Leveraging the EHR to Connect Physicians and Consumers

Leveraging the EHR to Connect Physicians and Consumers DRG Digital DRGDigital.com Contact 2017 Digital@TeamDRG.com DR/Decision Resources, LLC. or All rights visit reserved. DRGDigital.com for more physician and patient insights

Manhattan Research is part of DRG s suite of healthcare intelligence DRG DIGITAL We re still Manhattan Research the industry s best source for multichannel research and expertise Enhanced further with DRG capabilities: Proprietary DRG data assets e.g. RWE database Custom analytics team and advanced methodologies Access to 200+ analysts; world s leading disease experts TO GET YOU COMPREHENSIVE AND ACTIONABLE ANSWERS TO YOUR TOUGHEST BUSINESS QUESTIONS 2017 DR/Decision Resources, LLC. All rights reserved. 2

Vast coverage to support brands and markets across your organization 28 countries 50+ brand categories HCPs Payers Patients Caregivers US Canada Europe Asia-Pac LatAm MEA Type 1 & 2 diabetes Oncology Cardiovascular disease Multiple sclerosis Rheumatoid arthritis Asthma Alzheimer's disease Atopic dermatitis Vaccines Rare diseases - custom research expertise Many more 2017 DR/Decision Resources, LLC. All rights reserved. 3

Significant shifts in the healthcare ecosystem New quality metrics Increased focus on patient outcomes in changing the way that physician success is evaluated New technologies Digital and healthcare innovations are opening up new possibilities in patient care, as well as training and learning demands for physicians New treatment decision factors Evolving market access dynamics and prescribing autonomy are impacting the treatment paths physicians set for patients New level of info velocity Smaller, more frequent drug launches adding to the stream of clinical information and updates for physicians to stay on top of New patient populations Emerging groups of consumers with new found access to care are entering the healthcare system, armed with online research and evolving expectations around their relationship with care providers 2017 DR/Decision Resources, LLC. All rights reserved. 6

Engage with new customers as care decisions shift IDNs, Payers 60% of US physicians say formulary guidelines influence their clinical decisions Traditional center of care decisions Doctors Patients, Caregivers 50% of US physicians say patient requests influence their clinical decisions Retail and specialty pharmacists spend nearly 1/3 of their day on patient care activities Nurses, Pharmacists Compared to 2 years ago, 38% of RNs seeing patients say they ve increased time spent on patient care Taking the Pulse US 2016, Taking the Pulse Nurses 2015, Taking the Pulse Pharmacists 2015 2017 DR/Decision Resources, LLC. All rights reserved. 7

Hours spent per day Decision Resources Group Manhattan Research, EHR Conference EHR and value metric demands are driving an increasing share of physicians time, strain on patient care Hours spent conducting professional activities on a typical workday: 4 3 out of 4 of U.S. physicians agree: 2.8 Adjusting to new quality and care metrics detracts from the time I can spend with my patients 2014 2015 2016 2017 Among U.S. physicians *digital resources includes professional websites, apps, mobile sites, etc. Source: Taking the Pulse U.S. 2014-2017 2017 DR/Decision Resources, LLC. All rights reserved. 8

and physicians are overwhelmed with the amount of information coming in Over half of U.S. HCPs agree.. I do not have time to manage all of the data I receive from my patients and outside resources Medical journals Patient reported symptoms Clinical trial data Population data Genomic data Patient reported device data Among U.S. physicians Source: Taking the Pulse U.S. 2016 2017 DR/Decision Resources, LLC. All rights reserved. 9

Reps are the primary touchpoint between pharma and HCPs 70% of physicians have visited with a pharma sales rep in the past year in-person I learn about how pharma can help my practice primarily from pharma sales reps. email phone U.S. Physicians Agree Among U.S. physicians Source: epharma Physician U.S. 2016 2017 DR/Decision Resources, LLC. All rights reserved. 10

However rep access has reduced 45% of physicians have a restriction on interacting with pharma company sales reps 37% expect the level of restrictions my practice has against in-person pharma sales rep meetings to increase in the next two years Among U.S. physicians Source: epharma Physician U.S. 2016 2017 DR/Decision Resources, LLC. All rights reserved. 11

Drug costs and their impact on patients are a top concern for U.S. physicians In which of the following areas is it most important for pharma to focus over the next year? 88% of U.S. physicians agree: I am concerned about the impact of the increase in the cost of care for my patients Ensuring patients adhere to their medications Simplifying the information and services they provide Providing more opportunities for medical education Supporting integration of multiple data sources 8% 7% 6% 5% Managing patient costs 49% Providing support and resources to caregivers 5% Among U.S. physicians Source: Taking the Pulse U.S. 2017 2017 DR/Decision Resources, LLC. All rights reserved. 12

Prescription medication costs are as important a consideration as doctor recommendations Factors influencing medication choices: Doctor Out-ofpocket costs Side effects Adverse events *Significant influence (ranked 5 on a 5-point significance scale) Among U.S. online adults Source: epharma Consumer 2016 Medication uptake Drug type Reputation of the manufacturer Dosage Patient reviews/ ratings Known brand name Additional patient support services 2017 DR/Decision Resources, LLC. All rights reserved. 13

Patients are risking personal health over financial health A quarter of consumers have NOT filled a prescription at least once in the past year Ways used to save money on a prescription medication: Used generic over brand-name Used a coupon/voucher/discounts Didn t fill a prescription Took medication less frequently Used a free trials/refill program Enrolled in a pharmacy loyalty program Used a rebate for a prescription Among U.S. online adults who have received Rx Source: epharma Consumer 2016 2017 DR/Decision Resources, LLC. All rights reserved. 14

Digital is a significant portion of a physicians workday 6 hours seeing patients Average time spent in workday: 4 hours in EHR 2 hours on digital resources* 2 hours doing paperwork Among U.S. physicians *digital resources includes professional websites, apps, mobile sites, etc. Source: Taking the Pulse U.S. 2017 2017 DR/Decision Resources, LLC. All rights reserved. 16

High interest in technology to help close the gaps in care Resources used/interested to support clinical practice: Use Interested in Using Clinical algorithms in EHR that support diagnosis Insights from population health data in EHR Remote monitoring of patients Virtual consults with patients Virtual reality applications for medical education/training 3D Printing Among U.S. physicians Source: Taking the Pulse U.S. 2017 2017 DR/Decision Resources, LLC. All rights reserved. 17

EHR adoption has come a long way and is now universal Adoption of EHRs 83% 12% 2001 2017 2001 2003 2005 2007 2009 2011 2012 2013 2014 2015 2016 2017 Among U.S. physicians Source: Taking the Pulse U.S. 2001-2017 2017 DR/Decision Resources, LLC. All rights reserved. 18

However satisfaction is driven by basic EHR functions 74% of HCPs are generally satisfied with their EHR system Among EHR users Source: Taking the Pulse U.S. 2017 High satisfaction Overall ease of use Design and layout Interoperability of EHR Moderate-low satisfaction. Ability to communicate with patients Patient education materials Patient support services (vouchers and copays) Clinical decision support tools 2017 DR/Decision Resources, LLC. All rights reserved. 19

Pushing physicians rely on outside sources for patient and clinical information I continue to use sources outside of my EHR to inform clinical decisions. Majority of physicians are going to external resources while in their EHR 3-in-4 physicians agree I prefer to use sources outside of my EHR when I have clinical questions. Among EHR users Source: Taking the Pulse U.S. 2016, 2017 2017 DR/Decision Resources, LLC. All rights reserved. 20

Physicians rely on non-pharma websites for information during the point of care, cutting pharma out of a crucial time Resources used during patient consults: Resources used between patient consults: EHRs Drug reference databases HCP websites Formulary lists Disease association websites Government websites Pharma websites Consumer health websites Among U.S. physicians Source: Taking the Pulse U.S. 2017 Online journals 2017 DR/Decision Resources, LLC. All rights reserved. 21

Pharma should work with EHR vendors, where possible, to provide patient support and financial support information within the EHR Information HCPs are interested in accessing from pharma inside EHR: Coupons/ vouchers Patient support info Dosing information Patient assistance programs Treatment guidelines Patient education materials Among EHR users Source: Taking the Pulse U.S. 2017 2017 DR/Decision Resources, LLC. All rights reserved. 23

Information resources and coupons should easy to share with patients Materials HCPs are most interested in sending via email to patients: Motivations to send digital info via email to patients 1. If I didn t have to sign into email and could do it from my EHR 2. If it was automated based on the drug prescribed 3. If I could flag it in my EHR for the nurse to do later Among EHR users Source: Taking the Pulse U.S. 2017 Copay cards/coupons Education materials about treatment Education materials about condition Education materials about lifestyle/wellness Medication reminders and adherence trackers 2017 DR/Decision Resources, LLC. All rights reserved. 24

as well as pharmacists Majority of consumers are choosing to pick up their prescriptions in-store 1. Via electronic Rx 2. Via paper Rx 1-in-3 consumers Prefer if coupons/discounts available for their prescription would be automatically applied at the pharmacy Among U.S. online adults who have received Rx Source: epharma Consumer 2016 2017 DR/Decision Resources, LLC. All rights reserved. 25

Taking medication can be fun Interest in adherence tools: 47% of consumers would be more likely to accurately follow their treatment regimen if they were enrolled in a program that rewards them for achieving goals Services that package medications together with dosing instructions (E.g. PillPack) Text reminders Mobile app with alerts Wearable device Electronic pill box Smartwatch Consumers are currently using pill box organizers and paper calendars Among prescription drug takers Source: epharma Consumer 2016 2017 DR/Decision Resources, LLC. All rights reserved. 26

Support treatment without adding a new work stream for HCPs Top ways interested in accessing self tracked data: In my EHR 53% In a printout 37% On an app 14% In an email 13% Among U.S. physicians Source: Taking the Pulse U.S. 2017 2017 DR/Decision Resources, LLC. All rights reserved. 27