Unifying the prescriber influence network (part II)

Paul Jones, Jan Malek, R.A. Bavasso and Leo Herbette

Cisco and Exploria SPS

(continued from “Unifying the prescriber influence network (part I)“)

A Personalized Approach

So, if these are the challenges, what is the solution? We believe the way forward lies in greater personalization, enabled through the seamless integration of intelligent content management systems with unified communications. This approach adapts information dynamically to the needs of different physicians and provides them with instant, on-the-road access to a panel of clinical experts.

Intelligent Content Management

Many pharmaceutical companies already furnish their sales staff with electronic aids in the form of CD-ROMs on laptop computers, but these do not capture immediate feedback from physicians during the detailing session. Some companies have, therefore, started using tablet PCs enabled with content management software, which allows for a two-way flow of information—between the marketing function and the sales representative, and between the sales representative and the physician.


“The way forward lies in greater personalization…to dynamically adapt information to the needs of different physicians.”


Most of these companies still use tablet PCs for a limited range of activities, predominantly delivering interactive presentations and obtaining electronic signatures.21 But a few firms are now experimenting with “closed loop marketing” (CLM), which involves tracking potential customers through the entire lead-to-close continuum—by analyzing syndicated sales and market research data, mapping different customer segments, and refining the marketing messages to which specific customers are exposed (see sidebar “The Evolution of CLM”). This gives pharmaceutical company brand managers a much clearer picture of how prescribing physicians behave, so that they can direct their communications more effectively.

Nevertheless, the insights CLM yields may still be quite limited if the details to which it is applied are too heavily scripted. It is here that intelligent content management systems have a key role to play. Such systems operate on the premise that material should be “pulled” by the people who need it, in the manner in which they need it, rather than “pushed” to them by someone else. But they also provide sufficient control to ensure that the participants in the discussion do not stray outside the regulations.

Box 3

The system developed by Exploria SPS is one such example. It starts with a presentation that the sales representative can vary, within preset boundaries, in response to the feedback he or she receives from a physician during the detailing session itself. It also provides certain options from which the physician can choose, thereby encouraging the physician to participate in the process rather than remaining a passive observer.

The heart of the system, however, is a powerful set of behavioral algorithms based on adult learning theory and how physicians, in particular, learn (see Figure 2).22 These algorithms are used to analyze how a physician responds to a detailing session, thereby enabling the marketing function to fine-tune the promotional materials it develops for detailing other physicians. They are also used to identify the learning style of the physician, which allows the sales representative to tailor his or her subsequent interactions with that physician. After several iterations, it is possible to understand the learning patterns of individual physicians and deliver content that is shaped to their specific needs, without violating regulatory guidelines at any stage in the process. This approach represents a major change in the way details are conducted. It builds on previous experience and promotes a genuine, two-way conversation between the sales representative and the physician. That, in turn, fosters a sense of intimacy and facilitates a dynamic, ongoing dialogue that offers the physician real value and accelerates his or her learning.

Figure 2

Figure 2: Physicians go through four learning stages

Unified Communications

Yet, even with the help of sophisticated content management systems, no sales representative can anticipate and answer every question raised by every physician. Here, a second technology—unified communications—can help. The past two decades have seen a revolution in the way people communicate over distance, with the development of e-mail, instant messaging, text messaging, voicemail, audioconferencing, Webconferencing, and videoconferencing, in addition to traditional voice telephony. But these technologies use separate platforms, function in isolation, and do not take account of when or how different users want to contact each other.

Cisco’s Unified Communications technology overcomes these restrictions. It consists of an intelligent communications network that integrates data, voice, and video, enables people to communicate anywhere via any device, and accommodates their individual preferences regarding the means by which they communicate and the times at which they do so (see Figure 3). In essence, Unified Communications provides a single platform for multimodal messaging and long-distance collaboration.

Unified Communications has numerous applications, but its main advantage in this context is that it can be used to give sales representatives immediate access to knowledge they do not possess themselves. Pharmaceutical companies typically have access to such expertise both internally and through academia—the clinical researchers and trial investigators with whom they have already cultivated relationships. With Unified Communications, they can call on these key opinion leaders (KOLs) to support the detailing process.

Figure 3

Figure 3: Unified Communications Integrates Data, Voice, and Video

So how might this work in practice? Suppose that sales representative Jane Smith is visiting a physician to discuss the benefits of a medicine for heart disease. During the detailing session, the physician asks her a question about a pivotal study of congestive heart failure that she cannot answer. Using the Exploria application on her tablet PC, Jane accesses a list of KOLs on congestive heart failure who have been specifically “tagged” to the particular piece of content that generated the physician’s question and have agreed to participate in the physician education activity. Her screen shows which experts are currently available and how they prefer to be contacted.

Jane notes that Dr. Michael Green, one of five specialists on congestive heart failure, is free, and that he prefers to be reached via instant messaging. So she sends him an instant message asking whether he would be willing to answer a question from the physician she is meeting. When Dr. Green texts her back to say yes, she accesses a second button in the Exploria application to dial Dr. Green and initiate a conference call through the tablet PC. She can also set up a videoconference between Dr. Green and the physician she is detailing (if Dr. Green is near a PC equipped with a Webcam), thereby enabling the two doctors to discuss the question face-to-face.

In fact, Unified Communications can be used to address a wide range of queries, including questions about reimbursement procedures and other commercial issues best answered by a company’s internal medical, sales, and marketing experts. The key point is that it provides a way of using peer-to-peer collaboration to virtually expand the resources available to the sales representative during the detailing session, and to ensure that physicians receive the information they want, when they need it.


“This approach offers all the stakeholders in the detailing process greater value than the traditional sales and marketing model can provide.”


This could be especially helpful in emerging markets, where it is often harder to obtain clinical and other information than it is in industrialized countries. A sales representative detailing a physician in China, for example, could access a KOL in London for consultation. It would also encourage many physicians to collaborate more readily, since they would derive more value from the detailing process.

As a multi-pharmaceutical company study conducted in Europe shows, most sales calls do not give prescribers enough on-the-spot information. The study notes that pharmaceutical sales representatives often have insufficient information, material, and background knowledge to answer doctors’ questions—and while this may lead to useful opportunities for follow-up visits, it also causes undesirable delays in the flow of information and/or additional work and costs for the pharmaceutical company.23

Benefits for a Range of Stakeholders

Clearly, using intelligent content management systems that are fully integrated with unified communications platforms can accelerate the delivery of key information and enhance the value of the detailing process to influence the prescribing decision. It raises some important practical challenges and entails ceding a certain amount of control. Nevertheless, this approach has a number of advantages for physicians and pharma alike:

Prescribing physicians: It would give physicians pertinent, “in-context” information tailored to their immediate needs and access to specialist knowledge at the point at which they can benefit from it. Information presented in this manner can encourage greater message retention and lead to increased physician knowledge.

Pharma: It would put pharma in a better position to understand what physicians really want and to target them more accurately, while also enabling smarter use of the KOLs with whom it has already formed relationships. In addition, this approach would allow pharma to accelerate the sales cycle and deploy fewer sales representatives more effectively.

Sales representatives: It would enhance the value sales representatives add, as well as giving them the opportunity to learn from the dialogue between KOLs and prescribing physicians.

Key opinion leaders: It might enable KOLs to learn from the practical nature of the questions posed by the prescribing physician. In one recent global survey, KOLs reported that their primary reasons for working with pharma were to acquire and share knowledge, and improve the care they could give their patients (see Figure 4).24

In short, this approach offers all stakeholders greater value than the traditional sales and marketing model can provide.

The Potential of the Web

The approach we have outlined above could also be used to enrich online details and to support professional networking forums—changes that could ultimately have an even more far-reaching effect. Although pharma has been slow to tap into the potential of the Web, the medical community has actively embraced it. The American Medical Association reports that 85 percent of U.S. physicians have high-speed Internet connections at work, 44 percent log on to the Internet for work purposes several times a day, and 86 percent of those who use the Internet like e-detailing. In another survey of British GPs, e-detailing also proved popular.26

Box 4

Access to the Internet is growing rapidly in the emerging markets, too. The number of Internet users in Asia Pacific is set to top 500 million this year, with China overtaking the United States as the most populous Internet nation in the world.27 The Internet is a powerful tool, but pharmaceutical companies have yet to take advantage of it properly. Using intelligent content management systems integrated with unified communications, they can improve their understanding of what individual physicians look for, both online and offline, and start capitalizing on the power of multichannel marketing.

The way in which medical information is disseminated, however, is changing dramatically (see sidebar “The Wonderful World of Web 2.0”).28 The advent of new Web-based technologies has stimulated the development of social networking sites where users can generate and distribute their own content, and several such sites have emerged specifically to serve the interests of physicians. One of the best-known examples is Sermo, which was founded in 2005 and had an estimated 41,000 members by the start of 2008.29 The site allows physicians to post clinical questions and draw on the collective knowledge of their colleagues, thereby accelerating the emergence of new insights into medications, devices, and treatments.

Figure 4

Figure 4: Clinical Leaders Work with Pharma Primarily to Acquire and Share Knowledge

Equally noteworthy is that most of those who post professional content online tend to be older and more experienced than the average physician. Sermo’s heaviest users, for example, are physicians aged 45 or older, and they outnumber younger physicians by three to one.30 In short, they are the physicians who are most influential.

This has profound implications for pharma. Social networking offers the industry the potential to reach a large number of physicians rapidly and economically—either by establishing its own communities of interest for specific conditions or by tapping into existing professional networking sites, as Pfizer has recently done (see sidebar “Pfizer’s Bold Move”).31 As other communities of interest emerge, the industry could also start forging dialogues with some of the new agencies now influencing the prescribing decision, which would better equip it to understand their needs. That, in turn, would result in greater collaboration—and, ultimately, benefit patients.

Box 5


Communications technologies are transforming the way in which we share information and collaborate. Sophisticated content management systems, data mining, and analytics are changing how we use that information. Together, these trends are making the world increasingly transparent. They also have a huge bearing on how pharma promotes its products.

The industry has traditionally invested most of its marketing resources in a detailing model that aims to manage the information it gives physicians—whether they receive it face-to-face or electronically—very closely. In the future, however, pharma will have to engage in a genuinely open dialogue with healthcare professionals and other stakeholders, because the discussions that shape prescribing behaviors will take place anyway. If pharma tries to control the discourse, it risks being excluded and ignored. If, on the other hand, it participates in an open dialogue with physicians, it will gain the invaluable insights it needs to play a part in influencing how medicines are used.

References (cont. from part I):

21. “Tips for the Tech-Enabled Sales Force,” Manhattan Research, 2007 http://www.manhattanresearch.com/ePPWhitePaper.aspx

22. “How Physicians ‘Learn’ from Pharmaceutical Representatives: An Exploration,” H.B. Slotnick and Arlinda F. Kristjanson, Journal of Continuing Education in the Health Professions, 1999, 19 (2): 84-96

23. “Potential Benefits and Challenges of E-detailing in Europe,” Roger Heutschi, Christine Legner, et al., International Journal of Medical Marketing, July 2003, 3 (4): 263-273

24. “What Do KOLS Really Want?” Martin Skelton, Susan Byrne, et al., supplement to Pharmaceutical Executive, September 2007, p.12

25. “E-detailing: How to Stop Worrying and Love the Internet,” eyeforpharma.com, January 7, 2008

26. Paul Jones and Nic Holladay, op. cit.

27. “500 Million Internet Users in Asia-Pacific,” Ben Macklin, emarketer.com, February 12, 2008 http://www.emarketer.com/Article aspx?id=1005929&amp,src=article1_newsltr

28. “Physicians and Web 2.0,” Manhattan Research, 2007 http://www.manhattanresearch.com/ttpwhitepaper.aspx

29. “Physician Websites Evolve,” Christopher Guadagnino, Physician’s News Digest, January 2008 http://physiciansnews.com/cover/108.html

30. Ibid

31. “Pfizer Follows Docs Online with Sermo,” Scott Hensley, The Wall Street Journal, October 15, 2007 http://blogs.wsj.com/health/2007/10/15/pfizer-follows-docs-online-with-sermo/

About the authors:

Paul Jones (based in the UK) and Jan Malek (based in the USA) are directors and co-leaders of the Global Life Sciences Practice in Cisco’s Internet Business Solutions Group. They may be contacted at pauljon2@cisco.com and jamalek@cisco.com respectively.

R. A. Bavasso is President of Exploria SPS and Leo Herbette is CEO of Exploria Inc. They may be contacted at bavasso@exploriasps.com and herbette@exploria.net respectively.

About Cisco IBSG

The Cisco Internet Business Solutions Group (IBSG), the global strategic consulting arm of Cisco, helps CXOs and public sector leaders transform their organizations—first by designing innovative business processes, and then by integrating advanced technologies into visionary roadmaps that address key CXO concerns.

For further information about IBSG, visit http://www.cisco.com/go/ibsg.

About Exploria Sales Performance Solutions, LLC

Exploria SPS™ offers sales performance solutions for mobile technologies and web based solutions to the pharmaceutical and medical device industries. Exploria SPS created its second generation tablet PC detailing solution for use in a Continuous Loop Marketing™ environment in direct response to customer dissatisfaction with the first generation offering. Focused on The Science of Detailing™, the Exploria SPS solution enables interactive detailing using native media and algorithmic logic to determine presentation of appropriate content in multiple venues based upon physician response. Exploria SPS now offers a portfolio of sales and marketing channels to accommodate the market need for an optimal channel mix.

Exploria SPS is headquartered in Hartford, CT. For more information and online product demonstration, visit http://www.exploria.net.

Copyright 2009 Cisco Systems, Inc. and Exploria SPS, LLC.