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Activating Digital Opinion Leaders
How the Internet, Social Media and Mobile Channels
are Changing the Key Opinion Leader and
Advocate Environment

A guide for pharmaceutical communicators and marketers
Activating Digital Opinion Leaders 2012 Creation Healthcare Activating Digital Opinion Leaders Introduction
Earlier this month I presented a session at KOL & MSL Best Practice
conference in Basel, Switzerland. The conference focused on
pharmaceutical companies' work with Key Opinion Leaders (KOLs) and
the role of Medical Science Liaisons, and I had been invited to speak on
how new channels like the Internet, social media and mobile are
changing the KOL environment.
In my session I introduced the concept of ‘Digital Opinion Leaders' for pharmaceutical companies, arguing that in today's digital environment there are two key concepts that affect the potential role of opinion leaders: 1. In the digital world, a pharmaceutical company's stakeholders are influenced by a surprising range of individuals who might not previously have been considered ‘Opinion Leaders' 2. In identifying those healthcare professionals who influence their peers, the role of digital engagement is an increasingly important aspect of their influence These concepts should not yet detract from ‘traditional' KOL activity but provide an added dimension to pharmaceutical companies' engagement planning. I presented Creation Healthcare's method of activating Digital Opinion Leaders in three steps: Identify  Engage  Activate. At first glance, this looks much like the model used in traditional KOL activity. The difference in the digital world, I illustrated, is that each of these steps requires a paradigm shift in order to be effective. This e-book has been written based upon what I presented in Basel, and includes more in-depth discussion and recommendations for those in pharmaceutical companies who wish to activate advocates in the digital era. 2012 Creation Healthcare Activating Digital Opinion Leaders The New Healthcare Engagement Environment
The new healthcare engagement environment is characterised by a web of two-way engagement between different stakeholders In many ways, communication between health stakeholders has been transformed by today's digital era. I use the term ‘healthcare engagement' to refer to two-way communication between stakeholders, and it is this area in particular that has been affected by new digital channels. Fifteen years ago, the concept of healthcare engagement might have referred to a fairly linear set of two-way relationships such as the dialogue that took place between a patient and their doctor; between individual doctors; or between a pharmaceutical representative and a 2012 Creation Healthcare Activating Digital Opinion Leaders healthcare professional. Today, the rise of digital channels has led to a disruption in traditional lines of communication between healthcare stakeholders. Examples of changes in healthcare engagement brought about by digital channels include:  Healthcare professionals discuss diagnosis of cases and clinical practice in open and closed forums to seek the advice of peers  Patients based all around the world share their experiences of living with disease  Wikipedia, a website edited by anybody, is used by both healthcare professionals and patients as a trusted resource on medicines  Pharmaceutical reps from different companies compare notes in social forum cafepharma.com New digital channels of communication have introduced numerous new concepts in healthcare engagement. The so here I will explore some of the other new concepts in digital healthcare:  The influential patient blogger  Patient social networks  New digital healthcare providers  Doctors' social networks  User-generated medical information  Mainstream digital channels as health information portals 2012 Creation Healthcare

Activating Digital Opinion Leaders New concepts in healthcare engagement are created by both mainstream and healthcare-specific implementations of digital channels The influential patient blogger
Some individual patients living with a chronic disease have become
highly active influencers online - and even offline, too. Kelly Young,
whose has
become a hub of resources on the disease, is just one example of a large
and growing community influencing hundreds of thousands of other
people. Kelly's online influence through RAWarrior includes herfollowed by almost 16,000; over 40,000 views
on her and her with almost 5,000
followers through which she leads a weekly Twitter chat.
2012 Creation Healthcare Activating Digital Opinion Leaders In my book, I write about Roche Diagnostics' initiative with a community of patient bloggers focused on diabetes. The company recognized the influential role of the online patient community and deliberately set out to engage them. Some of the lessons that Roche have learned through this initiative are highlighted in Patient social networks
is a social network of patients connected by their
experiences with disease. The community includes over 1,000 diseases
and operates as a tool where patients compare notes on conditions,
symptoms and treatments.
When I interviewed Ben Heywood, PatientLikeMe's co-founder in our 2010 Healthcare Engagement Strategy Awards, he told me then that 21% of patients responding to a survey had indicated that they had as a result of being part of the network. Two years ago, 10% of all US patients diagnosed with MS went on to join PatientsLikeMe. Since then, the network has grown from 50,000 to over 150,000 members. Other kinds of patient social networks include those dedicated to a single disease area, such as TuDiabetes, which connects over over two websites in English and Spanish languages. Manny Hernandez, founder of TuDiabetes and the Diabetes Hands Foundation, told me that the two different language networks were created to accommodate not only the language needs but across the international community of people affected by diabetes. New digital healthcare providers
One of the most interesting new concepts in the digital age is the role of
new and sometimes surprising digital healthcare providers. LiveNurse is
2012 Creation Healthcare Activating Digital Opinion Leaders a smartphone app that gives customers of US mobile services provider GreatCallfor advice 24/7, together with a medical library and symptom checker tool. The mobile provider has in a sense become the primary gateway to healthcare for customers of its service. Other disruptions to the traditional healthcare provider model include MediAngels, which describes itself as a and the world's first online hospital, where patients anywhere in the world can gain a second opinion from one of 300 medical specialists and pay for this online. Doctors' social networks
Digital platforms where healthcare professionals share ideas ranging
from clinical practice and drug information to out-of-hours pastimes
include strictly closed, single-country networks as well as more inclusive
and international environments. What they share is the concept of
connecting like-minded professionals together.
The list of major doctors' networks is extensive and diverse. In the US, describes itself as the largest online community, exclusive to physicians and has over 125,000 members. In Europe, numerous doctors' social networks include with over 190,000 UK doctors registered. The world's largest network for healthcare professionals is china'swith over two million members. I will explore further the activity of doctors in these social networks later, under ‘Healthcare Professionals in the Digital Era'. User-generated medical information
At a conference in Dubai, where I was speaking about mobile apps for
healthcare, a doctor commented that he saw little point in spending
time with pharma reps since he can learn much more about a drug by
searching for it on Wikpedia. User-generated medical information found
2012 Creation Healthcare Activating Digital Opinion Leaders online in blogs and wikis - digital encyclopedias covering every conceivable topic, which can be edited by anybody - is influencing not only consumers but professionals too. is arguably the most trusted user-generated wiki source. Search Google for any drug name or disease, and it is likely that the relevant Wikipedia page on the topic will be returned at or near the top of Google's natural search results. Editors of a typical medical information page range from medical professionals to students, patients and other stakeholders. Mainstream digital channels as health information portals
Despite the growing number of dedicated health websites, and social
networks for patients and doctors, the most popular online channels for
healthcare engagement are of course mainstream channels used for
search and social media. In most of the world, Google is the primary
tool used to search for information about healthcare, disease or drugs
not only by patients but by healthcare professionals too. Mainstream
social media channels including Facebook and Twitter are digital
channels of choice for many consumers to share their health
experiences, and even for healthcare professionals to discuss clinical
practice.
For a pharmaceutical marketer, activating Digital Opinion Leaders requires a familiarity with each of these new concepts of healthcare engagement. But for anybody with an interest in engaging Key Opinion Leaders in today's digital era, further consideration of the online behaviour of healthcare professionals is essential. I will explore this in the next section. 2012 Creation Healthcare Activating Digital Opinion Leaders Healthcare Professionals in the Digital Era
Healthcare professionals are using a range of dedicated digital tools as well as mainstream online channels To plan how to engage and activate healthcare professionals online, it is worthwhile considering the kinds of digital channels being used by healthcare professionals and the role that each channel plays. We might broadly categorise these channels into three groups:  Healthcare professionals' social networks  Dedicated digital tools and resources for healthcare  Mainstream digital channels 2012 Creation Healthcare Activating Digital Opinion Leaders Healthcare professionals' social networks
I have already mentioned the breadth of social networks for healthcare
professionals, which range from country-specific, validated closed
networks to international and more open networks. While some are
restricted to registered doctors, others are open to a wider range of
healthcare stakeholders.
Among the more open andhosted by the UK's BMJ Group, which includes doctors' forums, blogs and social networking features including the opportunity for doctors to create a personal profile page, ‘friend' and recommend others, and comment on each other's posts. The network includes a public area which may be accessed by anybody, and a closed area intended for clinical discussions and restricted only to medical professionals. Even in doc2doc's open forums, healthcare professionals discuss the treatment of patients and medicines. A recent extensive discussion between users of the social network starts with a specialist from Ninewells Hospital in Dundee asking fellow members for help solving a particular patient case. "This weekend I found a very interesting patient, with an interesting constellation of symptoms, signs, and results", he posts. "…I think I have at least one diagnosis, but I can't explain everything. I thought I might tap into the collaborative knowledge of D2D [doc2doc] to try to get more answers… And it's a fun game", he observes, before describing symptoms and starting a discussion which includes questions and answers from doc2doc's international network of doctors. Another recent example of content discussed between healthcare professionals on doc2doc is a post by one user about the FDA approval of Astellas' drug Mirabegron, outlining the drug's use in the treatment of overactive bladder, its clinical trials and side effects. This post is 2012 Creation Healthcare Activating Digital Opinion Leaders followed by extensive discussion between healthcare professionals about the use and safety of the drug. The visibility of content inside healthcare professionals' networks varies greatly, from networks such as doc2doc, or DocCheck, which include some public areas of content, to completely closed networks such as doctors.net.uk where all discussion takes place behind securely authenticated areas. Many of these networks also offer tools for researching the behaviour of their users and for engaging healthcare professionals directly. Dedicated digital tools & resources for healthcare professionals
A vast and ever-growing range of digital tools for healthcare
professionals has developed in recent years, from tools accessed via a
web browser to mobile apps installed on smartphones.
Examples of these include diagnosis tools, s a suite of clinician-administered assessment scales and lookup tables related to COPD patients. Doctot Chest is one of a range of pharma-sponsored apps for iPhone developed by Doctot which include tools to evaluate stroke patients, sponsored by Boehringer Ingelheim, and to diagnose dementia, supported by Lundbeck. Other dedicated tools for healthcare professionals supported by pharmaceutical companies include specialist resources focused on a particular area such as which includes clinical tools designed to help healthcare professionals to support patients after transplantation, as well as resources supporting congresses and events. Traditional journals read by healthcare professionals are also behind new digital tools. the journal of the Society for Translational Oncology, which also operates an online community, provides its journal as avices. 2012 Creation Healthcare

Activating Digital Opinion Leaders Dedicated healthcare professionals include video lectures on The Oncologist app Whilst the mobile app version of The Oncologist includes all the content of the print edition, making it available wherever and whenever a healthcare professional wishes to read it, its real power lies in the inclusion of rich media content such as video. Full length lectures from specialists are among the resources available to view and hear via The Oncologist app. Mainstream digital channels
We have already considered the role of mainstream digital channels
such as Google or Facebook as health information portals, and of course
it is no surprise to discover that healthcare professionals' use of digital
channels is not restricted to dedicated platforms for doctors. We know
2012 Creation Healthcare

Activating Digital Opinion Leaders that doctors use Wikipedia, Google, and social media channels in both professional and personal contexts. Take the example of Dr Mehmet Oz, US-based cardiac surgeon with an Dr Oz has a large following on social media, with almost two million Twitter followers. Yet this particular channel appears to be little more than a broadcast medium, with little two-way engagement and virtually no following of other users. US TV doctor Dr Oz has almost 2 million Twitter followers, but little digital engagement with them More interesting from a healthcare engagement perspective is includes almost 55,000 followers and is far more engaging. Kevin Pho's digital activity includes an active drugs and the role of digital channels in 2012 Creation Healthcare Activating Digital Opinion Leaders healthcare. The blog is actively shared by other Internet users and has almost 87,000 subscribers to its RSS feed (a tool for reading blog updates) and 40,000 subscribers to a weekly email update, whileis ‘liked' by around 14,000 people. And it is not only in the US that healthcare professionals are using mainstream digital channels to engage others. As we will see in our next section on Defining Digital Opinion Leaders, doctors in Europe are also engaging with each other using public social media platforms. 2012 Creation Healthcare

Activating Digital Opinion Leaders Defining Digital Opinion Leaders
Patient bloggers like Kelly Young, who writes about life with Rheumatoid Arthritis, are among a growing number of categories of Digital Opinion Leaders In the context of the new healthcare engagement environment and having considered the role of healthcare professionals in the digital era, it is clear that the influence of stakeholders including healthcare professionals, patients, and policymakers upon each other has been disrupted by digital channels. We must therefore consider the concept of ‘Digital Opinion Leaders' with an open mind. This is true not only now, but at all times in the future as we continue to learn through engagement with, and observation of, digital stakeholders. 2012 Creation Healthcare Activating Digital Opinion Leaders We might define a Digital Opinion Leader as anybody, or an organization, who influences the view or behaviour of other stakeholders through digital activity. The opportunity for a pharmaceutical company is therefore to identify Digital Opinion Leaders who are having an influence upon those stakeholders whose behaviour the company wishes to shape. We will consider a practical approach to this in the next section, Activating Digital Opinion Leaders. First, we will explore the concept of a Digital Opinion Leader further by considering some possible examples. Patient Blogger, Kelly Young
I met Kelly Young in person at e-Patient Connections conference in
Philadelphia last year. Kelly is a patient who has lived with Rheumatoid
Arthritis for the past six years, and for the last three of those she has
been writing her blog,and engaging with
other patients and professionals through social media channels
includind
We already considered Kelly Young's digital influence when we looked at the New Healthcare Engagement Environment in the earlier section. Kelly says that through her writing, speaking and use of social media she is "…building a more refined and accurate awareness of Rheumatoid Autoimmune Disease (RAD) aka Rheumatoid Arthritis (RA) geared toward the public and medical community; creating ways to empower RA patients to advocate for improved diagnosis and treatment; and bringing recognition and visibility to the RA patient journey." Kelly's role in the area of Rheumatoid Arthritis is mirrored by countless other patient bloggers living with chronic disease. Other examples include Kerri Sparling, one of numerous active bloggers and social media advocates living with diabetes, wor Lisa Emrich who blogs at 2012 Creation Healthcare

Activating Digital Opinion Leaders Patient Advocacy Group, National Multiple Sclerosis Society
With over 136,000 ‘likes', the is a highly engaging environment connecting
stakeholders who are affected by MS. It is more than a channel where
the Society broadcasts information - every post on the page is followed
by lively responses and most are shared by others, extending the reach
of the page significantly.
National Multiple Sclerosis Society's Facebook page has over 136,000 ‘likes' and is an engaging environment Facebook is just one of the social media channels employed by the National Multiple Sclerosis Society to engage stakeholders. The Society operates its own dedicated patient community, MS Connection, designed to connect patients together through blogs, discussions and 2012 Creation Healthcare Activating Digital Opinion Leaders local groups. It is als and videos on theve been viewed almost 1.5 million times. The role of patient advocacy groups as online influencers has been recognised by pharmaceutical companies through the establishing of partnerships to achieve mutual goals through digital engagement. We will explore some examples of this approach in the next section, ‘Activating Digital Opinion Leaders'. Patient Activist, Christine O'Connell
I in March 2011, shortly after
pharmaceutical company KV Pharmaceutical's share price had dropped
by over 20% in just one day, and three weeks after Ms O'Connell had
launched a at the company's pricing of its
newly FDA-approved synthetic progesterone product.
"I started this page quite simply because I was outraged", she told me. "I knew if other people knew… they'd be outraged too. Facebook gave me the platform to reach a lot of people in a short time", she said, speaking of the page she created in protest at KV Pharmaceutical's pricing policy, which she entitled "Shame on you, KV Pharmaceutical and CEO Greg Divis". The Facebook page acted as a hub to connect mothers of premature babies who shared Ms O'Connell's anger, and also attracted healthcare professionals, news media and medical organisations. "We shared information and ideas on everything from boycotts to contacting our Congressional representatives", she said. Whilst the Facebook page was not the only activity that contributed to the FDA writing a letter of clarification three weeks after its launch, it clearly played a role in mobilising extensive activity both online and offline that ultimately had a major impact on one pharmaceutical company. 2012 Creation Healthcare

Activating Digital Opinion Leaders Christine O'Connell's Facebook page protesting about KV Pharmaceutical's pricing contributed to a wave of public action leading to an FDA announcement that caused the company's share price to plummet Social Media Doctor, Anne Marie Cunningham
Anne Marie Cunningham is arguably one of the UK's most influential
doctors on Twitter. With over 7,000 followers, the having posted almost 70,000 tweets
since she started tweeting in 2008. In the same year she launched her
blog, entitled in which she
promotes the idea of collaborative learning through social media.
2012 Creation Healthcare Activating Digital Opinion Leaders "Medical education on Twitter is fantastic. There are no professional or geographic boundaries to discussions", writes Dr Cunningham in her blog. "And no boundaries to patients participating either!" The majority of Dr Cunningham's tweets are used to engage directly with other doctors, who are located all around the world. Her social media engagement with others illustrates the global nature of the Internet, where ideas are shared openly between all stakeholders regardless of geographic location. In a recent conversation about clinical practice, she directed a tweet at a Paediatrician in London, UK, then a Postgrad Medical Student in the UK's West Midlands, and then a Gastroenterologist in the US. Dr Cunningham is representative of a growing number of healthcare professionals who actively use social media platforms to ask and answer questions and help shape each other's medical education through social media. The examples discussed here - the patients, advocacy groups and healthcare professionals actively engaged via social media - provide a practical glimpse into the role of Digital Opinion Leaders in shaping the behaviour of other health stakeholders, both online and offline. In the next section I will outline Creation Healthcare's three-step methodology for Activating Digital Opinion Leaders. 2012 Creation Healthcare Activating Digital Opinion Leaders Activating Digital Opinion Leaders
Three steps to activating Digital Opinion Leaders: Identify; Engage; Activate. Since we have considered the role of Digital Opinion Leaders in shaping the behaviour of others, it will be essential for a pharmaceutical company wishing to partner with Digital Opinion Leaders to take steps to encourage positive engagement. This does not occur by chance but is possible by taking a three-step process: 1. Identify Digital Opinion Leaders
2. Engage Digital Opinion Leaders
3. Activate Digital Opinion Leaders
At first glance this approach may appear to be similar to the traditional method of working with Key Opinion Leaders. The difference is that, as 2012 Creation Healthcare Activating Digital Opinion Leaders we have already seen, in the digital world the role of influencers is non-linear and not limited by traditional models of stakeholder engagement. 1. Identify Digital Opinion Leaders
Accurate targeting will ensure the most effective deployment of
resources in activating Digital Opinion Leaders, and will increase the
likelihood of positive outcomes. To identify those influencers who will
be most relevant and effective for a pharmaceutical company, the goals
of Digital Opinion Leader engagement should be clearly defined.
What is the desired outcome of Digital Opinion Leader activity? Is it, for example, to influence prescriber behaviour, or that of patients? To influence policy? Or to prepare a market for a product launch? Identifying these goals will direct the search for digital opinion leaders. Research into Digital Opinion Leaders may take place using a range of tools, including the following:  Social Media Research, or ‘Passive Listening' includes analysis
of themes, language, and attitudes discussed around a particular topic such as a disease area or drug, to identify channels and individuals of influence.  Digital Primary Research often involves ‘Active Listening',
asking research questions in a social media environment, and may include any form of primary research such as surveys or polls posted onto websites, forums, communities or by email.  Digital Influence Analysis is an in-depth study of the influence
of individuals online. Attention is given not merely to the numbers - such as number of followers - but to the focus of engagement, to identify insights relevant to the goals that have been set.  Digital User Behaviour Analysis is the study of actual and likely
journeys taken by stakeholders across digital channels and may include search activity, social media engagement, and website 2012 Creation Healthcare Activating Digital Opinion Leaders content browsing. A range of software tools and manual analysis techniques are used to develop a picture of user journeys in order to plan for the role of Digital Opinion Leaders.  A Closed Networks Review includes a diverse range of research
approaches inside closed networks, subject to tools and techniques made available by providers of platforms such as doctors' social networks. All of the activities above may be carried out either by a pharmaceutical company's in-house teams, or by external multichannel research and planning specialists such as Creation Healthcare, or in many cases, a combination of both. In my book, I write about Pfizer's ‘Can You Feel My Pain' initiative which was awarded the Healthcare Engagement Strategy ‘Patient Empowerment' Award for its activation of patients and advocacy groups online. Louise Clark, Director International Public Affairs and Policy at Pfizer describes the use of research in the campaign planning process: "We carried out research to look at who was talking about what, in which places; and those greatest places of engagement opportunity were our initial target." 2. Engage Digital Opinion Leaders
Having identified possible Digital Opinion Leaders, establishing mutual
goals will be essential to any successful collaboration, advocacy or
partnership. Engaging Digital Opinion Leaders may take place online or
offline, although digital channels are often used for initial contact.
For over three years, Roche Diabetes Care has been engaging an online community of diabetes bloggers in the US. Rob Müller, Associate Marketing Manager with Roche, says that the engagement started with honest conversations in the online communities where the bloggers were active. "We went in [to online communities] and told everybody, 2012 Creation Healthcare Activating Digital Opinion Leaders ‘Hi, I'm Rob, I'm with Roche, I'm here to answer any questions you may have'", he says. It takes patience to engage Digital Opinion Leaders, as trust is established over time. For Roche Diabetes Care, it has been worthwhile. After the company had hosted an annual summit of diabetes bloggers for three years, one of the "Seeing my fellow diabetes bloggers and advocates is always the highlight of this summit. I can't lie about that. Walking into a room and wanting to hug everyone in it is a rare thing. However, since this was the third Roche Summit I've attended, I sort of wanted to hug the Roche people, too." Partnering with Digital Opinion Leaders requires an alignment of messages that serve mutual goals, and selection of channels for the most effective impact. Research carried out during the identification step is likely to inform these requirements. In some cases, the collaboration between a pharmaceutical company and Digital Opinion Leaders is relatively uncoordinated, with few parameters of channels fixed. In others, deliberate selection and use of specific channels between partners can support the building of engagement momentum. "We learned a lot from talking with the patient groups and understanding how we could shape the campaign," says Pfizer's Louise Clark about the ‘Can You Feel My Pain' initiative in which the company partnered with patient advocacy groups across Europe using social media channels including Flickr to share photos. 2012 Creation Healthcare

Activating Digital Opinion Leaders Pfizer's collaboration with patient advocacy groups and patients included use of Flickr to share photos. 3. Activate Digital Opinion Leaders
Having identified and engaged Digital Opinion Leaders, activating them
is a deliberate step to ensure that their advocacy or engagement is
communicated online to those who they influence. As with any
partnership, the Digital Opinion Leader must see the value in this
process to them, not just to the pharmaceutical company.
Value given to Digital Opinion leaders may take various forms, such as increasing the profile or status of the Digital Opinion Leader; providing a new platform or tools for engagement; providing unique knowledge; up-skilling the Digital Opinion Leader for digital engagement; or or support for a mutual cause. 2012 Creation Healthcare Activating Digital Opinion Leaders "We helped [our partners] to deliver beyond this campaign, online. Now these organizations are tweeting, undertaking their own social media activities," says Louise Clark about Pfizer's partnership with European patient advocacy groups, which equipped them to be more active online. In some cases, then, activating a Digital Opinion Leader means strengthening the ‘digital' aspect of their opinion leadership. Thus any current opinion leader may become a Digital Opinion Leader by being digitally equipped or activated. Finally, the quest for Digital Opinion Leaders does not necessarily negate the role of traditional Key Opinion Leaders or current channels used in KOL activation. Remember that even Digital Opinion Leaders are real people offline, too. 2012 Creation Healthcare

Activating Digital Opinion Leaders What next?
If you found this guide to activating Digital Opinion Leaders helpful, I
invite you to sign up to receive our monthly e-journal, free of charge. It will keep you informed about
tips and techniques to improve your digital engagement and includes
analysis of how new communication channels are changing healthcare.
If you would like to equip your team in any aspect of multichannel healthcare engagement, I would be pleased to tell you more about Creation communicators and marketers. Courses range from half-day starter workshops to a comprehensive series of practical, hands-on equipping and digital mentoring. Email me now at to find out about in-house training and mentoring. If you would like to start activating Digital Opinion Leaders to support your goals online now, I would love to help you. Whether you would like a brief consultation to help you get started, or a comprehensive Digital Opinion Leader Identification, Engagement and Activation service, call me on +44 207 849 3167 for a conversation about how to make a start. I look forward to working with you. Daniel Ghinn CEO, Creation Healthcare +44 207 849 3167 2012 Creation Healthcare

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