When thalidomide was launched as a sedative in the middle of last century, it was lauded as a “wonder drug” for insomnia, coughs, colds and headaches. Not only that, but it was discovered to be an effective antiemetic which had an inhibitory effect on morning sickness. Within a few years the horrible truth became clear that infants were being born with deformities resulting from an adverse drug reaction (ADR).

An outcome of this discovery was a commitment from government regulators and pharmaceutical manufacturers to institute tests and clinical trials for safety during pregnancy. Additionally, postmarketing surveillance is now an industry standard process following the launch of any medicine.

Primarily through health care professionals, adverse event reports (AERs) are submitted to medicine and healthcare regulators on a territory by territory basis.

However during the mid-1990s, the Internet provided a new platform for health information discussion which was outside of the traditional healthcare system context. It became apparent that spontaneous reportable adverse events might occur on any number of different websites, making the job of monitoring much more complex.

In 2001 the World Health Organization Collaborating Centre for International Drug Monitoring (a.k.a Uppsala Monitoring Centre) launched the Vigibase Online project, now known as VigiFlow.

The impact of online conversation

Since the turn of the millennium, the Internet has had exponential and explosive growth in all countries and cultures of the world; meaning that the sheer number of opportunities for conversations online has also resulted in the potential for an increasing amount of spontaneous adverse event reports that could overwhelm reporting infrastructures and pharmacovigilance teams.

A few years ago now, research from a US-centric perspective attempted to quantify the actual number of reportable adverse events which may occur for any given number of ‘mentions’ of a brand of product; to determine a generalized golden rule for understanding the potential risk of high reportable adverse events through emerging channels such as social media.

However, in an international context, this idealized ‘golden ratio’ for reportable adverse events online does not have much meaning.

The Uppsala Monitoring Centre succinctly reinforces this point in their guidelines to pharmaceutical companies entitled “Safety Monitoring of Medicinal Products: Guidelines for Setting Up and Running a Pharmacovigilance Centre”;

“…there are differences between countries (and even regions within countries) in the occurrence of adverse drug reactions and other drug-related problems. This may be because of differences in:

• drug production
• distribution and use (e.g. indications, dose, availability)
• genetics, diet, traditions of the people
• pharmaceutical quality and composition (excipients) of locally produced pharmaceutical products
• the use of non-orthodox drugs (e.g. herbal remedies) which may pose special toxicological problems, when used alone or in combination with other drugs”

New research into Reportable Adverse Events online

Creation Healthcare has therefore undertaken speculative research to better understand reportable adverse events online in an international context. The primary hypothesis which Creation Healthcare will prove or disprove when complete, is as follows;

“There is no generalized ratio of reportable adverse events versus product mentions in Internet-based conversations. The quantity of reportable adverse events varies by therapy area, channel, and language”

The focus of this piece of research is centered on three questions;

1. What kind of social media conversations are likely to result in reportable adverse events?
2. Are there variations in the prevalence of reportable adverse events online by therapeutic area, platform, country or language?
3. How can pharmaceutical companies choose the most effective digital engagement strategy to suit their approach to handling reportable adverse events?

A presentation of the highlights of this research will be revealed at the DigiPharm Europe conference in London on Wednesday 29th September 2010.

Subsequently a comprehensive report will outline how the number of online reportable adverse events for one therapy area in particular (cardiovascular prescription medicine) also varies by brand name, generic name, active ingredient name, and identifying the breakdown of the number of ‘mentions’ which relate to online sales of medicine (with and without prescription). These will be compared with the top-selling medicine in nine other therapies areas.

Preliminary findings

Unsurprisingly, there are great variations in the numbers of ‘mentions’ of both brands (excluding generic names) and active ingredients throughout the international landscape. Looking at the top-selling heart medicine, during a one-week period from the 4th July 2010 to the 10th July 2010, the differences can be seen as pins of varying sizes on the global map;

Also comparing the top ten therapy areas, according to sales of prescription medicine, it is again apparent that the number of mentions during this same study week varies considerably. Brands (excluding generic names) and active ingredients in the area of Diabetes Type II are the most prevalent;

When looking more closely at a single area (cardiovascular and heart medicines), a great proportion of the mentions of brand names, active ingredients, and generic names is in relation to the sales of medicine online – often without prescription.

Consider this breakdown where the top 5 heart medicines by sales volume are monitored for their brand name (excluding generic names) and active ingredients compared with results which mention side effects, results with terminology associated with selling drugs, and results which contain personal pronouns or evidence of conversation rather than general medical information;

Approximately 50% of the results appear to mention a side effect however it is not until investigating further within this category that the true extent of potentially reportable adverse events can be determined. Looking only at the results with a mention of a side effect, and a mention of a brand name or ingredient; it becomes apparent that approximately 50% are producing results which are specifically about selling medicines online. Many of these contain words like ‘without prescription’ or ‘no prescription’; an alarming fact in itself although not a primary focus for this research.

Early conclusions

Clearly there is an increasing amount of content on the Internet, and in the case of medicines a great proportion is from illegitimate suppliers of products online. Much of the content is produced for the purpose of medical education and information and there are naturally a number of results which contain reportable adverse events with an identifiable person associated with the event.

What is also apparent is that these types of results do seem to vary by brand name, active ingredient name, and generic name; they also vary by country, language, and therapy area.

The process for reporting has become somewhat more complicated in an online environment where there are no traditional country borders, and where people converse freely in their own preferred language with others who are located in other parts of the world; each theoretically regulated by separate frameworks and systems.

Creation Healthcare will be presenting more detailed findings at the DigiPharm Europe conference including an overview of the regulatory differences and the actual number of reports that were made in various territories. Be sure to come and hear the latest, and we certainly hope to see you there. If you cannot make it, please do contact us to arrange a meeting where we can discuss these findings in confidence.

Amongst emerging channels for healthcare engagement, mobile devices are still very much at the ‘emerging’ end of healthcare engagement. That is not to say that many great applications don’t exist; but I believe the full potential of mobile for healthcare has yet to be realised.

Mobile health, or ‘mHealth’, covers an extensive scope of platforms and applications, creating many new opportunities exist for enhancing patient care, extending the reach of patient support, and equipping physicians.

A huge range of health-related apps already exist for the iPhone alone – designed to help people stay healthy, support patients living with disease, increase health literacy, manage medical information, and support medicine compliance to name just a few applications.

In this article I will review some mHealth iPhone apps and briefly consider the role of engagement strategy in mHealth.

WebMD Mobile

A plethora of self-diagnosis apps exist for the iPhone, from ‘Stress Check’ to ‘Vision-Test’ or ‘Ear Test’. Should healthcare professionals worry that the iPhone will put them out of a job? I don’t think so – even with some of the most comprehensive medical diagnosis apps, my analysis would indicate that reliable diagnosis is unlikely.

A popular diagnosis app is WebMD Mobile, partner app to the WebMD website. Its Symptom Checker tool includes an intuitive interface allowing users to locate symptoms and answer series of related questions. In our simple tests it was quick to diagnose a painful knee as possible Shingles or Multiple Sclerosis.

WebMD Mobile’s symptom checker

Of course the application is not intended as a substitute for professional medical advice. In fact, the first item in WebMD Mobile’s Terms and Conditions of use states that “WebMD Mobile Does Not Provide Medical Advice”.

In our tests, WebMD Mobile’s possible conditions for a painful knee were somewhat alarming

WebMD has taken an interesting approach with WebMD Mobile and it is difficult to identify the application’s strategic benefit. Its functionality is significantly limited when compared to WebMD’s website, which can be used by any iPhone user with Internet access and includes community features and extensive up to date editorial content. WebMD Mobile seems to have missed the opportunity to extend the reach or scope of service through an iPhone app that could have built on WebMD’s reputation to provide useful personal tools. The app does include a feature to locate local health services such as a physician, pharmacy or hospital although this service is only available for users in the United States.

SOS 4 Life

Some of the most popular mHealth applications are those that enhance users’ lifestyle, especially when living with disease. There are many iPhone apps designed to help people to live with disease – at the time of writing, for example, iPhone’s App Store returns 186 possible apps in a search for ‘diabetes’.

We have written many times in Healthcare Engagement Strategy about the need for translation in a global healthcare context. So I was excited to learn about SOS 4 Life, an iPhone app that translates your medical information into any of seven languages.

Designed to support patients whilst travelling, the app allows users to enter essential medical information such as personal details, emergency contact information, health conditions, known adverse reactions, and medications. The interface and patient data are then displayed in any selected language.

SOS4Life translates essential medical information

The app is well rated by iPhone users, and SOS4Life claims the application will soon be available for Blackberry, Windows Mobile and Android.

AirStrip OB

Much has been said about the extent to which digital platforms such as the Internet and mobile devices are changing healthcare by empowering patients. But some interesting examples demonstrate the role of mHealth in supporting physicians too.
AirStrip OB is an app for Obstetricians, providing waveform data such as fetal heartbeat and maternal contraction patterns onto an iPhone. Or to put it another way, as the app describes itself on Apple iTunes, “AirStrip OB is intended for use by Obstetricians who deliver babies”.

AirStrip OB’s monitoring interface

The app integrates with a hospital-based system that sends data to the iPhone, allowing real-time monitoring of patients when the doctor is not at their side. As Dr Marco Giannotti, Obstetrics and Gynecology, The Woodlands Hospital says about AirStrip OB, “It fundamentally changes the way I’m able to interact with labor and delivery.”

AirStrip OB provides real-time maternal waveform data to obstetricians

Defining a strategy for mHealth applications

If thinking about these iPhone apps has given you an appetite for mHealth, hopefully it has also started you thinking about what makes a successful application.

If you’re looking to develop a strategy for mHealth, my advice is that you do not. Do not set out to create an mHealth strategy. Doing so would ‘put the cart before the horse’, as they say. The result is likely to be just one more app amidst the vast number of pointless mobile apps released every week.

The key to successful healthcare engagement is to focus on your goals, and the engagement strategy, before the platform or channel. It may sound boring, but it will force you to think about what you really want to achieve.

Yes, you certainly should consider the characteristics of emerging channels including mobile applications. Tools such as location-based services, touch-screen interfaces, voice controls, and HD video all have the potential to help you achieve your goals in new ways. But if you start with features like these they may rapidly become a distraction from your real goals.

Creation Healthcare’s Discovery Methodology for informed strategy development helps healthcare companies and organisations to define engagement strategies that really do achieve business goals using emerging channels, and to measure the accomplishment of these goals. Why not speak with us about how we could help you?

Daniel Ghinn will be speaking at mHealth Conference in Dubai, 13-15 September 2010.

New and emerging communications channels have brought significant change to the landscape in which pharmaceutical companies operate. The relationship between stakeholders including patients, carers and healthcare professionals is being transformed by new phenomena. For pharmaceutical companies, many traditional channels of communication are decreasing in effectiveness, whilst lack of regulatory clarity and strategy are tending to hinder the successful implementation of engagement strategies that embrace new and emerging channels.

Embracing the changing healthcare engagement landscape means responding to both its opportunities and its threats strategically. It means finding new ways of internal stakeholders in marketing, communications, pharmacovigilence, legal, and IT working together. It may also mean new ways of engaging and partnering with external stakeholders including healthcare professionals, patients and carers, patient advocacy groups, regulators, and even competitors.

Many in the pharmaceutical industry are looking to regulators to define policy and guide best practice. Indeed, as the world waits for guidance to emerge from the FDA’s hearing on the promotion of regulated products using the Internet and Social Media tools, there is an expectation that precedents may be set by such guidance that influence regulators the world over.

In the mean time, as engagement channels continue to emerge and evolve, the pharmaceutical industry operates cautiously within existing regulatory frameworks that provide guidance on product marketing and communications but do not explicitly address changes to the healthcare engagement landscape created by emerging channels.

Professionals in the pharmaceutical industry must define and implement strategies that embrace the new healthcare engagement landscape. It is time for an informed strategic debate amongst pharmaceutical company stakeholders including pharmacovigilence, legal, marketing and communications professionals, and amongst external stakeholders including regulators, healthcare professionals and patient advocates.

Creation Healthcare is calling for an open international debate that will:

• Explore the opportunities and threats posed by emerging channels
• Propose and develop strategies for pharmaceutical companies to embrace these opportunities and threats
• Share best practice
• Propose guidelines for ethical and regulatory-compliant engagement
• Inform and influence policymakers

If you agree that it’s time for such a debate, why not get the ball rolling? Show your support for the call in one of the following ways:

• Tweet this call for action
• Tell your peers
• Ask your industry organization to get involved
• Make a suggestion: we’re very open to ideas about what form such a debate might take
• Tell us how you would like to support the call
  • Openly, by tweeting me @EngagementStrat
  • Directly, by emailing me

The French digital economy development plan of October 2008 identified the deployment of information and communication technologies for health and wellbeing as one of the French government’s investment priorities for the future development of digital applications and services:

“The digital revolution in the world of health is still in its infancy. The production, dissemination and sharing of information is at the heart healthcare. [Digital information]  opens considerable opportunities. The elderly, frail, disabled, and sick at home, all need technology to overcome illness, maintain social bonds, get help, and simply live better”.ⁱ

This year, “e-Santé”, or e-Health (a term referring to technology-enabled healthcare) is experiencing a dynamic and growing interest among all health stakeholders in France including healthcare organisations, patients, health professionals, and the healthcare industry.

Indeed, the Health 2.0 Europe Conference, held for the first time in Paris in April and the opening a few months later (23rd June) of a government website dedicated to eHealth, http://esante.gouv.fr, is a good indicator of this vitality.

A government “e-Health” website open to all

Through the esante.gouv.fr portal, the Health Shared Information Systems Agency (ASIP Santé), operator of e-Health for the Ministry of Health provides “a platform for information and awareness about the challenges of e-health in France that tries to develop projects and initiatives in this regard”. This website allows all stakeholders to exchange, share and comment on articles online.
Thus, anyone interested in these issues can play a part and contribute to the development of e-health. This website, available in English too, allows for a wider international debate.

The DMP and telemedicine as a spearhead of e-Health

The objective of the DMP or Personal Medical Record (a French Personal Health Record) is to allow a healthcare professional (with the patient’s consent) to access a patient’s “medical memory” via the Internet. The record includes all medical information, diagnostic and therapeutic information reported by healthcare professionals in clinics and hospital, as well as data collected if the patient has stayed in a healthcare facility. This service should be available in December 2010 and will be deployed across the whole of France during 2011.

Such a service will certainly accelerate the development of telemedicine and establish a collaborative mechanism for the care of patients with chronic diseases (which affect 17 million people in France).

Collaborative medicine for patients

Beyond its ability to respond in part to the need to reduce public health expenses, e-Health is intended to be a solution to improve access to information, support and prevention of disease in a networked and collaborative environment. This environment, in which the patient is a stakeholder in their own health whilst being surrounded by a community of professionals with common goals, each having access to the same information is an emerging concept often called “Medicine 2.0“.

Each stakeholder, whether the healthcare professional, patient, government or the pharmaceutical industry is in an environment where information is ubiquitous, shared, commented and evolving. This “social” environment born with the development of new digital communications tools built on ‘web 2.0’ platforms, is changing patients’ views about their health. No longer isolated, they have access to information via the internet. The “patient 2.0“ communicates differently; he’s looking to share experiences, a community online or simply reliable information, and he tries to find these where they occur and where access is the easiest: on the web.

Thus the relationship between stakeholders has changed. This is where communication strategies must evolve in line with this new digital environment. The patient must be at the heart of strategies to best meet their needs, expectations and all the questions surrounding their disease and the “patient ecosystem”.

If this article has made you think about your healthcare engagement strategy in a new way, and you would like to talk to an expert who could help you develop your ideas, Creation Healthcare can help. Contact us now to find out about our approach to global healthcare engagement strategy.

References:

1. http://www.gouvernement.fr/sites/default/files/legacy/FRANCE_NUMERIQUE_2012.pdf

There has been considerable discussion in recent times about ‘local’ versus ‘global’ engagement strategy, or whether there is some kind of mystical balance of the two. Earlier this year Creation Healthcare was pleased to facilitate seminars in New York and London with leading global pharmaceutical and healthcare companies, during which the constraints and opportunities of global healthcare engagement strategy were discussed.

Creation Healthcare are long-time proponents of setting aside time to define an overarching global strategy; we are therefore sometimes asked by new clients, “Do you really think we should have a global engagement strategy?”

This is a great question, to which we (almost) always answer “Yes”.

Some may say, “What about the local nuances?”; “What about the language challenges?”; “What about the regulatory variations?”; “What about the different technology constraints in each region?”; and so on.

We certainly do understand these issues. With 30 consultants all over the world Creation Healthcare is well aware of the challenges facing each territory, and we are constantly increasing our local in-country knowledge in order to make the best recommendations for our global clients. As much as we often encourage global strategy, we also know that it is absolutely necessary to have a local, tailored strategy to suit each individual territory or brand.

It is also true that at a global and companywide level, there are inevitably some common guiding principles that can bring continuity and consistency to the way an organization communicates, presents the brand personality, and ultimately engages with people – even on an international scale.

Incidentally, if you are skimming this article to find the quick-fix, ‘give-me-the-ten-tips’ commandments, you may wish to pull out now.

The reason for the title of this article is that it describes an approach, rather than a one-size-fits-all solution.

Let me explain using a ubiquitous metaphor. Most people in the world – regardless of their own personal religious belief, country of origin, or language – have heard of the so-called “10 commandments”. Indeed, quite a few people could list at least some of them from memory.

Interestingly, orthodox followers of the ‘Torah’ (as these books of laws are known) usually insist that there are actually 613 commandments all told, and that the 10 commandments are more of a ‘table of contents’ – a sort of cheat sheet for remembering the detailed laws and regulations.

Elsewhere, there is even a further distillation in to just two guiding principles. It is fair to say that in religious circles the 10 commandments have certainly permeated the human race over the past several thousand years, across millions of people in many languages and cultures.

We’ve found that this same concept also works for guiding an organization in healthcare engagement. Creation Healthcare maintains that it is possible to create ‘10 commandments’ which can be implemented globally, to bring new levels of (consistent, on brand) engagement.

Of course there really isn’t a single set of ‘10 commandments of healthcare engagement’ that would apply equally well to every company or organization, hence you will find no simple list here as a ‘take-away’.

Rather, each organization is uniquely different in its own right, with particular heritage, traditions, idiosyncrasies and ‘personality’. Therefore it makes perfect sense that each company should really develop their own global engagement strategy (and resulting 10 commandments).

Creation Healthcare can deliver a customized process to help you formulate your own global strategy 10 commandments; all you have to do is give us a call now.

The Global Fund to Fight AIDS, Tuberculosis and Malaria describes Born HIV Free as one of the most ambitious campaigns of its kind. Its aim, to mobilize public support for the work of the Global Fund and for a world where no child is born with HIV by 2015, is huge.

The Global Fund manages funding of US$ 19.3 billion for more than 572 programs to fight AIDS, Tuberculosis and Malaria in 144 countries. Endorsed by governments and individuals as diverse as Ban Ki-moon, Bill Gates and Bono, the Global Fund is currently saving 3,500 lives every day and 1.3 million lives every year.

Founded in 2002, backed by the United Nations after a call from Kofi Annan for the creation of a global fund, the organisation is unlike others in the United Nations family. When I met John Busch, Manager Online Communications at the Global Fund’s headquarters in Geneva, he told me that the organisation had a vision to use the web from the start.

And it shows: with a total staff of 600 people, The Global Fund employs a team of nine people dedicated to online communications. That’s 1.5% of the entire organisation. So when the organisation says this is one of the most ambitious campaigns of its kind, it’s no wonder that digital engagement is embedded deep into the strategy.

Integrating channels

It’s not all about digital. With films produced by Oscar-winning creative team H5 and featuring music by Amy Winehouse; a special video by actor and director Vincent Pèrez featuring Carla Bruni-Sarkozy; collector’s items produced by Tiffany & Co. and Jean-Paul Gaultier; a live concert by Paul McCartney in London’s in Hyde Park; and events around the world, the campaign is well resourced with assets around which to build engagement.

The campaign’s goal is for people to show support for their country’s contribution to the Global Fund by signing up on the campaign website. It’s important, because The Global Fund relies primarily on public funding, so it is not asking individuals to donate money. And in October this year, UN Secretary-General Ban Ki-moon will chair a meeting of donor countries in New York where they will pledge financial support to The Global Fund for the next three years.

The Born HIV Free website features a call to sign up in support

Engagement with the campaign takes place across all major social media platforms: Twitter, supported by Twibbon; Facebook; and a dedicated Youtube channel which has received over 13.5 million views to date.

Spreading the word

To encourage sharing on social media and internet platforms, the website makes available downloadable spreadkits of campaign material: logos, banners, photos, videos and facts. Meanwhile, each social media platform utilised includes plenty of opportunities to share and link with other channels. Over 31,000 Facebook users have ‘liked’ the Youtube Channel.

Born HIV Free Youtube Channel

With so many places to connect with the campaign, it would be possible that some Internet users might not make it back to the campaign website to sign up in support. To ensure that opportunities for support are not missed, a separate sign-up mechanism is included on the Youtube channel, whilst a Facebook Cause has already captured over 47,000 sign-ups directly from Facebook.

Multi-language engagement

The campaign’s reach is also strengthened by its use of multiple languages – the website is available in English, French, German, Spanish and Italian; as is the Youtube channel which switches instantly between languages. Language-specific Facebook pages add thousands of followers in Spanish and French, and even the campaign spreadkit includes logos and banners in five languages.

This is a great example of a strategy that builds on a compelling cause with powerful creative assets both offline and online, doing so in a highly effective way through the integration of complimentary digital channels that truly engage and direct users to clear, measurable calls to action.

Earlier this year I wrote about how language barriers are creating a new digital health divide and I suggested that the single biggest barrier to successfully connecting patients online internationally is language. On the one hand, the Internet has broken down many boundaries and has changed the geography of healthcare, uniting patients and healthcare stakeholders all over the world so that people are not constrained by information available in their own country alone. Yet on the other hand, language has become an even greater barrier as it separates people into groups – the advantaged or the disadvantaged – based on the information they can access.

I concluded that innovation is required, and offered some ideas about how to tackle language barriers in healthcare engagement. Now, in this report, I explore some of the innovative solutions being developed that are transforming healthcare engagement, improving access to healthcare, and literally saving lives by breaking down language barriers.

Solving patient-clinician language barriers

In the United States, over 34 million people speak Spanish as their primary language at home. When it comes to providing effective and reliable healthcare to this Spanish-speaking population, it is in the face to face encounter between physician and patient that any language barrier becomes critical.

I spoke with Dr Martha Bernadett, Executive Vice President at Molina Healthcare, a leading national healthcare provider in the United States, about the challenges of ensuring effective healthcare communication amongst non-English speaking communities in the US.

“It’s in the patient-clinician face-to-face encounter that patients gain the most important information and have the most important interaction,” says Dr Bernadett. “All other non-face-to-face interactions are trusted in a secondary manner, compared with the face to face encounter with a nurse or physician. After that is any written communication that the patient might take home, that they use to convey to family members what happened at that encounter. Those are the two critical elements in healthcare delivery where you don’t have as much margin for error.”

Molina Healthcare focuses on enhancing the relationship between patients and physicians, enabling them to communicate effectively with each other. Dr Bernadett told me that matching physician and patient language is an important aspect of the work they do. Where language matches or bilingual healthcare professionals are not available, interpreters are used for face-to-face encounters. Pre-translated documents also play an important role in efficient and accurate cross-language interactions.

Automating patient-physician interaction

Meanwhile, new technologies for automating translation are emerging and have been used successfully in healthcare. Staff at Bayshore Community Hospital in Holmdal, NJ, communicate with Spanish-speaking patients using an automated spoken translation tool that listens to a sentence in English, translates it to Spanish and speaks the Spanish sentence to the patient.

I spoke to Dr Mark Seligman, President and Founder of Spoken Translation whose product, Converser for Healthcare, is the innovative tool used by the hospital to engage patients in their own language and I asked him what makes the product reliable enough for use in a medical environment.

One of the keys to the product’s effectiveness, as Dr Seligman demonstrated to me, is ‘back-translation’ which confirms to the original speaker in text, what the translated text looks like when translated back into its original language. Through this innovation, it is easy to identify whether the context of an English word with multiple possible meanings has been correctly understood. If not, the correct meaning or inference can be specified by the user before the correct translation is spoken by the tool.

In the example below, the ambiguous meaning of the word ‘right’ in “Your right knee is broken” is clarified by selecting the correct meaning:

This is certainly an effective tool for reliable, context-sensitive translation that is making a real difference to areas including patient safety and compliance. The tool includes pre-translated compliance tools such as an informed consent form.

“Consent becomes a stronger thing when you can know and prove what you have said in a foreign language”, says Dr Seligman. The tool retains a transcript of conversations so it is possible to review exactly what was said. This opens another possibility for the future – the integration of transcripts with electronic medical records. Dr Seligman hopes this will be achieved next year.

“The challenge [of integrating with electronic medical records] is organisational rather than technological”, says Dr Seligman.

If this is starting to sound a little too much like a move towards fully-automated medical interactions, Dr Seligman is quick to reassure that Converser is not trying to replace human interpreters.

“Human minds, human hearts, human cultural understanding is irreplaceable.” says Seligman. “We’re not trying to replace humans. Converser will always work along with human interpreters.”

Emerging applications for automated translation

I asked Dr Seligman about the potential application of Spoken Translation’s technology into digital engagement channels such as social media. He explained that this is where he started out in the mid-1990’s, working on automating chat translations and it is certainly something that he hopes Spoken Translation will return to in the future. The company has a vision for applying their technology of today to live, verifiable, chat translation:

Spoken Translation’s vision of the future: live, verified chat translation

Other innovation in the pipeline includes server-based technology that would allow Converser to be used from portable and mobile devices. Dr Seligman hopes this will be available for iPhone and Blackberry during 2011.

Purpose built automated healthcare translation

During my research for this article, I was pleased to learn from TAUS, a think tank on translation strategies, about customized machine translation systems (aka automated translation) which are designed for use in specific sectors. This is in contrast to Google translate which can be unreliable for specialist areas such as healthcare. These customized engines are trained using database of previous translations from a specific industry and include features to ensure consistent use of terminology. The result is better quality, more accurate translations.

Just such a sector specific solution is used by the Pan American Health Organization (PAHO). Their system was originally developed in the 1970s, and today covers all combinations of English/Spanish and Portuguese and is being used daily for 90% of all PAHO’s translation needs, as well as by 75 clients. Another example is a Danish customized machine translation provider, Languagelens, whose purpose built solutions are used during clinical trials by pharmaceutical companies. Whilst human translators are needed to ensure that the final text is up to the high quality needed, the use of such customized automated engines drives down the cost of translation, increasing the amount of translation that can be done, and speeds up time to market.

TAUS also told me that it is possible to create automated engines rapidly when needed – within three weeks of the recent crisis in Haiti both Google and Microsoft added Haitian to the list of languages supported by their automated engines.

Real-time translation crowdsourcing

As automated translation technologies are deployed into healthcare environments, other innovative approaches to solving the automation challenge are emerging. New York, US based SpeakLike has developed a process that is enabling social media engagement to take place across 37 languages. Sanford Cohen, SpeakLike’s CEO told me that they were looking for a solution to enable real-time chat amongst people speaking different languages.

“We explored machine translation and found it was not good enough for our needs,” explains Cohen. “So we thought, ‘if machine translation were perfect, it would be integrated into everything we use – it would be in our email systems, in our chat systems, and in our content  management systems; but it’s not. But why can’t we have something that can be integrated into everything we use, with good quality translation?’ That’s when we started looking at crowdsourcing.” Cohen says this idea was how SpeakLike started:

“We got a large number of translators on our system, and users could send in a request when they needed it, 24/7, and then whatever translators were available or logged in first would provide the translation.”

The first application of the process was live chat, and in a 2008 beta SpeakLike demonstrated live, real-time chat between three users speaking English, Spanish and Chinese. This technology was implemented by PETLinQ, a provider of radiology imaging software management tools, to enable their user base of 71,000 doctors to collaborate in their own language.

After experimenting with the physician-patient interaction, where a dental reconstructive surgery in New York could support its worldwide patients pre- and post-surgery via international chat, SpeakLike started to develop other applications of the process. The translation platform was expanded to integrate with email, website content, and social media applications.

Today, a Twitter connector automates the translation of tweets, enabling either a single, multilingual Twitter feed or separate feeds for each language. Meanwhile, for bloggers using WordPress, a plugin automatically posts translated content into languages selected by a content author.

SpeakLike’s system is designed to manage the end to end process, automatically notifying translators, managing translated content, and publishing based on user options.

Cohen told me of a customer who was previously waiting typically for two weeks to have website updates translated into nine languages, but their content was out of date within four days. By integrating SpeakLike into their content management system, they were able to publish translations within less than 24 hours.

Responding to international health crises

The potential for transformation that can be achieved when people from different countries collaborate to solve healthcare challenges is exemplified in the work of international aid organisations such as Médecins Sans Frontières, where healthcare specialists from around the world work together in response to a crisis. But when the international team leaves an area of need, local physicians are often left without access to the international knowledge pool that exists during an aid mission.

Murdo Bijl, Founder and Executive Director of Health Connections International, saw this situation first hand when working with Médecins Sans Frontières in the former Soviet Union. The experience inspired him to set up an organisation focused on facilitating and promoting communication between professionals through multi-lingual exchanges of information. Health Connections International operates on a non-profit basis and focuses on improving responses to the HIV, tuberculosis and drug use epidemics in developing countries and resource-poor environments.

The organisation’s online knowledge and information sharing platform has been designed to allow healthcare professionals across the globe to share their experiences and exchange information, quickly and easily across multiple languages.

Healthcare professionals register as members of My Health Connections and can ask medical questions in their own language. Most questions are then manually translated and labelled by subject area (such as HIV/AIDS, treatment, medication) before being routed to an appropriate expert to be answered. Once answered, the response is translated back into the language in which the question was originally asked. It’s a laborious process but the result is a rich and growing knowledge base accessible in multiple languages.

MyHCI includes a growing, multilingual expert medical information knowledge base

I spoke with Murdo Bijl about his vision. He told me that in the proof of concept that has been running since April this year, 600 unique questions and answers have been posted. He said that as the number of questions and answers continues to grow, the knowledge base will be able to provide the answers to most commonly asked questions:

“There will be a moment when the knowledge base will have enough information for people to find the answers to their questions. Then all the questions will be translated into Russian, Spanish, Arabic and Chinese. Right now we have 500 Q&As online, translated into Russian.”

Supporting hard-to-reach healthcare professionals

In Kyrgyzstan and Tajikistan, local ‘focal points’ have been set up to bring Health Connections International’s service as close as possible to those healthcare professionals who may not have access to the Internet. As Bijl told me:

“We work with the medical academies and the ministry of health in the countries where we operate. They create their own knowledge centre in the capital city, with small focal points throughout the country which are equipped and manned by local physicians.

“In Kyrgyzstan and Tajikistan, we have twenty four ‘focal points’ on the premises of the ministry of health’s facilities, such as an AIDS centre or tuberculosis clinic, where local doctors who may not have access to the Internet can take their questions.”

Bijl says that the online model has allowed Health Connections International to continue to support medical professionals when other more traditional methods and have been unable to:

“What we’ve seen in Kyrgyzstan is that when many organisations had to halt their programmes because of political unrest and violence, we had an increase in user traffic. So even in political unrest, the work goes on.”

But Bijl is not content to stop at the existing online solution. He is already exploring new channels to increase the reach into low-income countries using mobile technologies.

“The next step for us will be to use mobile technology. 3G is virtually everywhere now in the low-income countries where we operate.”

Global collaboration

Amidst these examples of innovation in translation, TAUS supports the translation industry and aims to help the world communicate better through better translation, actively encouraging collaboration, sharing of knowledge amongst stakeholders and open innovation.

I spoke with Rahzeb Choudhury, TAUS’ Operations Director, about their vision for collaboration between translation organisations. He told me about the TAUS Data Association, a collaboration platform for sharing translation data, where Molina Healthcare is one of 40 founding members. This non-profit organisation provides an open platform for sharing translated texts into a single shared database which is a key enabler for experimentation and innovation, providing open access to language resources to help train better customized automated language solutions such as those used by PAHO and Languagelens.

The resulting repository of translations currently contains 2.6 billion words in 315 languages, including a giant corpus from the European Medicines Agency. The benefit of such a platform for healthcare (or any industry) can be seen by searching for a medical term in the free language search engine.

A glimpse of what is possible

From face to face physician-patient interaction in the United States to crisis response in the former Soviet Union, it is encouraging to see innovators establishing approaches and technologies that are breaking down barriers and achieving successful multi-language healthcare engagement. There is much still to be achieved, yet the examples here provide a hopeful glimpse of what is possible.

I am grateful to TAUS for their support in researching this report. My thanks are also due to the following:

Health Connections International
Molina Healthcare]
SpeakLike
Spoken Translation

As part of a strategy to increase global capacity, Creation Healthcare is pleased to announce a new location for its London office.  From 1^st August 2010, the company will be moving to improved premises with greater capacity.  The new address will be:

Creation Healthcare
90 Long Acre
London  WC2E 9RZ

Telephone: +44 (0)207 849 3167

This move follows the recent opening of a new office in Tokyo, as part of Creation Healthcare’s commitment to continually support clients located around the world with the expertise they need in local markets.

With a global team of 30 consultants located in 12 countries, Creation Healthcare is ideally placed to advise international clients about healthcare engagement strategies with the benefit of local cultural and language insights.

Creation Healthcare’s Co-founder and Director of Digital Engagement, Daniel Ghinn, explains why London is so important for a global consultancy:

“We’ve been in London for over twelve years now, and having travelled all around the world working with healthcare clients, I’m convinced that this City is the best place in the world to run a global consultancy from. With easy access to North America and Europe, we’re also well placed to connect with Asia, supported by our new Tokyo office.”

Some of those to whom I’ve said many times before that Creation Healthcare doesn’t do industry awards, might be surprised to learn that together with Pfizer we have just been awarded ‘highly commended’ at the Communiqué Awards 2010 for our digital strategy to change online behaviour in Real Danger, Pfizer’s campaign to tackle counterfeit medicines sold online from illegal websites.

Being awarded ‘highly commended’ by the Communiqué judges for this award was very special and the whole team at Creation Healthcare is proud that the digital strategy has been recognised.

But before you start to wonder if I’ve sold my soul and forgotten all those things I’ve said in the past about industry awards, let me explain: my frequently-voiced ramblings about awards like these have been on the basis that whilst much excellent work is often recognised, it is usually for what I believe are the wrong reasons. Great creative ideas, innovation, fantastic production, and even a campaign’s reach are all very admirable (and have been consistently highly awarded) but too often we find ourselves asking “so what?”

When Creation Healthcare is planning strategies with clients and their agencies we frequently find ourselves asking what can be uncomfortable questions about outcomes. To us, healthcare engagement is nothing without tangible, measured results against clear goals. Opportunities to view, website visits, social media reach and such measures are all well and good but we want to know – and we help our clients to discover – the actual impact of a campaign or strategy against goals that make a difference.

For Pfizer’s Real Danger campaign, the end goal was about changing the behaviour of consumers online. Knowing that consumers had been engaged at their point of risk, re-envisioned, and that they had taken tangible steps reflecting behaviour change as a result. In the end, up to 85% of people polled on the campaign website said that they would change the way they buy medicine online. Up to a quarter of visitors engaged further with campaign partners and accessed resources to help them change their behaviour.

Pfizer’s Real Danger campaign has been well awarded in many areas but I’m excited to see it gain recognition for these tangible outcomes online. It takes real guts and vision for a pharmaceutical company to put a digital engagement strategy at the heart of a campaign, and all credit is due to the Pfizer communications team for making it happen. The results speak for themselves… and the ‘highly commended’ is an added bonus!

“This house believes patient care will be enhanced through pharma’s involvement in social media“. So read the title of the debate I was invited to take part in at the PIPA Annual Conference 2010 on 5th July.

I was especially excited to take part in this debate, not only because of the opportunity to participate alongside an excellent panel of experts on the subjects of pharmaceutical companies, social media and regulatory affairs – Andrew Spong, Klynn Alibocus, and Sam Temple-Scotton. Even more so because the debate was hosted by PIPA, the Pharmaceutical Information and Pharmacovigilance Association.

In their own words, ‘PIPA is the professional organisation for individuals who are involved in the provision and management of information and those involved in the fulfillment of regulatory requirements relating to drug safety‘. In other words, the debate was hosted by regulatory, medical information and pharmacovigilence professionals. The fact that such an organisation placed this important topic on its Annual Conference agenda is an indicator that the questions being asked by pharma about how to engage through emerging two-way channels such as social media are being taken seriously.

At Creation Healthcare, one of the most enjoyable, if sometimes challenging aspects of our work is when we get to bring together internal stakeholders from across a pharmaceutical company – communicators, marketers, legal and medical colleagues, to develop healthcare engagement strategies embracing emerging channels. And from my experiences of this I know that amongst visionary pharmaceutical companies it is possible for these colleagues to strategise proactively together to achieve real health outcomes through innovative use of social media and other emerging channels.

Sarah Dunnett, Senior Medical Affairs Manager at Baxter Healthcare and PIPA President, chaired the debate and asked for a pre-debate vote. 42 conference delegates agreed with the motion (albeit some with caveats) whilst 21 disagreed, to at least some extent.

Not one to miss the opportunity to encourage healthy discussion about healthcare and social media, Andrew Spong kicked off the debate, playing devil’s advocate as he argued against the motion and highlighted some favourite objections including adverse event reports.

I followed with a brief outline of seven examples of pharma’s involvement in social media, outlining how each example demonstrated the potential for enhancing patient care. I included some of my favourite examples such as Johnson & Johnson’s Health Channel on Youtube, UCB’s partnership with PatientsLikeMe, Boehringer Ingelheim’s sponsorship of a Tudiabetes video, and AstraZeneca’s engagement with healthcare professionals through doctors.net.uk.

Sam Temple-Scotton then supported the case against the motion and pointed out that pharma is struggling to keep up with the level of change in digital channels.

Finally Klynn Alibocus made some excellent points about the breadth of ways in which pharmaceutical companies can enhance patient care through social media, drawing the debate away from marketing to consider other areas including clinical trials recruitment.

In the discussion that followed between the panel and PIPA delegates, some key issues were debated including trust, transparency, responsibility, stakeholder partnerships, business process change, and resourcing. Many of the most challenging issues were raised and debated. From my perspective, there was general agreement about points including:

• Pharma is generally mistrusted and this makes social media engagement difficult; but social media might play a role in enhancing trust through transparency
• Given the amount of discussion taking place by patients using social media about health issues, pharma has a responsibility to get involved
• Regulatory constraints make it difficult, but not impossible, to plan proactive engagement
• Avoiding adverse events reports by not listening to social media conversations is not the answer
• Successful social media engagement may require changes to the way pharma operates

Finally, a post-debate vote revealed the extent to which we had convinced PIPA delegates: after all the discussion, just 39 delegates agreed to any extent with the motion – a reduction of 3 – whilst 23 disagreed. On the face of it, it appeared we had done more to convince pharmacovigilence colleagues not to support pharma’s role in social media! But all in all I believe the debate was healthy, timely and relevant and I hope will encourage some of the PIPA delegates to take a proactive approach to working through some of the challenges with colleagues in their businesses. I am still reassured that 63% of pharmacovigilence professionals believe pharma’s role in social media will enhance patient care.

I understand that a more comprehensive report on the debate will be published in PIPA’s journal, PIPELINE. In the mean time, feel free to tweet me with your comments at @EngagementStrat.