Tech Toys 2: Revenge of the App

When Apple CEO Steve Jobs heralded the age of the mobile application two years back, few had a clue what it would mean for the way people consume media, advertising, and information. For years, we've been reading about the benefits of using mobile apps in the pharmaceutical space; gallons of ink have been spilled predicting how physicians will one day meet with patients with a stethoscope in one hand and a tablet PC in the other, or how sales reps will be able to detail doctors by beaming clinical data through their Palm Pilots.

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Still, those heavily hyped plans remained pilot programs, and mobility never seemed to catch on. And then came the iPhone. Within a year, the app went from concept to fruition, sparking billions of microprograms that do everything from play games to balance your checkbook. It's official: The age of the app has arrived.

According to a recent report from Manhattan Research, in 2009, more than 20 million adults used a mobile device to search for health information. That number is pretty staggering considering high-speed Internet access for phones has only really been around for a handful of years.

"There is nobody that I know [in the pharma industry] that isn't working on a concept design; an RFP ... there's definitely a great deal of interest in looking at where application fit into the communications mix," explains Ignite Health founder and CIO Fabio Gratton.

Pharma has traditionally struggled with online adherence and compliance programs. Only a fraction of patients sign up for the Web-based programs, and too often patients view the sites as marketing ploys. With mobile applications, however, patients can access programs whenever and wherever they wish, removing the biggest challenge for pharma marketers—getting the patient to remember to access the content.

Designing the Perfect App (GETTY IMAGES / SCOTT DUNLAP)

"Applications are easy to use, updatable, and mobile—they just make a lot more sense than a Web site that patients may or may not visit," says Nima Farzan, US head of marketing for vaccines and diagnostics at Novartis. "One of the neat things about the platform is that it really opens our eyes to some innovative ways to reach out to people. There was probably nothing stopping us from having a [Web] program like Vaxtrak available three years ago, but it took something like [the iPhone] to show that mobile applications can really address a problem—which in our case was to raise immunization rates."

Physician Adoption

Manhattan Research data shows that, as of this year, 72 percent of US physicians own smart phones. And that's likely to increase to 81 percent penetration by 2012. Currently, the RIM Blackberry and the Apple iPhone are neck-and-neck in terms of physician users, but Google's Android platform is creeping up, albeit slowly. PALM also has an app store, but its numbers are far from healthy.

Healthcare applications have strong potential for use among physicians, says Monique Levy, senior director of research at Manhattan Research. "You see doctors using their phones to check a drug reference or clinical data, or snacking on content. And the majority of physicians that use the Internet during patient consultation are doing so on a handheld device. Pharma is extremely interested in this. The industry gets that for physicians smart phones are a critical channel and must define what they are offering."

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According to Manhattan Research, physicians' professional use of mobile devices is primarily for research and reference-checking purposes; they generally leave more complex activities like CME and social networking to their PCs. But as mobile browsing capabilities improve, physicians will start to use smart phones for more advanced activities. By 2012, about half of physician smart phone owners will use their devices for administrative functions, learning, and patient care.

"I don't think anyone would have predicted this type of adoption rate a few years ago," says Rose Crane, CEO and president of Epocrates. "But there are so many apps in the healthcare category. Once you get past the second page of apps in the iTunes store, you get buried. I think the idea of 'If you build it, they will come,' is not always true. [Doctors] need to see value in the application."

The top applications for physicians include drug reference programs from Epocrates and Medscape; more apps should start springing up for patient monitoring and clinical data dissemination, as well as those that help doctors run the business of their practice.

"Physicians have always been ahead of the curve in terms of using applications for checking drug information," Levy says. "It's going to be interesting to see how things change when electronic medical records are adopted and how detailed content creation will be done on a larger device like the Apple iPad."

The challenge with healthcare is that it's such an information rich medium with electronic medical records, etc, but everything has always been hidden behind firewalls and in proprietary systems—the data wasn't accessible. Farzan says, "What we are seeing with mobile platforms, and the concept of these app stores, is a way to break through these barriers of segregated proprietary data."

FDA on Apps: Dabbling in a Gray Area (GETTY IMAGES / SCOTT DUNLAP)

Joe Volpe, director of marketplace innovation at J&J agrees, going as far as calling remote healthcare "the future of healthcare." "You're going to see a push towards things that can be done in the home to get the patient more involved in the process, and that inform and educate them," he says.

Epocrates knows that very well: They've been in the game for close to a decade, having originally launched their mobile physician resource on the Palm Pilot. The reference program is designed for doctors to use at the point of care to look up more than 4,200 monographs. About 180,000 of the 275,000 Epocrates users are using the program on the iPhone.

"The iPhone, when it came along, just accelerated the use of drug reference tool by physicians, because so many doctors adopted the iPhone," Crane says. "We have a product called DocAlert Messaging that pharma companies can sponsor. One in four of the clinical messages are sponsored by a pharma company."

Within the app, Epocrates offers technology that allows pharma companies to message physicians directly. These sponsored pharma tools include mobile detailing and a product called "Contact Manufacturer" that allows a doctor to reach out to a manufacturer for more information about a drug.

"The phone is a great tool for messaging because everything is approved and we work with the regulatory departments to make sure everything is okay to release," Crane says.

Is There An App For That?

So far, the few apps that have been released for consumers have been healthcare information dissemination tools, which have little to do with marketing regulations.

"What you are seeing at this point is a recognition from pharma that it needs to change the way the companies are working and talking with their customers," Myers says. "People have come out with unbranded work that is about disease state support, which it appears as if pharma had stepped away from. The apps from Sanofi-Aventis and Novartis are on the cutting edge—they're using GPS-based technology, which is all the buzz right now."

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Early applications were one-way conversations, but things have changed and new apps that really integrate into peoples' lifestyles are beginning to appear on the market.

"That appears to be the best way to reach your customer," says Marty Hardim, senior vice president, creative director of media lab at Palio. "You're not delivering a message, but you're helping patients."

The most remarkable, and useful, applications will be connected to tools like biometric sensors, Gratton hypothesizes. "Suppose I'm an Alzheimer's patient. My mobile app can constantly monitor my GPS position. If I lose my way, the app can set off a trigger that alerts caregivers about where I am.

"We are already seeing things like this on the market, but we're probably 12 to 18 months before we start seeing pharma companies create apps like these and release them on the market."

APPLICATION SPOTLIGHT #1

Sanofi-Aventis

GoMeals

Sanofi-Aventis worked with inTouch Solutions to create an application that allows users—particularly people living with diabetes—to track their calorie intake. GoMeals is part of a campaign that includes a interactive Web site and a YouTube channel.

"Applications are just as popular in the diabetes community, so we looked at challenges that patients face where mobile could be used," says Lynn Crowe, senior product manager, diabetes marketing, Sanofi-Aventis.

One of the biggest challenges for diabetes sufferers is carb-counting—the process of making sure they know how much carbohydrate they are consuming, which correlates to the amount of insulin that must be injected. While there are plenty of books and Web sites that can help, few patients can figure their carb intake at a restaurant or do the math on a foreign food they don't eat on regular basis.

"It's a daunting task that takes years of practice. And people are still not always accurate," Crowe says. "[GoMeals] takes a tool that was well developed on Web sites and puts it in the hands of people when they need it, such as at the grocery store or when they're having dinner with friends."

The other big challenge was to create a program robust enough to best the other calorie-counting apps on the market. To do this, the team joined forces with CalorieKing and built a database tailored to the diabetes community.

Sanofi-Aventis talked with patients and dieticians to determine the perfect mix of tools for the application. These include: a calorie goal, the ability to track against that goal, and a way for patients to understand the percentage of the breakdown of the calories that they eat each day. Additionally, the app lists menu items and nutritional value of more than 40,000 food items. If there's a restaurant that a patient would like to see in the app, they can simply send a tweet to SA's GoMeal's Twitter account, and the team will try to get it into an upcoming update.

The company made a concerted effort not to focus on the disease state on the app, and instead tailored the program around making good choices, which, according to Crowe, is a far less daunting task when you are working with a disease that will last a lifetime.

"There's a bit of a philosophical intention to remember that folks with diabetes are living their lives like everyone else," Crowe says. "And we just want to get the tools in their hands to remove some of the barriers they have when they are trying to be successful with their disease management."

APPLICATION SPOTLIGHT #2

Novartis

Vaxtrak

As one of the biggest vaccine providers in the industry, Novartis is well aware that parents face a huge challenge keeping to vaccine schedules for infants and adolescents. Between booster shots, immunization shots, and flu vaccines, it's very easy to forget a dosage.

Enter VaxTrak, a vaccine tracking application that updates caregivers about the latest vaccine information, keeps track of their children's vaccinations, and finds a local vaccination center. Launched in early 2010 and officially promoted as of May 1, Vaxtrak has already been downloaded by 3,000 people—and that's with very little promotion.

According to Farzan, the three main reasons for pharma to consider using the Apple platform are: ease of use, automatic and painless updates, and a built-in maps system that allows patients to identify nearby locations and get directions. Beyond vaccine centers, pharma can use apps to help patients find specialty physicians, healthcare centers, and clinics.

The application eschews traditional branding; it states that it was created by Novartis, but there is no Novartis logo and zero product branding anywhere on the program. The company also made sure that the program includes all vaccines, not just those it provides.

"We decided that the application should not be about one vaccine or another, but around the whole schedule," Farzan says. "But we had to be careful about making sure that the vaccine schedule is up-to-date and can be further updated if the CDC makes a change recommendation."

Parents can change a schedule if they don't want a vaccine at a certain time. And while it does list CDC's recommended schedule of vaccination, Novartis made sure that it didn't appear as if the drug company was making the schedule for the parent.

"We don't want to be too prescriptive with the parent, and we want to give them the ability to delay a vaccine too," Farzan says.

VaxTrak has clearly cut through the app clutter and is resonating with caregivers. The plan now is to educate physicians about the app and get them to recommend it to patients. "There are millions of apps out there so it's hard to find a way to break through," Farzan says. "Our vision is to provide this physicians as a tool that they can talk to their patients about. The channel here is through the doctors."

APPLICATION SPOTLIGHT #3

Johnson & Johnson

CareConnector

Johnson & Johnson is leading the mobile application charge with two strong programs: Black Bag, for physicians; and its latest addition, CareConnector, designed to provide caregivers information that will help them better care for their patients.

"If you've ever dealt with caregivers who work with patients with an acute or chronic condition, you know that they are taxed," Volpe says. "They are often frustrated and can't find the information they need."

J&J created an application consisting of relevant data points for caregivers to have with them at all times, particularly during an emergency or when speaking with a physician. Launched in December 2009, the application contains insurance information, health provider info, emergency contact data, and lists to keep track of the patient's daily treatment regiment (be it therapy, medicine, or exercise). The inclusion of a journal allows parents or caregivers to write about a situation or even take a photo of an incident (such as a seizure) and email it to the physician.

"The most important thing to consider when building an app is functionality," Volpe says. "You must make these applications so that people can use them. Most developers overdo it—they only need a Volkswagen, but they try to create a Cadillac. We wanted to start out simple, get some feedback, and build out as we see fit."

One big challenge was catering to caregivers that work with patients with many different disease states. To satisfy everyone, J&J built in core elements that cover important caregiver questions, and the company is constantly refining the program through frequent updates.

The whole program took eight weeks to develop and get approved by Apple. The app's popularity got a huge boost after Apple spotlighted the program as a featured application. The team behind the app was glowing over the positive reviews and download numbers.

"We designed CareConnector around the day-in-the-life of caregivers," Volpe says. "We are solely focused on that and we're not trying to sell other products around this—we are in this game for those folks and are trying to make their lives easier."