Social Media's Role in Healthcare Marketing

Social Media and
Healthcare Marketing

Steven Nelson, AP42

December 1, 2011

AP42
2303 Camino Ramon, Suite 280 • San Ramon • CA • 94583 T (925) 901-1100 F (925) 901-1104 http://ap42.com

Social Media and
Healthcare Marketing

The following notes are from a presentation on December 1, 2011 in conjunction between AP42 and Med Ad Agency,
looking at the use of social media in healthcare marketing, a snapshot in time taken from several vantage points.

In preparing for this presentation, the problem was not a lack of information or points of view on the subject. Actually,
there is an abundance of information, with more appearing every day. The problem was to cull, collate, and curate this
information into a coherent story that can help you both understand and act effectively in the social space. So this
discussion is not encyclopedic (or even wikipedic) on the topic, but a starting point with some current context. For
experts in healthcare marketing, if this discussion is merely 10% of a catalyst, the other 90% of its value is within your
own experience and expertise in healthcare marketing that you’ll bring to the social media arena.

I’ll start by looking at three general trends in digital experience that affect both marketers and consumers (both
professionals and end users). Then I’ll look at how these trends have led to increasing use of online social media among
medical professionals, healthcare marketers and end users. Finally, I’ll get more speciﬁc guidance about how to approach
social media marketing planning, whether you’re getting started or looking to improve your presence.

AP42: Social Media and Healthcare Marketing
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PART 1: THREE TRENDS

Rather than just diving into lists of 10 do’s and don’ts for social media or how to create a branded Facebook page, I
want to talk first about three larger trends that have accelerated the impact of social media on online marketing and
communications. None of the three trends is “social media”, but all contribute to its realization.

TREND 1: ALWAYS ON
You (and everyone else) is increasingly always connected via the internet. There is very little friction separating you from
these connections. Over the past dozen years dialup has given way to broadband, meaning connected computers no
longer had to take the step of dialing up the internet. It was always there. And with increased bandwidths, there was less
of a mental calculation of whether it was even worth it to use a web-based resource vs. the time it would take to retrieve
it. And with increased search effectiveness, there was less of a mental calculation of whether it was even worth looking
for information. If you can imagine that it was there, it probably was, and you could find it.

And the mobile phone transformed into a hand-held everything device. Phone. Computer. Browser. GPS, Camera.
Always on and always facilitating two-way connectivity.

And the tablet gave everyone all that plus a wider window into that world of always-on information. At the same time, the
always connected TV expands that window. And brought together, they’re removing any friction from the connection.

We’re also entering the internet of things, where internet-ready devices range anywhere from vehicles to appliances, to
toys, to plants, to doggy-doors. To pedometers and flow rate meters. And bandages. And pills. And pedometers.

It’s not just what plugs you in that makes it always on - it’s how.

Add voice to the mix, as well as recognition of faces, and gestures, and you are always on and always interacting.
Biometrics automatically connected. And every-present ways of bridging what is already out there with what is virtual,
whether by slapping a QR Code onto everything, or by just recognizing things, or people by face or voice. Through
technologies such as augmented reality, the always-on world can be seen through an ever-present bionic eye. Voice
input systems such as iPhone’s Siri - with an always ready connection may be another game changer. Even technologies
like Microsoft’s xbox connect that responds to your gestures and motion as interface are finding their way into many
applications, such as this one in neurosurgery.

It’s not just your systems and devices that are connected in the internet of things. The computers, the things, the people,
the software always on and always connected.

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TREND 2: DATA EVERYWHERE
Now that you’re always on, your data is everywhere. Not only are you always connected, but something flows across
the connection. Data - lots of it. Big data. Yours and everyone else’s. Even if it your most private data that you only share
with yourself, increasingly it is carried by that connection and stored somewhere. From you phone to your computer to
your ipad to your ipod to your TV to your printer to your camera to your journal. This is why it’s now thought of as in a
“cloud”.

The proliferation of data is exponential, especially in the last few years and looking forward. In the last ten years we’ve
gone beyond gigabytes a thousand fold into terabytes. Cisco estimates that by 2015 the amount of data on the internet
will move not just a thousand times beyond terabytes to petabytes or a thousand times beyond that to exabytes but a
thousand times beyond that to zettabytes.

This can be attributed to hardware and software. With Moore’s law chugging along since the 70’s, we’re getting more
storage, faster bandwidth, faster computers, better interfaces and displays. And they’re getting smaller in size and cost.
Much of that power is about generating and harnessing vast amounts of data.

Software has also contributed to this trend. Database technology has changed to accommodate such large amounts of
data like Google’s index of the entire Web, or distributing the data over many servers, or providing programming
interfaces to access the data, or making the location of the data virtual, as in cloud-based software.

Much of that data is about you. Not just the data that you are explicitly generating and sharing, but the data that emerges
as you carry on in your everyday life. Sometimes with your knowledge and permission, sometimes apart from it.

The past seven years or so have brought the rise of user generated content. All the words, pictures, videos, music that
people have created have been transmitted, stored and shared on the Internet.

It has also seen all kinds of connected devices generating, sending, storing and sharing that data as well. And just as
the pipes have increased in number and size and speed, to connect and carry the data, the costs of doing so have
plummeted. And the ability to store this data forever has increased as the costs of doing so have similarly dropped.

Beyond that, this storage has become separate from identifiable location. Not just your disk, or a disk on a specific
server, but “out there”. In the cloud. It’s everywhere and it is forever.

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TREND 3: THE SEMANTIC WEB
All this data itself is becoming organized, connected and meaningful, and that is the third trend.

Not only are you generating “content”, you are generating content about the content.

The data is being organized explicitly as people expertly apply information architecture, taxonomies, structures and
definitions to kinds of data.

The data is also being organized implicitly through usage, connection, emergent behavior.

The first two decades of the internet were about sharing text and files, first between government researchers in the 70s,
and increasingly by schools and companies in the 80’s.

Then in the 90’s the web was born as “Web 1.0”. which was serving up and displaying files - text, graphics, etc., from
servers to browsers, and hyperlinking all that text and graphics into one all-connected Web. But you had to have and
manage a web server to do this, and that wasn’t always a simple thing to do.

In the last decade Web 2.0 emerged, the web as platform, that made access and use of this data programmable and
open, not just to web designers, but to everyone connected. Not just browsers accessing services, but services
accessing each other.

And Web 3.0 mines the semantic structure of all that data - how it relates, how it is connected and organized. Data is
connected by meaning.

The semantic web is what allows people’s connections with each other, and with content, to itself be data contributed or
generated. The social graphs that see who connects with each other (explicitly) or who influences each other (implicitly)
also connect those connections with information.

Semantic web enables the phenomenon of “crowdsourcing”, where large numbers of people influence ideas, decisions,
actions based on their sheer numbers. Again, their effects can be explicitly elicited, or can be observed to emerge from
their group behavior.

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In the era of always connected, always generating data, and always connecting that data with meaning, concepts such
as privacy are rapidly evolving. This has a special significance for healthcare uses of social media, so I’ll finish this part
with three quotes that indicate how the concept of privacy is evolving:

“People have really gotten comfortable not only sharing more information and different kinds, but more openly
and with more people. That social norm is just something that has evolved over time.

“We view it as our role in the system to constantly be innovating and be updating what our system is to
reflect what the current social norms are.” - Mark Zuckerberg, CEO, Facebook

"If you have something that you don't want anyone to know, maybe you shouldn't be doing it in the first
place." - Eric Schmidt, Executive Chairman, Google

“In the future, the less private you are, the longer you’ll live.” - Jonathan Richman, Dose of Digital

We’re seeing this evolution play out with sites like 23andme.com, where your personal genome is shareable with friends,
family, anyone really, and as a result you may learn valuable information about yourself in the process.

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PART 2: SOCIAL MEDIA

Always connected, always generating data, and organizing and connecting all that data based on meaning. These have
been the drivers of change leading to online social media and its influence. By social media, I am including online
platforms that include four things:

• Presence centered around individuals and the profiles they create to represent themselves on the platform.

• Content generated and shared by these people, ranging from 140 character tweets to blog posts to pictures and video
to comments and ratings

• Interactions among the users (and content) are facilitated by the system

• Various forms of connection among people (and content) built into the system - following, liking, friending, connecting.

This is a good test to separate social platforms from other online platforms such as message-board-based online
communities, or at least to determine how social the focus of a given platform is.

I’d like to look at how three groups are using social media: patients and consumers of healthcare services and products,
healthcare professionals, and companies who develop and market services and products to medical professionals and
their patients.

But the effect of social networks predates the power of today’s online social media, and in fact, they haven’t lacked a
power of their own. Social networking, the science of how peoples’ connections influence them, is nothing new. (Believe
it or not) even before computers, people connected with one another. And the effects on health decisions and behaviors
can be striking.

Long-term studies like the Framingham Heart Study that measure not only specific states of health and health decisions,
but also family and social connections among the participants show that factors such as obesity, smoking, propensity to
visit the doctor, are influenced by a network effect that extends to three degrees of separation. The tendency to be obese
is not just increased among, say, spouses, but can be correlated with a spouse’s co-worker’s best friend.

Recent Facebook research showed that the average degrees of separation between any two Americans on Facebook
wasn’t the six degrees seen in the 60s, but four degrees, getting very close to the three degrees that can influence health
and health decisions.

This is why accelerated online networks amplify the trends that have been there all along. This, as much as anything, will
be both the driving power and the urgent call to participate in the social space.

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PATIENTS USE SOCIAL MEDIA
In “10 Things I'm Tired of Hearing About Pharma Social Media” Jonathan Richman includes some things that should now
be stipulated, and so don’t need to be droned on about in presentations such as this one. “People use the internet to
search for health information” is one of those.

But searching on the Internet and finding good data are different things. As it relates to health, there is much
misinformation, and search relevance and reliability are important factors. Information has been shared among like-
minded communities via message board style platforms for years, and these continue to play a role. Just as in the pre-
Internet era, people base health care decisions on those that they know, this is still a factor. Communities of common
interest are merging with networks of influence in and among the various online platforms. These are also affecting
search results, as search engines such as Google factor in one’s online social circles into their algorithms for determining
relevance.

Other factors, such as mobile access to applications, the evolving definition of privacy, and participation in
crowdsourcing, influence peoples’ use of social media.

Individuals come with varying degrees of readiness to engage online, and in social or community platforms. One size
doesn’t fit all, and in next section, I focus more on models for reaching different parts of the audience based on
readiness. But it’s not just about different marketing tactics, but its also about understanding the dynamics over time.
How do these different groups of consumers evolve over time, and how do they interact with each other? Because
ultimately, the social effect takes place about how the people are connected with each other, and how you can factor
that in to your own social participation.

Empowered patients want both information and connection, and will naturally see physicians as part of that equation. But
how about the doctors?

PHYSICIANS USE SOCIAL MEDIA
The past year has seen a remarkable rise in the number of physicians who use one or more social platforms. Though
more use the platforms for personal use (90% vs 66%) the increase over the past year is what has been striking.

Surveys from the first half of 2010 showed numbers like 42% of doctors using social media. The first half of this year that
was up to 84%, and it’s now approaching 90%. One of the main drivers of this was increasing use of smart phones - as
I said before, that has been a significant driver for all of social media, and is especially true in healthcare.

Those who use social media for either professionally or personally are not (for the most part) using it to connect socially
with patients. And they are not (for the most part - yet) tapping into patient communities.

Doctors want online information, whether for journal research, or for understanding authoritative information on drugs
and devices.

Fewer physicians use social sites professionally than socially (66% vs 90%), but of those who do, physician communities
rank the highest in use. Sites like Sermo restrict themselves to physicians, but bridge into the community of marketers

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by providing valuable information about the activities and insights of their membership. This is a two-edge sword,
however, and has been an occasional PR problem for Sermo.

The highest ranking site for social activity in the personal context is on Facebook. (Hey, doctors are people too.) YouTube
is the second most popular, which hows the difference between highly social sites - such as Facebook - where the
connections matter as much as the content, and sites such as YouTube where the content is primary, even though there
are social components to it.

One area where usage has not been seen is physician awareness of patient communities. However, where patients are
aware, there is high regard for the value of patient communities, both for the patients as well as for the physicians. When
they are aware of them, physicians use them to learn more about their patients, how they manage their health care, how
their conditions affect their lives, how they are subject to misinformation, and so on. And doctors in an era where they are
seeing more and more patients arriving with some level of information or misinformation, as well as patients who have
already interacted with healthcare marketers, understand that patient communities are as influential on the patients’
mindset as is advertising. Physicians who felt that DTC advertising was already influencing their patients and turning the
system on its head have not felt the full effect of empowered online patients and healthcare marketers who connect with
them in a social context.

Once they do, and that small percentage of physicians that understands the social power of connection increases to the
degree that their social usage has increased, there will be a social context that brings together physicians, patients, and
healthcare marketers*.

(as well as other significant participants, such as insurance companies, hospitals and health systems, federal and state
governments, and information giants such as Google, Facebook, Apple or even Microsoft.)

There are also efforts to create platforms to explicitly bridge patients and physicians, and not just target one or the other.
Some platforms enhance communication between practices and patients via email, scheduling, and information sharing,
but it isn’t to the level of true networking. Others, such as HealthTap bring networks of patients and physicians together
to tap into knowledge.

HEALTHCARE MARKETERS USE SOCIAL MEDIA
By their general nature, healthcare marketers are in the business of meeting market needs for their products, and
engaging with those markets through all available and effective media. And by their unique nature, healthcare marketers
face specialized constraints in their models, methods and technologies as regulated by governing laws and regulations.

And now social media. The governing laws and regulations so far have not clarified how social media and healthcare
marketers mix. This has inhibited some marketers from engaging in those media. But others have moved forward and
tested and succeeded. Those who have done best have adapted their understanding of existing regulations and
projected them onto the new media.

Many marketers provide online information for health care providers separate from information for patients, for example
on their website. But in the area of social media, most marketers have concentrated on patient communities. If you look

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at the Dose of Digital healthcare wiki, you’ll see lots of “brand sponsored patient communities” and lots of “healthcare
provider communities” but not a lot of “brand sponsored healthcare provider communities”. But as the awareness and
bridging among these communities happens based on both experience and platform functionality, there will be more
opportunities to connect.

Social media presence can take several forms, and they’re not mutually exclusive.

Profile presence is a baseline, where your company is essentially registered on the social media platforms with basic
information, including pointers to your more fully developed online assets. This helps search engines and other locators
find and connect your dots, and it also counters the sense of digital absence that would happen if you weren’t there.

Beyond basic profile you can also have branded presence on social platforms with a greater degree of customization and
engagement. This takes more planning and diligence, especially for regulatory compliance, but can pay off if done
correctly. I’ll talk about a model for doing that in the next section.

• And bridging between marketers and physicians in online community can start to be seen in platforms designed
explicitly for this.

• Success in a social platform is due to:

• encountering people where they happen to be (the Willie Sutton rule)

• developing a broadcast model so that your digital messaging connects among the various media

• doing something of real value to your visitors

• being (literally) remarkable so that your visitors will want to share

• removing the friction from sharing (e.g. “share this”)

• ideally incorporate unique social features into social platform apps

The following idealized scenario has not yet fully played out as physicians, patients and marketers all work in a larger
social ecosystem, but I predict the following:

• Physicians participating in (or being aware of) more patient communities

• Frictionless sharing of information into closed physician communities

• More actual bridge platforms between the various target audiences

• The network effect will continue to play out, within and among platforms.

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PART 3: JUMPING IN

We’ve looked at three drivers of technological change that has enabled the power of social networking through online
social media. We’ve looked at how patients, physicians and healthcare marketers are factoring social media into their
everyday patterns and communications. Now I want to talk about the steps to engage in with social media.

You can consider four separate steps:

1. Observe

2. Understand

3. Plan

4. Deploy

Notice that the ﬁrst three steps happen before you make your ﬁrst tweet.

STEP 1: OBSERVE
A key step in social media is to observe. As I said before, there is plenty of information out there, including information
about what has and hasn’t worked. The observation step includes:

• Observe your customers

• Observe other companies

• Observe the market

There are many ways of observing your customer. Here is an example of how I use Twitter to observe customers:

• Search on terms relevant to your product on condition

• Find several people who are tweeting interesting things

• Look and see who they are following

• Look and see who is following them

• Look and see where they are listed

• Look and see who else they list

• Take it out one level: follow the followers

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This requires some pattern recognition on your part, but you will see:

• Trending topics

• Who is influencing whom (people follow media, etc.)

• What language people use

• etc.

Observe other companies - just go see what they’re doing in the open space. Use resources like Jonathan Richman’s
Dose of Digital Wiki, where you get an up-to-date survey of what other companies are attempting (and often succeeding
at) in this space. As I said before, absent clear regulatory info from the FDA, this shows what people actually are doing.

Observe the market - Use Google Alerts to bring you specific news about what is going on in your market. (This is a great
way to get inspired for your blog!)

STEP 2: UNDERSTAND
Once you know what to observe and have begun the process of observation, you need to take the step of
understanding. This is where you see the patterns and develop the models based on what you’ve seen. This is where
you ask yourself specific questions about your business objectives and organizational readiness and know how
everything could fit together. You generate alternative possible ways of connecting your digital assets, your brand assets,
your organization, your target audience and other stakeholders in your market. You understand the platforms and what
they offer, and how they connect. You understand the roles and relationships between people, groups, companies, and
the difference between individuals projecting their personal presence versus their professional presence.

Part of understanding is developing or applying a deeper model of who your target audience is and how prepared for
connection they are.

One model that I’ve found useful is the Forrester Social Technographics Ladder. There are other models of engagement,
but the idea is that you go through this step with this model, or a similar one, so you can understand before you plan.

Forrester has developed a model that categorizes the readiness of your audience for social engagement so that you can
craft your tactics against your objectives with appropriate levels of social activity. You can also then track shifts in your
audience as they adapt their online habits to new social media and technologies.

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The categories are (starting at the bottom of the rung):

• Inactives (don’t have any engagement in social media)

• Spectators (read blogs, watch videos)

• Joiners (maintain a profile)

• Collectors (social bookmarks, RSS feeds, taggers)

• Critics (rate and review)

• Conversationalists (post updates, tweet, etc.)

• Creators (publish a blog, update websites, upload videos)

• Curators (guide others to content)

By understanding or even thinking about your audience this way, you start to see how you might meet their needs
through different ways of engagement. You also understand how it is through experience, helping each other, and your
help, that people inevitably move up the ladder. (e.g. Inactives moved from 52% to 17% from 2006 to 2009)

It helps to understand that social media is not in isolation, but embedded in your business. In other words:

• Your business model begets your marketing model.

• Your marketing model begets your online model.

• Your online model begets your social media model.

One way to tie together your business objectives and organizational readiness is through a series of questions that we
have developed. They’re conveniently organized into a series of Who, Why, Who (again), What, When, Where and How.
By answering these first, you develop an understanding that you can take directly to the planning phase. AP42 has
provided a Social Media Workbook (PDF) with these questions in detail.

STEP 3: PLAN
Having observed your social ecosystem in the wild and developed models to explain how your specific market engages
with social media, you can develop a blueprint for your social media engagements. There is no one size fits all, so it is
heavily dependent upon the previous two steps.

And then you get tactical.

You still need to get the basics: selecting platforms, establishing baseline presence, factoring in your “non-social” digital
assets. But it helps to have a model. One that I’ve found especially helpful in the healthcare area was introduced by
Amber Benson of IMC2 Health and Wellness.

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It builds on the Forrester Social Technographics Ladder, where you’ve understood the readiness and participation of your
audience.

1. Map your offering based on audience engagement and outcome investment

2. Look at where your audience sits in this engagement space

3. Map your brand objectives to your social media objectives based on this mapping

4. Find the right forms of engagement that map to these objectives

5. Develop social tactics to implement these forms of engagement

As we’ve seen here, planning follows the models of observation you’ve made. It also follows the questions you answered
in the Workbook step. For each general question, a Playbook will direct the steps you take on an ongoing basis during
deployment. E.g. Who in your organization (roles and responsibilities) is responsible for What (content? workflow?
approval? monitoring? response?) When (scheduled editorial? crisis management?), and so on.

Your plan will succeed if you see it as a whole system, not silos of effort on each platform. There are plenty of models out
there that show, for instance, how your web site, your blog, your Facebook page, your LinkedIn profile, your twitter
account, your youtube account, etc., all tie in and mutually support each other and facilitate flow and connection among
your content and your audience, which is the true strength of social media.

STEP 4: DEPLOY
Once you’ve developed a tactical plan, deployment should be based on executing that plan. In a way, this is the easiest
part, because of the steps you took to observe, understand, and plan.

The key is to have the right plan that will match your organizational preparedness, whether you are going alone or have
outside help. You can have a plan that matches your needs by not over-reaching your capability. You can have presence
even with a small staff, as long as your presence is crafted to not imply more than you can take on. Somewhere between
no presence and inability to keep up with what you’ve unleashed, is the right level.

There are plenty of resources out there to give you guidance how to plan and deploy social media, and I didn’t want to
stand here and reiterate these, but one stuck with me that I wanted to conclude by sharing.

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It’s step #9 of Jonathan Richman’s “9 simple steps”:

9. Automate

At first I thought he meant making sure all the RSS feeds were there to tie together all the social media, but what he
means is make the social context come automatically to you by understanding the power of connection among people
and content, and these models of how this works, and what these opportunities are. When you have new clients or
customers, follow them, connect with them, share with them. When you have new content, ask first how it could be
socialized and then go for it. It should be a first thought, not an afterthought.

Keep working at it, and it will become automatic.

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References

AP42
http://www.ap42.com
http://ap42.com/socialmediaworkbook
http://blog.ap42.com

Forrester Social Technographics / Forrester Research
http://empowered.forrester.com/tool_consumer.html

Amber Benson, imc2 / "Is Social Media Right For Your Healthcare Brand"
http://www.imc2healthandwellness.com/documents/Social_Media.pdf

Jonathan Richman / Dose of Digital
http://www.doseofdigital.com
http://www.doseofdigital.com/2010/03/9-simple-steps-started-social-media
http://www.doseofdigital.com/2010/06/10-thing-tired-hearing-pharma-social-media
http://www.doseofdigital.com/healthcare-pharma-social-media-wiki

Med Ad Agency
http://www.medadagency.com

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