networking project reaching out to all corners of the health communication community.

The project stems from two statements Johnmar came across in his experience as a healthcare marketing consultant and prolific blogger: “I wish I knew that” and “I wish we had a place to collect this information”-suggesting a widespread desire for communication and sharing across the increasingly fragmented and insular “silos” of the industry.

Social marketers, public relations professionals, advertisers, pharmaceutical/biotech marketers, public health communicators, academics and others were working, innovating, making breakthroughs within the confines of their own specific communities-but not broadcasting any of this outside of those borders.

Why start with comics? The comic serves as a flashy and visceral gateway to the nitty-gritty of the project as a whole, and while he says it has puzzled some audiences, it has reached out to even more. “The key word here is interdisciplinary. We are trying to reach across silos and centers of practice rather than working within them.”

“I prefer to ‘nest’ key real-world themes into the story rather than let them drive it,” says Johnmar, referring to the six pillars of Specto’s “Path.” “Requiring hidden knowledge requires exceptional stamina”; “A flexible mind is capable of great insight”; “Rigorous and objective measurement is a prerequisite for measurement.” These and the rest, he says, apply equally well to Specto’s chosen trio and real world health communications success.

“Perhaps the most difficult thing to figure out has been striking the balance between using mystery to spark people’s curiosity versus laying everything out on a platter.  Ultimately, I decided to be a bit mysterious about how the whole thing fits together (the comic, the movement and the community).”

He believes that this kind of renaissance approach to the field is vital as, paradoxically, specialists become ever more specialized: “With events and trends moving so rapidly, it is imperative that health marketing communications professionals be open to ideas and information from diverse sources. In the past, one could focus almost exclusively on non-profit communications, PR, advertising or social marketing. Today, that’s no longer an option.  Our profession is becoming tactically agnostic.  If you aren’t open to new perspectives, you’re going to fail.”

What implications does Johnmar’s mission have for the e-patient? He responds in three parts:

1)      “If people in public health understand why and how patients are consuming information online, they will be better able to reach people seeking credible medical content

2)      If social marketers understand how mobile technologies are being used by poor and underserved populations, they will be able to communicate with them more effectively

3)      If a non-profit communicator is struggling to understand how to produce and distribute an online PSA and they have an easy way to ask a seasoned digital marketer for advice, patients ultimately benefit.”

“Information is power.  We’re collecting and surfacing content that will make health marketers more powerful at what they do.  I believe e-patients will benefit from this.”

I just released our newest white paper, Patients Rising: How to Reach Empowered, Digital Health Consumers.

Download here: http://bit.ly/VDDvp

With over 25 years of IT experience working at power houses including Control Data Corporation and Oracle, Fred Eberlein comes to patient tools from the technology side of things. His flagship product is a patented, secure web-based approach to pain tracking and management. Fred splits his time between his clients in the United States and his development office in Hungary, and I interviewed him over a crystal clear phone line while he was working in Budapest…

Kevin Kruse, Kru Research: So when did you start ReliefInsite and what was your mission at the time?

Fred Eberlein, ReliefInsite: We started developing ReliefInsite in January 2005. But my interest in pain management started in 2000.  I learned back then that all the issues had been worked out in terms of protocols and logic for assessing pain, but as so often has happened in healthcare, none of this was put it into a digital form. As one who has spent his career in IT, this really amazed me.

Kru:  You focus exclusively on pain management and pain tracking?

Eberlein:  That has been our niche, our strong point. If you look at our website you’ll see that it’s free for patients, and healthcare providers.  But as our focus is on developing customized branded patient diaries/trackers for industry clients - this is where our revenue comes from - we have spent little resource driving traffic to our site. That will change later this year when we introduce the ReliefInsite Community.

Over the longer term, with the website, we are giving it away to ultimately create that community and then be able to create research components of that, reports and other things from the system and that we will sell.

Kru: Unlike many other health 2.0 companies you seem to have a very practical view of business with an immediate eye towards revenues

Eberlein:  Well, we are very nimble and I watch all the pennies. My goal is to create a balance between the web community, the research reports, and then customized development; it should work nicely.

Kru:  Can you give an example of a client who is using your platform?

Eberlein:  We developed the Rheumatoid Arthritis Symptom Tracker site (https://www.rasymptomtracker.com/) for UCB which is currently unbranded. UCB just got approval from the FDA for their RA drug, Cimzia, which is also prescribed for Crohn’s disease. Now that the drug is actually approved we will go through a redesign to match the brand of the drug.

Kru:  Any lessons learned that you can share from you experience with your pain tracking site?

Eberlein:  You commonly hear PHR [personal health record] utilization being at 3% and our stickiness is an order of magnitude better than that, I am happy to say. But frankly I am not satisfied with it. I think one of the big challenges we face now with all this technology is making it part of the patient’s lifestyle and the providers’ process.

I have the benefit of seeing firsthand over the last few years how utilization works. I’ve seen what patients do, what physicians do, and I think you cannot make it simple enough, you can’t make it easy enough, you can’t make it fun enough.

Kru:  What comes next for ReliefInsite?

Eberlein: Technology adoption is a big challenge and things like the iPhone and mobile technologies in general are helping to break down some of those barriers. Mobile is definitely the future.

I think what we really have to be thinking about is bringing gaming into the equation, and how to integrate health tools into our lifestyle as much as we can. Of course that includes integration to biometric devices and other types of things, because the whole idea of monitoring should be pretty much non-obtrusive and invisible to the patient but, of course, with their consent.

Run, don’t walk, to YouTube and setup your own channel. Have a hospital? Set up a channel for your hospital. Have a drug? Set up a channel for your disease state. Trying to get people to wash their hands, or take Vitamin C, or get their blood pressure checked more often? Setup a channel.

Nielsen Online estimates that YouTube gets almost 100 million visitors a month, which puts it right up with Google and Yahoo as one of the top 5 most visited websites on the Internet. And it’s still growing fast.

Click over and look at the J&J channel on YouTube. Go ahead, I’ll wait until you come back… OK, you saw it?

In less than a year J&J has posted over 140 videos, and the top 20 most viewed have garnered a whopping 425,000 views. Additionally, they have over 1,000 loyal “subscribers” who are anxious to view new content as it’s broadcast (er, published?).

Unless you have a mega-brand that is driven by tons of expensive DTC TV ads, I’ll bet there are few product websites out there that get over 40,000 views a month. And when is the last time 1,o00 people asked to subscribe to your branded website?

Need more examples? The Mayo Clinic YouTube channel (with 365 videos) is a good approach for hospital marketers and of course I’ve written before about the amazing job the CDC is doing with their channel.

And the kicker is that web video is cheap. You probably have all kinds of video shot for other purposes that you could repurpose for the web. And you don’t even have to pay for a separate web site or video hosting. YouTube has it taken care of. It’s a mantra…video, video, video.

Novartis deserves credit for jumping into the social media space with a very unique site, CML Earth. Its purpose and audience:

CML Earth is a global interactive social network dedicated to connecting the CML community from around the world. We invite patients, patient groups, and healthcare professionals to join us in building this new online community.

This is an instance of a condition-focused social network which enables patients and their care givers to provide support and information.

The Design

In keeping with the name, the main interface to the site is a beautiful image of the Earth itself and member location is prominent. Like other web mapping program, you can zoom in and out and scroll to different locations. Small circles show where other members live. Most impressive, the site provides support for nine languages.

Like other social networks users can sign-up and enter their name, birth date, and location. But when it comes to telling “more about me” you are forced to select from a series of drop-down menus. Instead of just writing who I love, I have to pick from a list that includes my parents, my kids, etc.

This forced entry system is even stranger as it applies to telling your story. When answering “What I look forward to” you must choose from a pre-set list that includes items like “just being” or “laughing last.”

This forced set of choices for your personal information is so awkward there must be a good explanation for it. I would have guessed that it was so nobody had to screen the entries in the open ended fields, but in fact there is a final open text box that lets you write whatever you want. I just don’t get it.

The main purpose of social networks, or course, is to connect with others. You can see in the image below that you can get profile information on other members and, similar to Facebook “flair”, you can send members signs of encouragement by sending smiles, hugs and high-fives.

When it comes to communicating with another member for some reason it doesn’t seem like too many users have activated that feature. You can go through a lot of members before finding someone who is willing to accept an email from you.

Guidelines and the Adverse Events Problem

When it comes to social media, health marketers often worry about things like spam, adverse event reporting, and negative comments regarding their brand. Novartis handles this with strict and clearly stated policy.

Refrain from sharing any treatment information or names of specific medicines or companies; Do not include any profanity or indecent or inappropriate language, whether in text or image; Do not embed any links in your profile.

So how does Novartis handle the dreaded adverse events reporting problem? Easily-they don’t allow them.  They inform users:

CML Earth is not the place to report adverse events.  If you wish to report a suspected adverse reaction to a Novartis product, click here.

The Business

Many companies are trying to make online patient communities a business, but in that regard most are struggling or failing (eg, Trusera). I suggest that online communities are a valuable tool, but just hard to monetize. To be sustainable online patient communities will have to

1)      be directly sponsored, like Novartis CML Earth

2)      be indirectly sponsored, like JDRF’s Juvenation which is sponsored by Novo Nordisk

3)      be hosted on a public platform, like McNeil’s ADHD Moms on Facebook

4)      be an add-on to an existing health information business

I don’t know what Novartis’ goals are for the site but I’ll bet they’ll exceed them. They have clear corporate branding-no hiding in the footer here-and rather than going for mass adoption they seem to be using this site as a tool to offer the community. It’s certainly going to be something to talk about when they are with physicians, and will earn good will among CML patients.

Areas for Improvement

Some things definitely jumped out at me during the review:

1)      Optimize for search engines-there is almost a complete lack of SEO effort thus far on the site. Keywords are limited to “cml” and “cmlearth”. This is such an obvious oversight that I would think they are purposely trying to fly under the radar, yet they are buying Google adwords to drive traffic.

2)      Tell the world-Novartis should issue a press release and upload their demo video to YouTube. Two simple actions that would drive awareness and a positive image for the company.

3)      Ditch the canned responses in profile-enough said.

4)      Add low-bandwidth or mobile version-the site is beautiful and uses a novel, geographical driven primary interface. But I wonder how accessible this site is in low-bandwidth countries in other parts of the world, and as many people do their social surfing from the mobile phones, a lightweight mobile version or iphone app is in order too.

5)      Provide content-one key that most private networks are ignoring is to provide a library of content. Even though the point is to connect members, a simple library of content-rich articles provides added value, makes the site stickier, and Google loves it too!

Summary

Novartis deserves high marks for jumping into the social network world with a very innovative, slick design. They deftly handle the AE issue with a clear policy. Hopefully they will open up the member profile data, make it mobile friends and do more to promote CML Earth to the rest of the world.