10 years of doctors’ social networks

What have we learnt? What can we expect?

Views from leading doctors’ social networks

Len Starnes Digital healthcare consultant

Sermo, USA

The Rounds, Canada

Coliquio, Germany

Doctors.net.uk, UK

Drportal, Hungary

iVrach, Russia

DXY, China

Peter Kirk CEO Sermo

Osnat Benshoshan CMO Sermo www.sermo.com

10 Years of Physician Social Networks

What has been HCP social networks largest impact on the practice of medicine during the last 10 years?

• The largest impact HCP social networks have had on the practice of medicine during the last 10 years is the practice of medical crowdsourcing, which marks a transition from working in isolation to collaboration.

• Most cases fall into a ‘grey zone’ meaning that the diagnosis and/or the treatment are not clear, and the HCP isn’t sure how to proceed. HCPs have been conditioned to work in isolation, so there wasn’t a way for them to get help on such cases before these social networks existed – patients suffer, doctors suffer, the system suffers.

• HCP social networks are carving out new ways for doctors to collaborate and work in unison from anywhere on the planet, and its driving meaningful changes and better outcomes.

– We saw over 7500 challenging patient cases posted by doctors last year – up 2,500% in three years.

– 89% of the doctors who posted got the help they were looking for within 24 hours.

– They are even asking for help on cases about themselves or their own families, which goes to show just how much they trust the network to provide solid information.

What has been HCP social networks largest impact on the practice of medicine during the last 10 years?

• The second largest impact HCP social networks have had on the practice of medicine during the last 10 years is the new way it allows medical knowledge to be shared.

• There is a lot of official medical information out there – so much that it is difficult to keep track of. In addition to official news, doctors make breakthroughs every day. There hasn’t been a way to share these findings without going through cumbersome channels, even though they may be relevant to a doctor’s day-to-day work.

• HCP social networks act like ongoing medical conferences where HCPs can learn from each other and stay abreast of the newest and most important findings. The material shared is a pulled from many sources – pharma companies, governments, laboratories – and is compiled along with actual HCP experiences, which makes it more valuable than information from any single, sole source.

• Then, over time, the networks become massive databases of this information that can be referenced when HCPs have questions.

What has been HCP social networks largest impact on physicians’ behaviors and expectations during the last

10 years?

• The expectation used to be that doctors had to work cases alone – now, more doctors are discovering every day that there are private networks where they can collaborate on cases in an open way with other experts.

• This has changed physician behaviors. We see them:

– Becoming more comfortable admitting mistakes and things they don’t understand

– Asking questions on behalf of their patients and sometimes themselves or their families

– Sharing discoveries and triumphs to benefit others

– Actualizing issues that face the profession as a whole, and taking a public stand when necessary

– Learning from other doctors and improving their patients’ outcomes

– Developing better practice management ideas, sourced from peers

How do you see HCP social networks developing in the next 10 years, from a U.S. and global perspective?

• We think networks that are currently U.S.-only will find value in expanding to the global stage.

– National borders don’t confine medical research, and we expect that the ability to collaborate internationally will become more and more important to U.S. HCPs with time, and will drive changes in their social networks as well.

– The interest is already there from non-U.S. doctors – since we started expanding globally, we get requests daily from all over the world to join.

– International conferences are seeing attendance drop, due to price and other concerns, but the need to communicate globally has not diminished.

How do you see HCP social networks developing in the next 10 years, from a U.S. and global perspective?

• Once global, the main way we see networks developing is by enhancing the way in which they support the practices outlined above – medical crowdsourcing and sharing medical knowledge.

• Much of medicine is anecdotal – its like searching for a needle in the haystack. A global scale is useful because it combines more anecdotal evidence, but HCP social networks will need to develop tools that help sort this information quickly in order to support these practices.

• HCP social networks will also need to figure out how to protect the space they’ve created for HCPs while harnessing the power of these networks to solve the toughest cases. This may be through:

– Partnerships with NGOs, patient advocacy groups, or non-profits to source cases

– Improved tools to find and compare similar cases and build progressively on cases that have already been medically crowdsourced (searching images or verbal content, categorization of cases, measuring quality of unique responses, etc)

– Improved targeting and notifications to drive the maximum help from the most relevant people in minimum time

Blair J. Ryan

Chief Executive Officer

The Rounds, Canada

Conor Cox

Manager, Strategic Partnerships

The Rounds, Canada

www.therounds.com

#HealthcareisSocial

What has been doctors’ social networks’

largest impact on the practice of medicine

during the last 10 years?

Doctors’ networks typically all set out on the same three

goals; save doctors time, money, and help them save

lives. The successful networks have found a way to

execute on at least two of those goals. The best ones

have gone above and beyond; not only are they

connecting doctors to one another, but they’re also

pulling all of the relevant sources of information into one

place.

What has been their largest impact on

doctors' behaviours and expectations

during the last 10 years?

Expectations:

Physicians have been empowered by technology; specifically

by doctors’ networks. They have come to expect faster (read:

instantaneous) access to the people and data they need; they

will not suffer second-rate user experience, and they insist that

their continuing education be on their terms (read: free, fast, and

on-demand).

Behaviors:

The behaviours are more or less the same; rather it’s the place

they go and quality/speed of the results that have changed. In

fact, it is our belief that doctors' networks wouldn’t work if they

weren’t analogous to ‘the old way’ only with better results.

How do you see them developing in the next

10 years, from a Canadian and global

perspective?

Doctors’ Networks as the OS:

Collaborative networks will no longer be seen as one of

the tools a doctor can use; instead they will become the

foundation upon which all other health IT will be built.

The doctors’ social network will serve as the ‘operating

system’ for physicians, as more IT solutions are built

out, and plugged in.

10 years of doctors‘ social networks

Statements by Felix Rademacher, CEO and founder, coliquio, Germany

The physicians on coliquio

54.3 years

average age

Ø 2,000

physicians sign up per

month

more than 70

medical specialities

more than 4,000

new posts per month

Ø 13 years

professional experience

more than 165,000 physicians

signed up overall

What has been their largest impact on the practice of medicine

during the last 10 years?

Physician Only Social Networks (= POSN)

achieved something quite significant: medical

knowledge – once spread throughout different

sources and individuals – is now instantly

available for every doctor in one place.

Physicians interact daily on coliquio,

discussing patient cases and sharing their

experiences amongst their colleagues. As the

largest network for doctors in Germany,

Switzerland and Austria we provide a

constantly growing knowledge database.

What has been their largest impact on doctors' behaviours and

expectations during the last 10 years?

Having experience-based knowledge

available at our fingertips is more important

than ever in society. Today personal

recommendations are crucial for our

decisions. This also affects doctors’

behaviour. Todays’ physicians rely heavily on

the advice and the experiences of their

peers and other specialists. This way, they

are able to solve problems more quickly than

just by reverting to traditional knowledge

sources, like medical books for example.

How do you see them developing in the next 10 years, from a

German/EU and global perspective?

The digitization of the healthcare market will gather

speed, and digital channels will become more and

more significant – not only for the doctors and the

pharmaceutical industry, but for all the stakeholders in

our healthcare system. Closer connections have to be

established in order to make healthcare as a whole

more efficient. Such a development is not only

relevant from a German point of view, but also from an

European or global perspective.

How doctors work – then and now

Felix Rademacher, founder and CEO, coliquio

www.coliquio.de

Dr Tim Ringrose CEO M3 Europe eu.m3.com

1. What has been their largest impact on the practice of medicine during the last 10 years? Biggest impact has been the ability for doctors to gather information and share opinion and knowledge within a trusted network or community of colleagues. For example doctors can discuss difficult cases and get advice from colleagues about investigations, differential diagnoses, appropriate colleagues to make a referral to and of course best treatment options. This impact has been evident across both primary and specialist care, but arguably its most significant for doctors working in small or single-handed practices where they have traditionally had little ability to get advice from colleagues without making a formal referral.

(1. continued) Online networks allow doctors to have instant access to a very wide pool of colleagues – we see answers being posted within minutes of the question being asked. Sometimes the discussion continues as the patient progresses through a series of investigations and this creates a repository of very valuable information that all the doctors in the network can make use of for their continuing professional development

(1. continued) Over recent years it has been fascinating to see how pharma is starting to engage with online networks. A lot of the time the interaction is rather “old school push marketing” but that still has some value with new products, but more and more companies are starting the engagement trying to understand the clinical viewpoint of a particular therapy area and then working out how they can provide information or services that are addressing the needs that the doctors see. For example this can mean that an educational programme is the right option. As a result of this we can see that the relationship between doctors and pharma is starting to improve.

2. What has been their largest impact on doctors' behaviours and expectations during the last 10 years? As already mentioned doctors are able to get advice and information from colleagues with great efficiency and this undoubtedly increases the standard of care they provide – whereas in the past a doctor might have been continuing to practice medicine in a way that was out of date this is much less likely to occur now. Doctors are also adjusting to the wider implications of the internet – over 90% say that the internet has been a positive impact on healthcare but it does require doctors to behave differently.

(2. continued) Doctors tell us that they are becoming less paternalistic and are helping patients make more decisions for themselves and they are investing more time in recommending good sources of information to their patients. They expect the internet to have even greater impacts in the next 5-10 years; rather than it being about information they expect a significant proportion of consultations to be done virtually and that near patient testing will mean that trips to the hospital will become a less frequent event for patients with chronic disease. All this means big changes for the profession and online networks will continue to help them adjust to the new normal.

3. How do you see them developing in the next 10 years, from a UK/EU and global perspective? Doctors.net.uk continues to see continued growth in usage – each day over 50,000 doctors use the services and we expect this to continue to grow. We expect to see use via mobile devices to become the norm (it’s already very high) and are investing in technology to support this. I expect that across Europe we will see a lot of growth of online networks and communities and it will be interesting to see how much consolidation occurs.

(3. continued) M3’s experience is that doctors are very driven to engage with colleagues within the same environment as a priority. That means for many doctors, engaging with colleagues from other countries is a lower priority that some might expect but this will change over time especially for specialists such as oncologists. I also expect that the mis-trust between pharma and the medical profession will change to become more a constructive sense of mutual respect. I think doctors will increasingly see governments and healthcare regulators as the enemy!

Gabor Gyarmati Founder and owner The Szinapszis Group, Hungary www.qcg.hu

As of February 2017 Drportal is a medical portal only. Its views are included here as an example of a portal which recognizes the critical importance of adding community functionality to complement its medical content offerings.

1. What has been their largest impact on the practice of medicine during the last 10 years?

Drportal was founded in 2009 so we cannot speak of 10 years of history but only 7 years of experience in the Hungarian market. As at this moment drportal.hu provides more than 4,000 articles on 20 therapeutic areas. We have become a trusted source of professional information for Hungarian physicians. As our portal is an independent online network, visitors prefer our resource on professional topics to pharma-owned physician sites. They use the information found on our site in they everyday practice, and it helps them to keep their medical knowledge up-to-date and competitive.

2. What has been their largest impact on physicians' behaviours and expectations during the last 10 years? Based on our market research, Drportal (together with other Hungarian physician sites) has totally changed the way Hungarian doctors access medical information: fewer and fewer paper-based articles are read, more and more clinical studies and CME are accessed via the internet. Drportal is changing doctors’ preferences towards personal attendance at conferences and symposia; visiting our portal’s conference videos and highlights summaries is a faster, cheaper and more convenient way than travelling to big events…

(2. continued) Besides these changes in doctors’ behaviours the largest impact has perhaps been on the doctor/patient relationship. Patients are becoming true consumers and see themselves as partners with their doctors; this realization has been a major shock for the Hungarian medical profession. Our site helps doctors better understand patients’ changing attitudes, preferences and behaviours, whilst providing advice and best-practice tips on how to successfully manage the new doctor-patient relationship.

3. How do you see them developing in the next 10 years, from a Hugarian/EU and global perspective?

As we have seen during the last few years, online physicians’ communities and medical portals have helped doctors to become increasingly digitally savvy. The next decade is going to bring even more dramatic changes to the Hungarian medical profession; doctors will not only be online but truly connected with one another…

(3. continued) Online physician communities should transition to be a channel of the Internet of Things helping doctors to communicate with each other, their patients, and all other healthcare stakeholders. They should also help to connect doctors with patients’ tracking or diagnostic devices. These communities could function as dashboard for doctors to enable them track patients’s vital data, while at the same time providing essential professional therapeutic advice and information.

10 years of doctors' social networks

November 2016

Q: What has been HCPs SN

largest impact on the

practice of medicine during

the last 10 years?

A: HCPs only networks are part of wider social

media trend that had a significant impact on

medical practice. HCPs networks enabled instant

access to a wide circle of colleagues and thus

increased peer support availability at the point of

care. This is of a particular importance to those

physicians who work in remote areas and/or do not

have the whole set of consultants in their clinic.

Q: What has been HCPs SN

largest impact on doctors'

behaviours and expectations

during the last 10 years?

A: HCPs’ only networks changed the way of peer-

to-peer communication by creating a new

environment that facilitates clinical decision

support as well as peer verification of various

promotional claims and statements. This situation is

not going to fade over the next 10 years which, in

turn, is going to re-shape pharma-physicians

communication processes dramatically.

Q: Continued. What has been

HCPs SN largest impact on

doctors' behaviours and

expectations during the last 10

years?

In the past publishing a piece of content was the

final point of pharma marketing efforts. Today it is just

a beginning. Once published (or presented by a

rep) this contents is taken then to HCPs SN for further

peer analysis and review. As a result quite often

physicians get a list of additional questions to

pharma and expect collaboration with the industry.

Unfortunately pharma companies are still quite

ignorant of such post-publication developments,

loosing the opportunity to engage with their target

audience.

Q: How do you see HCPs’ SN

developing in the next 10

years, from a Russian and

global perspective?

A: From a global perspective over the last 10 years it

became clear that that HCPs’ online communities

cannot rely on professional forums only. On top of this

basic functionality physicians expect to get other

services as well, something that could help them

excel professionally even further.

For the region of our focus (FSU countries) the need

to access professional information on a cross-country

scale is quite strong and to bring global knowledge

to local HCPs’ communities will be an important task

for a HCPs’ SN working in this part of the world.

About us We specialise in working with HCPs within specific geography that

comes usually as a blank spot on majority of reports and

presentations produced by western companies

Yet former Soviet Union (FSU) counties

have a large HCPs population (estimated

to be over 2 mln) and offer significant

opportunities for global pharma

companies, particularly so if reached by

cost-effective digital channel

iVrach is a gated portal for

for Russian-speaking physicians

We are in Top 3 most

visited HCPs portals in

Russia

We are a fastest

growing HCPs only portal

in Ukraine

We are building up

HCPs base in Kazakhstan

Thank you! Oxana Kolosova

Managing Partner London: +44(0)7496 812505

Moscow: +7 495 249 90 35

oxana.kolosova@ivrach.com

Stanley Li Chairman DXY, China

1. What has been their largest impact on the practice of medicine during the last 10 years? The practice of medicine in China has evolved considerably over the last 10 years. This change can be attributed to many different factors including changing expectations of physicians and patients as a results of improved access to health information. At DXY, we believe that the increasing use of physician social networks like ours has had a positive impact on the practice of medicine. Convenient access to trustworthy and reliable information from curated sources as well as from peers is one pillar of the DXY platform. An effective editorial style to make this information easily consumable is also an area where DXY invests considerable effort. Information that is not quickly and easily usable is worth very little!

2. What has been their largest impact on physicians' behaviours and expectations during the last 10 years? The impact of physician social networks has evolved alongside the changing on-line behavior of physicians in China and around the world. The origin of DXY was helping physicians to access clinical and research knowledge more efficiently. First that was access to PubMed, later it evolved into access to a trusted peer network to share medical questions and answers. DXY's history reflects several generations of technology media, from BBS to web portals to apps including WeChat today. This evolution of media will continue….

(2. continued) Due to heavy case loads, physicians in China have always had very limited time to stay informed about new clinical practices, guidelines, pharmaceuticals, devices and other important developments in their fields. DXY helps physicians to identify the most important, relevant and reliable information quickly so that they can focus on what really matters - patient treatment and outcomes. Talent mobility in the health care field is also an outcome of the increasing use of physician social networks. This is improving patient access to clinical talent throughout China.

3. How do you see them developing in the next 10 years, from a Chinese and global perspective? At DXY, we believe that the physician is core to a successful health care eco-system. China's 13th Five Year Plan includes components to improve access and quality of health care in China. As a physician social network, DXY is designed to support these objectives. DXY will continue to provide convenient access to reliable and authoritative information to support the effectiveness and efficiency of the practice of medicine…

(3. continued) DXY has always been a connector within the health care eco-system. As the eco-system evolves, this connector role will also evolve. For example, while medicine becomes more personalized, DXY is supporting physicians and enhancing the patient experience by connecting eco-system participants seamlessly. We are investing in these solutions today. Physicians in China recognize that there are opportunities to automate components of patient monitoring and care, especially for chronic diseases. DXY has done extensive work with partners in diabetes management. We believe that this work will dramatically impact chronic disease management practices by lowering costs and improving outcomes.

This presentation is part II of an analysis of the history and future of doctors’ social networks. Part I, ‘10 years of doctors’ social networks: What have We learnt? What can we expect’, is accessible on Linkedin Pulse:

https://www.linkedin.com/today/author/0_0RjhwUdn7dGoo7K_oDlqHj?trk=prof-sm#

I would like to sincerely thank all the contributors to this presentation and all those who helped to make it happen:

• Osnat Benshoshan, CMO, Sermo, USA • Conor Cox, Manager, Strategic Partnerships, The Rounds, Canada • Mark Garlinghouse, DXY, London • Gabor Gyarmati, Founder and owner, The Szinapszis Group, Hungary • Nathalie Haidlauf, PR Manager, Coliquio, Germany • Peter Kirk, CEO, Sermo, USA • Oxana Kolosova, Managing Partner, iVrach, Russia • Stanley Li, Chairman, DXY, China • Felix Rademacher, CEO and founder, Coliquio, Germany • Dr Tim Ringrose, CEO, M3 Europe, UK • Blair J. Ryan, CEO, The Rounds, Canada

lenstarnes@gmail.com T: + 49 30 781 5513 M: + 49 172 1788253 Skype: lenstarnes www.linkedin.com/in/lenstarnes www.twitter.com/lenstarnes www.slideshare.net/lenstarnes

Len Starnes

Len Starnes Digital Healthcare Research & Consulting