Tag Archives: innovation

Seizing Hope – An Anthropologist’s Perspective on a Movie Screening

Last night, I attended a screening of ‘Seizing Hope – High Tech Journeys in Pediatric Epilepsy’ at the Peter Gilgan Centre of Research and Learning at the Hospital for Sick Children in Toronto.

The evening was remarkable through the presence of a girl with epilepsy and her mother. I noticed them right away when I came into the auditorium and saw the girl in her wheelchair. I thought “Ah, a patient” and walked on.

Being an anthropologist by training and a market researcher for Canadian pharmaceutical companies and someone who does not spend much time in academic settings any more, two things struck me as remarkable in the set-up of this event:

Everyone was wearing a mask – “of course, we’re at a hospital” I thought.

Everyone in the auditorium had a microphone on their desk and the house lights were on the audience, whereas none of the panelists upfront had a microphone and no lights were illuminating them. I wondered whether this was a glitch in setup or reflective of the medical professionals’ attitude – “it’s not about me, it’s about the patient”.

The movie ‘Seizing Hope – High Tech Journeys in Pediatric Epilepsy’ which follows four families in their journeys leading up to and after getting a neurostimulator device implanted in their child’s brain, was both informative and touching. The most touching moment for me was when one of the mothers describes how her then four-year old daughter first got epilepsy. She lost the ability to walk, talk, deteriorated back to baby status and no longer recognized her as her mom. Any parent can feel the heartbreak that that entails.

I had seen an epileptic seizure before, but I did not realize the profound impact that the disease has on those affected, including families. This thoughtfully and gently composed movie is highly effective at communicating this. In addition to introducing new technologies that have the potential to help people with drug-resistant epilepsy, it really brings home the dire need for treatment and the equally important need to support families in their support of the patient.

However, real life is an even more effective teacher than any movie can be.

As the mother in the audience who had been in the movie was invited to the front to be part of the panel discussion, it was clear than her daughter also wanted her place in the spotlight (which wasn’t actually turned on, as mentioned before…). She walked up to the moderator and said hi, …and continued to make comments to her mom, the doctors she knew, her family members in the audience, and did not want to sit back down and listen. While the movie had talked about the impact on families, watching the family try to enable the panel discussion to move forward drew me and the other audience members right up close and into the experience.

But that was not all.

Towards the end of the event, when the girl had actually sat back down with her grandmother, she had a seizure. Her family, including her younger brother, immediately sprang into action, assisting her and dealing with the situation like the experienced support team that they are.

While most of the audience members turned to watch the event, I directed my gaze towards the pediatric nurse, neurologists, and neurosurgeons at the front. Clearly, they were torn between their assigned roles as panelists to wait and continue the discussion and their instinct as healthcare professionals to jump in and help. Several got up and sat back down again, struggling with the decision. A couple called out ‘Are you ok?’ to the family. Finally, one, the moderator, walked over and assured himself that the family was ok and able to cope on their own with what was occurring.

This cluster of family members around the girl in peril – their expert handling of the situation, from the oldest to the youngest person – this brought home more than anything to me how epilepsy affects lives.

Takeaways:

  • Doctors wear many hats. They are first and foremost caregivers, focused on making patients feel better and keeping them safe. They are also scientists, exploring new frontiers of medicine. And finally, they are advocates. It became clear in the panel discussion that access to new medicines and new technologies can be a huge issue and doctors play a role in advocating to governments and sometimes even to the manufacturers of these medicines and devices to make them available in Canada.
  • A film about patient experience is a powerful tool for education and advocacy. The four families whose lives were shown in the film had requested that it would strike a balance between authoritative voices and compassionate portrayal, and it did. It was informative about the new technologies and the ethical dilemmas inherent in them, as well as successful at showing the profound impact of the disease and at fostering empathy for those affected by it.
  • First-hand experience is even more powerful than a movie. Watching the girl interact with her doctors and nurse, observing their responses, seeing the concern in their eyes when the seizure happened and witnessing the family’s rush to help was something that a lay person like myself is unlikely to forget.  

Why was I at that event? Just a desire to see something new, after a long pandemic-induced hiatus. I have done some market research in neurology in the past, and would like to engage more with companies in the field, so I thought it would be a good idea to get some more exposure to an area within neuroscience.

What did I learn that could benefit my clients? Patient voices can be powerful advocates for bringing new medicines and technologies to Canadians, but physician voices also play an important role.

Evidence: How much is enough?

I recently tried to identify why the back brake on my bike was not working well. After taking the brake system apart, I discovered that the lever at the handle was badly bent out of shape. Reason for malfunction found! Could not be bent back, brake system replaced, done.

When you are running an organization, your problems are much larger. Which technology should a company invest in to gain a strategic advantage? Which product benefits should be highlighted to consumers? Which new features will users want in a year from now?

One way of making these decisions is going by your gut, or your industry expertise. But it is probably good to collect feedback from the world outside your building and do some (market / customer / user) research.

How much evidence do you need to address your business problem? Will a few user interviews do the trick? Do you need a survey or conduct some ethnographic research? Or is the information already available somewhere, in your in-house data bases?

Let’s start here: The research you conduct should be proportionate to your problem. If you are pondering a major change in strategic direction, you should probably take your time, allocate a considerable research budget and think deeply about which data you want to collect and how it will help you make your decision. In contrast, if you want to tweak a minor feature, a few quick user interviews or a small scale A/B test may do the trick.

Also, research to support business decisions is not an exact science. There are no standards for how much research a particular problem warrants. There is always more to be learned, always some doubt remaining about whether the evidence was sufficient. How do you deal with that?

It’s simple! Time and money are the key factors in determining where to draw the line in your research efforts. Business decisions need to be made in a timely manner, and if the strategy session with the CEO is in six weeks from now, your research needs to be done by then. Likewise, if you have a research budget of $30k you cannot commission a project that costs $100k. Business research is conducted in support of business goals and business decisions, and these are constricted by time and resources.

But…

Sometimes, you want to recommend that the company push back its strategy session by a couple of weeks to allow for collecting more comprehensive information about the customer. Or you lobby for an expansion of the research budget so that the size of the research better fits the size of the problem.

If you are unsure if the evidence will be enough, work from the concept of understanding. After collecting your evidence, do you feel you understand the customer enough to move ahead with your business decision? Or is there something missing?

If you feel your understanding is insufficient to make your business decision with confidence, go back, collect more evidence. If there is no time / no budget, frame your research results with caution signs, so that their limitations are clear to all.

Often, organizations develop a sense over time of what constitutes an acceptable amount of evidence. Some are happy with 4-6 interviews to explore fairly major problems, others want a large-scale study. Some don’t trust qualitative insights at all and feel that a quantitative survey must be conducted to support important decisions.

Usually, research results are not perfect. They do not meet all your insights needs. They do not include all possible stakeholders. But they provide valuable real-world guidance from users and customers that counter-balance gut-based decision making. Now, gut and industry experience and business sense still play an important role and insights stemming from research are only a part of the bigger picture.

Plus, when research results come back, their relationship to your business problem is usually not one-to-one: brake lever bent = brake not working = install new brake. Rather, they are subject to interpretation and often beg further analysis.

Research is no replacement for business sense, vision and leadership. These must have the last word and take responsibility for the future path of the product or organization.

Post Disruption: Market research, what next?

Based on my personal experiences

Around 2011 the owner of the company that I then worked for came to Toronto and challenged the employees to go on social media. At that point, few had considered how important this was about to become for our jobs.

In the pre-historic days of market research, consumer data were collected by walking around the city, knocking on doors and interviewing people face to face. I caught the tail end of this when I started in market research in Russia (which is another story). Then, call centres became industry standard and most survey research was conducted on the phone. However, qualitative discussions were still held in person at focus group facilities.

In the 1990ies, online surveys took over as the main means of eliciting consumer data. Rather than finding consumers through random digit dialing, companies now started to build online panels of people who were willing to answer surveys. There was some concern about the representativeness of these panels at first, but it was soon put to rest when the considerable cost savings of this approach became apparent. Initially, research companies needed specific expertise, expensive software and sufficient server capacity to program, host and run these online panels and surveys. Quite a few even tried to develop their own software.

The 2000s saw a rise in self-serve online research solutions. The idea of software as a service (SaaS), and ‘freemium’ products such as SurveyMonkey made it possible for anyone to collect the data they wanted. It seemed no longer necessary to have any particular expertise or resources. At that time, I felt that many established market researchers were reluctant to open their eyes to the new reality. A few companies were blazing ahead, but the majority sat back and hoped it wouldn’t get too bad.

I realized myself around 2012 that things would never be the same again. When I had the opportunity to start my own business in 2014, I jumped with both feet into the world of SaaS, social media and startups, looking for ways to innovate and carve out a niche for myself in the insights community. I read Clayton Christensen and Eric Ries. I experimented with different tools and methodologies. I immersed myself into WeAreWearables Toronto, then a monthly event at the MaRS Discovery District, an innovation hub that offers services for startups and scaleups, and various other incubators and accelerators around the city.

Innovation was the buzzword, and also agile, real-time, lean and design thinking. The word disruption became popular in my neck of the woods a little later. Hard to believe that this was only six years ago. Now the word already seems a little tired. I feel that the dust of disruption has settled in market research, and firms have made adjustments.

Those who started off with the new technologies – for example Qualtrics, or the Canadian company Vision Critical – have probably done very well (not that I know their books). The traditional firms have incorporated various technologies into their offering. Many have social media analysis products. Some run large-scale customer feedback platforms for their clients. Some use virtual reality goggles for concept testing or shopper studies. Some offer online communities or hold virtual discussion groups. And to cut cost, many move business functions into the cloud, and outsourcing is widely used.

Whether this is sufficient to keep traditional market research organizations profitable, I don’t know. What I have learned in my own business is that I am still selling ATUs, segmentations, concept tests and one-on-one interviews. After the frenzy to be innovative and different, what clients seem to appreciate is my expertise. They trust me to know how market research is done properly, to execute the project for them, and to deliver them results that reflect a thorough understanding of their business questions, and in a form that adheres to their internal processes and requirements.

That’s why I stopped following the hype in the last couple of years. Disruption happened, but that was in the past. No amount of research automation can substitute understanding. And understand the customer we must.

But…I recently started renting a co-working desk at a business centre. I am with ease twenty years older than the majority of the other tenants there. So now I am back in a startup environment, and I see that while the hype has decreased, startups are here to stay for the foreseeable future. Businesses who are trying to disrupt various fields are numerous and, with the myriad applications of AI, far from done.

It will remain important to understand how new technologies fit into and change existing businesses. For example, I am intrigued by the anatomy of the Cloud, where servers are located, how data are moved around and what implications different factors have on data loading speeds, data security etc. When some people that I recruit for surveys complain about it taking longer than they thought, is that because their Internet is slow, or because the survey hosting company has switched from using their own servers to the cloud?

Data governance also interests me. With many market research companies using subcontractors, it is almost impossible to see all the way down the supply chain where data may be stored, processed or transferred to. The business risk related to data governance has increased exponentially for market research firms. Good times for lawyers and insurance companies.

But understanding AI, Cloud and computing in general is and will be immensely important for anyone interested in the affairs of this world. I think this is a topic that they should teach kids about at school, so that future citizens can make informed decisions about it. I want to learn more. So far, I have read three books on AI – it’s a start.

Barbara’s AI reading list:

  • Kartik Hosanagar: A Human’s Guide to Machine Intelligence
  • Ajay Agrawal, Joshua Gans, and Avi Goldfarb: Prediction Machines
  • Virginia Eubank: Automating Inequality

Update, also… Janelle Shane: You look like a thing and I love you

Why Startups don’t do market research (but should)

Startups are great at coming up with innovative ideas, but why don’t they ever do market research?

“A startup is a human institution designed to create a new product or service under conditions of extreme uncertainty”, said Eric Ries in The Lean Startup. Extreme uncertainty is a defining feature of the startup experience. Uncertainty about the product, the supply chain, the customer, the business model. Two key success factors are experimentation and customer orientation. They enable the startup to achieve product-market fit and to creative a product that can eventually be commercialized.

Getting input from target customers is essential in developing a great offering. Yet, when I talk to startups about conducting market research, many dismiss the idea.

Often, startup founders believe market research is only for large multi-nationals, or that it comes later in the evolution of a company, when a company is established and has multiple successful product lines. Some think it is too expensive or they don’t fully understand the ROI. In addition, many founders tell me that they already have all the customer information that they want.

Let’s look at how startups typically gain information about their market, and what they are missing out on by not conducting market research:

1. At the early stage, founders’ market research typically consists of talking to ‘friendly individuals’ who are willing to give some feedback on the startup idea. The problem here is that the selection of individuals is very likely biased towards people who have a positive affinity to the founder and/or to the product to begin with. It is simply easiest to reach out to your existing network. How objective is the feedback of these individuals going to be?

In addition, we tend to connect with people who are similar to us – similar in age, in gender, in ethnic background, in social status – as it lets us stay in our social comfort zone. How representative are these people for potential users of your product? Particularly if a startup is developing a health-related product or service, potential users are likely very different from the twenty-something healthy males who tend to populate the startup community.

Plus, the ecosystem within which founders operate tends to be highly tech savvy. Getting feedback only within their own ecosystem gives founders a rather poor idea of how regular people would see their product. Granted, tech savviness is going to increase in the future. But do you really have enough time (and cash reserves) to wait for fifteen or twenty years until the majority of the population has caught up with you?

Opportunity missed: Conducting market research early on may help a startup discard an idea more quickly that won’t be popular outside their immediate circle of friends and like-minded acquaintances (‘fail early, fail fast’). Real market research means soliciting feedback from individuals that are not personally connected to you, and who belong to the intended market segment for your product.

Many startups use Kickstarter/Indiegogo as a means to assess if there is really a market out there for their product. While it is comforting to know that two thousand people are backing your campaign and are willing to pay good money now for something great to materialize in the future, this is not enough to build a successful company on. Also, let me tell you a little secret as a market researcher and anthropologist who is in touch with the ‘common man/woman’: Many people have never heard of Kickstarter or Indiegogo.

2. As startups mature, products typically go through many iterations and user experience is incorporated in a continuous feedback loop in the product development process. The UX lead will bring in users, expose them to the latest version of the product and propose adjustments accordingly. In addition, the product itself, assuming that it has a digital component, sends back usage data, which allows the startup to assess how well certain features are performing and conduct A/B tests.

Having a mountain of data that streams back through the device or app makes founders confident in their ability to optimize the product. While this is certainly the case, at times it is hard to ‘see the forest for the trees’. As startup guru Steve Blank said, you need to ‘get out of the building’ to understand your potential market and to learn about your potential customers.

Usability research and user experience research are essential for product development from a technical standpoint and from a design standpoint. In contrast, market research helps you understand the broader picture, beyond your immediate product to prospective customers and their evolving needs and pain points for which your product (along with many others) may provide a solution.

Some methods employed for market research are similar to user research, and some are different. Market research consists of the full gamut of large-scale, quantitative surveys, mobile quick check-ins, trade-off exercises, ad tests, focus groups, location-based research, ethnography, online discussion boards, co-creation labs, in-depth one-on-one interviews and many more.

Opportunity missed: User research looks at, well, users. Market research looks beyond. Only input from a wider target audience will help your startup understand where your product is missing the mark in a fundamental way.

You should also engage in market research as a ‘disaster check’ before going to market. While your product may be delightful and great in terms of functionality, perhaps you are not communicating something that you think is trivial, but that consumers want to know. Safety in wearable devices is a good example. It may be obvious to you that devices have to undergo rigorous safety testing before you are allowed to sell them to people, but the regular person may not be aware of this. If you launch a new wearable without a footnote on safety in your communications, you may be impacting your sales in a significant way. While safety may not be the reason people want to buy your device (unless it is a safety device) they want to be reassured that it is not going to harm them.

Then, after a successful product launch, your startup will only be able to continue expanding its market if you find out what non-users need and want, and if you understand their perceptions of the competition. A successful product fulfills a need better than other products. To find out what target customers need and how your product stacks up against others in addressing that need, you have to engage in market research.

Market research enables startups to step out of their comfort zone, go beyond speaking to the ‘enthusiasts’ and ‘evangelists’ and build an offering that resonates with a larger audience. Do not miss out on this opportunity to critically examine the appeal of your idea and to lay the foundation for exponential growth.

Market research for startups has clear ROI in the following areas:

  • Establish the size of your potential market (ROI: A key talking point when you approach investors at your next funding round)
  • Determine size of different segments within your market and prioritize them in terms of their potential for your product (ROI: Don’t waste money and effort on marketing to a segment that you have personal affinity to but that is tiny or less likely to buy your product)
  • Uncover needs and pain points of potential customers (ROI: Allows you to pivot early, and conserve precious early funding, if your product misses the mark)
  • Validate and refine user personas (ROI: Supports better product-market fit and sets you on a growth trajectory beyond current users to potential future users)
  • Optimize marketing and communications to focus on the product benefits that potential customers most care about (ROI: More bang for your advertising buck)
  • Get an understanding of competitive offerings, how your product stacks up and how to position your product for success (ROI: Stay ahead of the competition and get a bigger share of the pie)
  • …and last but not least: Obtain unbiased feedback on what people really think about your product (priceless 🙂 )

Some questions that startups may have about market research: Is it expensive? Can I do it myself? How do I go about it? There are many reasonably priced ways to conduct market research. Some components can easily be done by the startup itself. However, it is important to get expert advice on methodology and on the design of the research questions, to ensure your research is representative and unbiased.

If you’d like to get more information on what market research can do for your startup, please contact me. I am happy to give you an initial consultation free of charge. You can reach me at: barbara@creativeresearchdesigns.com

Also published on Medium

Microsoft spitting into Google’s soup

Has your computer been sending you ceaseless reminders to update to Windows 10? I have just updated mine, and now I understand why Microsoft is so adamant that everyone gets the new operating system. Because it is not just an operating system.  

Pumpkin soup

If you choose the ‘Express Setup’ features, you will give Microsoft access to all sorts of data that would not normally be shared with your operating system provider. It will allow Microsoft to make the sorts of rich data connections that so far only Google with its web of interconnected and super-user friendly services has been able to gather (and profit from handsomely).

My new operating system is also very persuasive in getting me to use its search engine Edge and so far I have found it difficult to stay with Google as the default search engine. What a huge coup for Microsoft and major threat for Google! I read an article or two about Edge, saying what a great new thing it is, but who knows who pays these blog writers… Also, when you search on Edge, ominously the old Bing logo appears – not very reassuring, since nobody really liked Bing, right?

But…so far I have not figured out how to keep Google as my default search tool and perhaps I’m starting to like Edge. So what’s Google going to do about that?

Have you upgraded your Windows yet?

Disclaimer: I am not in IT, perhaps I am not fully understanding all the technical details, but the business strategy seems pretty clear…

How pharma may or may not win in a digital world

Healthcare is going digital at a rapid pace. A recent article by McKinsey & Company titled ‘How pharma can win in a digital world’ outlines emerging trends in digital health and how pharma needs to evolve to keep up with the times.

A number of predictions in this article are, I believe, misguided and reflect a common, but incorrect understanding of the potential of digital in health.

Digital health collage 2

Prediction # 1: “Patients are becoming more than just passive recipients of therapies”

Patients have certainly become more knowledgeable about their own health and about available therapies. And hopefully, health-related apps are helping people lead a healthier lifestyle and stay on top of their medical conditions and medications. However, patients have never been passive recipients of therapies. Patients have always had the choice of taking or not taking their pill, cutting it in half, skipping a dose, forgetting to take it, taking it with food when they are not supposed to etc.

Having served pharmaceutical clients for more than a decade, I have frequently observed that it is difficult for someone within the industry to understand that the medicine they are producing is not the be-all and end-all of a patient’s existence. Life is a busy thing. You work, you look after your family, you eat, you entertain yourself, and you may have a health problem that benefits from taking a medication. The act of taking a pill consumes a fraction of your time and attention. Medicines for health issues that are non-symptomatic may be forgotten because the patient does not feel sick. Medicines for chronic, life-threatening conditions may have suboptimal compliance because the patient would rather not be constantly reminded about his or her precarious situation. For acute conditions, compliance wanes as soon as the patient feels better. Side effects deter patients from taking their pill, etc. Compliance would not be such a huge unsolved problem for pharma if patients were ‘passive recipients of therapies’.

Prediction # 2: “Patients will be actively designing the therapeutic and treatment approaches for themselves with their physicians”

I have read this type of statement numerous times in articles about the future of pharma. Perhaps I am lacking understanding of what’s technologically possible nowadays, but for now let’s assume I have a pretty good handle on it. Designing a pharmaceutical product is an extremely specialized and complex process that involves scientists and labs. A chemical or biological compound with certain properties is created to address a specific health issue, and this compound cannot be easily customized. Rather, it is created and then subjected to rigorous testing, costing hundreds of thousands of dollars (or more), and if it does not hold up to scrutiny, then it’s back to the lab for more experiments and tweaking before another round of expensive testing resumes.

Physicians who spend most of their time in clinical practice do not design therapeutic and treatment approaches. They are merely the retailers of those approaches, acting as consultants to their patients and advising them which approach may be best suited for them. And patients will not be actively designing their own therapies unless they are experimenting with mixing pills and brewing up concoctions of their own invention (caution: don’t try this at home, kids!).

With substantially increased access to information patients can play a much more active role in selecting treatments, but they will not design them.

alchemist-300px

Prediction # 3: “Medicine will be personalized to address individual patients’ needs” (not in McKinsey article, but can be found in many other publications on digital health).

The move towards personalized medicine is certainly well underway. However, it does not mean that a therapy will be designed on the spot for the individual sitting in front of his or her physician. Again, the physician is the expert mechanic using existing wrenches and bolts to fix the car. The inventor who comes up with new wrenches and bolts does not deal directly with the customer whose car broke down.

Tools

Personalized medicines are medicines that target issues more precisely than was previously possible. While physicians used to set off a grenade to blast away your breast cancer, and half of your body as well, they now use a precision rifle that locks in on the malignant area and eliminates not much else. And depending on your genetic profile, there are different bullets that are most effective for your particular type of problem. So the array and precision of weaponry in the physician’s arsenal has increased vastly, and affordable genetic tests have contributed to better targeting of the weapons. But none of these things are designed on the spot, while you’re sitting in the examining room, nor will this be possible for a long, long time.

Explanation: Poor understanding of digital vs. physical contributes to common misperceptions

How do these misconceptions come about and why do smart people write these things?

The past five to ten years of our experience of living in a digital world have greatly impacted our beliefs in how easily things can get done and our feeling of agency. Want to customize your new car? Just click on the features that you want – sunroof, heated seats and the colour red – and you can get this exact model without any effort on your part. Select the perfect outfit? Choose the style, colour and size, and get it delivered to your doorstep the next day. Don’t like part of your video? Just delete and replace.

The ease of these digital experiences has gotten us into the mindset that things can be designed instantaneously, delivered rapidly and modified on the spot. We rarely think about the physical realities that enable our digital experiences. To give you the experience of ‘designing’ the perfect outfit for yourself, the maker has to come up with new styles to attract your desire, run efficient manufacturing to put the piece together with acceptable quality and at an affordable price, ensure the supply chain to enable the manufacturing, build in agility to adapt supply to demand quickly, and create a distribution system to bring the piece to you. All of these things are not done through click of a button, but through the hard work of setting up systems, negotiating agreements, fine-tuning machinery and materials and implementing physical processes.

It’s the same for pharmaceutical products. They are chemical compounds, after all.

Digital opportunities

However, the potential of digital solutions to transform the way we care for ourselves and the way healthcare is provided to us is undisputed. From life tracker apps that help you remember to take your pills on time to smart contact lenses that monitor blood glucose levels without pricking your finger to ingestible sensors that give you peace of mind that your schizophrenic brother has actually taken his medication, digital interfaces, algorithms and sensors can deliver great value to the patient.

The question is how this translates into business opportunities. Many people believe that pharmaceutical companies should transform themselves from being “a products-and-pills company to a solutions company” (see McKinsey & Company article). The idea is to not only provide medicine to the patient but also digital tools for monitoring of the patient’s condition, for communicating with the patient’s circle of care, for scheduling and reminders, for supporting rehabilitation after events and for outcomes tracking. From a patient perspective, this could certainly be a valuable offering. From a business perspective, the value proposition is less clear.

First of all, pharma companies do not typically have the expertise to develop digital solutions in house. Some form alliances with tech companies. Novartis and Google are developing smart contact lenses for people with diabetes and are scheduled to start trials this year. Otsuka and Proteus Digital Health have teamed up to embed a digital sensor into a schizophrenia medication to track compliance, and have submitted the first digitally enhanced new drug application to the FDA. J&J has set up a series of incubators and rewards startups for coming up with interesting ideas in digital health. Merck sponsors health hackathons.

What does the pharmaceutical company get out of this? Will physicians choose their medication over competitive products because it comes with a digital value add? Is the digital component just another cost factor that is necessary to stay competitive these days, or is there a revenue model somewhere? It seems that there is currently a climate of experimentation without a clear business model path ahead, not unlike many other areas of digital development.

In crowded markets with little product differentiation, it is possible that the companion app could become the deciding factor in recommending one drug over the other. However, it is hard to imagine that it would play any role if there were differences in efficacy or side effect profile between the compounds. A tricky little question is also what to do with patients who need to switch off one product and go to another. Should they be denied continued usage of the app?

To be truly solutions providers, pharma companies would need to be structured differently, around disease states, not around products. It would make more sense to form a company that is, say, a ‘cardiology broker’, offered great digital tools to manage a variety of cardiologic conditions and give patients access to the full gamut of cardiology drugs available. The sales reps for this company would not overtly or covertly ‘push’ one or two drugs, but they would advise physicians on what is new in the field and impartially discuss the merits of the different options. There are some attempts of pharma companies to become leaders in a therapeutic space and assume the role of expert provider – for example Roche or Novartis in oncology, where both companies have a large product portfolio. However, by and large, this type of business model does not apply to how pharma companies are organized and how they make money currently. It would be more applicable to private payors, and we see some organizations in the U.S. moving in this direction.

Low-hanging but sour fruit

The obvious area where digital tools can be used very effectively to drive engagement is patient-related. Arguably, a more engaged patient will likely be more compliant and stay on therapy longer, resulting in immediate benefit to the bottom line.

However, while many companies try to be patient-centric, any direct engagement with a patient carries the risk of an adverse event report with it. While adverse event reporting systems have been set up to keep patients from harm, unfortunately, reporting requirements are ridiculously broad. Nobody is keen on generating massive amounts of adverse event reports for their drugs. So digital engagement of patients has to be done with all sorts of caveats to reduce the risk of learning about an adverse event. Some companies stay away from direct engagement with patients altogether for that reason; others have taken the plunge and struggle to come up with creative ways around the problem.

Another challenge in engaging with patients through digital tools and platforms is finding appropriate engagement formats for particular audiences. A platform that has been designed to help kids with pain through gamified challenges and ‘levels’ may not be the right approach to engage a 70-year old cancer patient. Very little testing and research has been done to date to find out what tools best support patients with certain conditions. The key here is to be open to a multi-platform approach. While a game may be great at motivating one audience, a combination of text reminders and phone support may be best suited to keep another audience adherent to their treatment. Unfortunately, many of the vendors that design patient engagement tools on behalf of pharma are either all digital or not digital at all. What would be needed is a new type of vendor who can pull together various types of tools and customize them for a particular target patient population.

Low-hanging sweet, sweet fruit

One area where pharma could employ digital innovation easily and with sustained impact is in the way companies communicate with physicians. While almost everyone has switched to iPads for detailing over the past few years, pharma companies (in Canada, my home turf) still have limited understanding of how digital can be used to improve access and deliver value to physicians. Knowledge about different forms of digital engagement is lacking in marketing departments where people think Twitter and Instagram are for self-absorbed teenagers with too much time on their hands. Also, there is a feeling that digital is not important to the physicians who are core to the business. However, as one year after another go by and younger physicians become key opinion leaders and high prescribers, companies may find that they have missed the boat in establishing a digital rapport with these individuals.

Only recently have some companies started to think about conducting media audits and finding out from their core target how they use digital tools and what might be of value to them. Putting some effort and resources into understanding the myriad of different ways digital can be used, and physician preferences in this regard is relatively simple and will almost certainly have a payoff within a five-year timeframe. There will likely be some resistance from the sales folks who tend to see alternatives to face-to-face engagements as a threat to their position. However, I believe that the 21st century sales rep needs to be an expert in offline and online relationship building. Pharmaceutical companies need to figure out how to integrate different forms of digital and non-digital engagement optimally, and create internal structures and tools to maximize value for the customer.

Cartoon

McKinsey & Company article source:

http://www.mckinsey.com/insights/pharmaceuticals_and_medical_products/how_pharma_can_win_in_a_digital_world

Image sources:

‘Digital health collage’: Made the image myself

‘The alchemist’: https://openclipart.org/detail/222415/alchemist

‘Tools’: DeWalt DEWALT DWMT72163 118PC MECHANICS TOOL SET on http://toolguyd.com/dewalt-ratchets-sockets-mechanics-tool-sets/

‘Cartoon’: I’ve seen this cartoon on the web many times, but don’t know who made it originally. I’ve copied it from https://effectivesoftwaredesign.files.wordpress.com/2015/12/wheel.png?w=640

 

Wearable Tech and Health – not quite there yet?

Wearable tech is revolutionizing healthcare delivery – at least that’s what the pundits have been predicting for a number of years. The array of devices that are under development or already commercially available is stunning.

Looking only at devices that are used by patients on a day-to-day basis, there are three different areas of usage for wearable tech:

  1. Continuous monitoring of chronic illnesses

Many patients with chronic illnesses need to monitor certain biophysical parameters that indicate how well they are doing, if their medications are working and when an exacerbation of their condition would warrant visiting a healthcare professional.

Wearable devices that can sense and accurately measure heart rhythm, breathing rate, or blood glucose levels enable continuous tracking of critical markers and can help alert patients and their healthcare providers early to any arising problems.

  1. Improving the lives of people with disabilities

This is an area in which assistive devices have had a long history (think: hearing aids, wheel chairs, etc.). Digital sensor technology is now making devices more accurate, more personalized and more helpful.

Some examples of new technology that improves daily living include:

  • eSight Eyewear: A device consisting of a high-end camera, video processing software and processing unit and highest quality video OLED screens which project a real-time image that allow legally blind people to see.
  • Sensimat Systems: A series of pressure sensors that are placed under a wheel chair cushion. The sensors use a proprietary algorithm to monitor the seating pattern of the wheel chair user, and send a notification via smart phone when it is time to change position to minimize the risk of pressure sores.
  • TAPS Wearable: Velcro touch pads that can be worn on top of clothing or on the wheel chair. Each pad is a trigger for a smart phone app to play a pre-programmed phrase. This helps people who have difficult speaking (for example due to ALS or cerebral palsy) to communicate more easily.
  1. Recovery and rehabilitation devices

Also an area in which assistive devices have had their place for a long time, digital enhancements now tailor these types of wearables more to the patient’s needs. A number of companies are working on solutions to increase patients’ mobility – typically using some form of exoskeleton, together with sensors and algorithms to help with movement and recovery.

 

How do these new technologies fit into our healthcare system and how accessible will they be to patients who can benefit from their use?

Our healthcare system is already set up to evaluate new assistive devices, and potentially pay for them. Device makers would have to prove that their inventions are useful and enable patients to live more independently and / or return to work earlier and save or reduce disability payments or insurance costs.

Those who develop the wearables have to figure out which ones of the many institutions that share healthcare costs in our country they should approach to be considered for funding.

Funding is more difficult for wearable devices used in monitoring chronic illness. In most cases, there is no precedent for continuous patient monitoring.  Not only the patient’s engagement in the process is required, but a whole new infrastructure approach to healthcare is needed on the provider side. Currently, neither private practices nor hospitals are set up to receive, monitor and act upon myriad patient data coming in through wearable devices.

Many barriers impede adoption of new technologies for patient monitoring:

  • Concern about the reliability of incoming data – how accurate is the wrist-mounted heart monitor, are there differences between different devices and who is at fault if the device either gives a false positive and triggers an unnecessary medical intervention, or a false negative that puts the patient’s health at risk?
  • Integration with existing technology – how will data come into the clinic, will it be compatible with currently used IT solutions, how can staff easily access the data and how will confidentiality and privacy be safeguarded?
  • Integration into existing work flows – who will review the data, at what intervals, and which actions should follow particular cues? Will healthcare professionals need special training on how to read the data? Is extra staff required? How can incoming data be standardized to avoid confusion?
  • And last, but not least, who pays for the extra time that clinic staff spends on continuous patient monitoring?

Many of us are still in the phase of excitement over the wealth of possibilities that wearable tech affords us for delivering better healthcare. The successful players will be the ones who figure out how the possible can be turned into the doable, and profitable, within the constraints of our infrastructure and funding environment.

Confessions of a First Time Wearables User

Since I started my business in healthcare-focused market research, I have been paying attention to wearable devices. Wearables devices have great potential for monitoring health parameters and improving care for certain chronic conditions.

The business press has been making a big deal of wearable devices, predicting exponential market growth over the next few years.

Wearables market growth

I am interested in the user perspective – how useful are these devices, actually? Some statistics show that, similar to fitness club memberships, many people who purchase fitness tracking wrist bands abandon them after a few months of usage.

As an anthropologist, I believe the best way to learn about a certain area of life is to immerse yourself in it, to experience what it feels like and to understand how it works. So I started going to these meet-ups for people engaged in the world of wearable devices. They are awesome!

Run in Steve-Jobs-style corporate presentations by the inspiring wearables guru Tom Emrich, companies in the wearables space present their prototypes and the audience gets to try stuff out in the post-presentation mix-and-mingle. My favorite so far has been the mind-controlled beer tap.

I have met many people in the wearables community, and they are certainly very different in style and outlook to my usual clientele (executives from pharma companies). However, I have hesitated to take the plunge into trying a wearable myself.

I am a pretty fit person, working out two to three times a week, to maintain my health and my sanity, eating pretty healthy, and most of the time walking to public transit rather than taking the car. Whether I run 5 minutes less today than I did last week is not really important to me, as long as I get some exercise every few days. Competing with others along fitness goals does not interest me at all. But I realized that not trying out a wearable myself would deprive me of certain insights that could be essential for conducting the user research that I am so interested in doing.

So I bought a Garmin Vivofit last week. Three things enticed me to purchase this device rather than some of the other ones that are very popular (Jawbone Up, Fitbit, Fuelband).

  1. It shows the time. I am of a generation that still wears a wrist watch, and wearing both a fitness wrist band and a watch separately seemed silly.
  2. Its battery life is supposed to be one year. Charging devices is a big pain, and in my household we are competing for outlets and charger cables to charge the various cell phones, iPods etc for the next morning.
  3. It has a red progress bar that shows up after you have been sitting around for too long. My occupation requires a lot of sitting in front of the computer. I tend to get into a state where I push myself to concentrate only half an hour longer, then another, then another, and then become all tense because I have not taken enough breaks. So a little nudge to get up and walk around seemed like a very useful feature to me.

Garmin Progress Bar

Here are my first experiences with the device:

  • Putting it on is quite uncomfortable. You have to press down on this clip to go into these holes, and doing that hurts the inside of my wrist. Watch wristband makers have certainly figured that one out better. Maybe if you are a tough man you don’t mind. But I’m a lady.
  • The red progress bar is very useful. It has actually helped me take more frequent breaks when I am doing computer work, and I feel better after getting up and walking around for a few minutes.
  • The red progress bar is dumb. This so-called smart device apparently registers only walking activity, i.e. when I swing my left arm back and forth. I was frustrated to see the red bar show up after I spent an hour in the kitchen preparing dinner, and after I was in the back yard, raking and bagging leaves. Apparently, either the sensor or the algorithm don’t realize that these are physical activities.
  • The red progress bar can be fooled. Just for fun, I tried out swinging my arm back and forth for a minute while I was sitting at the dinner table, and it actually tricked the device into registering this as physical activity, so the red bar disappeared.
  • The dashboard that shows my steps and my sleep is kind of interesting. I have only worn the device for a few days, so can’t say yet how useful this data is going to be long-term, if at all, but it’s neat to look at in a narcissistic way – the same way I look at my Twitter account from time to time and delight in the fact that I actually have some followers.

Anyway, it has been a very interesting experiment so far, and definitely proof of the value of ‘walking in the shoes of’ to really understand something.

The true potential of wearables is difficult to tell at the moment. There could be all sorts of useful applications that have not yet been developed or that have not yet gained broad acceptance. After a lot of enthusiasm in the media, there seems to be a bit of a backlash now.

Here’s a recent page from The Atlantic, with quotes of tech opinion leaders all questioning the enthusiasm for wearables:

Atlantic article

And here’s an article written by a health IT consultant about the more technical challenges of integrating mobile health monitoring devices into electronic medical records.

http://medicalconnectivity.com/2014/11/04/challenges-using-patient-generated-data-for-patient-care/

While I share some of the skepticism, the wearables space is certainly an area worth watching, and with great growth opportunities for companies who ‘get it right’. I am excited to be part of this journey.

Sea Change in Market Research

The art and skill of market research lies in asking the right questions and drawing the right conclusions from the answers. I know how to ask questions.

I know how to ask them online, on the phone, in person, in a fashion that makes responses quantifiable, in a fashion that allow us to publish the results, in a fashion that elicits emotions, in a fashion that minimizes bias, in a fashion that entertains my clients. I know how to ask questions to old people, to young people, to people with illnesses, to people with children, to CEOs, to large donors, to physicians, to nurses, etc. etc.

In a house, with a mouse, in a box, with a fox, here and there, I can ask questions anywhere…

What if market research is no longer about asking direct questions to real, live people? Why are we asking questions anyway? Our clients want to know what people think and feel, and what they will do, based on their thoughts and feelings. How they will vote, who they will support, what they will buy.

Much of this can be elicited from data that is produced without asking questions. I recently read an article on how you can predict someone’s age, gender, sexual orientation, level of education and the emotional state he or she is in relatively accurately from the pattern of likes they leave across the Internet. Predictive modelling is the name of the game. How can you link likes, content of posts, tweets and comments to action, online and offline? The best people who develop these algorithms sit no longer in traditional market research companies.

They sit in large IT companies. Or they sit in smaller digital shops, where they specialize in a particular thing. And probably in some large financial institutions. And government think tanks.

What do they understand about people? What do they not understand about people? What do my clients need me for? Sure, I know my clients business. I consult. I interpret. I put things in context. At the end of the day, it is still all about making the right connections. So you know what pattern of online behaviour precedes a purchase. Now what? What information do you really need, and how do you use this information to your advantage? That is where the consultant comes in.

To do the job right, however, the consultant needs to understand what kind of information is out there, what is technically possible, what is practical and what is economically feasible in terms of analysis. And to stay on top of that is becoming more and more time consuming with the data explosion in which we are currently caught up…