Physician key opinion leaders (KOLs) have been viewed as a valuable resource in the pharmaceutical (heretofore referred to as Pharma but included are medical device companies) industry. In one study in which 100 KOLS were surveyed, the most important characteristics of a KOL were: “regularly sought out by their colleagues for opinions or advice, speak often at regional or national conferences have published articles in a major journal during the past two years, consider themselves early adopters of new treatments or procedures and help establish protocols for patient care.” In another survey of KOLs in endocrinology taken in 2011, by Thought Leader Select, a KOL consulting firm, 70 percent of veteran KOLs reported that they preferred and expected contact primarily with industry executives or a medical science liaison, versus sales or marketing. Digital Pharma devoted approximately 3% of marketing budgets to Digital in 2013. But did anyone ten years ago think that 60% of retail sales would be via the Internet? Digital Pharma marketing currently is generally categorized as patient-focused or physician-focused. There should be a third and possibly even more effective strategy, that of targeting the patient-physician engagement team. Multichannel marketing will thus also include hybrid customer group marketing. Physician KOLs will blaze the trail laying the foundation for provider acceptance of shared decision-making. Pharma is in a unique position to facilitate adoption of patient engagement on both provider and patient fronts. Payers can do this but not as easily on a mobile digital level and not easily at the point of care. These new KOLs will not displace traditional ones but will compliment them. There will be segments of both provider and patient populations which are less (hopefully just initially) receptive to digitally-based marketing tools. These KOLs will have respect by peers on a medical level and will be faces of patient advocacy. They will help physicians adopt the tools as well as work with digital technology tool clinical investigators. I would like to discuss some fundamental arguments for the establishment of physician Digital KOLs.
- The efficacy of mobile apps should be evaluated with clinical studies. This will be a new necessary focus of healthcare in the future, from both marketing and clinical outcome perspectives. Mobile apps directed at disease management will likely find themselves on formularies of payers as well as hospitals, similar to drug formularies. One expects that positioning on such lists will be tied to clinical effectiveness (and cost to a much lesser degree than drugs or devices). Clinicians will always ask “Has it been shown to work?” Physician Digital KOLs are those who will present the proof. They will be developing and leading studies (at much less cost and regulatory hurdles than drugs) which evaluate both clinical outcome as well as the user (provider, patient, and caregiver) experience aspect.
- Physicians are at the crossroads of all things medical and Digital. The EHR is seen as the Digital hub of healthcare today. At one point in time this will no doubt shift to the patient portal. The patient portal will ideally become the gateway to connected health data from wireless glucometers, vital sign monitors, more sophisticated sensors, and other patient-derived filtered data. A patient-facing Digital tool will have maximal success of adoption and adherence if recommended by a physician. The clinical loop around the app (pertinent actionable data provided by the patient and hopefully generated treatment recommendations) will necessarily flow through the clinician via the EHR.
- KOLs provide the best insight into clinical and workflow problems addressed by digital tools. There is no more obvious an example of a potentially great digital tool that has not been well-received because of its difficulty in conforming to clinical work flow than the electronic health record. It was designed to address regulatory and reimbursement issues, not conform to the way care itself is delivered. Success of digital tools is dependent upon their insertion into clinical workflow (best done at the point of care). In addition, processes need to be in place to support the tools. Patient behavior determines whether the tool is downloaded and revisited. Adherence is not a new problem. However I would submit that determinants of adherence to medications differ from those of a digital tool. Knowledge about the user experience, connected IT issues, and the education of an entire provider community about mobile health in general are unique to Digital. The impactful integration of a comprehensive digital strategy into Pharma will take years. It will accelerate with the partnership of Pharma companies with other disciplines (mobile health, behaviorists, user experience specialists) and the presence of physician KOLs.
- It’s not about the product; it’s about the human experience. As noted above, success of digital tools ultimately hinges on behavior tied to patients consistently using the digital tool and viewing it as a beneficial part of the life experience, translating into enduring motivation. The physician is the human element between the digital tool and the patient. They must be an integral part of delivering the tool and providing the environment in which the digital experience is nurtured and developed. Empathy (much lacking in healthcare today) can be transmitted to a patient only via a human interaction. Suggesting a digital tool to the patient or caregiver conveys empathy by engaging the patient in new ways. KOLs can provide the support, encouragement, and clinical rationale for the adoption of these technologies to their peers. In this way, the human experience of the provider using these tools is improved as well.
- Patient engagement necessarily involves the physician. Patient engagement can best be defined as “actions individuals must take to obtain the greatest benefit of healthcare services available to them.” Implicit in this definition is that the best information (and tools communicating it) has been supplied to the patient. The best patient care includes shared decision-making by an engaged patient. The physician closes the loop and is a therefore a critical component of the patient engagement tool. Physician Digital KOLs are most appreciative of the role of digital tools in the developing focus of patient engagement. A tool is a solution only if used in a context of patient engagement. Teaching how these tools can therefore be turned into solutions by providers is the mission of physician Digital KOLs.
It is clear that Pharma sees the patient (and the public) as customers. If the ‘sale’ is disease state awareness, that can be accomplished (within the framework of digital and health literacy considerations). However, the next step is adoption (i.e. filling the prescription) and then adherence. Here is where the rubber needs to meet the road. Digital will succeed (on many fronts) more than traditional channels. However, a new breed of marketer as well as KOL is needed. I call upon Pharma to help take patient engagement to the next step via a new unique marketing strategy.