Can the iPad Save Sales?

For the past five years pharmaceutical sales has had precious little good news. Waves of declining access to physicians, mergers and acquisitions, the patent cliff have all led to declines in sales force and plateaued sales numbers. Enter the iPad.

Of course, pharma is not alone in pinning great expectations on the iPad. According to a recent report by Morgan Stanley, the tablet market is predicted to explode to as many as 100 million devices in 2012. Those tablets—by all accounts mostly iPads—will be found not only in consumer households but in various workplace settings as well. But that still doesn’t answer the fundamental questions for the pharmaceutical industry: Can the iPad save the pharmaceutical sales channel or does pharma have its head in the cloud?

Given the growing buzz around the iPad impact on sales, in July we devoted an episode of Pharma Faceoff to the topic. Joining me in the conversation were Bojan Zuzek, chief information officer for EKR Therapeutics; Neeraj Singhal, vice president of product management and Innovation at Cegedim Relationship Management; and Ross Quinn, managing partner and director of customer integration at Concentric. In all we spoke for more than 45 minutes on the topic, while fewer than 15 minutes made it into the Pharma Faceoff episode. What follows is the transcript of much of that conversation, with minor edits for style and grammar.

So, will the iPad save the pharmaceutical sales force?

Bojan Zuzek: I don’t think so. I think it’s a novelty that is currently very well received by physicians because it’s something new; but once you’ve been around with the story a couple of times, you have to develop a continuous program of communications and be very smart how you engage the customer. It’s not going to last for very long.

Neeraj Singhal: I tend to both agree and disagree with Bojan. I agree that iPads alone will not be able to save the pharma industry, but I think the combination of iPads with great applications that are user friendly and rich media, which could be provided to field users will provide great opportunity for pharma sales reps in the future.

Ross Quinn: You do hear a lot of talk about the innovation. Innovation is great. I have my iPad. But, really relevant content is important. If you really want to influence behavior, having content that the physicians can really connect to is equally vital.

Is this a fundamental shift in technology for pharma or are we just talking about the next generation past the previous tablet PCs?

Singhal: In terms of innovation, iPads have provided really great opportunity, and that is primarily because of three things: Mobility with family that is powered by powerful devices, frictionless delivery of applications and content, and the capability to have these devices always connected. These factors didn’t exist before. So this is a paradigm shift in terms of technology, which will help the pharma sales rep.

Quinn: I would agree. It has really made the transition to tablets a lot easier. They’re a lot more efficient and helping the transition from a paper world to a digital world.

Zuzek: It’s the first device that is “human” from a design perspective. This is how we want to interact with technology. You want to feel it, you want to touch it. And the fact that it’s instant on I think is an extremely important factor. When you’re a sales rep, you do not have any time to waste powering some machine up.

Singhal: The adoption itself shows that how powerful and different these devices are as compared to the past. Physicians historically were not used to using technology; but the adoption that we are seeing with physicians is immense.

Zuzek: But it’s also a challenge because right now you have a situation that if, for instance, a pharmaceutical company is not very aggressive in adopting this technology, you have a sales rep that looks positively ancient. That’s not going to look very good.

Quinn: You need to be as innovative as your product.

Zuzek: Absolutely. The pharmaceutical industry is being forced into this; and the faster they adopt it, the better.

Who you think of as the iPad’s customer: Is it the rep, the physician, or the patient?

Zuzek: All of them. One of the things that we can see is that pharmaceutical industry was very slow in adopting technologies that bring it closer to patients. They haven’t broken down that barrier yet; and if that void is being filled now by other means and it’s not driven by pharmaceutical industry, it’s driven by entrepreneurs, by some medical association or so trying to help patients manage their conditions better and pharma is kind of just nowhere. They’re absent in that field.

Quinn: It really makes a difference on the whole practice dynamic for the physician and the patient being able to have your iPad right next to the patient, access their medical records, show them demonstrations of their condition, handle prior authorizations, prescribe medications. It really creates a much more dynamic patient/ physician relationship.

Singhal: From a CRM solutions point of view, our focus is primarily the primary care reps and so the pharmaceutical industry and their customers, which is healthcare professionals. And we see that iPad provide a great way of collaboration between the field user and the physicians. It is one device that the physicians and rep could work on and see together, which forms a bond, more collaboration, better relationships.

So you don’t mind it if when they open up their iPad it’s Tap Zoo or Angry Birds that’s the first thing that emerges there instead of their detail?

Zuzek: Well, let’s put it this way, we put a pretty rigorous policy out there in terms of what is appropriate content and so on. But they are relationship managers, so if the doctor is an Angry Birds fan, and you have the latest version, maybe that’s not a bad intro.

Does the iPad pose different kinds of challenges that we perhaps haven’t really thought about before?

Zuzek: Well, I’ve taken an interesting approach to that. I said, “Okay, use it as a personal device,” because I want to increase the adoption. I want them to really live with that thing as if it were their own machine. But at the same time, then you have to manage everything else, all the other assets. I agree with Neeraj that at least the environment, from a technology perspective and from an app development point of view is a lot more robust than anything else that’s out there. I would not even look at an Android tablet.

Is this technology changing the nature of how technology is being served to pharma?

Singhal: Cloud computing will make this innovation move forward at a much quicker pace. It certainly will trigger solution providers and pharma companies into thinking how we can leverage the cloud and combine it with this novel device, which is always connected to download content or to download information to field users that is most current. And that capability is certainly available now, and it wasn’t available before.

Zuzek: But it does pose a challenge, right? It becomes a much more unmanageable security situation. It’s not just the fact that you will have your information assets somewhere else, but, once this iCloud goes into operation, there is no way of telling what the users are going to do themselves. You may have policies and everything else in preventing issues, and they will sync up with some service somewhere out there and the information is gone. Not lost, but it’s no longer under your control.

Quinn: But that could also happen today with even printed pieces and the current tablet.

Zuzek: Oh, I agree with that.

Singhal: On the other hand, I think it provides convenience because if I have an iPhone and an iPad, I don’t have to worry about keeping things in sync. I don’t have to email myself, if I’m transferring information from one place to another. It all happens behind the scenes. And we think about this as being something that should always have been available, but it was never available. So now that it is going to become available, I think it’s going to remove one burden from field user’s mind where they have to keep things in sync. It’s always going to be available on the device that they have in their hand to talk to their customers.

How does this change the role of the rep? When you have powerful applications that can walk them through a detail, do you really need a rep?

Quinn: I think a great rep builds great relationships with their physicians, and the technology just allows for more relevant content. If a rep knows that a physician might be more into patient stories than clinical data, you could actually design your presentation to focus on that first and balance it. So I think it just enhances the relationship versus hurting it.

Singhal: This is a great tool that is going to help the reps have better relationships, but it is in no way going to do what some people have at least talked about: Replacing the rep. I think it will augment the relationships. People in the end like people. People like to talk to people. Healthcare professionals like to talk to reps. There have been multiple surveys, and it has been confirmed that they would like to talk to the reps.

Zuzek: We’ve had this going for six months already in the field. And we have 30 tracks out there that they can use. When we recently conducted a study to figure out really how we should improve it further, one of the key finding was the need to navigate out of sequence. To be able to jump around and respond to physician needs— that’s the primary responsibility of the rep. You need a human there making decisions.

Is this providing new data on what is actually happening as the sales reps are in their sales calls?

Zuzek: When you implement something like this, then doing the call notes and call recording a week later no longer applies. You’re capturing information as you speak, as it happens. So that really tells you something about where that call was made, what was discussed, how it was presented—everything. It’s very valuable.

Singhal: If they have the right application, the CRM tool, it’ll certainly make them more efficient. They can be ready when their customer is ready. In essence it empowers customer to build interactions, which was not possible before, especially in a specialty rep or hospital setting. It is important where the reps are able to have a conversation with the healthcare professional even when they are walking from one area of the hospital to another area, which was probably not possible before.

Zuzek: And it gives them the opportunity to build a network. This is another social ecosystem that is emerging. And I don’t think that we know exactly how to deal with it from a regulatory point of view because the government isn’t quite ready to figure out how to do that, so we’re using commonsense and some logical.

But it’s a completely new multichannel world. The face-to-face interaction is no longer the only thing. This set of technologies powers up a much longer engagement with the customer because there are follow-ups, so the prequels there are sequels.

Do you see this as a tool to improve the efficiency of how companies are managing their sales force too?

Singhal: This tool certainly provides all the capabilities to pharma companies to enhance and improve the efficiency of their field force. Serving the right content, having the right application, having quick interaction, customer-driven interaction—these are all capabilities, which will make pharma reps more and more efficient. The reps have the capability to see where they are, who their next customers are, and whether the customer is available. If an existing customer is not available they can go to the next best customer they can find.

The system is there, the applications are there that will help improve the efficiency. And this is just the beginning. We think that there is going to be more and more innovation in this area moving forward.

How do you make sure that this remains a vibrant technology that continues to engage the physician?

Quinn: By having tools that really help the physician with their practice and help them connect with the consumer, with the patient. So it’s not just an app or a tool for a drug or medication. It’s more for a condition or more holistic for the practice. And let’s not forget the patient. Thirty percent of all mobile healthcare searches are done in the waiting room. So the patients in the waiting room, they’re on their phone, they’re looking for information. They’re in the exam room waiting for the doctor. It just enables them to connect on a common platform.

Zuzek: I completely agree with you. This is where the industry is missing the boat big time because the adoption of technology in the physician’s office is increasing. Electronic medical records are happening whether the government mandates it or not.

When the physician and a patient really are interacting it would be an awful lot better if the patient could come back with a diary that describes the condition a lot better than words can. You can see facts, you can see details, you can reach better therapeutic decisions; and you can increase the awareness component of managing a patient.

If you want to reduce the healthcare costs this is an obvious choice, but nobody is stepping up to the plate and really driving that initiative forward, except maybe some insurers and plans are now beginning to act on those sort of things.

Singhal: Historically technology used to be a barrier between the healthcare professionals and the pharma reps because they were either using paper or different technology. But with the adoption of the iPhones and iPads by the healthcare professional, that barrier is gone. So it’s more about support of both the sides are comfortable with the technology. It’s now about how do you use that to establish better relationships?

It has started with additional promotion and closed group marketing; that is the first phase. But we see a transition where this technology could lead to further innovations. And in terms of having new ways of detailing with physicians or having discussions with physicians, more services that are location based using augmented technology, augmented reality that is coming up as part of this new device. The opportunities are huge. We are just seeing the beginning of it right now.

And do you see this as actually integrating with other technology trends like electronic medical records?

Zuzek: Oh, I think so. Before long doctors are going to be walking around in their practices with iPads and not laptops.

Quinn: And it’s starting in the medical schools where they’re giving the medical students iPads for all their textbooks, and they’re beginning to use them as part of their everyday practice. It’s only going to become more prevalent, and it keeps the physician next to the patient at all times. They don’t have to walk away to a computer or to another room. It really forms that connection a lot stronger.

Singhal: In terms of EMR and pharma, I think this is something new in our opinion. The intersection of that probably has not been explored further. This was one of the topics of our discussion in the innovation council that we held with the senior pharma executives [last month], and there seems to be a lot of interest. So if the physician is going to carry one device, which is going to be an iPad, how can pharma find a space on that stream and have the conversation with the doctor or how can the doctor reach pharma using the iPad? That’s innovation I think that we’ll see more and more of in the future.

Zuzek: You really have to have a very good communications policy and figure out how you’re going to manage your channels. And then this set of technologies and tools will really elevate to the next level. Just the novelty just say, “I have a new product detail,” and you come around once or twice. I mean, that’s not going to do it. You have to package the whole thing together.

Quinn: And something even as basic as having mobile-ready sites. I mean, we’re talking about apps, but even having a mobile-ready site where a physician and a patient can go quickly and get the information that they want most companies don’t have mobile-ready sites right now for the medications. And that’s vital.

Singhal: Over a period of time we see that this technology will evolve more from a one-way selling platform to additional sales platform; and there will be multiple channels, as Bojan just talked about and we just heard where the healthcare professional will have their preferences and pharma would need to find a way of communicating with that healthcare professional based on their additional preferences. It’s not going to be a simple, face-to-face detail, which it historically was. We’ll see tremendous efficiencies, in our opinion, for pharma and more new ways to connect with the healthcare professional.

We started by pointing out the challenges for pharma sales. I can’t imagine how the iPad will actually save the pipeline, but maybe that’s somewhere down the road. It sounds to me, though, that the three of you agree that this could actually increase access after years of decline. Is that accurate?

Singhal: It certainly provides a huge opportunity for pharma to innovate on a new technology that never existed before. So there is opportunity and we are sure that working with pharma solution providers like ourselves will be able to provide new and innovative solutions on an ongoing basis.

Quinn: I think it allows the pharma companies to serve up relevant content in a platform that the physicians are open to and are used to engaging with.

Zuzek: We’re getting conditioned to immediate response. If the sales rep is smart and the company is smart then they can provide an infrastructure in there to be able to really satisfy the information needs or whatever the doctor has very quickly.

Quinn: It’s coming down to the sales rep being able to manage that relationship, understand the needs of the customer.

Zuzek: Sure. It’s the relationship management.

Quinn: Right. And the technology serves up the relevant content.

Zuzek: If reps are worried that their jobs are going away: They aren’t. The job is just changing, morphing. If you don’t change with it, then the consequences will be pronounced I think. So the access will be given to whoever is of most use, or most service to the physician.

Quinn: It also gives the access a longer tail where we see in the multichannel approach that you’re talking about where the interactions within the detail could then trigger follow-up emails, communications, invites. Exactly, so it actually extends the access beyond that call.

I guess in some ways the iPads, the iPhone it’s all about the apps itself. Do you have thoughts on what your killer app for pharma would be. Is there something that you’re looking for that you would like to see for someone to develop?

Zuzek: Ah ha! You used the wrong word there, killer app. No such thing. There is an app for that. I mean, this is what Apple brought up, so the "megillah" of all applications does not exist.

The application has to be simple. It has to be absolutely focused, targeted, and immediate. If you can do those sort of things, then you will have a number of those. So that’s what you need, not one application. It’s not going to change anything. I think you need a whole bunch of those sort of things for specific purposes. And then if it’s of use to the physician, well bump the phones together and transfer it. That’s what you should really aim for.

Singhal: In our view, the killer app or the most useful app for the pharmaceutical field force will be one where the reps are not only able to have the most efficient conversation with their customers, but also complete their day-to-day tasks. So it’s going to be a single device environment now and moving forward. The reps spend about 20 percent of their time in really communicating with the healthcare professionals and the remaining 80 percent of the time they have to either complete their customer information or analyze data or look at other information that has been passed in the home office.

We feel that an application that provides all the capabilities to the users in both of these areas will be the ultimate thing that the reps would use. And we have an application like that in the field, we continue to enhance it, and we’ll get some feedback from pharma companies.

Zuzek: Now from an internal point of view, I agree with that. I was thinking more about what you do with the customer.

Quinn: From a customer’s point of view, I agree, single focused in really understanding what objective are you trying to accomplish. If a physician can have 1,000 apps on his tablet, he ought to know where to find them or where to go. So really understanding what will improve their practice and what will improve their patient care and really zoning in on that objective is key.