Navigating the eDetailing Maze
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Abstract:
eDetailing is currently under consideration by many pharmaceutical companies as a way to maximise sales force time, cut costs and increase physician prescribing. eDetailing is not a single entity but can take many different forms: from remote live discussion with a sales rep to a purely scripted interaction with a web site or an Interactive Voice Response phone line. Most eDetailing models have been tried in the US and only some models such as some forms of Scripted eDetailing have been shown by independent studies to increase prescribing compared to traditional detailing methods. eDetail models from the US are starting to become available in Europe where there are tighter regulations concerning physician promotions that make it harder to incentivise physicians to participate in eDetailing. Also, each eDetail model differs in its popularity and applicability to specific physicians, for example, GPs are more easily accessed than specialists in Scripted eDetails. Therefore, pharmaceutical companies need to consider their eDetailing options carefully to choose a model that will be right for their particular product, target physician group and country. Many pharmaceutical companies are simply starting a pilot with one or two models but this will not necessarily be sufficient to reach a conclusion for all cases.
The Growth of eDetailing
The use of the internet to promote pharmaceutical products to the medical professional is still in its infancy but is being trialled or used by all of the top ten pharmaceutical companies in the US and a number in Europe. Aside from overall development of the internet in everyday life, there are three direct drivers behind the growth of eDetailing;
Falling effectiveness and increasing costs of sales representatives, Increasingly busy doctors with little time to see reps, High connectivity and acceptance of the Internet by physicians.
In the US, the industry is reckoned to spend $15billion a year advertising its products to the medical profession. Detailing, that is, using sales representatives to call on physicians to promote products, accounts for the lion’s share of this spend, around 45% of the total1 as shown in Figure 1. The last decade has seen substantial growth in the use of sales representatives as the marketplace becomes increasingly crowded with similar products and the length of market exclusivity of new innovative products falls.
Figure 1: How pharmaceutical companies market drugs $15.5 billion marketing expenditures 2000
The top 40 pharmaceuticals companies in the US now employ an estimated 80,000 sales reps, a doubling since 1996, though the increase in prescribing in this period has risen by only 15%. Some studies from the US suggest that 40% of sales reps’ calls are cancelled or rescheduled and over 80% of conversations between reps and physicians last not much more than two minutes. In Europe, studies2 suggest that 30% of GPs no longer see sales reps from pharmaceutical companies in the UK. Physicians, both in Europe and the US, are acknowledged to be highly time pressured and encouraged to see as many patients as possible. The conclusion is that there is a lack of sufficient time for the physicians to meet with sales reps. Consequently, pharmaceutical companies’ very significant expenditure in traditional detailing is not yielding the desired returns. With a constantly increasing number of drugs to sell, the sales forces’ efficiency is dramatically decreasing.
There is no doubt that detailing directly to the doctor serves an important purpose. Physicians want and need information from the sales representatives - but on their own time terms. eDetailing can potentially provide physicians with a more convenient means of getting the information they want at a time that suits them, see Figure 2 which shows that the majority of physicians are most likely to use eDetailing outside the normal office hours.
Figure 2: Times of day that GPs are most likely to use an eDetailing facility
Types of eDetailing
To date the majority of online medical information offered to physicians by pharmaceutical companies has been largely static product information websites. This may be useful for a one-time visit, but it does not engage the physician, nor encourage them to return to the site and develop a long-term relationship with the pharmaceutical company. This is verified by a Forrester study3 where physicians ranked pharmaceutical product websites last with respect to perceived value and frequency of use; indeed more than 50% of the doctors surveyed had not visited a pharmaceutical company website in the past 6 months.
eDetailing simply means using digital technology, in the detailing process, therefore many formats are possible including use of technologies such as the internet, video-conferencing and Interactive Voice Response (IVR) for enabling the interaction with the physician. It is important to remember that the “e” does not simply equal use of the internet. Any technology that can allow interaction with the physician is eligible. Appropriate technologies can be used to achieve the content and effect of traditional details, including educating the physician about products and interacting with the physician to answer questions regarding their individual information needs. eDetailing technology can also be used to offer samples, encourage product use and increase prescriptions written.
Mednet Media has identified three main types of eDetailing models.
Virtual live eDetailing
With the virtual live eDetailing model, the doctor (chosen by the pharmaceutical company) is provided a preconfigured personal computer with all the necessary applications preloaded and webcam to see and speak with a sales representative. The doctor is provided with incentives and in return is contracted to telephone all the pharmaceutical company representatives enrolled in the system at a minimum set frequency per month in exchange for receiving the hardware and software. The physician initiates the eDetail session and has control over the timing of the call (both in terms of when to call and the length of call). A typical interactive session lasts around 10 to 15 minutes. During the call the physician and sales representative (via a videoconferencing system) view and listen to a multi-media presentation about the promoted product and have the opportunity to discuss any points. During the eDetailing session, the physician would be able to interact with the sales representative via video and audio in real time. This type of system was pioneered by iPhysicianNet in the US. A variance on this approach, is a system where only the sales representative is viewed, or only audio and data slides are shown, depending on the wishes of the physician. This type of model is unlikely to be acceptable in Europe where there are much more restrictive limits on the value of goods that can be given to physicians during marketing.
Benefits of Virtual Live eDetailing
In the US, this type of model has been associated4 with providing a longer interaction with the physician more cost effectively when compared to the cost and length of the traditional face to face call so that the number of sales rep calls per day and the number of physician interactions are increased. However, there is no independent data on the impact of such eDetailing on the numbers of prescriptions issued.
Scripted eDetailing
Scripted eDetailing enables the physician to use a personal computer to launch a sponsored learning application, often consisting of a series of interactive screens with multi-media information about the promoted product, including research evidence, clinical practice guidelines, prescribing information and patient advice. The doctor 'walks through’ the screens, usually for an honorarium incentive. This system may be on the Internet or on a closed Intranet or via IVR telephone line. A form of customised profiling software is usually used so that individual doctor preferences are taken into account during the session. This system does not have a live interaction between the physician and the sales representative. Questions and requests from the doctors would be available via an email link with an option for telephone call/visit from a sales representative. The Physicians Interactive and MyDrugRep5 systems both use this type of approach.
Benefits of Scripted eDetailing
In the US, this type of model has been has been shown to deliver clear, well-structured messages to physicians that is 5-10 times longer than the normal face-to-face sales rep call but at a reduced cost. Participating physicians especially like the convenience of the 24 hours a day, 7 days a week availability of this model. Unlike the other models, some forms of scripted eDetailing have been found in independent studies6 to show actual increases in prescribing of the drug featured in the eDetail - that can be directly attributable to the eDetailing done whether that is via the internet or via IVR.
Physician Portal eDetail
Online physician communities via physician portals, offer an opportunity to deliver pharmaceutical company messages to a specific audience of physicians. This model has been used in the US and is emerging in Europe (e.g. DoctorsNet.co.uk). This model is most often used for delivering “soft” general marketing messages (via sponsorship of a disease area forum or an online CME module). Potentially, it can be used to provide “hard” product specific messages (like traditional detailing) via alliances with Scripted eDetailing players.
Benefits of Physician Portal eDetailing
Potentially, physician portals can provide access to hard-to-reach physicians (e.g. specialists) though for most portals, the number of physicians who actively use that portal is usually significantly less than the official membership list. Portals can usually provide online statistics that give insight into where physicians spend their time and hence an insight into their web habits and interests. However these are not necessarily straightforward to interpret. For instance, there is no easy way to know whether the reason a physician spent 10 minutes looking at a web page was because he was interested or because he was bored and took a break to something else whilst the web page was open! There is little evidence of the actual impact of portalbased eDetailing on number of prescriptions issued.
Differences in eDetailing between US and Europe
Regulations governing pharmaceutical promotion are more restrictive in Europe than in the US. In the US, companies can supply higher value goods to physicians during promotion than in Europe, for example:
• iPhysicianNet provides free of charge the PC hardware required for video conferencing to physicians in return for the physician agreeing to place, receive or return videoconference calls with iPhysicianNet's pharmaceutical clients. • Pharmaceutical company Lilly in a deal with ePocrates (provider of prescribing information) gave palm Personal Digital Assistants (PDA) together with the ePocrates software to a group of physicians selected by Lilly. • Some of the eDetailing vendors give physicians a popular medical book or a $25 certificate redeemable for a medical education product in exchange for a completed eDetail. • A “pay per eDetail” model is being considered by a Cincinnati physician group which is offering pharmaceutical sales representatives guaranteed detailing time for a fee. Debate on the legality of this approach has meant that no-one has yet taken up this offer7.
However, in Europe the value of goods that can be given during promotion is much less. For example, in the UK, the Association of British Pharmaceutical Industry’s Code of Practice governing promotion of pharmaceutical products limits the value of any gift/benefit given to a physician to be no more than six pounds (plus Value Added Tax) cost to a company. Hence, the extent to which the success of eDetaling in the US can be replicated or even improved in Europe depends on finding appropriate ways to incentivise physicians without breaching current regulations. It is unlikely therefore that models such as live video detailing can be replicated in Europe under the current regulations.
On the other hand, Europe is potentially ahead of the US in technologies that can be used to provide convenient 24 hour by 7 day access to physicians. In addition to the Internet, some technologies that are potentially relevant in future for eDetailing in Europe are mobile phone/PDAs and Interactive Digital Television (iDTV).
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