F E RDIN A NDO S C A L A - L E A NDRO AG RÒ From Crowdsourcing to BigData. How ePatients, and their machines, are evolving Health.
Aboutthe authorsFerdinando Scala is International Digital Strategist at Razorfish Healthware, a PublicisHealthcare Communications Group company. His main fields of expertise are Strategy Ferdinando ScalaConsulting, Digital Strategy, Digital Transformation, Digital Engagement, Digital MetricsModelling, Collaborative Media, Marketing and Communications, Change Management.An Alumnus of the prestigious Nunziatella Military School of Naples, Italy, Ferdinando holds anMSc in Biology (summa cum laude), received MBA training, and is currently pursuing a BSc inCommunications and Media.He started his career as a researcher in the field of satellite- and airborne-based environmental Linkedin.com/in/ferdinandoscalamonitoring, working in collaboration with CNR, CNRS, DLR and European Space Agency. Hesuccessively spent 12 years in Big Pharma companies, holding positions in Sales, Marketing @fscalaproand Commercial Operations at national and international level. ferdinando.scala.phiA passionate Wikipedia author (13.000+ contributions), on June 2011 he has been shortlistedfor becoming a member of the Board of Trustees of the Wikimedia Foundation; and he was theCandidacy Leader for the City of Naples, Italy, to be the hosting town for Wikimania 2013, theglobal conference of Wikimedia Foundation.Leandro Agrò is the Global Director User Experience at Razorfish Healthware, a Publicis Leandro AgròHealthcare Communications Group company. His main fields of expertise are Service Design,User Experience, Interaction Design, Digital Strategy. Visiting Professor at Siena University andProducer of Frontiers of Interaction Conference, Leandro has been awarded Venice Biennaleof Architecture, ADI Index, TechGarage, New York Times, Wired, WebAward, and otherInternational Institutions.Leandro’s education originates from the Italian design culture. He completed a post graduatedegree in Interaction Design at Domus Academy (Milan, Italy), winning the Interaction Designcompetition at Apple Computer, Cupertino, CA in 1997. As blogger and writer, Leandro Linkedin.com/in/leeanderpublished more than 300 articles mostly focused on the consequences of technology and @leeanderinnovation; he contributed to four books and gives talk at TEDx, World Usability Day, UXCON,eTech, World Business Forum, BayCHI (ACM). leeanderIn the last 15 years, Leandro, designed the first UMTS/3G user interface never developed; Hecontributed to patents in the photo-video field -and- designed the first multimodal computer UIbased on eye-gaze (patented) used in the healthcare field.
Introduction This whitepaper exposes today’s most relevant patient and healthcare data trends for the benefit of health marketers, and how they will impact the Healthcare value chain. Today oceans of data are being produced and collected both by people and machines, at the same time changing the way we think about healthcare as a field of study; as a result Patients - actually ePatients - are becoming ever more informed and independent with their healthcare decisions. This “perfect storm” in the making, revolving around new paradigms of “Crowdsourcing” and “Big Data”, will radically change the current Healthcare Industry and reality of marketers. The mode in which drugs and healthcare delivery are to be presented to healthcare professionals, patients and other stakeholders is increasingly important in this new data driven paradigm. Are you as a marketer ready to embrace this change?
Razorfish | Healthware From Crowdsourcing to BigData February 2013 4As the seminal bookBlue Ocean Strategyby W. Chan Kim and René Mauborgne......demonstrated in 2005, real progress for a company does not lie in fighting for space in already crowded markets.Instead, the creation of new operative space, where to operate alone, otherwise known as “blue oceans”, is the soleviable option for building consistent and durable strategic advantage.While being highly rewarding when a company manages to find them, “blue oceans” are not easy to spot or build.Basically, building a durable strategic advantage requires one to identify and put in relation concepts and resourcesthat are apparently unrelated. Normally, companies are not good at spotting new opportunities, since their operationalmodel is built to robustly guarantee excellence in delivering effectiveness around the available products andservices. The convergence of apparently unrelated concepts is in fact determining a quantum leap in the healthcareenvironment, and only the companies that are prepared to ride the wave will succeed in the next years.In the following paragraphs, we will show you how a monkey, a typewriter, the largest global encyclopaedia, yoursmartphone and your health records are all related and will shape the future of healthcare industry.
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Razorfish | Healthware From Crowdsourcing to BigData February 2013 7 KNOWLEDGE IN THE AGE OF INTERNET Knowledge Nearly every possible question has example, Prof. Walter Lewin, from repositories: TED, an answer to be found somewhere Boston’s MIT Open Courseware, amongst others on the Net. This is valid if you are is one of the best professors of searching for a theory, a point of physics on the planet – and his Author: Leandro Agrò view, or some relevant data and knowledge and highly entertaining information about it. This statement, lectures are available to everyone for as extreme as it might seem, is free on the Net. true irrespectively to whether you In summary, the Net is today the are looking for the manual for your repository of the best information washing machine, or want to build a ever expressed by humanity in space rocket – or Satellite - in your virtually every area of knowledge own back yard! and industry; and this knowledge Maybe building a satellite in the becomes growingly organized in garage is not the most practical hubs For example, TED conference thing to do, but the fact that (TED.com) is a major destination it is possible shows that the where everybody can find this knowledge available to everyone type of high-level knowledge. on the Internet even makes an Much importantly, TED is delivered apparently impossible task as space in a lecture/audience format exploration available to the masses. accessible to all via video. This The same depth of information is leading conference also has a a not limited to space exploration, but version called TED MED, specifically could empower individuals in their focused around healthcare (http:// knowledge of other uncommon www.tedmed.com/videos). subjects such as Physics. For Prestigious universities, conferences that generate knowledge useful to the future, new generation institutions like the Singularity The Language Issue University (SU), as well as individual We can hope that “soon” (in a few decades), we will reach the tipping point investigators who have an open- that will allow for accurate automated translations, for now we must make source mind set and raise revenue use of the only intelligence adequate for this task: multilingual human by mean of crowd funding, all beings. have one thing in common: they Crowdsourcing is becoming the way to handle accurate and contextual are collaboratively building and multiple language translation. disseminating their knowledge for Places like TED.com or VIDEUM.com (a video portal dedicated to free on the Net. In this respect, healthcare) are leveraging crowdsourcing to -potentially- translate and SU is one of the most important “language enable” all content for the benefit of users around the world. examples of how this can happen. As an institution whose mission
Razorfish | Healthware From Crowdsourcing to BigData February 2013 8 Career analyst Dan Pink examines the puzzle of motivation, starting with a fact that social scientists know but most managers don’t: Traditional rewards aren’t always as effective as we thinkis “to assemble, educate andinspire a new generation of leaderswho strive to understand andutilize exponentially advancingtechnologies to address humanity’sgrand challenges”, SU uses thecollaborative strength of its students,some of the most brilliant mindsin the world, to tackle and solveproblems which are out and beyond WHAT IS CROWDSOURCINGtheir normal field of competence.The reasons behind the successof collaborative phenomenon are Traditional knowledge building The infinite monkeycomplex, and they are eloquently models are linked to the linear model theoremexplained in Dan Pink’s TED lecture: of thought. The organization of Author: Ferdinando ScalaThe puzzle of motivation: (http:// concepts into a coherent significantwww.ted.com/talks/dan_pink_on_ unit, like a speech, an article or amotivation.html) book, always requires the author(s)In order to understand how the to plan in advance a logical structurecollaborative building of knowledge composed by “buckets”, like issuesis realized, and what implications to be addressed or chapters. Theseit has for the information diffusion “buckets” had to be organized inin general, and for the healthcare a linear concatenation, so that thefield in particular, we need to reader could easily follow the traindelve deeper in the world of of thought of the author(s). Morecrowdsourcing and collaborative importantly, this kind of processcommunities and projects. was considered as the only one efficacious to deliver coherent results. Linear knowledge building models have been put in discussion when first confronted with the theoretic possibility to have infinite time and resources to build a logical sequence of concepts. A well- known exemplification of this theory is the so-called “Infinite
Razorfish | Healthware From Crowdsourcing to BigData February 2013 9 EXPECTATIONS 3D Printing Adapted from Gartner HypeCycle Wireless Power BYOD HTML5 Social Analytics Private Cloud Computing Gamification Application Stores BigData Augmented Reality Crowdsourcing In-Memory DB Management Speech-to-Speech Translation NFC Payment Audio Mining Speech Analysis Natural Language Q&A Internet of Things Cloud Computing Autonomous Vehicles Mesh Networks Predictive Analytics 3D Scanners Speech Recognition Gesture Control Automatic Content Recognition Holographic Display In-Memory Analytics Biometric Authentication Methods 3D Bioprinting Text Analytics Consumerization Quantum Computing Media Tablets Human Augmentation Mobile OTA Payment Home Health Monitoring Virtual Worlds Technology Peak of Inflated Trough of Plateau of Slope of Enlightenment Trigger Expectations Disillusionment Productivity TIME Plateau will be reached in: Less than 10 years More than 10 years CROWDSOURCING HYPEmonkey theorem”. According to building task is possible. Positioned in the Gartner Hype Cycle 2012 http://en.wikipedia.org/wiki/Hype_cyclethis theorem, if a monkey (therefore Things consistently change when before the “Peak of Expectations”a being not provided with human Crowdsourcing is still the “new thing”. The experimental conditions change. opportunities to leverage this technology andlogic or sense of purpose) had a approach are in front of us, and the knowledge When we have at our disposal we have infused in the Net is too much to betypewriter and infinite time at its handled. sentient and self-aware humandisposition, it would be able to build beings, who perform voluntaryup the complete works of William actions, which are driven by aShakespeare by sheer brute force, sense of purpose, the time to buildby randomly tapping on the keys. a knowledge artefact consistentlyEven if this theorem has some reduces, in exponential relationstrong limitations, it is very important to the number of individuals orfrom the conceptual standpoint. It resources available, even in theconveys the idea according to which absence of a formal scope oreven in apparently unfavourable organization.conditions (non-human being, The above mentioned conditions arerandom actions, lack of sense of at the base of the crowdsourcingpurpose), by having infinite time and concept, which first appearedresources available, any knowledge- in 2006 in a seminal article by
Razorfish | Healthware From Crowdsourcing to BigData February 2013 10 Jeff Howe in the review “Wired”. formatting pages, Wikipedia is as of The author presented for the first now the most complete repository time the possibilities offered by of human knowledge. One of the the unstructured, collaborative Top-5 ranked websites in the world, approach for business purposes. and consistently in first position in Since then, the meaning expanded any Google search page, Wikipedia to a significance that here we define contains 23 million articles, has as: about 100 000 active contributors and it is edited in 285 languages. In 2011, it received 2.7 billion page “The use of crowd, without views per month from the United any formal or hierarchical States alone. coordination structure Also when examined in terms among its members, for of quality of content, Wikipedia performing a certain shows good consistency and scope, in order to pursue credibility, despite it being the which, an exceptional result of unstructured work. In a amount of resources would renowned 2005 article in Nature, be necessary; where Jim Giles argued that for some “exceptional amount scientific areas Wikipedia individual of resources” means a articles had the same rate of errors that a review of the homologous quantity of time, money, article on Encyclopaedia Britannica personnel or skill, and their (EB) could put in evidence. Even combinations, which would though the article was disputed exceed the capabilities of by EB, eliciting a successive any formal organization.” rebuttal by Nature, it remains evident that individuals, simply driven by their will to contribute, Since this publication, the concept and working in an unstructured has exploded in a series of way, can collaboratively achieve applications outside the business results which normally implied world, of which Wikipedia is the the construction of a structured most well-known example. expert panel, and the investment of physical and economic resources. The total Wikipedia is probably the best- More importantly, it demonstrated encyclopaedia: known example of crowdsourcing the feasibility of an apparently Wikipedia applied to knowledge building at a daunting scope: gathering all human worldwide and cross-cultural level. knowledge in a single place, in Author: Ferdinando Scala any possible language, and freely Built from the collaborative effort available to everyone. of anonymous contributors, each adding up a more or less big piece While still probably being ahead of information, revising grammar and in terms of overall content quality,
Razorfish | Healthware From Crowdsourcing to BigData February 2013 11 EB fails in a fundamental aspect Once we understand the basic of knowledge diffusion, i.e. the concepts of crowdsourcing, we are The Credibility availability of its contents in any ready to revert the infinite monkey Issue possible language worldwide. theorem, and bring our analysis on Furthermore, even if EB would set a further level. The next questions to Today: All places that are mono-cultural or with a single itself to this scope, the amount of which we should find an answer are: sender that operates in logical personnel, skills and especially a. what happens when data broadcast, make it increasingly monetary resources would be generators are potentially infinite difficult to gain trust. Also, on the prohibitive, and would doom the both in number and in the other hand, it is difficult today quantity of parameters they take project to failure. that a “pyramid” not sufficiently into account? open - as is typical of crowd- In summary, from the Wikipedia b. what completely new possibilities mechanisms - can find the vs. EB example, we can derive a are available when data necessary trust. general theorem, which proves itself generators are networked into Pyramids – as well as YouTube as correct when conditions are a system running under a set of - were built by many. Stories, respected: cybernetic rules, which ensure information or generally speaking, constancy, reproducibility and “content” define who we are and analytical accuracy of measured what we are able to do. While the “Given a collaborative phenomena? old giants –like Encyclopaedia knowledge-building task of Britannica that are not available The answers to these questions are any dimension, the quantity found when examining the world of in a print version anymore- are silently passing in time, all the of time and monetary Big Data, the concept of Quantified new mega-content-structure resources necessary to Self and their consequences for the emerges on the web, shaped in complete it is inversely healthcare domain. ourselves in near real time. proportional to the number of contributors and their individual specific skills level; while the quality of final outcome is directly proportional to this number and skills set.” We have examined how crowdsourcing allows the generation of huge quantities of organized data by means of the non-coordinated effort of unrelated contributors. Even if there is no hierarchical relationship among contributors, the creation of these huge knowledge buckets is still strictly related to individual human skill and willingness.
Razorfish | Healthware From Crowdsourcing to BigData February 2013 12 WHAT ARE BIG DATA?Measure Everything: If The renowned physicist Lord Kelvin technologies, they are becomingyou cannot measure it, (1824 - 1907) proclaimed, “If you an active actor in health, nutrition you cannot improve it cannot measure it, you cannot and wellness data collection. The Author: Leandro Agrò improve it”. This law was designed diffusion of these technologies is by humans to meet the needs of becoming so widespread, sensible Science that were becoming more in terms of measured parameters, complex. Over a century later, we and easy to carry for people, that it continue to find this complexity in is opening a brand-new opportunity, every moment of our working lives. called the Quantified Self movement (QS). Measuring everything has become a “human centric” issue – about QS approach is to incorporate knowledge and control in the Internet technology into data acquisition on Age - exactly when technology was most aspects of a person’s daily able to fill it. But more importantly, life in terms of inputs (e.g. food measurement has emerged as a consumed, quality of surrounding Social Need today because we are air), states (e.g. mood, arousal living in real time in the digital sphere. and blood oxygen levels), and performance (mental and physical). …and this WAS just the beginning of an incredible emergent trend: In the Internet Age, or better yet, The primary methodology of self- in the upcoming Internet of Things quantification is data collection, Age, we do not have enough followed by visualization, cross- humans to take care of all sensors, referencing and the discovery of devices, satellites, and –in general- correlations. infrastructures that we create. This powerful trend has inspired Measuring everything is an intrinsic numerous hardware devices (mostly need of the technology we are in the wellness area) that leverage leveraging to build our world. And components for cost reductions actually it is also a need of the in sensor technology, mobile world itself, as a planet, to face the connectivity, and battery life, and impetuous evolution of the human that have already become part of footprint. Measuring everything has everyday life of millions of users. This already changed other industries trend resulted in the appearing and and Healthcare is not immune. explosive expansion of products like Withings, Nike+, fitbit, as well Data sources: as software apps for smartphones Patients are the biggest community the Quantified Self used to track almost every aspect in healthcare and – today – of life. Author: Leandro Agrò thanks to all their portable smart
Razorfish | Healthware From Crowdsourcing to BigData February 2013 13 Behind the QS, there is an emerging desire for an individual to improve The day in which we will oneself, but it is also driven by a produce more content in a natural human tendency towards single day, than the rest of competition within one’s own human history, is near at microcosm (friends & followers). hand. The QS is also related to the philosophy of interdependence, However, currently the donating information about oneself amount of data produced by to be used as a contribution towards humans is very much less new knowledge about people’s than the data produced by behaviour and habits as well as the machines. discovery of new medical cures. From the Pharma perspective, QS is creating an emerging and counterparts. The evolution immediately relevant group of of human crowdsourcing and stakeholders. Right now, most of participation is a mixed human/ the work of data collection and machine crowdsourcing and publication is made manually, while participation. every day more and more devices In the field of health, “we can benefit become autonomous. from the multiple data types coming on-stream at the same time. These include electronic medical records, Data sources: Using pen and paper, people are inexpensive gene sequencing,crowdsourcing for men already able to collect and share personal sensor data, qualitative and machines tons of useful data. Using shared contributions by self-tracking, and Author: Leandro Agrò tools such as Wikipedia –or any more”. (Cit. When data disrupts other collaborative tools on the web- health care) people are able to conceive and evolve spaces of sense and culture. We need to talk with people, as well as to integrate in the “discussions” Powered by sensors – ever more of their machines. present in many devices – and thanks to cloud computing – a It takes us to big data, and remote service that collects and unleashes the potential of analysing crunches the data – people are information on a worldwide scale re-writing their own knowledge and, for almost every possible topic or with it, a perception of the today’s matter. reality. The availability of different datasets The Net is both for humans and presents an opportunity for High machines, and today we should Tech Companies because data bear in mind that machines are scientists and technologists more numerous than their human already have the skills to manage
Razorfish | Healthware From Crowdsourcing to BigData February 2013 14 the data. We have already done b) a limited capability of facing something similar in the financial scientific problems, which is delimited field, today almost completely driven by the individual and collective skills by machines based on big data of the R&D team members; and the analysis and relevant results can be sheer number of people, time and found correlating the many health resources on hand. care data sources. As a consequence, when an R&D Up to this moment, we established problem that is exceeding the talent the basic concepts of crowdsourcing, pool or organizational resources Big Data and Quantified Self, and capabilities arises, the development we could be tempted to consider process can come to a halt, with them as distinct and far away from huge consequences in terms of daily reality. Quite the opposite, overall financial and operational these technologies and trends are capability of the company. already impacting the pharmaceutical Crowdsourcing is a way of expanding industry. In the following the available pool of talent, and paragraph, we will understand how even gaining insights that would not crowdsourcing is impacting R&D. have possibly been generated, just because the structured development processes inherent to a corporate InnoCentive: a case The traditional model for R&D structure, simply would not havestudy in crowdsourcing development in any company allowed them to arise. for pharma operating in whatever field has always been based on the selection, Based on this concept, in 1998, Author: Ferdinando Scala hiring and consolidation of the best some Eli Lilly executives generated talent, which eventually produces the idea at the base of InnoCentive, innovation suitable to be transformed a crowdsourcing platform whose into products to be sold on the initial field of application was market. This kind of process has the pharmaceutical R&D, but today advantage of ensuring consistency extends its business model in other and continuity of effort toward a areas like engineering, computer certain objective, and it functions science, mathematics, chemistry, well when the amplitude of problems life sciences, physical sciences and to be solved is consistent with the business. The InnoCentive business dimension of the R&D structure. model is based on the online sharing of pharmacological or clinical As a downside, having a development problems, for which consolidated R&D structure implies: it is unpractical to find a solution a) a consistent organizational effort in internally, and the call for proposals order to select, maintain and manage to platform members. InnoCentive’s the right people in the right place, members have thus the possibility with huge expenses in terms of HR to contribute to the resolution resources; of proposed problems, earning
Razorfish | Healthware From Crowdsourcing to BigData February 2013 15 consultancy fees for their contribution the best models. ranging from 500 to 1.000.000 USD. BI is actively engaged in this The model has encountered a platform to further our business. considerable success, to the point Predictive in silico modeling of that today prominent organizations biological endpoints is an important in a wide array of business sectors and useful component of the drug like BAE Systems (avionics), discovery process. Through the Booz|Allen|Hamilton (consultancy), construction of a competition to The Economist and Nature (editors), investigate potential genotoxicity Hershey’s (food), Hewlett-Packard liabilities in small molecule (computers), Eli Lilly and Roche candidates, the Research Team (pharmaceuticals), NASA (space expected to realize the following exploration), PepsiCo (beverage) benefits from Kaggle: and Procter&Gamble (FMCG) are • Competitive in both cost and currently partnering with InnoCentive time to delivery in order to solve their problems. The • Allows engagement with InnoCentive community includes an external community of about 200 000 individuals from more data scientists to create an than 170 countries, and as of now, awareness around BI as it has distributed fees for an overall a cutting edge, innovative amount of 28 million USD. organization • Reactivity: can almost immediately deploy the winning Kaggle Data Science All the Healthcare market players model(s) internally for use by Competition: a BI case have in common one very relevant medicinal chemists throughstudy in crowdsourcing thing: they produce data. The Bipredict, or other local distribution platforms whole of Healthcare is becoming an Author: Leandro Agrò industry based on Big Data. The competition was launched, as planned, on 16 March 2012. As early Could be this high end technology as 22 March there were 74 teams an entry barrier in the healthcare comprised of 90 players who had space? No. Dozens of companies submitted 277 entries. Twenty-four are already competing in the of these entries represent models massive data collection arena, that are ‘better’ (i.e. more predictive) fighting to offer qualified – low cost – than the best initial benchmark. analytic tools. The success of this project Kaggle – based in California - is a has been covered in external good example. Financed with USD communication via a BI press 11MM, they launched a platform release and subsequent coverage for predictive modelling and in several blogs. Tweets from both analytics competitions. Companies @boehringer and @boehringerUS and researchers post their data. have garnered >200K impressions Statisticians and data miners from all to date. over the world compete to produce
Razorfish | Healthware From Crowdsourcing to BigData February 2013 16“ Through the previous paragraphs, it has become apparent that crowdsourcing, Big Data, and Quantified Self are important trends, which enable the surge of a revolution about how previously consolidated, but inherently limited frameworks, like clinical studies, and the development of new drugs, can happen. The impact of these trends, however, is not limited solely to the domain of clinical research; they are also readjusting the way corporations communicate to their external audiences. In the following section, it will become apparent how traditional, linear, communication models are being substituted by completely new ones. The result of this process is a brand-new marketing and sales paradigm, which requires pharma executives to readjust their cultural and operational models. ”
Razorfish | Healthware From Crowdsourcing to BigData February 2013 17 COMMUNICATION MODELS Hierarchical models The communication process is also had the possibility to determine and broadcasting traditionally defined as the passage not only which information had to of informational units (content), flow from emitters to receivers, but Author: Ferdinando Scala coded into some sensorial artefact also which information should not be (language) from an entity which delivered. produces them (emitter) to another Also, traditional advertising models entity with receives them (receiver). conformed to this hierarchical logic, Context and channel employed in in which there is a linear and non- passing the informational units from equal relationship between the one entity or the other are pivotal in emitter and the receiver, where the determining the quantity of delivered latter is passive in terms of acquiring information and its interpretation. information. Traditional advertising When described as such, it is is based mainly on the attraction evident that communication of target users in predetermined has historically been interpreted channels; the offering of valuable as a linear process, in which content to them; and the application informational flow travels in one of the so-called contextual (printed direction, and no feedback is paper) or interruption marketing considered. This philosophical (radio and television). In this attitude was the cultural substrate respect, the main strategy used by to the construction of the mass advertisers to ensure their content communication system, whose was received was the saturation of media (newspapers, radio and physical (tabular advertising) and/ television) acted as unidirectional or media (press/radio/television) channels for message delivery from space. This is so that the end user emitters to target users. The result had a high possibility to encounter of this model was that the owner(s) the message throughout the day. of media channels were also the In parallel, within a specific medium owners of information. Media (like television), the most successful owners were indeed in a position brands were the ones that had the to determine the agenda, i.e. the possibility to win the competition type, combination and frequency of for the most fruitful time slots (prime information which, delivered from time), i.e. the moment of the day when emitters to receivers, massively most users were connected to that contributed to build the audience’s medium/channel. Finally, persistence knowledge, attitude and opinions of the message, and therefore the about whatever issue the agenda realization of sales, depended on the setters felt functional to their own single campaign extended over time, needs. In addition, agenda setters and frequency of message repetition
Razorfish | Healthware From Crowdsourcing to BigData February 2013 18within a single day. equivalent of broadcast media, a large number of representativesWhile functioning well for many using the same materials anddecades, and allowing the surge delivering the same message toand fortune of a whole industry their customers. Pharmaceuticalbased on traditional media, this companies have already beenmechanism has proved to be moving from this traditional modelprogressively less efficient over using customers profiling to tailorthe last few years. Television in messages and interactions. This isparticular suffered an extensive becoming ever easier to manage vialoss of efficacy in terms of the variety of digital channels nowpublic adherence, principally available to reach physicians.owing to an exaggeration in thefrequency of interruption marketingpractices. The introduction of These past years have been the The network modeltechnologies like remote control testimony of the surge of the digital and P2Pand TIVO strongly empowered revolution, with the progressive Author: Ferdinando Scalausers against the mounting wave introduction of technological assetsof advertising slots, and their and tools that have fundamentallyexcessive frequency in the body changed the communicationof programs. Furthermore, while panorama. The building of thestill remaining interesting for the World Wide Web and its mobilegenerations which were involved in development generated athis system of content broadcasting, completely new system of relationstelevision progressively lost its and communicational fluxes, whichpower as a medium especially in is identified as a “network model”the younger generations, the oneswhich first embraced the digital The network model disrupts themedia revolution and its mobile traditional hierarchical models, bydevelopment. breaking the linear and non-equal relationship between emitter andThis resulted in the declining receiver. The receiver becomes anefficacy of television as a mean of information selector and also ansales generation for Fast Moving emitter, whose influence and impactConsumer Goods (FMCG), but also, depend on the extent and depthin the pharmaceutical field for Over of his social network. The rate ofThe Counter (OTC) drugs. While disruption is so deep that lexiconcommercial and pharmaceutical has also changed, generating theindustries started to realize this fact, neologism “prosumer”, in order toa growing number of investments identify a new type of actor. Thewere progressively diverted from term “prosumer” results from thetraditional media to the new digital merge of the words “producer”ones. and “consumer”, and in the specificThe traditional sales force could informational domain, it has thebe seen as the prescription drug significance of “person who is
Razorfish | Healthware From Crowdsourcing to BigData February 2013 19simultaneously producer and direct colleagues of a GP or theconsumer of information”. People peer Specialists in a Hospital, andpreviously known as “target” or generally limited to the immediate“audience” have been enabled geographical surrounding); to manyby the construction of networking hundreds, in relation to the extentinfrastructures and tools (namely of the virtual network a singleSocial Networks like Facebook or individual has, and irrespective ofLinkedIn; or Collaborative Media the geographical dimension.like Wikipedia) to exit the traditional In this context, while still maintainingparadigm, where they were solely a strong power of influence, theabsorbing information coming from opinion of Key Opinion Leaders ishierarchical, unidirectional media; somewhat mitigated and blurredand become information emitters by the possibility for other subjectstoward their nearer peers. It has to (prosumers) to actively select andbe noted that information exchange spread information, according toamong peers existed even prior to their own rules and belief. In thisthe invention of Social Networks. context, the personal relationshipsIndeed, a large part of the traditional among peers (where personaladvertising model was based on the does not necessarily imply a directprimary influencing of the so-called knowledge in the physical world;“opinion leaders”, i.e. individuals but is based on the frequency andwho had, because of their quality of interactions) are based onstanding and power of influence, trust and credibility.the capability to spread and affixin the minds of others messages It is therefore important tocoming from the interested emitters. understand the new rules whichThe pharmaceutical world has apply to the new channels, whichalways relied on this paradigm, for are much more volatile andexample by passing information immaterial than beforeabout the new drugs or newindications, clinical studies and so We shouldn’t consider this evolved Real time is foron, to prominent physicians (Key marketing scenario -where peers marketing (theOpinion Leaders - KOLs), who need to be frequently reached Cluetrain manifesto)assumed the role of interpreters of with coherent messages- just as athe pharmaceutical industry’s data Author: Leandro Agrò fragmented target to address withand messages toward the medical a common message. Empoweredcommunity. HCP and Patients are walking awayWhat has changed forever with from any kind of broadcast. Todaythe advent of Internet and Social the most efficient way to reach themMedia is the fact the number of is joining (or leading) the so-calledpeople simultaneously reached “Conversation”.by a discussion about a topic has As a quick background about thechanged from a few (let’s say the idea of “conversation”, we should
Razorfish | Healthware From Crowdsourcing to BigData February 2013 20 start from the seminal book “The The Clue Train Manifesto contains Clue Train Manifesto” (also known as 95 theses that re-defined Online CTM, 1999). Markets and re-shaped marketers culture. During these years, powered by the digital change, networked markets self-organize faster than the companies that have traditionally served them. Thanks to the web, markets become better informed, smarter, and more demanding of qualities. In this new scenario –as declared by the first thesis of the Clue Train Manifesto: markets are conversation. What does it mean when one says, “markets are conversation”? Authors assert that people leverage the “human to human” conversations with companies, potentially transforming traditional business practices radically in today’s reality. Conversation is the CTM key concept: According to the second and third thesis reported in the book, “Markets consist of human beings, not demographic sectors” and “Conversations among human beings sound human. They are conducted in a human voice”. These few theses are enough to radically shift what most of companies are doing in their communication plane, both in the physical and digital spheres. The consequence is the communication of a totally new value chain, because “Hyperlinks subvert hierarchy” and people – through the Internet - no longer depend on traditional knowledge and information sources.
Razorfish | Healthware From Crowdsourcing to BigData February 2013 21INTRODUCING THE ePATIENTAuthor: Leandro AgròIn a world where a global conversation and how to treat diseases to whichis evolving the whole healthcare we are vulnerable. In just twomarket, people can find over the hundred years we have gone fromInternet tons of information about a society suspicious when it comesany disease, and potentially contact to science, to one centred aroundanyone to collectdifferent opinions. science.The power in the hands of any singleperson today, is bigger than the one Today we live in a world whereavailable to US President 20 years private companies such as SPACEXago. Today we have the “big picture” launch into the orbit every kind of This video illustrates how over the past two centuries, life expectancy and per capita wealth, have vastly improved for many nations. Of courseof healthcare at our fingertips. For flying object and where ten percent the current state of health does not mean that there are no other potential alarms for the planet,example, today we know that there of the gross domestic product of the BUT if you look at our health, we cannot miss thehas never been a time in the past world’s major economies is spent on underlying declaration of this video that WE ARE GOOD and have NEVER BEEN BETTER.when humanity was better off than health. (Source: http://en.wikipedia.it is today. This video “The Joy of org/wiki/Health_care_industry)Stats. 200 Countries, 200 Years, In the world of pharmaceutical4 Minutes” by Hans Rosling (BBC companies, we find examples suchFour) - http://www.youtube.com/ as Johnson & Johnson (the largestwatch?v=jbkSRLYSojo – could of all), which is at 40th position ofsuffice to inspire this systemic the Fortune 500 ranking. The sizeoptimism. of this company is based on its 120,000 direct employees and overIf we are good, well this depends $60 billion in sales. In comparison,on many factors, including what Apple, with its $65 billion and half ofwe know today about our health the employees of J&J, is just above
Razorfish | Healthware From Crowdsourcing to BigData February 2013 22 at 35th position of Fortune 500 (pre- iPhone5 rankings). Healthcare is moving out of The comparison - even that of her “Ford” era just as the wealth – between the consumer- culture of the Internet is oriented Apple, and J&J or any other growing evermore rampant, pharmaceutical company, might and this mix is potentially seem completely out of place, and disruptive. actually for a long time, it was. In recent years, however, the mutation of both economic and pharmaceuticals may undergo cultural dynamics has made drastic changes or even some comparisons like these more surprising extinctions. This crisis justified. The need to be more has forced many companies to efficient and closer to the end return to invest in R&D and by nature customer, even in the sanctuaries of contemporary approach often of health organizations, is changing translates into research in the field from within. of biotech. As a result, the culture of many companies is moving from a The digital culture that permeates “cure-all drug” to “a drug tailor-made society has changed the needs and for you.” expectations of customers, forcing entire industries to convert to certain A key point of this cultural shift is the important mentalities or come to change in the almost total access to terms with the traumatic entry of the medical information base. At the outsiders. Also, this being 2012, and same instant in which a disease - regardless of your opinion of the especially if not particularly severe - Mayan prophesy announcing the affects us, we become transformed end of the World by 21 December not into “sick people” but into 2012, this is the year in which some ePatients: people who are able, major players in the healthcare world through the distributed knowledge in are going through their “perfect the Internet network, to learn about storm.” their conditions as well as treatment options, comparing the different 2012 has indeed been labelled therapeutic approaches and results. ‘annus horribilis’ due to the number of healthcare patents that are However, one needs to be careful approaching expiration | Source: and not consider the ePatient | http://www.pharmatimes.com/ http://en.wikipedia.org/wiki/E-Patient Article/11-02-03/2012_real_annus_ | as a consequence of technology or horribilis_for_patent_expiries_-_ an outcome of the Facebook era. EvaluatePharma.aspx Dave deBronkart, archetype of the By 2015, following the expiration ePatient by definition, was the one of other very relevant patents, who made famous this term with the ranking of the 50 largest his speech at the TED Conference,
Razorfish | Healthware From Crowdsourcing to BigData February 2013 23when he narrated this episode: to help save their own lives, and looking at the opportunities thatThat Fall of 1969, the Whole Earth this change has created, youCatalog came out. [...] We think of could say this democratisation andhippies of being just hedonists, but consumerisation of healthcare is notthere’s a very strong component necessarily a bad thing.-- I was in that movement -- avery strong component of being ePatients are not the only forcesresponsible for yourself. This that are influencing the world ofbook’s subtitle is: “Access to healthcare. The entire industry isTools.” [...] Tom Ferguson was the affected by new situations. Recently,medical editor of the Whole Earth in The NewYorker, an article wasCatalog. And he saw that the great published with this provocative title:majority of what we do in medicine Restaurant chains have managed toand health care is taking care of combine quality control, cost control,ourselves. In fact, he said it was 70- and innovation. Can health care?80% of how we actually take care The thesis of the author of thisof our bodies. Well he also saw that article, an employee of an academic,when health care turns to medical non-profit health system calledcare because of a more serious Partners HealthCare, is as follows:disease, the key thing that holds The Cheesecake Factory, used as anus back is access to information. example, is part of the Casual DiningAnd when the Web came along, industry and, present everywhere inthat changed everything, because the United States, can serve freshnot only could we find information, food, cooked on the spot, with awe could find other people like growing price / quality ratio to eightourselves who could gather, who million people each year. In attainingcould bring us information. And this result, they have democratizedhe coined this term e-Patients -- access to certain foods for lowerequipped, engaged, empowered, income groups, and at the sameenabled. time, they had to influence theThis hippie counterculture note processes of supply logistics andhelps emphasize how seeing the their suppliers, optimizing logisticsePatient as an insignificant role and processes both internal andwould be a double faux pas. Firstly, external.since it is an ingrained, long- This action, which affects the source,established phenomenon. And is of course only possible when yousecondly because phenomena that reach a certain critical mass. Thebenefit from digital advancement process of improving the quality/costare rapidly approaching their tipping ratio of the entire sector of Casualpoint: http://en.wikipedia.org/wiki/ Dining, started when the chainsThe_Tipping_Point became protagonists. Now, thisePatients are motivated and very same change is happening inprepared to do everything it takes healthcare.
Razorfish | Healthware From Crowdsourcing to BigData February 2013 24 “Medicine, though, had held out blood pressure directly on your against the trend. Physicians iPhone. http://www.withings.com/ were always predominantly self- en/bloodpressuremonitor. employed, working alone or in small From ePatients to the influences private-practice groups. American due to changing forces in the field hospitals tended to be community- in the value chain, the world of based. But that’s changing. healthcare is changing rapidly. A Hospitals and clinics have been key player in this change is that of forming into large conglomerates. technological acceleration. When According to the Bureau of Labor digitalization affects one industry, Statistics, only a quarter of doctors it does not leave it immune to its are self-employed—an extraordinary actors, or better yet, pulverized and turnabout from a decade ago, in many ways expands the supply when a majority were independent. chain, requiring all existing actors They’ve decided to become to deal with change and possibly employees, and health systems predisposes it to new opportunities. have become chains. In medicine, Healthcare is not free from this we are trying to deliver a range explosive effect of digital and of services to millions of people ePatients represent the most visible at a reasonable cost and with a part of this rapid change. consistent level of quality. Unlike the ePatients are not aliens that have Cheesecake Factory, we haven’t arrived from outer space. We are (yet) figured out how” ePatients when we: http://www.newyorker.com/ • Seek information on the Internet reporting/2012/08/13/120813fa_ about symptoms or diseases fact_gawande?mbid=social_ • Seek practical advice via social tablet_f?share=OIfZ2X networks and share experiences Similar examples can be drawn related to health in many areas of the world of • Use self-tracking or wellness healthcare. Even the area of medical devices because we aspire to devices is not without drastic feel better changes. Just going to the Apple • Think of a hospital as a service Store, one can find many medical company devices that cost less than a • Look at the tools that doctors hundred dollars. Just five years ago, use and compare them with we could find these devices only the technologies that we have in-house in a pharmacy and we would have purchased them only on medical • Look at drugs no longer as advice. closed boxes accessible only by doctors, but as products we One example? Withings Blood use and to which we subject to Pressure Monitor, for an easy and careful scrutiny before purchase accurate self-measurement of your
Razorfish | Healthware From Crowdsourcing to BigData February 2013 25 Health industry.We, in Pharma, can’t drive, As easily understandable, theover-influence or hide above mentioned trends are notthe global conversation restricted to pioneer attempt towardePatients started about a new level for patients to acquire and share medical information. Onhealthcare. We should be the contrary, it already generatedpart, and culturally lead it. PatientsLikeMe, a very notable example about how collaborative attitude can incredibly improve the • We influence those around us levels of treatment and quality of life by sharing our experiences on of patients. health.Some issues published in January16, 2012 by TechCrunch “PEWResearch was reporting that 17percent of mobile phone userswere using their devices to look uphealth and medical information, andJuniper recently estimated 44 million The World After the ePatientshealth apps were downloaded in2011.” A bright mind, an anthropologist, a TED fellow, recently discovered that heIn 2011, in terms of earnings, the has brain cancer.area of mobile health applications As an artist and freethinker, he decided to publish on the Net all datareached $ 718 MM. The main regarding his disease. Unfortunately most of the data were recorded inreason for the significant growth is private data format, hence were not visible and sharable over the Net.an increase of smartphone users on What did he do?the demand side, and the increase He hacked the data, and published everything on a website. Thousandsof mobile Health applications on the of people read the data, hundreds of physicians participated by providingsupply side that has doubled since alternative information and data to him and to the medical staff.2010. This Italian ePatient’s story was so largely followed by the media, that theMany major health care companies Ministry of Health declared their willingness to pass a law engaging medicalhave found mobile Health institutions to provide health exams in an open format.applications as being an effective This is not the end to this story as this thinker – working closely with themedium to promote and deliver authors of this whitepaper – declared:healthcare products and services. “the ‘e’ before the word ‘patient’ is not there to testify technology. This ‘e’More information on the mobile is there to destroy the word “patient”, usually considered as a subset ofHealth application market can be people with inferior autonomy, power and will (as is often the case whenfound in the detailed report by someone enters in a hospital).”research2guidance entitled, “The The Internet is a disruptive ingredient and ePatients will leverage thisMobile Health Market Report 2011- superpower to stay in the same category as the other humans. The next2016”, which describes the impact word will be just “persona”.of smartphone applications on the