Medical Device Link.

This example characterizes the ultimate challenge of bringing a medical device to market. Companies need to align the diverse needs of a myriad of stakeholders, from providers, hospital purchasing units, and managed care groups, to the end consumer. With shorter product life cycles, increasing competition, and market confusion created by industry consolidation, medical device manufacturers are looking for new strategies to differentiate their products more precisely and rapidly. Personalized product messages—addressing drastically different needs of different audiences—need to break through the growing proliferation of available information.

If timing is everything in a product launch, then the days of patient brochures, live lunch-and-learns, and face-to-face detailing sessions are giving way to faster, more-customized on-line education. Medical product manufacturers, just like other healthcare players, are beginning to view e-learning as a powerful way to educate buyers and drive product sales. This article describes how e-learning is changing the way medical product firms leverage the power of the Internet—through launch and beyond—to build relationships and sell products. More importantly, it explores specific steps companies can take to help harness the power of e-learning.

Like many new promises of the Internet, e-learning is fraught with hype. Some firms, in a zealous effort to create consumer pull, have invested heavily in on-line patient education, overlooking the critical role of the physician-patient interaction. Other companies have spent frivolously on educommerce programs (on-line education linked to purchasing vehicles) directed toward hospital purchasing groups, then painfully realized that physicians were actually making product decisions. Still others have tried to use e-detailing (detailing physicians on-line) to replace costly sales forces. What many firms are finding, however, is that when e-learning is used to supplement—not replace—off-line sales and marketing efforts, the impact can be more dramatic.

When many think of e-learning, they imagine a student hunched over a laptop, scrolling through perpetual screens of text. In fact, e-learning refers broadly to any type of learning program delivered electronically. Applications of e-learning include not just Web-based learning modules, but on-line collaboration tools, CD-ROM, satellite broadcast, interactive television, and even videotape (see Table I). Though e-learning is not likely to replace traditional learning modalities, in many situations it offers significant advantages over traditional learning modalities such as instructor-led training, self-study using print or video materials, and other training methods. Unlike paper-based material, e-learning can be interactive, changed constantly, and distributed for nominal variable cost.

Table I. E-Learning tools and vendors cover a wide array of modalities. Source: Forrester Research Inc. (Cambridge, MA), "On-Line Training Needs a New Course," August 2000. Reproduced with permission.

Customize Experience. Many forms of e-learning, particularly Web-based instruction, can be customized to meet the needs of specific learning audiences and individuals. Companies can deliver tailored training materials to the desktops of people in different business units or product groups, or different customer and stakeholder segments (e.g., primary care physicians, specialists, health consumers). E-learning can be designed to support flexibility in moving through the information, so that learners can focus on areas of greatest need or interest. And unlike classroom training, e-learning can provide learners with a personalized experience precisely where and when they want or need it.

Monitor Performance. E-learning greatly enhances the ability of the organization to monitor and track the learning that is actually being accomplished. Reports that document completion of a course, as well as the proficiency level that was attained by learners, can be used to ensure that important learning has taken place. Certification of learners in critical areas is generally much simpler and more accurate using an e-learning approach, compared with administering written tests or passing around attendance sheets in a classroom.

In the early days of the Internet, firms tried to create e-learning by transferring existing content (product binders, educational brochures, and video demonstrations) to intranets and extranets. While this was easy, it produced little additional value to users. As a result, firms are now looking to e-learning for new means of accessing, sharing, and experiencing new information.

Although e-learning can sometimes act as a substitute for alternative means of learning, it is best leveraged as a complement to other means. For example, weeks before a product launch, a salesperson can take a brief pretest on-line, then immediately receive his or her performance results relative to the rest of the sales force. Days prior to launch, he or she participates in a one-hour tutorial that focuses on areas that he or she needs to understand better. During the three-day launch event, the group competes in teams of five in a simulated sales exercise. Finally, after the launch, the sales rep joins those teammates for a reunion module to collaborate with colleagues and exchange information about objections or competitive detailing. As new indications or clinical trials are posted, the sales rep learns about them through weekly visits to his or her personalized e-learning portal.

John Chambers, CEO of Cisco Systems (San Jose), calls e-learning "the next killer app for the Internet." Cisco cites dramatic paybacks of the Internet's role in transforming its sales force from transactional agents to strategic advisors. Indeed, despite bursting bubbles in the Internet space, the e-learning industry is expected to grow 900% between 1999 and 2003. Forrester Research Inc. (Cambridge, MA) estimates the on-line training market will surpass $25 billion by 2003.

Originally, e-learning's value centered on its being a more cost-effective way to educate global employees. But increasingly, executives are viewing e-learning as a way to build and sustain customer relationships, increase sales, and achieve competitive advantage. Medtech firms perhaps have as much to gain from e-learning as anyone in the healthcare industry. Still, firms have been slow to fully leverage e-learning to complement strategic initiatives.

Unlike industries that offer less-complex and lower-priced products, the medtech industry has an ability to leverage e-learning. If a medical device manufacturer succeeds at educating a respected physician on a particular endoscope, for instance, several outcomes are likely. First, the physician is likely to remain loyal to that product unless a competitive product offers a dramatic new feature. Second, that physician will likely train his colleagues on the use of the product, and perhaps become a valuable thought leader for the procedure.

Simply put, switching costs are high, so the investment in educating physicians can create a lasting residual. Although education efforts are typically focused on physicians, nurses, and residents, many medical device manufacturers are finding applications for e-learning to enrich a number of different relationships (see Table II).

Table II. E-learning applied. Medical product manufacturers are uncovering a multitude of applications for e-learning, customized for various stakeholders that influence product uptake. Here are some representative ways to leverage e-learning to build relationships and drive sales. Source: KPMG Consulting.

Educating the Web-Savvy Consumer

Changes in the Web patterns of U.S. consumers are causing many medtech firms—who have historically invested little to no funding in patient education—to investigate the return on investment of consumer-education initiatives. Studies indicate that 70–90% of on-line adults currently use the Internet to find health information. Many of these health-med retrievers visit the Internet before seeing a doctor, then print out Web pages to guide their discussions with physicians. This statistic offers medical device manufacturers a new means to create consumer pull for the treatments associated with their products. Creating consumer demand—for example, for a new surgical procedure—tends to increase physician interest in training on the procedures. Consumer marketing initiatives are also effective ways to help loyal, trained providers build their practice—and hence increase their purchase of products.

One large medical device manufacturer last year, for example, was exploring ways to market a new device that solved a very common health problem in women that was unfortunately frequently misdiagnosed. The company's research suggested that while consumers experienced severe inconvenience and discomfort resulting from this ailment, physicians considered it part of a normal aging process. To increase consumer awareness of symptoms, the firm conducted extensive focus groups on women suffering from symptoms, but who had not made an effort to improve their situation. The firm found that these women thought they were alone and that they had to cope with their problems. Many made dramatic lifestyle changes to cope with symptoms, and were embarrassed to even discuss them with their husbands, much less with physicians.

The company decided to invest in a direct-to-consumer marketing initiative that was almost exclusively focused on Web-based education. On-line promotion on portals and health sites helped ensure that the women (and their caregivers) found information efficiently (the cost per lead was dramatically cheaper on-line than it would have been through an elaborate print or television campaign). Then the women were invited to an e-learning Web site to understand symptoms, learn about causes, and explore treatment alternatives. Finally, the company connected the consumer with a physician who was trained on their device. The firm described this initiative as educommerce, because through educating consumers, they indirectly drove the sales of the procedure.

Increasingly, firms are seeing the value in e-learning—and seeing competitors leverage it effectively—to provide competitive advantage. The challenge is investing appropriately in e-learning and ensuring that it is fully exploited. Being able to leverage e-learning successfully doesn't happen overnight, but leading companies are uncovering ways to expedite the process and ensure its long-term success. Here are some concrete steps to build e-learning within and beyond the enterprise.

Build to Last. E-learning efforts, like any marketing plan or e-business strategy, should start with a foundation. At a minimum, such a foundation should include the following elements.

A comprehensive e-learning strategy starts with a clear set of business objectives. Is the goal to drive sales, reduce costs, increase compliance, or strengthen key relationships?

Next, firms typically audit both existing e-learning programs and traditional learning activities, and evaluate the successes and failures associated with them. Very often there are good reasons that certain types of learning occur in the field or in classrooms, and it is costly and futile to change these practices. A Web site, for example, will not likely replace the power of a leading physician meeting with a group of colleagues in a hospital. However, a gap analysis comparing strategic priorities to current practices will often help identify opportunities for short- and long-term solutions.

Embracing e-learning also requires more than a strategy and top-level support. Often the best e-business strategies miss reaching their full potential because managers overlook such critical governance issues as who owns the processes, who funds it, and how teams will function. Some firms appoint an e-learning guru to advocate new initiatives, but many life sciences organizations are finding it more effective to introduce e-learning champions within product management teams, a position from which they can interact with other cross-functional members and ensure that e-learning initiatives are tied tightly to the group product strategy.

Select the Right Technology. Firms also need to make critical technology decisions to ensure that they have an e-learning platform that is stable and enduring. While early e-learning programs were based on simple HTML, newer learning management systems (LMS) offer such possibilities as content management, testing and measurement, searchable libraries, and open architecture to integrate existing e-learning modules. Some LMS vendors are partnering with application service providers to offer firms complete end-to-end outsourcing of hosting, management, and maintenance of e-learning technology. Such a turnkey solution can often be more rapidly deployed, although certainly at a cost. Most firms conduct a technology requirements assessment to explore existing e-learning technology and how it needs to evolve.

Experiment and Improve. Many companies have stalled an overall e-learning strategy because they simply don't know where to begin. The life sciences firms that are ahead of competitors in e-learning have taken an iterative approach. They created early wins by focusing e-learning efforts on high-visibility and well-funded areas. Major product launches offer excellent opportunities to pilot e-learning programs. Next, they have taken an aggressive stance on soliciting learner feedback. For example, one firm conducted live on-line events to educate global participants on a complex new product offering. The instructor provided an open-mike session in the last 15 minutes of the one-hour course to refine the event and seek learner input. As a result, the company revamped the program to create more precourse self-study of the product's details, then used live events to compare customer feedback during the launch process. Since participants were interested in knowing how to overcome new objections and competitive threats, attendance in the on-line courses increased dramatically.

The challenge of many e-learning vehicles is that students are typically one click away from departing. E-learning lacks the social pressure that keeps a student from leaving a classroom when they become disengaged, and on-line learners are notorious for exiting when content isn't interactive and engaging. That's why some of the best e-learning modules are designed not by those with instructional design degrees but by those with gaming backgrounds. Users need to stay engaged and participate in the activity. If the event is a live virtual-classroom training event, students should have the ability to interject with questions. If a module is a self-study device, it needs to be constantly interactive so students don't read more than a few paragraphs without having to select, click, drag and drop, or complete a quiz. Most importantly, e-learning needs to be separated into small, manageable chunks that can be conducted in short spurts at the learner's convenience. Physicians with downtime in the evening may be receptive to a 15-minute interactive overview (especially if it's certified as continuing medical education [CME]), but few are going to watch 45 minutes of streaming media from a convention.

Vary Modalities. E-learning is ideal when it combines the best of synchronous learning (where an instructor and a learner interact simultaneously) and asynchronous learning (where a student experiences information on his or her own). On one hand, a physician curious about a new procedure associated with a wound closure device may not care about live interaction with colleagues. E-learning, then, might be best facilitated by simply providing him or her with a quick route to that information. On the other hand, a hospital technician struggling with new applications of a dialysis machine might well want to collaborate with his or her counterparts in other hospitals. Retention is increased dramatically when individuals aren't limited to just reading text, but hear voices, see images, and interact with data.

As bandwidth increases, companies are turning to virtual reality as a way to help physicians explore new devices and technologies. Some firms are providing select physicians access to password-protected extranets that offer virtual body tours. Here, doctors can experience simulated consequences of different treatment alternatives. Other companies are sponsoring case-based learning that allows physicians to gain CME credits—typically through a university or accredited institution—by participating in learning programs based on real clinical cases.

Particularly as wireless technology becomes prevalent, companies need to look creatively at ways to push out short e-learning modules at the time and place that learners want. By offering users a variety of choices, companies increase the likelihood that individuals will experiment with e-learning and change behavior accordingly.

For example, companies can experiment with e-learning initiatives by piloting sales force education programs to select audiences and benchmarking the performance of those participants with the average. Likewise, firms can measure the impact of physician education on territory sales. Longitudinal consumer studies can compare patient behaviors before, during, and after e-learning programs.

Manage Expectations Carefully. As stated earlier, e-learning is not ideal for all learning needs. It is best considered as a significant component of a blended model of learning, in which different forms of synchronous and asynchronous learning methods are used to achieve maximum results. Leaders in an organization must be careful to manage expectations concerning what e-learning can and can't do, so that its use is limited to those learning needs that it can most effectively meet. Additionally, the desire for glitzy, media-rich e-learning must be balanced with the practical reality of technology and infrastructure capabilities that exist within organizations and the desktops of health consumers, physicians, and other stakeholders. Bringing a network to its knees or locking up a health consumer's PC with e-learning that is heavy on video-streaming content will likely ensure that learners will not return to the learning experience in the future. Until infrastructure and bandwidth enhancements are widely available, many organizations will have to keep their e-learning simpler and smaller to avoid unpleasant and ineffective learning experiences.

E-learning offers tremendous potential in helping medical device companies achieve competitive advantage. It can play an important role in educating the sales force, physicians and clinicians, and health consumers during the launch of a new product. It also can offer powerful ways to enhance and support the relationships between the organization and its customers that are so important in today's competitive environment, in which many entities are aggressively competing for the mind-share and desktop of physicians and health consumers.