The HITECH provisions of the 2009 stimulus package were the subject of a recent Washington Technology Industry Association (WTIA) security community group meeting. Among the subjects covered were the implications of the HITECH Act on making medical information more-readily available online, including the security and privacy of patient data as it whirls across the the Internet. Justin Wilcox, CTO of Nimbus Health, challenged skeptics, pointing out that paper records are no less accessible to those who wish to steal private information. Wilcox drew an analogy between electronic medical records (EMR) and the immense number of online transactions carried out by financial industry; the financial industry has to provide for the privacy and security of these systems, and medical records should be no different.

One serious issue discussed at the WTIA event was getting physicians comfortable with new technology. The medical industry tends to have a slower adoption cycle, especially when the learning curve is high. According to a recent study published by the Centers for Disease Control and Prevention (CDC), only about 44% of physicians have either partially adopted or fully adopted an EMR system into their practices. That leaves 56% of physicians still relying on pen and paper(1). While not necessarily surprising, it is at least ironic that the practice of medicine still holds to its walls of paper files as opposed to going digital -- for a profession that depends so much on complex, cutting edge clinical technologies they are so slow to adopt administrative technology.

But while there are no longer any material technical barriers, there are plenty of financial, logistical and (perhaps most importantly) psychological barriers to EMR adoption. For example, all of those paper records have to be digitized, which requires non-trivial time and money. And when hospitals communicate sensitive information to one another, who is liable if any information falls into the wrong hands? And, of course, the elephant in the room... how are the business models of hospitals and physicians impacted by the easy availability and interoperability of patient records across health care

The medical field is making progress in the digital space, and will continue to feel pressure from outside influencers to make this transition. There is a generation gap between physicians, and an even more apparent psychographic one. Most physicians practicing less than five years went to college and medical school in the age of computers, and for most of them the question is not whether to adopt EMRs but which one. Certainly the adoption of new technologies (including EMR) is part of what will distinguish tomorrow's physician.

But at the end of the day, the issues around the widespread adoption of EMR systems are not technical -- and they haven't been technical for a long, long time.

1Thorman, Chris. "EHR Software Market Share Analysis." Software Advice. RiverGuide, Inc., 14 May 2010. Web. 21 May 2010. .

Understanding the HITECH provisions of the 2009 stimulus package can be a challenge. Here is a short list of what we think are some of the best sources for help decoding HITEC and its implications for physicians.

What is the HITECH Act?
· http://www.practicefusion.com/pages/HITECH.html
· http://hitechanswers.net/about

What does the HITECH Act mean for physicians?
· http://www.practicefusion.com/pages/healthcare_stimulus_center.html
· http://healthcare.somersetblogs.com/2009/03/05/hitech-what-does-it-mean-for-your-practice/

Why so slow to adoption?
· http://hitechacthelp.com/2010/05/17/hurldles-slowing-down-the-adoption-of-electronic-health-records/

If I told you that Adam Gerson is an entrepreneur on a mission to help develop a novel class of conjugate therapeutics to combat HIV, Malaria and Tuberculosis you might assume that he also expects to get rich if he's successful doing it. His primary interest is not cashing in his ideas... he's a "social entrepreneur", inspired by science and the story of one of his personal heroes, Arthur Ashe.

A health science investigator with 20+ years of experience OSHA, Gerson's active mind was engaged by an article he read about fusion inhibitors targeting HIV. In an epiphany, he wondered if adding extra functionality to those inhibitors might be possible. In lay terms, Gerson describes the mechanism of his concept as akin to the operation of basic soap that attaches to a pathogen, bridging it to an immune reaction and facilitating the excretion or or serving as a marker for some other external treatment, such as elector magnetic irradiation. He began talking to everyone who would listen; but mostly what he heard was negative feedback about the concept -- until he heard from Emory University. Their response supported Adam's belief that the idea was both novel and may actually work.

Since then, Gerson has been prolifically, and very transparently, networking with professionals in the pharmaceutical research industry. Gerson admits that there has been a steep learning curve working with pharma because transparency is a barrier to collaboration in pharma because of the potential for competing commercial interests.

Next steps for Proxy Therapeutics is recruiting a principal investigator to design and monitor clinical trials and to support raising the capital necessary to carry it off. Gerson hasn't work with physicians on his project yet but is keen to get there perspective on the treatments that he believes could follow if Proxy Therapeutics is successful. It is clear that Gerson has a deep respect for the humanitarian motives that drives so many physicians to pursue medicine; it's also clear that he is driven by a similar motive and insists that he wants to make Proxy Therapeutics success for "the right reasons". I asked Gerson who he wants to benefit from the success of Proxy in the event that it achieves its goals, "I would like to divert downstream profits to Fisher House to help US military vets." That sounds like a "right reason" to me.

If you have an interest in learning more about Proxy Therapeutics or would like to contact Adam Gerson, please visit his website at https://sites.google.com/site/proxytherapeutics/

As a man approaching middle age, I have to say I listened to Beatrice Langton-Webster, CEO of Cancer Targeted Technology (CTT), with a little extra interest. CTT is developing a PET imaging agent that helps diagnose and monitor early and late-stage cancers; their first product, CTT-54, is aimed at prostate cancer. Incorporated in 2005, with initial patent filings, CTT became fully operational in 2009 when Dr. Langton-Webster took the helm, bringing 25 years of experience in pharmaceutical drug development and commercialization. I asked Bea to share some of the challenges facing early stage pharma companies and what is in store for the future of CTT.

With a little over 5 years of development, clinical trials and FDA approval , CTT has a lot of work ahead but in reality this timing is rapid for this type of diagnostic agent due in part to similarities with another product currently on the market. Bea stated "it is important for Pharmas and Biotechs to understand not only what makes their products better than their competitors, but also what the patient and physician really need and will use." Bea is excited about CTT-54 due to significant benefits it has over existing agents. According to Bea, "CTT-54 targets an important molecular marker in prostate cancer, and will have important advantages over the marketed imaging agent, Prostascint, and other agents in development, including the ability to specifically image abdominal and distal bone disease, the ability to collect better resolution images and the ability to image smaller tumor lesions. For the physician it is important that we develop an agent that has the capabilities to specifically detect minimal disease in multiple locations. For the patient, it is important that we develop a diagnostic with time and cost convenience. We will be able to provide CTT-54 images within a couple of hours with better overall diagnostic accuracy, no associated toxicity and at a cost that is lower than our competitors".

Continue reading "NW Life Science Profile: Cancer Targeted Technology" »

Throughout April and May, we will be highlighting innovative life science companies headquartered in the Northwest. We're kicking off this project with an interview with Chris Rivera, President of Washington Biotechnology and Biomedical Association (WBBA).

You (and a lot of others) may not be aware of this but the Northwest generally, and Seattle in particular, is one of the leading centers of life science innovation in the country, with well over 100 biotech, 200 medical device companies and nearly 30 leading research institutions; and when it comes to emerging innovation, says Rivera, Seattle is one of the leaders. Chris took the helm of the WBBA in January 2009 and is on a mission to grow the region's capabilities and distinction in the industry... and to make sure the world knows about it. "There are world-class companies, individuals and opportunities in the Northwest and unsurpassed talent when it comes to innovation and commercialization", stated Rivera. "Another unique quality about the Northwest's life science sector, is the ongoing integration between diagnostics, medical devices, therapeutics, IT and our global health community. "We are at a crossroads of a technological explosion in life sciences. Many experts predict that we will see more advancement in life sciences in the next decade than we saw in the last several combined. The most exciting part of this is, Seattle and Washington are at the eye of this storm."

I asked Chris why he thought the Northwest has become such a hive of life science innovation. As you might expect, there are many factors. First, the Northwest is host to some of the leading medical and research organizations in the world, including the University of Washington Medical Center, PATH, Fred Hutchinson Cancer Research Center, Seattle BioMed, the Bill & Melinda Gates Foundation, WSU and many, many others. The Northwest also has a deep tradition of innovation-oriented entrepreneurs and companies from Microsoft and Boeing, to Amazon and Expedia. Washington's burgeoning culture of innovation is also reflected in the hundreds of early-stage technology companies in the region - including iMedExchange.

Last month the WBBA's annual Life Science Innovation Northwest Conference drew leading and emerging life science companies, leading researchers and many from the Global Health community from around the Northwest, the country and around the world. In addition to record attendance, a deep partnership with Burrill & Company, and a keynote address from Steve Burrill himself. The conference also hosted a delegation from China that appears to be fostering many new national and international relationships. In fact, 95% of attendees reported that they made significant contacts at this year's meeting that will continue with follow-on discussions after the conference. For iMedExchange's part, we conducted interviews with many of the companies in attendance and will be sharing those with you over the coming weeks.

When I asked Chris about what was next for the WBBA and for the region's life science sector, he said he wanted to see more emphasis on transitioning from early stage research to commercialization of the best ideas and innovation. This, Rivera said, is where he sees an important role for physicians. "Executing clinical trials are a huge challenge for early stage companies and the most expensive part of the commercialization process. Physicians can play a critical role in helping to enroll patients in these trials." Chris also thinks that physicians can provide enormous benefits in helping biotech companies understand what's most important in gaining adoption of new treatments and devices by their colleagues and patients, and in helping identify unmet needs.

iMedExchange is excited to work with the WBBA and its members and to help connect them with physicians in the region and around the country in value add ways.

- Bob Crimmins

Social media is big... really big... and it's here to stay. This video blossoming social media revolution is required reading for understanding the magnitude of what's happening.

But health care is unique -- it's private, it's regulated, peoples lives are at stake. Physicians, patients, nurses, pharma, device, insurance companies and so on all need to figure out how to leverage social media... and one size does not fit all.

Faruk Capan and Wendy Blackburn co-authored yet one more good piece directing pharma marketers to think more about what their audience wants and less about what they think they want to do "at" them. Social media has changed the marketing game in revolutionary way and industry is no doubt trying hard to figure out the less-and-less-new media. But as the authors say, "If pharmaceutical companies insist on continuing to drum the self-serving brand messages, pharma's attempt at social media will fail."

At iMedExchange we think about this challenge in terms of turning the tables on ROI. In the context of physicians, this means that if you don't figure out how to deliver meaningful ROI for their investment of time and attention then you won't get any ROI yourself. Physicians have real needs that industry can fulfill and if they really consider how physicians think and what they care about then they can add some real value. In simplest terms, docs need to connect with relevant, high-quality information delivered in the most time-efficient way possible. If you do that then you're adding value to a physician's life and you'll have his/her attention. iMedExchange is working hard to help physicians fulfill this need online and based on the enthusiasm of responses we are hearing from industry we are looking forward an exciting next few months as we evolve the next generation of the iMedExchange platform. We are currently in a closed beta with our existing physician members but look for some exciting announcements throughout the summer as we move forward.

As the regulatory and access landscape continues to become more and more of a challenge for the traditional pharma sales rep model, I often hear comments about how sales reps are going the way of the dinosaurs. A lot of these comments actually come from senior pharma reps that have the experience and perspective to give their views weight. That said, there are some smart people looking to innovative the field sales force model with programs that bring value to docs. A recent idea I ran into would have reps working with docs in their offices to connect them into live speaker web conferences with their peers.

On the face of it... not a bad idea -- after all, live web conferences on relevant topics with quality speakers can be value add for physicians. The challenges will be the logistics of scheduling a docs time, ensuring the technology works seamlessly and demonstrating the value that THE REP brings by being there. The last challenge may be the most onerous. Why wouldn't the doc just say, "thanks... but just send me the URL to login and I'll tune in if I have time." What's the value add to the physician for the rep being in the office? Follow up discussion of the web conference material? Would docs view that as sufficient value to warrant the interruption? In an "on demand" world, everyone (especially physicians) is embracing technologies that allow them to engage when it's convenient for them... not when it's convenient for a sales rep. That said, these are smart people working on these problems so I suspect we'll see some innovative justifications for having the rep in the room.

• Email: Sending a physician an email typically adds little value; more ofter it just further clogs their already-jammed up inbox.  And even if the content was of high quality, the odds are that the email will get caught in a spam filter or otherwise deleted before it's even read.  Given that you're contributing to a clogged inbox, your chance of adding value to the life or a physician through an email is a very long shot indeed.

• Banner Ads: Think about how you feel about banner ads.  Do you love them?  Do they add a lot of value to your life?  Face it, physician or otherwise, banner ad are just not a value-add tactic.  It either distracts or, worse, it annoys.  Even if relevant, clicking a banner ad holds the promise of taking you out of your current context (bad), to some place that will likely provide a terrible user experience (bad) and will plant cookies or send encrypted nugget to third parties aiming to further profile you and increase the volume of advertising you'll be exposed to (bad).  Banner ads are at least an overall zero value for physicians, if not a negative value proposition.

• Brand.com: There is a reason that Brand.com sites get so little traffic -- they don't add sufficient value to warrant a physician going to the trouble of finding, visiting and navigating the site.  The content may be good but asking a physician to use 11 different web sites for 11 different brands, all with a different (and usually poor) user interface on top of poorly organized information is just too much to ask.  Having a Brand.com site sitting out in space getting 5 hits per year per target physician doesn't hurt anyone so perhaps it's not a negative value proposition but it's hard to see how it gets much above zero if physicians are using them.

• "Ask your doctor....": Just ask any physician what they think of this one.  Nuff said.

• Microsites: There is potential here but typically these microsites are buried in a labyrinth of some other site that adds it's own barriers to value through inferior user experience or limited relevance.  And while an aggregation of microsites makes finding all 11 sites a bit easier, these microsites are still typically poorly designed Brand.com sites... just embedded into some other site -- if they didn't add enough value to warrant a visit on their own then it's doubtful that they will provide significantly more value now that their are embedded into BigMedicalInfoSite.com.  Will the value warrant a special visit to BigMedicalInfoSite.com just to access it?  It better be pretty darn good content if that is the expectation.

The iMedExchange team has been debating the value/liability in referring to what we do as "social media". Certainly, physicians participating in, e.g., forum discussions on iMedExchange are engaged in a flavor of social media. But not everything that happens in and around a social media site is actually social media, For example, reading a newsfeed could be just that... reading. Of course, if users are able to rate the quality of the article or leave a comment for other readers... or respond to another readers comments then it becomes social media. But a pharma banner ad on the same page that a conversation is happening is not social media. Similarly, if a pharma company makes product information available inside a microsite within a social media site like iMedExchange that's not social media either... it's just media.

As an admittedly unscientific estimate of how many things a pharma (or device) company could do within the context of a social media site that wouldn't actually be social media I would say at least 2/3 are just regular old, one-way, content-driven e-marketing stuff that pharma companies have been doing all along. So when I heard several ePharma Summit presenters last month suggest that it may be time to stop calling it "social media" and just call it "online marketing", "e-marketing", or "Internet marketing" I couldn't have agreed more. Calling a non-social marketing tactic "social media" just because it happens where others are engaged in social media only increases the perceived risk of the tactic and the commensurate legal and regulatory overhead required to actually get the tactic approved and launched.

Eventually, I believe it will be good for physicians, patients AND pharma to have a real dialog but until the regulatory liabilities are sorted out, much of what pharma will be able to do in Social Media will not be social.

Earlier this month, Google Adwords announced that it will no longer use PharmacyChecker, a physician-founded online pharmacy verification system that helps consumers navigate the potential perils of counterfeit drugs and fraudulent online pharmacies. Instead, Google will rely on an accreditation program of the National Association of Boards of Pharmacy. This is big blow for legitimate online pharmacies that aren't certified or would otherwise find it difficult to gain certification. Here's a link to the PR Newswire release from NABP and here is a local news station report on the issue.

Although print media and television have their own set of metrics, online media is measurable in a way that no other marketing tactic ever has been. From hits to clicks to opt-ins to downloads to occurrences to durations to repeats to progressions to... well you get the idea. It was clear from the presentations and from the discussions I had with attendees, pharma has very high expectations around the metrics of online media tactics. What was less clear was just which metrics were the most relevant or valuable. Certainly, rich metrics are a valuable source of data to understand, predict and adjust tactics. But just because you can measure it doesn't mean it will tell you what you want to know. Of course, the metric that matters most is scripts and the ingenuity pharma has brought to bear on the measure of script activity relative to marketing activities (both in the virtual world and the "real") is impressive to say the least. But are there ancillary returns that, over the long run, would also be important? What is the return on a supportive, value-add relationship with a physician. What's the metric for that?

Most folks I talk to agree that pharma has an image problem, both with physicians and with patients... and healthcare regulators and healthcare institutions... and maybe some patient advocacy groups and family members of pharma execs. Wow... that's a problem. I can't quantify the cost of that negative image but is suspect there are plenty of pharma folks thinking about it. How does pharma repair their image among physicians in the world that PhRMA has created? One component could be establishing a value-add relationship with physicians that doesn't involve dinners, pens and golf outings. But what sort of relationship can a pharma company have with a physician in the fragmented world of drive-by hits and clicks and downloads, i.e., a world without a persistent, stable, engaging network of physicians to be in front of and to provide value to. What would the ROI be for that kind of relationship and how would you measure it? I propose that a persistent, balanced, positive, value-add relationship to manifest in more product awareness and a deserved improvement in sentiment toward the brand.

A clear theme of the ePharma Summit in Philly last week was that social media is here to stay and that pharma engagement is no longer optional. Joe Shields, Pfizer Program Director and ePharma Co-Chair, was perhaps the most-compelling voice in this regard. He, along with others, suggests that expecting unambiguous guidelines from FDA/DDMAC anytime soon (or ever for that matter) is a fool's game and the prudent way forward is to decide at the company level what makes sense based on the organization's tolerance for risk and to set internal standards and guidelines... and just get started.

As more and more physicians embrace the Internet more and more often, pharma clearly has a strong interest in cracking the code on how to be present in the medium while staying on the safe side of regulatory constraints. The good news is that there are simple ways to engage physicians online with little risk of running afoul of the FDA. As I wrote in a previous post, it is not necessary to actually engage directly in conversations with physicians... just being there is sometimes enough. That said, I believe there is tremendous value to be had for both parties in fostering a more-robust and collaborative online relationship between pharma and physicians. We're beginning to see more and more of this and I suspect we'll see much a lot more in the near future.

A lot of ground was covered in the 3 days of the 2010 ePharma Summit in Philadelphia this past week. Over the coming days I will share in some detail my takeaways from that event but first here is a list of very high-level themes that I encountered at the Summit.

• Social media is here to stay and pharma is behind in both understanding and adoption.
• Waiting for the FDA to provide clear guidelines is not an option.
• Legal and regulatory risk must be managed but also should not be a barrier to getting started; pilot approach is key.
  
• Pharma generally agrees the measurement in social media is essential but is not sure precisely what to measure or what counts as success.
• Social media is a tactic, not a strategy, and should complement a brands overall marketing mix.
• ROI for social media is not exactly the same as for other media... but that's not a reason not to measure and set expectations.
• ROI on Brand.com sites and "ask your doctor about" has not materialize.

The ePharma Summit this past week in Philadelphia was a stand-out event -- well attended, well organized and... well... good. The topics presented were timely and salient, the speakers thoughtful and articulate and the attendees engaged. However, competing with the throngs of travelers trying to escape Philly after all flights out were canceled due to the record-breaking snow fall was no fun at all. But after four successive canceled flights over three days, two subways (including witness to a threatened knifing and two fist fights), a bus, a train and two stand-by flights I finally made it home very late on Friday night. And while there were no sheep, sirens, Cyclops or suitors in sight, I felt a little like Odysseus making his way back to Penelope after the Trojan War. Needless to say it's good to be home.

Over my next few posts, I will share some thoughts on the conference themes that I think are most relevant to industry participation in social media generally and online engagement with physicians specifically.