1. 1
Why Pharma must join the Big Data and
Digital Movements
PA Russo, MD, FCPP
(Wharton -ISB MBA Course-2015)
Consumerism is the transformation of an industry from a primarily business-to-business (B2B)
sell model to business-to-consumer (B2C) transactions. Traditionally, the health care marketplace
has operated through B2B trades among large employers, payers, providers, and pharmaceutical
companies. With this model, the end users, the patients or to be patients, have little involvement
in making choices about costs. However, this is starting to change. The Affordable Care Act has
transformed the health Insurance marketplace with the introduction of the Health Insurance
Exchanges (HIXs). The HIXs allow consumers to compare plans based on price, quality and
benefits. In addition, the federal government and the private health care industry have introduce
reimbursement models intended to shift the delivery of care from volume to value. At the same
time, many of the insurance benefits shift some of the financial risk to the insured in the form of
copays and deductible. In this way, consumers are getting a more active role in how they spend
their healthcare dollars. The consumerism movement is redirecting the health care market towards
a business to consumer sale model (B2C) in which companies entertain transactions directly with
the customer rather than with other businesses, B2B model. Patients, as clients, are starting to be
seen as part of the solution for a healthcare system that continues to be afflicted by significant
high costs. These changes are transforming, to same degree, the health care market to a retail
market. In a retail market that requires communication directly to the consumer of the value
proposition of services and products offered, data collection and analytics are essential to operate
effectively and gain a competitive advantage.
Indeed in several industries, the transformation into B2C models has been facilitated by the use of
digital solutions, particularly social media and mobile solutions (digitization). Mobile solutions

2. 2
allow to engage the customer in a wraparound way more and to collect and exchange data at the
point of sale (digitization). Mobile solutions provide an “Amazon like”, personalized customer
experience, through the digital collection of information from multiple sources, data integration,
and analytics. More than seventy percent of patients surf the web regularly in the United States,
and more than forty percent of people see their physician with information about their condition,
or even diagnosis, gathered on line.
Leveraging the fact that average employees pay up to 25% of the cost of their drugs, Castlight
Health, a digital medical and pharmacy solution, states on its website: “Want to fully engage your
employees in their healthcare decisions? Pharmacy is a great place to start. …….Managing
prescription medications are the most frequent healthcare activity for an employee. Enable
employees and their families to compare drug prices across therapies, channels and even retailers
with comprehensive pricing information—available via the website, our mobile app ……save by
switching to generic medications, purchasing through a mail order pharmacy or asking a doctor
about a more cost-effective therapy right when employees are making their purchase decision”.
An online community, PatientsLikeMe, encourages its member to donate data about their
conditions for clinical research studies: “that data helps you track how you’re doing over time,
helps the next person diagnosed learn what could work for them, and tells researchers what
people really need so they can develop more effective treatments, faster.”
Health Grades banner states”: “Now you can choose a doctor based on knowledge. Not chance.”
Indeed, Health Grades offers reliable information on physician and hospital services and post
patients testimonials.
Another new development in mobile technology and consumer centric care is sensor technology
and GPS applications that collect biometrics or other data from wearables or even ingestible.
Proteus Digital Health offers a number of options for real-time physiological data
(electroencephalograph, electrocardiogram, movements, heart rate, and glucose levels). The
devices provide also status reports and alerts that can alert care givers and call centers of deviation
from expected parameters.

3. 3
Propeller Health uses GPS technology in inhalers used by asthma patients to establish the
locations where the inhalers devices are used. The goal is to identify potential environmental
triggers for the use of the inhalers devices and warn the patients of potential hazards in those
locations.
Personalized and intensive patient engagement includes telemedicine, electronic remote
monitoring and nurse coaching. For example, telemedicine with remote physiologic monitoring
employed by the Veteran Hospital Administration and other Facilities has been associated with
dramatically reduction of the risk of complications from diabetes and improved utilization of
health services by patients with chronic disease. Nurse coaching and personal engagement has the
added advantage to provide social, behavioral and demographic information that augment the
biometrics data.
In brief, before buying, consumers, are now researching health care options on line, like they do
for any other retail service or product and real world data is now progressively available to them.
Availability to collect, understand integrate and utilize data from multiple sources will influence
the degree of competitive advantage that each company will have in the market place. Currently,
in the US, the competitive advantage belongs to government agencies, not only in the US, but
globally. The US Department of Health & Human Services (HHS) has already made available
1,000 data sets on its web site, healthdata.gov. Government health agencies, globally are
following the same path of aggressive collection and analyses of health data on providers,
facilities and patients. Greater access to data is already driving changes in care protocols, allowing
the benchmarking of physicians, aiding the identification of clinical best practices, informing the
adjustment of benefits and reimbursement structures, and resulting in actual behavioral change.
At the federal level in the United States, for example, the recent release by the Centers for
Medicare & Medicaid Services of Medicare reimbursements to providers put some physicians on
the defensive to explain billing perceived as excessive, and the organization also proposed
rescinding the prohibition against releasing prescriber, pharmacy, and plan identifiers related to
Medicare Part D payments. In another example, the new open FDA application-programming-
interface initiative for drug-adverse events allows researchers to synthesize, interrogate, and
generate insights from a decade (2004–13) of adverse-event reports

4. 4
The Role of Mobile Solutions and Data Collection, Integration and Utilization in Pharma
Despites the rapid transformation of the health care envirement into a retail coustemer center
market, with few exceptions, pharmaceutical companies have been slow in joining the digital
world. Yet, the shift of reimbursement and delivering of care from volume to value will affect the
pharmaceutical industry that will face the challenge of moving away from a strategy focused only
on selling more pills. The reason is that patients, patients to be, and employers are already
receiving information on value of prescription drugs from other sources. Government agencies,
the FDA, online services and payers, all provide data directly to the consumer on drugs
indications, side effects, cost effectiveness, and even alternatives.
An example of high quality initiative in real world data research about comparative effectiveness
and clinical outcomes is the National Patient-Centered Clinical Research Network, (PCORnet) an
initiative of the Patient-Centered Outcomes Research Institute (PCORI). “PCORnet is a large,
highly representative, national network for conducting clinical comparative effectiveness research
(CER) and other types of patient-centered health research. It fosters a range of observational and
interventional research that harnesses the power of clinical data gathered at the point of care in
health systems across the country. The clinical data can then be augmented by data contributed
by patients via registries, mobile devices or other sources. For all of its studies, PCORnet will
adhere to all applicable regulatory requirements that govern the use of data for research. PCORnet
is comprised of both Patient-Powered Research Networks (PPRNs) and Clinical Data Research
Networks (CDRNs), and is supported by a Coordinating Center: A Coordinating Center, led by
Harvard Pilgrim Health Care Institute and Duke Clinical Research Institute, provides technical
and logistical support to the data network”. Clinical Data Research Networks (CDRNs) are
networks that originate in healthcare systems, such as hospitals, health plans, or practice-based
networks, and securely collect health information during the routine course of patient care.Patient-
Powered Research Networks (PPRNs) are operated and governed by patient groups and their
partners and are focused on a particular condition or characteristic.” (from
http://www.pcornet.org/about-pcornet/). Data aggregation across “networks of networks”
generates a large number of observational studies that include randomization, in a fraction of the
time necessary to complete research using traditional registries. Information about real world

5. 5
effectiveness of treatment generated from multiple sources (from electronic health records, social
platforms, insurance claims, and demographics) is generated expeditiously using very large
samples. Private payers and the CMS in the USA and in Europe now don’t consider the data
generated from prospective randomized clinical trials sufficient to make reimbursement decisions.
Instead, these entities are seeking post market real world effectiveness that includes segmentation
from a population perspective and from an individual perspective. In Europe, the national health
service of several Countries, use real-world evidence to decide on reimbursement and prices using
comparative analysis (International Society for (Pharmacoeconomics and Outcomes Research).
Examples of Digital Pharma
Although, by enlarge, Pharma has been slow at adopting digitization, a few examples exists of
innovative use of mobile technology and web platforms by large pharmaceutical companies.
There are about 190 digital platforms available for information and connected prevention
designed by pharmaceutical companies: “Merck has 19,000 Facebook fans, Sanofi US, Novartis
and Pfizer have respectively 33,000, 94,000 and 140,000, Bayer has over a million, and Johnson
& Johnson Care Inspires Care 3 million” (http://blog.econocom.com/en/blog/healthcare-the-
pharmaceutical-industry-gets-social-and-connected/). The American Institute for Health
Technology Transformation (IHT) has identified between 1000 to 1000 twitter activities for
individual pharmaceutical companies since 2008, focusing mostly on marketing messages. A
brilliant example of how social media can be used to engage patients is the Pfizer campaign on
You Tube addressed to smokers (#QuitWithHelp), offering education and encouraging seeking
professional help to stop smoking.
White and all first studied evidence of drug interactions from search log data. The authors found
that “compared to analysis of other sources such as electronic health records (EHR), logs are
inexpensive to collect and mine, are not dependent on healthcare utilization, and are not subject to
the same latencies. The results demonstrate that logged search activities by populations of
computer users captured by Internet services can contribute to drug safety surveillance”. From
queries entered in Google, Yahoo and Microsoft searches, the authors discovered unreported
prescription drug side effects before they were found by FDA. (http://research.microsoft.com/en-
us/um/people/horvitz/Pharmocovigilance-signals%20from%20the%20crowd.pdf)

6. 6
Future Digital Role for Pharma
According to Pfizer, “BIG DATA”, including Real World Data will transform R&D; precision
medicine through patient centered research & development; commercialization; market
segmentation and targeting; adherence / compliance; relationships among patients, providers,
payers, and developers of new therapeutics; social networking and increasing access to public data
sources

7. 7

8. 8
.

9. 9

10. 10
ToSenses‘s CoVa necklace, and prototype floor pad and cuff/handle combination, measure pulse
oximetry, heart rate, blood pressure, respiration rate and temperature. The various forms of monitoring
are meant to improve compliance and ease of use. CoVa has received FDA clearance, and is primarily
used as a congestive heart failure alert/management system. The scale-like pad uses bioimpedance and
ECG to measure thoracic fluid levels and also measures weight. The cuff/handle device measures vital
signs, plus blood pressure. The user holds the device at the stomach to measure thoracic impedance, and
inflatable bladders in the arm cuff compress the radial artery to measure blood pressure.
(http://wearabletech.nyc/)

11. 11
The Rx Timer CapTM is a pill bottle with a digital timer on the cap that shows the amount of time it’s
been since you’ve last taken your pills. These caps are great reminder whether taking multiple pills at
different times or just once a day. We have caps available in EZ-Twist (senior friendly) and Child
Resistant to choose from. The timer on the cap works like a stopwatch, counting the time since the last
medication was last taken, and resetting itself every time the container is opened. This easy and simple-
to-use healthcare tool helps patients take medication on-time, according to the doctor’s prescription.

12. 12
How a Remote Health Monitoring System Based on Wearable Sensors works

13. 13
Google Glasses
Google Glass is being tested for numerous healthcare applications: for example, surgeons recording
operations in the operating room, office physicians retrieving and sending information to electronic
medical records through the device, and emergency-medicine physicians transmitting video or images
taken by Glass. A new version is ready for sell to the public next year.

14. 14
Basis Science, one of the most popular fitness tracker and sleep patterns tracker
“MC10 is developing products that can be used both on and inside the body, including sensors that
monitor head impact, heart rate, brain activity, muscle function, body temperature and hydration, as well
as an entirely new class of intelligent medical devices with embedded sensors for enhanced sensing and
therapeutic capabilities”

15. 15
Health Tap offers access to 73,000 doctors via Televideo, plus several other applications including
diseases and drugs information. Accessible through Apple I phones and Apple watch.
Doctor on Demand is another similar service that can be accessed as an Apple app.

16. 16

17. 17
Pfizer is leading the effort to integrate data from multiple sources to Improve the Development and Use
of Medicine (Optimizing the Leveraging of Real-World Data to Improve the Development and Use of Medicine -
M L Berger, and all -www.sciencedirect.com). Below is a list of parternerships that Pfizer has established in
order to achieve this goal.
In order to sustain a profitable future in the new B2C world, all health care stakeholders will embrace
retail-like strategies and tactics, including robust consumer analytics, and leverage the disruptive
innovation introduced by companies that provide easy data collection directly from the patient or patient
to be. Segmenting and targeting the right consumers with the right products and service will be the key to
long-term competitive advantage. Understanding consumers through socio-demographic, clinical and
utilization lenses will layer existing employer-driven focus with newer consumer-oriented approaches.
Retail-like metrics and methods in clude are member acquisition statistics to optimize sales campaigns
and member retention analytics to improve renewal rates and cross-selling and upselling.
Pharmaceutical companies need a data strategy that reflects the shift in how data are shared and analyzed,
as well as a plan to manage all types of data that affect product sales, pricing, and reimbursement.
Healthcare is moving from a focus on addressing point-in-time issues toward coordinated, continuous
health management. The need to provide ongoing management of chronic diseases and to predict and
prevent severe episodes and events offers new opportunities and places new communication demands on
every member of the healthcare team, including pharmaceutical companies. Clinical Data is particularly

18. 18
poised for increasing usage. With the generation of Real World Data burgeoning across both the public
comes the ability to shape the discussion on pharmaceutical products’ benefits and risks by stakeholders
throughout the healthcare system. Pharmaceutical companies that remain focused solely on prescription
volume, rather than on sustaining relationships between a brand and patients, risk ceding the role of
trusted provider to others. For industry participants to thrive in the digital era, they must build a broader
menu of service offerings instead of merely using technology solutions to increase prescriptions. Indeed
collaboration in obtaining meaningful intelligence through dynamic dashboards is an essential element of
the B2C model. Analytic platforms that provide capabilities such as enhanced data integration and
proactive quality management, targeted member profiles and real-time quality dashboards increase the
accuracy of ongoing business strategies and provide insights into value opportunities in healthcare.
Integrated warehousing solutions translate disparate data into actionable information for population
health and risk identification & management. The Centers for Medicare & Medicaid Services
tightly manage and limit access to the national, high-quality, standardized data sets of the U.S. Medicare
population. There is specifically a ban on commercial organizations using the data, which limits access to
the companies that develop medicines. An alternative option for pharmaceutical companies is to partner,
as Pfizer is doing with health plans, providers and companies that provide patient navigation and care
coordination in order to achieve the goal of data integration from multiple sources.