Published in International Journal of Medical Marketing, May 2002, Vol 2 Number 3

Abstract:
eDetailing is currently under consideration by many pharmaceutical companies as a way to maximise sales force time, cut costs and increase physician prescribing. eDetailing is not a single entity but can take many different forms: from remote live discussion with a sales rep to a purely scripted interaction with a web site or an Interactive Voice Response phone line. Most eDetailing models have been tried in the US and only some models such as some forms of Scripted eDetailing have been shown by independent studies to increase prescribing compared to traditional detailing methods. eDetail models from the US are starting to become available in Europe where there are tighter regulations concerning physician promotions that make it harder to incentivise physicians to participate in eDetailing. Also, each eDetail model differs in its popularity and applicability to specific physicians, for example, GPs are more easily accessed than specialists in Scripted eDetails. Therefore, pharmaceutical companies need to consider their eDetailing options carefully to choose a model that will be right for their particular product, target physician group and country. Many pharmaceutical companies are simply starting a pilot with one or two models but this will not necessarily be sufficient to reach a conclusion for all cases.

The Growth of eDetailing
The use of the internet to promote pharmaceutical products to the medical professional is still in its infancy but is being trialled or used by all of the top ten pharmaceutical companies in the US and a number in Europe. Aside from overall development of the internet in everyday life, there are three direct drivers behind the growth of eDetailing; Falling effectiveness and increasing costs of sales representatives, Increasingly busy doctors with little time to see reps, High connectivity and acceptance of the Internet by physicians.

In the US, the industry is reckoned to spend $15billion a year advertising its products to the medical profession. Detailing, that is, using sales representatives to call on physicians to promote products, accounts for the lion’s share of this spend, around 45% of the total as shown in Figure 1. The last decade has seen substantial growth in the use of sales representatives as the marketplace becomes increasingly crowded with similar products and the length of market exclusivity of new innovative products falls.

The top 40 pharmaceuticals companies in the US now employ an estimated 80,000 sales reps, a doubling since 1996, though the increase in prescribing in this period has risen by only 15%. Some studies from the US suggest that 40% of sales reps’ calls are cancelled or rescheduled and over 80% of conversations between reps and physicians last not much more than two minutes. In Europe, studies suggest that 30% of GPs no longer see sales reps from pharmaceutical companies in the UK. Physicians, both in Europe and the US, are acknowledged to be highly time pressured and encouraged to see as many patients as possible. The conclusion is that there is a lack of sufficient time for the physicians to meet with sales reps. Consequently, pharmaceutical companies’ very significant expenditure in traditional detailing is not yielding the desired returns. With a constantly increasing number of drugs to sell, the sales forces’ efficiency is dramatically decreasing.

There is no doubt that detailing directly to the doctor serves an important purpose. Physicians want and need information from the sales representatives – but on their own time terms. eDetailing can potentially provide physicians with a more convenient means of getting the information they want at a time that suits them.

Types of eDetailing
To date the majority of online medical information offered to physicians by pharmaceutical companies has been largely static product information websites. This may be useful for a one-time visit, but it does not engage the physician, nor encourage them to return to the site and develop a long-term relationship with the pharmaceutical company. This is verified by a Forrester study where physicians ranked pharmaceutical product websites last with respect to perceived value and frequency of use; indeed more than 50% of the doctors surveyed had not visited a pharmaceutical company website in the past 6 months.

eDetailing simply means using digital technology, in the detailing process, therefore many formats are possible including use of technologies such as the internet, video-conferencing and Interactive Voice Response (IVR) for enabling the interaction with the physician. It is important to remember that the “e” does not simply equal use of the internet. Any technology that can allow interaction with the physician is eligible. Appropriate technologies can be used to achieve the content and effect of traditional details, including educating the physician about products and interacting with the physician to answer questions regarding their individual information needs. eDetailing technology can also be used to offer samples, encourage product use and increase prescriptions written.

Mednet Media has identified three main types of eDetailing models.

Virtual live eDetailing
With the virtual live eDetailing model, the doctor (chosen by the pharmaceutical company) is provided a pre-configured personal computer with all the necessary applications preloaded and webcam to see and speak with a sales representative. The doctor is provided with incentives and in return is contracted to telephone all the pharmaceutical company representatives enrolled in the system at a minimum set frequency per month in exchange for receiving the hardware and software. The physician initiates the eDetail session and has control over the timing of the call (both in terms of when to call and the length of call). A typical interactive session lasts around 10 to 15 minutes. During the call the physician and sales representative (via a videoconferencing system) view and listen to a multi-media presentation about the promoted product and have the opportunity to discuss any points. During the eDetailing session, the physician would be able to interact with the sales representative via video and audio in real time. This type of system was pioneered by iPhysicianNet in the US. A variance on this approach, is a system where only the sales representative is viewed, or only audio and data slides are shown, depending on the wishes of the physician.

This type of model is unlikely to be acceptable in Europe where there are much more restrictive limits on the value of goods that can be given to physicians during marketing.

Benefits of Virtual Live eDetailing
In the US, this type of model has been associated with providing a longer interaction with the physician more cost effectively when compared to the cost and length of the traditional face to face call so that the number of sales rep calls per day and the number of physician interactions are increased. However, there is no independent data on the impact of such eDetailing on the numbers of prescriptions issued.

Scripted eDetailing
Scripted eDetailing enables the physician to use a personal computer to launch a sponsored learning application, often consisting of a series of interactive screens with multi-media information about the promoted product, including research evidence, clinical practice guidelines, prescribing information and patient advice. The doctor ‘walks through’ the screens, usually for an honorarium incentive. This system may be on the Internet or on a closed Intranet or via IVR telephone line. A form of customised profiling software is usually used so that individual doctor preferences are taken into account during the session. This system does not have a live interaction between the physician and the sales representative. Questions and requests from the doctors would be available via an email link with an option for telephone call/visit from a sales representative. The Physicians Interactive and MyDrugRep systems both use this type of approach.

Benefits of Scripted eDetailing
In the US, this type of model has been has been shown to deliver clear, well-structured messages to physicians that is 5-10 times longer than the normal face-to-face sales rep call but at a reduced cost. Participating physicians especially like the convenience of the 24 hours a day, 7 days a week availability of this model. Unlike the other models, some forms of scripted eDetailing have been found in independent studies to show actual increases in prescribing of the drug featured in the eDetail - that can be directly attributable to the eDetailing done whether that is via the internet or via IVR.

Physician Portal eDetail
Online physician communities via physician portals, offer an opportunity to deliver pharmaceutical company messages to a specific audience of physicians. This model has been used in the US and is emerging in Europe (e.g. DoctorsNet.co.uk). This model is most often used for delivering “soft” general marketing messages (via sponsorship of a disease area forum or an online CME module). Potentially, it can be used to provide “hard” product specific messages (like traditional detailing) via alliances with Scripted eDetailing players.

Benefits of Physician Portal eDetailing
Potentially, physician portals can provide access to hard-to-reach physicians (e.g. specialists) though for most portals, the number of physicians who actively use that portal is usually significantly less than the official membership list. Portals can usually provide online statistics that give insight into where physicians spend their time and hence an insight into their web habits and interests. However these are not necessarily straightforward to interpret. For instance, there is no easy way to know whether the reason a physician spent 10 minutes looking at a web page was because he was interested or because he was bored and took a break to something else whilst the web page was open! There is little evidence of the actual impact of portal-based eDetailing on number of prescriptions issued.

Differences in eDetailing between US and Europe
Regulations governing pharmaceutical promotion are more restrictive in Europe than in the US. In the US, companies can supply higher value goods to physicians during promotion than in Europe, for example:

• iPhysicianNet provides free of charge the PC hardware required for video conferencing to physicians in return for the physician agreeing to place, receive or return videoconference calls with iPhysicianNet's pharmaceutical clients.
• Pharmaceutical company Lilly in a deal with ePocrates (provider of prescribing information) gave palm Personal Digital Assistants (PDA) together with the ePocrates software to a group of physicians selected by Lilly.
• Some of the eDetailing vendors give physicians a popular medical book or a $25 certificate redeemable for a medical education product in exchange for a completed eDetail.
• A “pay per eDetail” model is being considered by a Cincinnati physician group which is offering pharmaceutical sales representatives guaranteed detailing time for a fee. Debate on the legality of this approach has meant that no-one has yet taken up this offer .

However, in Europe the value of goods that can be given during promotion is much less. For example, in the UK, the Association of British Pharmaceutical Industry’s Code of Practice governing promotion of pharmaceutical products limits the value of any gift/benefit given to a physician to be no more than six pounds (plus Value Added Tax) cost to a company. Hence, the extent to which the success of eDetaling in the US can be replicated or even improved in Europe depends on finding appropriate ways to incentivise physicians without breaching current regulations. It is unlikely therefore that models such as live video detailing can be replicated in Europe under the current regulations.

On the other hand, Europe is potentially ahead of the US in technologies that can be used to provide convenient 24 hour by 7 day access to physicians. In addition to the Internet, some technologies that are potentially relevant in future for eDetailing in Europe are mobile phone/PDAs and Interactive Digital Television (iDTV).

EDetailing Technologies

Internet
The internet can provide physicians with convenient access to from the home or office, within or outside office hours. Virtually all physicians now have Internet access either at work or at home. In the US, according to Harris Interactive, most physicians connect to the Internet on a daily basis. In the UK, the National Health Service (NHS) has positively encouraged general practitioners to put their surgeries online through the NHSNet initiative. Figures from physicians portal www.Doctors.net.uk, indicate that 39% of physicians choose to conduct online Continuing Medical Education (CME) from home, compared with 26% at work. This desire for flexibility appears to be a key point behind physician acceptance of eDetailing. In a recent survey of UK GPs, Mednet Media found that 23% of UK physicians are likely to use an eDetailing facility after 9pm .

eDetailing via Mobile phones/PDAs
Mobile phones can potentially provide physicians on the move with added convenience in accessing e-detailing. Already in Europe, most people have a mobile phone and use it for calls as well as sending billions of text messages a month. Forrester Research predicts that one third of the European population will access Internet services using mobile phones by 2003. Combination mobile phone/PDAs are just emerging though the Gartner group predicts that by 2007, more than 60 percent of the European Union and U.S. population aged 15 to 50 will carry or wear a wireless computing and communications device at least six hours a day, and by 2010, more than 75 percent will do so, Already in the US, a Harris Interactive poll in August 2001 showed that the percentage of physicians who utilise PDAs increased to 26% last year though many of these physicians use PDAs for personal, rather than professional use. Some pharmaceutical companies are already beginning to supply information to mobile phones e.g. Aventis launched a WAP phone-based service in June 2000.

eDetailing via iDTV
iDTV can potentially provide physicians at home with added convenience in accessing e-detailing. Within Europe, UK is in the lead on iDTV penetration so that 30% of households have iDTV. Other countries with high iDTV penetrations are Denmark, Spain and Sweden. In the UK, the first medical channel for doctors was launched via Sky BSB’s satellite service which is available to all UK’s GPs but cannot be viewed by the public. Medical content via iDTV is likely to become more commonplace as the number of households with iDTV grows.

The emergence of eDetailing so far
At the time of writing, it would be fair to say that eDetailing is almost wholly a US affair, though European companies are beginning to emerge as shown in Figure 3. ‘Pure’ eDetailing companies such as iPhysicianNet and Physicians Interactive, which was established in 1996, are now well established players with most of the top 20 pharmaceutical companies signed up as clients in the US. Physicians Interactive claims to have completed 60,000 details on behalf of its clients. Many other marketing service companies, such as Aptilon, are also offering an eDetailing package.

Pure eDetailing players

• ePocrates (US)
• iPhysicianNet (US)
• MarketRx (US)
• MyDrugRep (US)
• Physicians Interactive (US)
• RxCentric (US)
• TargetRx (US)

• Aptilon (Canada, Europe)
• CRX Solutions(US)
• Dendrite (US)
• Doctors.net.uk (UK)
• InfoMedics (US)
• Medsite Inc (US)
• OnMedica (UK)
• Quintiles (US, UK)
• Synavant Inc (US and Europe)
• Zestica (Sweden)

Source: Mednet Media

As yet there are no figures to indicate the prevalence of eDetailing. In the US all of the top 20 pharmaceutical companies have some involvement or investment with eDetailing. A number of eDetailing companies have strategic alliances with physician portals giving potential access to large numbers of professionals. For example, MyDrugRep has an alliance with Salu which has 30,000 physicians registered.

In Europe, no more than a handful of physicians have been exposed to the concept in very small scale trials though some pharmaceutical companies are now beginning to embark on small and local pilots.

Benefits of eDetailing from a Pharmaceutical Company Perspective
An eDetailing system offers both the pharmaceutical company and the physician a number of advantages over a traditional sales representative. However, Mednet Media believes that eDetailing should not be seen in isolation, but as a compliment to an existing sale force. A good eDetailing strategy can potentially improve the effectiveness sales rep by allowing them to focus on priority products and key physicians who respond well to face-to-face calls. In this way, eDetailing can be used for reaching remote/hard-to-reach physicians.

Benefits of eDetailing from a Physician Perspective
Physicians are likely to be divided into those that prefer traditional detailing and those who prefer one of the various eDetail models. Preference is likely to vary by physician specialty as well by country. Hence, market research to understand physician’s needs, technology constraints and incentives is going to be a key prerequisite to any eDetailing pilot or programme.

Pros and Cons of eDetailing from doctor’s point of view

Advantages:

• Schedule appointments at convenience
• Time savings
• Improved information
• No need to see reps

• Removal of social interaction with sales rep
• Technology failures
• No time saving
• Poor information

Conclusions
eDetailing offers pharmaceutical companies the potential to revolutionise medical promotion by increasing both the reach and quality of their messages to a wider audience of physicians and potentially to other healthcare influencers. At the same time, eDetailing is not a replacement of the sales force, instead it allows sales reps to be more effective and concentrate on those physicians for whom face-to-face calls are essential.

References

Bailey E. & Bates A. (November 2001) eDetailing: A strategic analysis of implementation and ROI . Mednet Media Ltd

Benson J. (2000) iPhysicianNet, personal communication

Bernewitz T. (2001) eDetailing: Where does it fit in Pharmaceutical Sales? ZS Associates Inc.

Boehm E.W. et al. (2001) Pharma’s Detailing Overhaul Report. Forrester

DataMonitor (2000) The ROI of e-detailing; evaluating the opportunity

Doctors.net.uk (2001) Online learning and e-detailing in General Practice; a survey of UK doctors

Fisher J. & Wang R. (2001) Pharmaceutical Marketing for the Millennium. WR Hambrecht & Co

HyGro Group Inc. (2000) Physicians Interactive eDetailing Study