Creating markets & marketing strategies
April 15, 2015
Welcome to BioMarketing Insight's monthly newsletter.
We have a new mobile friendly newsletter.  Love to receive your feedback.
Last month I covered, New Legislation Regarding Pharmaceutical Pricing.   If you missed last month's article, click here to read it.   This month's newsletter will cover highlights from the Medical Informatics World Conference held April 4-5, 2016 in Boston.
Read on to learn more about this topic and other current news.  The next newsletter will be published on May 15th.
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Please email me, Regina Au, if you have any questions, comments, or suggestions.
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Developing a Product?  Anchor1
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If you are developing a product and have not conducted the business due diligence to determine commercial viability or success, contact me for an appointment.  For successful commercial adoption of your product or looking to grow your business, contact me for an appointment.


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Save the Date: April 27 - 28, 2016  Anchor4
Laboratory Products Association Spring Meeting
The 2016 LPA Spring Meeting will be held at the Fairmont Copley Plaza in Boston, Massachusetts on April 27-28. 
Geared for upper- and mid-level management, the Spring Meeting will present the 2016 Laboratory Purchasing Trends (North America & Europe) & eCommerce Report, discuss the future of medicine and technology, explore corporate wellness, and tackle digital marketing and methods, as well as provide various opportunities to network with your colleagues. Over the course of a couple days, LPA Members will take home specific calls-to-action for both their company and personally.  For more information, click here.

I am pleased to announce that I will be speaking on Thursday, April 28th on
"Challenges, Trends and Opportunities in the Pharma/Biotech Industry" at 8:30 am.   


I am pleased to announce that my article " Genetic Modification: Science Fact" on recent advances in the CRISPR technology has been published in the European BioPharmaceutical Review (EBR). To read an electronic version, click   here and scroll down the table of content to my article.
Regenerative Medicine: Tomorrows World Anchor2

I am pleased to announce that my article "Regenerative Medicine: Tomorrows World" regarding remarkable advances in regenerative medicine has been published in the European Biopharmaceutical Review (EBR).  To read an electronic version, click here and scroll down the table of content to the last article.

Medical Informatics World Conference Anchor7

Last year, the main theme of the Medical Informatics Conference focused on incorporating electronic medical records (EMRs) to deliver better care for patients and to make life easier for physicians, while at the same time solving interoperability. However, incorporating EMRs is a very difficult task, as outlined by our keynote speakers. This year's theme focused on cultural change for innovation, first by way of coordinated care, then with technology (EMRs), which will automatically follow and achieve better healthcare outcomes. Here is a summary of some of the keynote speakers.
Nicolas Markos, MD, Chief Data Officer - Geisinger Health Systems
Stay Away from EMR and Innovate

One needs to make things simple for everyone so that adoption is easily accepted. One example would be to incorporate the concept of interactive data visualization. This means that nothing is static and the goal is to get closer to what is going on in real time. Having just a dashboard or a report is only the beginning,. The system must be interactive and responsive in real time.
A Culture of Change - implement a system that facilitates change, otherwise it won't work with everyone. Bring in the CIO, CMO, and anyone else who would be involved with the spectrum of information needed, including the data, hardware and informatics that should be used for implementation. With cultural change, you will achieve data change.
Adrienne Boissey, MD, Chief Experience Officer - Cleveland Clinic
Unlocking Patient and Clinician Experience: What's Technology Got to Do with It
Dr. Boissey's presentation focused on service and the people aspects, rather than just focusing only on the technology to deliver better care. Essentially, we need to go back to basics and look at the patients' needs to motivate them to engage with their healthcare and how physicians can meet those needs. Then add technology to help meet these needs.
The Cleveland Clinic took a number of steps to accomplish this. When they polled their patients, they found that 70% were satisfied, but 30% were not. When they asked patients to identify the top five problem issues, communication and service were highlighted. Further, the following questions needed answers and possible solutions were considered.
  1. Access to a physician or healthcare professional - why is it requested and how do you deliver it?
  2. Service Excellence - how is the system or healthcare professional adding to patient suffering, rather than alleviating their fears or anxiety?
  3. Communication - really listening to patients, avoidance of treatment errors, even surgical errors, due to poor communication,---what is being done to avoid errors?
  4. Delays & Waiting - what is that environment like for the patient?
  5. Environment - is it calming or chaotic?
Due to this feedback, the Cleveland Clinic developed the mission of "Quality care anytime and anywhere." They developed the following programs:
  • Easy Access to healthcare profession - incorporated a patient portal, online scheduling, phone calls, same day appointments, texting, virtual visits, telemedicine. In the ER, since patients don't schedule appointments and they just show up, the wait time is very long. Increase virtual medicine or practice where it makes sense clinically and economically. Now MDs work 6:00 am to 11:00 pm.   But when one is innovating for patients, one must innovate with the MD to make sure it meets the physicians' needs as well.
  • New stroke care model - In the old model, if a patient had classic symptoms, someone called 911. The ambulance arrives and takes the patient to the ER, a CT scan is performed to determine whether the patient had a stroke. In the ER, most doctors are not comfortable giving the meds you need. The new model incorporates a stroke mobile that is specific to those who may have suffered a stroke. The ambulance is equipped with a mobile CT scanner to scan the patient's head. Through telemedicine, a stroke specialist can intervene and treat you at your house. However, this will require political change as well as medical change.
  • eICU- monitoring ICU patients and if a specialist is needed, can teleconference the specialist into the ICU. Remotely place orders, review labs and imaging. Can expedite intervention at each patient bedside rather than waiting for the specialist to physically come in.
  • Currently looking to virtualizing the management of chronic disease in a similar model as an eICU.
In order for these programs to be successful, we must include patients as Design partners as well as your own people as design partners, even board members of the hospital to get buy-in from all stakeholders.
They developed the R.E.D.E Model of Healthcare Communication
R elationship
E stablishment
D evelopment
E ngagement
Then look for technology that helps to demonstrate the gravity of your work in addition to helping to achieve the needs of the patient and physician/healthcare profession in facilitating communication with the patients. If you think you are very good, you won't change and improve. One way to achieve better communication is through complete transparency. For example, 60% of the patients choose their physician on line, so transparency is very important as to who these physicians are and it's better to have information come from the institution where you can control the information rather than having inaccurate information be the only information out there. By having this information on the physicians provided by the institution, patients can make a better match in choosing their physicians.
The concept of "Patient Centered" needs to be changed to "Human and Relationship Centered" to include everyone in the healthcare plan for the patient.

Jason Burke, Sr. Advisor, - UNC Health Care and School of Medicine
Designing Health Systems that Learn
The Institute of Medicine published an article on "Better Care, Lower Cost: The Path to Continuously Learning Health Care in America.
How would you even know if you are on this path for creating a learning health system?
Learning is highly contextual, what does the data actually mean and how do you interpret it and incorporate a workflow associated with it? One needs real time data so that it can be translated to practical purposes so that it will work. EMRs are not the key to a learning health system - EMRs are the beginning, not the end, because it needs to be free of decision bias, be in real time and be process driven.
How does one accomplish this?
Institutions traditionally focus on clinical research, quality improvement and practice- based experience. The element that is missing is real world factors and the ability to influence change which is a cultural change in feeling comfortable with their decision making.
Are you connecting to the Real World?
For example, in doing a risk segmentation and stratification where: 1) do a patient assessment; 2) once the program is designed, monitor it and collect data on adverse experience and 3) If this is the assessment, is that actually happening in the real world or in your institution?   In a closed loop model, you are always assessing and confirming your assessment in the real world implementing a higher design as a learning system.
The Three Stages of Learning Model by Fitts and Posner
  1. Cognitive phase - the beginning of learning something new, don't know the rules, sheer volume of things to learn, early drinking from the fire hose.
  2. Associated phase - taking concepts and putting them together, but not necessarily proficient
  3. Autonomous phase - where everything comes together. Logical maturity model.
The healthcare system will go through the same phases and right now we are in the cognitive phase. For example, when we think of quality, what are the metrics we are going to use to measure it? What metrics are actually important for my patient, for my organization, for my specialty and how to manipulate factors to optimize it to get the best performances?
Part of the solution is a cultural change. As adults, we tend to stick to the first most obvious potential solution, even if ineffective and do it over and over again, which is why it needs to be a cultural change. Children, on the other hand, will explore unique ways to solve the problem.
In order to achieve this, we need to institute new governance models that include the following:
1)         Proven transparency
2)         Self - service model
3)         Enabling end users
4)         Communication and enabling
5)         See the value of the program and change
6)         Are their explicit owners for each - accountability
7)         Practice based evidence translated into real world practice
  Adrian Zai, MD, Clinical Director of Population Informatics - MGH
Population Health Strategy, Infrastructure, and Technology: Results at Partners Healthcare.
Dr. Zai successfully implemented a population management strategy that incorporated many of the aspects that the keynote speakers discussed above in improving the delivery of better healthcare outcomes.
The first task involved their physicians in asking them why the old metrics were stupid and they received 200 reasons and addressed everyone of them (use your own people as design partners).
The second task was to identify what was needed to coordinate care amounst the healthcare professional and the patients. They created a central Population Health Coordinator Team to support population health initiatives across the entire primary care network because in acute care, they are already so busy, you can't task them with more work. The Population Health Coordinator Team consisted of the people from the community and college graduates instead of professionals. They also integrated these people into the care plan to make sure that all the activities were coordinated. Alignment between the central coordinator team and everyone involved is critical for success. At Massachusetts General Hospital, by reducing the administrative burden , there was an 85% positive impact in obtaining engaged and happy clinicians and staff (meeting the need of your people and patients).
The third task was a technology challenge in getting EHR, case management and Business Intelligence tools to talk to each other and then test a number of reiterations to make it work (continuous learning model). The reason it was a challenge is because the tools that needed to work together were found in different vendor solution rather than in silos.
A typical Population Health Management IT strategy include the following:
  1. Data aggregation
  2. Analytics
  3. Care Coordination
  4. Patient Outreach
Solution: Don't purchase a software package for each system --- need a system to pull all of them together.
The fourth task was to develop a high-risk population stratification strategy for early intervention of various diseases. From this task they found that they needed to consider the whole picture and not just one segment, high risk diabetic patients in the population. Even when they identified these high risk patients and intervened early, the percentage in terms of outcome was the same. Upon further investigation, they found that there was a continuous shift of patients from the low-risk to high - risk patient and a continuous shift of pre-diabetes to low-risk patients which is why outcomes never changed. Therefore, one needs to look at the whole picture or on a multilevel risk platform when treating diabetes (incorporating real world data or settings). The following questions needed to be asked:
  1. Why are they high - risk?
  2. High risk for what?
  3. Is the risk modifiable?
  4. Do we have an intervention available?
  5. Is the intervention effective? Need to measure your outcomes.
  6. What is the right intervention for the right patient?
Process for High Risk Care Management:
  1. Identify and assess,
  2. Evaluate
  3. Implement solution
  4. Plan for goals
  5. Determine the gaps
The take away message for this is the importance of the process. Only then, will you be able to learn and perfect your solutions. It took 12 years from concept to interviewing their people (patients, physicians, nurses, secretaries etc), analysis, implementation, assessment, and reiteration for a success outcome.
Closing Thoughts Anchor6

In order to have a more efficient and effective healthcare system that delivers better health care outcomes at lower cost, cultural change and change in general are inevitable. However, to implement a cultural change is very difficult for a society that doesn't like change and would prefer status quo to change. But as we heard from our keynote speakers, in order to innovate, people need to change in order to be open to new ideas, try things that may or may not work and learn from them. Only then will we be able to deliver better care at a lower cost.
The process to achieve cultural change is very similar to what we as marketers do to achieve buy-in from all those involved or stakeholders. When Drs. Boissey and Zai talked about using patients, physicians and other healthcare professionals as "design partners," it is the same as meeting the needs of all your stakeholders. You already have buy-in, because you've incorporated the stakeholders' needs and wants. Your stakeholders will dictate what your product will look like and that you need to satisfy the needs of all your stakeholders. One break in the link cause the program to fail. This is the reason why it's very important to incorporate stakeholders' opinion in the beginning of the process before you built your product/program/system.
When Jason Burke talked about incorporating "real world" and "real time" data into the equation to see if the assessment and interpretation applied to the real world, this was beautifully demonstrated by Dr. Zai's example of stratifying the high-risk diabetic population to intervene early for better care. What he found was that in the real world, things are not static. Some of the low-risk population may convert to the high-risk population and some of the pre-diabetic population may convert to low-risk population and therefore, one needs to treat diabetes on a multilevel in order to reduce the high-risk population overall. As marketers, we test various hypotheses by looking at factors such as market trends, natural history of a disease, competitive landscape to determine whether a product will be commercials viable or successful.
As more and more institutions begin to adopt this thought process of including "design partners" and incorporating "real world" data or situations, the innovation will flow naturally and they will be more successful.
Need help getting started with your product/service or population health program, incorporating your design partners or validating your hypothesis with real world scenarios to see whether your product or program is viable? Email me, or call me at 1-781-935-1462, we can help you achieve your goals.