Web-based Communities and Healthcare

www.gkbassociates.com/healthcare.html

Web-based Communities and Healthcare

Eman Anis Daoud
Course: INSS 687
Instructor: Dr. Dessa David

Introduction
The internet has become very important for people and organizations. People use internet in work, in business and social communication, in searching for information, in knowing the world news, and in shopping. Profit and nonprofit organization use internet to foster their businesses and to have competitive advantages. An additional advantage of the Internet is the web-based communities that allow people to communicate and share their experience and information with each other. Communities can be described as any group of people who have a common interest and can involve in information sharing, real-time dialog, and transaction facilitation.
There are web-based communities for healthcare that offer medical information to people. In the past few years, the number of people who have been accessing health-related web based communities has increased. These communities have a wide variety of health care topics about different kinds of diseases. For instance: Cancer, Asthma, Alzheimer’s, Arthritis, Back pain, Heart disease, Heartburn/GERD, Diabetes, etc. Also, they have discussion forums for not only patients to share their feeling and symptoms, but also for doctors and patients. Some physicians are members of these health-related web-based communities, and they can answer patients’ questions about their symptoms. Healthcare communities have become online place to comfort people and to contribute in the self-management of acute or chronic diseases.


What is web-based community?
A web-based community can be defined as a group of people who have common needs and interests, and they can interact and collaborate through the Internet without barriers of time and place. Transmission of ideas and information in an on-line mode is rapid and available regardless of how geographically dispersed community members are [Marshall-2000]. The interesting thing about on-line communities is that they are not only places for communication but also for offering a variety of topics on the specific issues of interests to the community members. This is the definition of online community developed by [Preece-2000].
An online community consists of:
• People, who interact socially as they strive to satisfy their own needs or perform special roles, such as leading or moderating.
• A shared purpose, such as an interest, need, information exchange, or service that provide a reason for the community.
• Policies, in the form of tacit assumptions, rituals, protocols, rules, and laws that guide people’s interactions.
• Computer systems, to support, and mediate social interaction and facilitate a sense of togetherness.

Evolution of technology that supports online communities
Email was developed by APRA net in 1972 and it is the first and still common way of communication via Internet. In the early systems communication was point to point which means that one person could send a note to other one person. Until 1975, Listservers which allow many postings were not invented. There are two ways for Listservers to be used, one is trickle through and the other is digests. Trickle through systems distribute each message as it is received. Digests comprise a list of messages one after the other in chronological order. In the mid of 1980s, systems with improved graphical user interfaces started to appear.
Bulletin boards were designed at the same time of email. People can post messages to the board and they are presented in various ways. The messages should be on the same topic. The first message forms the beginning of the thread and responses are followed it.
Usenet News, which is similar to a bulletin board and provides open areas for discussion of topics organized in hierarchies. People can read messages and respond to them later, may be after hours, weeks, or months.
Chat systems, which consist of instant messaging and texting systems, but the response to those messages should be in the same time. Usually, conversations are rapid and each individual message is short. In 1988, Internet Relay Chat (IRC) was developed by Jarkko Okarinen. Instant messaging made known by ICQ and AOL Instant Messenger.
In 1991, the World Wide Web (WWW) was developed by Tim Berners-Lee, and released by European Organization for Nuclear Research (CERN). Then the widespread use of web sites and the development of online community groups supported by web pages and different forms of communication software have been increased.
Internet telephone, streaming video, photographs, sound, voice, web cam, blogs, and wikis are all available technologies that can be used by online communities. “As computers morph and migrate into all kinds of places ‘ubiquitous computing’, online communities will have to contend with smaller devices, and therefore, WebPages will have to be adaptable to accommodate various sizes of screen displays and bandwidth.”

Foundations of On-Line Communities
There are seven foundations elements that support on-line communities’ development as follows:
1. Mission and Focus: an online community’s mission has to focus on the community members’ needs and interests. “An on-line community's mission and purpose need to closely parallel the needs of the targeted demographic group” [Andrews et al 2002]
2. Content: online community should provide information-rich content on the specific topics of interest to the community members. Community members want to find valuable information for their interested topics, and they would like to have the most recent information. [Bellini et al 2003] list the following content tools and services that can support communities: on-line training, library and news services, analysis of community-related themes, forum and chat tools, bookmark management, advertisements, search engine, electronic commerce, auction services, and calendar for community events.
3. Sociability: an online community is considered as a social interaction place where people feel comfortable communicating with each other. “On-line communities often use anonymity as a way to help members to feel comfortable contributing their ideas” (Cothrel et al -1999]
4. Roles: there are policies and roles to support and guide online community interaction between community members.
5. Technology and Usability: online community members have to be able to use community browsers easily. “Any Web-based community should be easy to navigate and invoke on browsers and accommodate the wide breadth of bandwidths and communication infrastructures.” [Bellini – 2003].
6. Trust: trust should be established not only between web-based community members, but also between members and the community owner. Members should know and trust that their community will protect their personal information.
7. Participation motivation: an online community will be successful, if its members participate in a regular base. In order to motivate community members, community managers should identify members’ needs, value desired and basics for participation.

Challenges in creating and maintaining on-line communities
According to Schwartz et al., American corporations have invested $300 million in setting up and managing on-line communities [Schwartz-2001]. Web-based communities are more unstable and have shorter life time than face to face communities because the barrier to leave one community and join another is low. On-line relationships are more easily replaced (by click of a mouse) than in the face-to-face world [Driskell – 2002]. Therefore, online communities’ management is very challenging because of the volatility of membership.
In order to build a successful web-based community, it must have some characteristics to keep and attract people. This includes "appropriate informational content, selecting the right on-line community technology, attracting people to the community, encouraging continued participation, and evolving the right balance of fact-finding and empathetic opportunities" [Andrews et al - 2002.]
Not all people are open to use online communities even though they use the Internet for surfing the web, checking e-mail, and reading the news. According to the Pew Internet and American Life Project survey in 2003, only 52% of rural residents use the Internet, compared to 67% of urban and 66% of suburban residents.
Although, online health communities have achieved success during the past few years, there are many concerns about the quality of online consumer health information. Of course there is a possibility for people to find poor information, but every person has to make sure of the credibility of his/her reading source. Most of the articles that are published on healthcare web-based communities should mention their sources. For example: when a patient visits WebMD to find some information for asthma, WebMD will mention the sources of any asthma article at the end of it.

Benefits of healthcare web-based communities
Online healthcare communities can be accessed from anywhere in the world at any time. When people who have any concern about a medical issue whether it is serious or not, they can visit online communities at any time. They don’t need to wait to call a doctor or a friend at an appropriate time to ask him/her, but they can visit any one of the online communities 24/7 to find an answer about their concerns.
Nowadays, many people consider the internet as a huge source of information that can educate them and provide them with the desired information that will not be available from doctors. Almost 80% of the World Wide Web users have used it to search for information about health. They feel that the internet is the first place to visit before even see physicians. Web-based communities for healthcare have a big impact to provide patients with information from different resources. Patients have many choices when they visit online healthcare communities. They can read articles about any health problem, they may communicate with other patients who have the same symptoms, or they can ask questions to specialized doctors.
On healthcare web-based communities, exchange knowledge between patients help them to cope with complex health issues. For instance, when someone has HIV and he/she embarrassed to communicate with people face to face, online communities will help him/her to deal with this disease. A patient can find support from other patients who have the same disease, and also from physicians who will answer any question. “The international possibilities of virtual communities allow individuals with rare diseases to find peer support and allow all users to draw on a wide range of health perspectives and experience.”
Some people find that visiting online health communities is more comfortable especially when dealing with sensitive topics. Adolescents or adults believe that online communication make it easier to express their emotions and their feelings. “Emotional support, affirmations, encouragement, understanding and empathy are the most frequent type of social support given in online communities.” [Preece – 2001]
Because of the availability of specialist knowledge about any disease online, patients have become more involved in healthcare decision-making. Two thirds of patients who surf the web to find health information claim that internet affects their healthcare decisions. Patients are no more ignorant about medical issues, now they can print out article from the internet about their symptoms to discuss it with their physicians. “The internet offers the potential for patients to become more involved in their own care, learning about their condition, accessing and contributing to their online health record, and interacting with health services—for example using shared decision-making tools.”

Key players
1. WebMD [http://www.webmd.com/]
2. Medhelp.ORG [http://www.medhelp.org/]
3. Steady Health [http://www.steadyhealth.com/]
4. Revolution Health [http://www.revolutionhealth.com/]
5. Health Talk [http://www2.healthtalk.com/]
6. Health Line [http://www.healthline.com/]
7. Health Central [http://www.healthcentral.com/]
8. iVillage Your Total Health [http://yourtotalhealth.ivillage.com/home]

WebMD
WebMD is one of the best online healthcare communities that offer a wide variety of healthcare information almost about every health issue. It provides credible information, supportive communities, and in-depth reference material about heath subjects. WebMD is not only a source for original and timely information but also material from well known content providers.
WebMD has got many awards in 2008 because it is considered one of the top health information websites. People who work for WebMD have to be full time professional and expertise in Health news for the public, Creating and maintaining up-to-date medical reference content databases, Medical imagery, graphics, and animation, Communities, Live web events, User experience, and Interactive tools. WebMD’s staff includes individuals who hold advanced degrees in journalism, medical illustration, health communications, clinical informatics, nursing, and medicine. These are the awards it has got so far in 2008 according to: [http://www.webmd.com/about-webmd-policies/awards]
Online Journalism Awards
· Winner of the Specialty Site Journalism award
Webby Awards
· People's Voice Winner, Health category.
World Wide Web Health Awards
· Gold medal in the Advertising/Marketing Information.
· Gold medal in the Health Promotion/Disease and Injury Prevention.
· Gold medal in the Patient Education Information.
eHealthcare Leadership Awards
· Gold award for Best Overall Internet Site.
· Gold award for Best Health Content.
· Silver award for Best Site Design.

WebMD Health Centers: these centers are specialized for different kind of diseases that are full of a variety of information about those diseases. For instance: asthma, arthritis, allergies, cancer, cold & Flu, Digestive disorders, and Diabetes. A center provides patients with all the information about a specific disease such as symptoms, diagnosis, treatment, news about this disease, questions and answers, discussion forum, and all related medications.
Healthy Living Centers: these centers offer information about living a healthy life and avoiding diseases. For example: Children’s health, fitness and exercise, pregnancy, men’s health, diet and nutrition. A center provides news, videos, questions and answers, different articles about the chosen topic, and discussion forum.
Health Care Services: WebMD offers services to help patients and healthy people. Examples of these services are a guide to find a doctor, good insurance, and a hospital.
Community: It includes message boards, blogs, heath experts, and questions & answers. Message boards and blogs have different kinds of online communities that cover topics from A-Z. Health experts (physicians) answer patients’ questions on message boards on any concerning topic.

Survey about online health communities
In March 1998, a survey was done by Tom Ferguson M.D., senior associate at Boston's Center for Clinical Computing and William Kelly, co-founder and executive vice president of Sapient Health Network, Inc., according to BW Health Wire. The topic name is “Online Health Communities Rated High”, and it was published in About.com.
The survey shows how online health information and support communities are more helpful than either specialist or primary care doctors. These are the specific areas that online communities received the superior rating.
Convenience
Emotional support
Compassion / Empathy
Best source of medical referrals
Best source of in-depth information about the condition
Best source of practical coping tips for the condition

The results of this survey according to About.com:
1. online health communities have emerged as valuable resources of:
health information
self-help
mutual support
2. The computer age has narrowed the physical distance between people in need of:
support
understanding
advice
3. Online subscribers have the ability to conveniently reach out to people across the country and across the world. The compassion which exists among people with same or similar illnesses is unique, and issues and concerns in common can be:
shared
discussed
sometimes solved
4. Online Health Communities are best at what doctors are worst at and vice versa. In real life, the best healthcare consists of a combination of physicians and online support communities. Many of the information and support that online communities offer are those that many doctors are unable or unwilling to provide.

Conclusion
In conclusion, internet has a significant impact on people, and different industries. After the evolution of technology and creation of online communities, people life has changed for the good. As mentioned above, online health care communities improve people health and comfort them. The availability of information and sharing experience with other people help patients cope with their diseases. In the coming years, patients are no longer unaware of medical issues because of the huge source of heath information. Online health communities not only educate patients, but also allow them to be involved in healthcare making decisions.

References:
1. [Marshall-2000]. Virtual communities and their network support: A cybernetic analysis. Cybernetics & Systems. 31(4), p.397
2. [Preece-2000] Online Communities: Designing Usability, Supporting Sociability. Chichester, UK: John Wiley & Sons.
3. [Preece – 2003] Preece, J., Maloney-Krichmar, D. and Abras, C. (2003). History and emergence of online communities.
4. [Kallioranta – 2006]. Web-Based Communities as a Tool for Extension and Outreach. Journal of Extension. Volume 44, Number 2, Article Number 2FEA4. Retrieved from: http://www.joe.org/joe/2006april/a4.shtml
5. [Andrews et al 2002]. A conceptual framework for demographic groups resistant to on-line community interaction. International Journal of Electronic Commerce, 6(3), 9
6. [Bellini et al 2003]. Rationale for Internet-mediated communities. CyberPsychology & Behavior, 6(1), p.3.
7. [Cothrel et al1999]. On-line communities. Knowledge Management Review, 1(6), p.2
8. [Bellini – 2003]. Rationale for Internet-mediated communities. CyberPsychology & Behavior, 6(1), p.3.
9. [Schwartz – 2001]. Real community is possible. Business 2.0. 6(5), p.64
10. [Driskell – 2002]. Are virtual communities true communities? Examining the environments and elements of community. City & Community, 1(4), p.373
11. [Andrews et al – 2002]. A conceptual framework for demographic groups resistant to on-line community interaction. International Journal of Electronic Commerce, 6(3), 9
12. [Preece – 2001] Observations and Explorations of Empathy Online. Retrieved from: http://www.ifsm.umbc.edu/~preece/paper/17%20ricekatz11.pdf
13. [Powell – 2003]. The doctor, the patient and the world-wide web: how the internet is changing healthcare. Journal of the Royal Society of Medicine. Volume 96. Retrieved from: http://jrsm.rsmjournals.com/cgi/content/full/96/2/74#SEC2
14. [Maloney – 2002]. The Meaning of an Online Health Community in the Lives of Its Members: Roles, Relationships and Group Dynamics Social Implications of Information and Communication Technology. 2002 International Symposium on Technology and Society ISTAS’02, 20-27.
15. [Eustice – 2007]. Online Health Communities Rated High. About.com Health’s Disease and Condition. Retrieved from: http://arthritis.about.com/od/support/a/onlinehealth.htm

Pfizer

INSS 687

Dr. Dessa David

Adam Casey

Eman Anis-Daoud

Ghadah Kaleel

Leonard Kareko

Nibal Ghandour

Pfizer

Seeking Innovation. Creating Value. Together

The Pharmaceutical industry develops, produces, and markets prescription drugs. Pharmaceutical companies follow different laws and regulations regarding the patenting, testing and marketing of drugs. In the United States, the FDA (Food and Drug Administration) must approve any new pharmaceutical product to be both safe and effective for human health. A pharmaceutical company has to submit preclinical data of the efficacy of the new drug to FDA’s investigational new drug (IND) program. When IND approves the new drug application, three phases of human clinical trials will be done. Phase I studies the toxicity of the new drug on healthy volunteers. Phase II assess how the drug works and the safest dose requirement to cure the disease. This phase is applied on (20-300) people.
Phase III evaluates how effective the drug is, it has to run on large number of people (300-3000). The last phase is called Post Marketing Surveillance trial. It ensures the safety of the new drug even after marketing; it can determine any rare or long term side effects.

Pfizer Incorporated is the world’s largest research based biomedical and pharmaceutical company; its main headquarter is located in Brooklyn, New York.3 Pfizer products are in cardiovascular and metabolic diseases, central nervous system disorders, arthritis and pain, infectious and respiratory diseases, urology, oncology, ophthalmology, and endocrine disorders. Pfizer ranks number one in the world and USA in sales. Its global sales were $44.4 billion and US sales were $23.5 billion in 2007.

It produces the number one selling drug Lipitor that achieved $12.7billion in sales which represented 28.4% of 2007 revenues. Lipitor (atorvastatin) is one of statins class that used to lower blood pressure.

Pfizer has seven top drugs that are the main source of its huge revenue; they are Lipitor, Norvasc, and Celebrex. Each delivered at least $2 billion in revenues while Lyrica, Viagra, Detrol/Detrol LA, Xalatan/Xalacom and Zyrtec/Zyrtec D each got $1 billion in 2007. Those seven drugs represent 58% of the total revenues.

There are many companies in the pharmaceutical industry that compete with each other.
The top ten companies that rival with Pfizer for first place are
· GlaxoSmithKline
· Merck
· Johnson & Johnson
· AstraZeneca
· Amgen
· Novartis
· Hoffman-Laroche
· Sanofi-Aventis
· Lilly
· Bristol-Myers Squib4

Pfizer, the world’s largest pharmaceutical company implemented IT infrastructure to be the best and the leader in the pharmaceutical industry. In the following section, we will discuss three types of information technology Pfizer has implemented, Groove technology, virtualization technology and RFID.

The IT department at Pfizer is using Groove Technology with Pharmacia Corporation which was merged with Pfizer. Groove technology is collaborative software to connect IT departments together and to manage departmental projects. By Groove application, IT departments are operating to be integrated and functioning as a one big department. Groove uses remote relay server to store documents, data and messages. Employee should have an account to log on the server to access and share documents with others. Teams can work together from different departments, share information and documents, and in the same time they don’t need to worry about the security of exchanging those information. “Groove's peer-to-peer architecture eliminates many of the headaches of setting up a secure, server-based collaboration application, so users don't have to worry about synchronizing data and checking documents in and out.” Said Courville the senior director of Pfizer's IT leadership team.5

Pfizer is using another technology called VMware’s virtualization technology to make server integration which has achieved a big reduction in the operating cost. Pfizer implemented VMware’s virtualization technology to reduce the errors that resulted from using many servers. Integrating servers help Pfizer to reduce the maintenance costs (operation, maintenance, and troubleshooting) for each server, shrink data center space and decrease fixed assets. The HP Server Virtualization VM solution enables Pfizer to improve server utilization, respond to changes in business quickly, maintain better control over utilization of resources, and access critical application during downtime. 6

Pfizer is using radio-frequency identification (RFID) to monitor drug movement till it reach to wholesalers and pharmacists. The Food and Drug Adminstration (FDA) recommends using of RFID technology to guarantee the safety and authenticity of drugs in the United States. By using RFID, Pfizer can track their drugs to get to the correct destinations. Pfizer is collaborating with SupplyScape through SupplyScape's RxAuthentication Service which is an online server; pharmacists and wholesalers have to subscribe to this website. After a pharmacist or a wholesaler receive Pfizer’s product, each one use an RFID interrogator that is linked to RxAuthentication Service to be able to read the drug tag. The RxAuthentication Service’s role is to check if this drug is produced by Pfizer or not. RFID aids Pfizer to reinforce its supply chain globally and keep patients safe by preventing any counterfeiting drugs from reaching them. "Pfizer is taking a leading role in attacking counterfeit and diversion threats to the drug supply chain to ensure patient safety," says Shabbir Dahod, founder and chairman of SupplyScape. 8

PORTER’S FIVE FORCES ANALYSIS
Buyer Bargaining Power (Low-medium)
There is little bargaining power for individuals who end up consuming the drugs because there are few alternatives for any specific drug and the individuals cannot form any unions or movements which may gain some bargaining power.

Pharmacies also have little bargaining power because they merely sell what the individuals demand especially when the product is recommended by a doctor. However, HMO’s and other health insurance agencies have significant amounts of bargaining power because they can choose not to subsidize certain drugs (deeming them unnecessary) or they can subsidize certain drugs more than others. Often a HMO will have a partnership with certain companies to favor that company’s drugs9. Insurance carriers set pricing and dictate which drugs their plan covers putting downward pressure on drug pricing and at least partly forcing pharmaceutical firms to conform to the level of reimbursement mandated by the institutional buyers.

Supplier Bargaining Power (Low)
Chemical plants and material suppliers such as Aldrich have very little bargaining power. Prior to the expiration of a patent, the cost of actually producing a brand name drug is very low compared to the retail price of the drug, as seen in the many-fold drop in price when a comparable generic is released. Even when a generic drug is released, there are still a number of suppliers to choose from; the resources required to produce the pharmaceuticals are not restricted to a limited set of suppliers, they are often commodity inputs10.

Pfizer for security, integration, and quality control reasons often owns part of its suppliers.
Individual scientists that work for a pharmaceutical company such as Pfizer have very little bargaining power since they sign away the intellectual rights to any discovered product while working for the company.

However, if a group of scientists independently, either in an institution or small company, make a discovery, that institution or company can have a potentially large amount of bargaining power for that discovery.

The institution will often license the right to the discovery while small companies often merge with the buyer.

Threat of New Entrants (low)/Barriers to Entry (High)
There are a number of barriers to entry, which is what contributes to making the pharmaceutical industry and the biotech pipeline very profitable. However, these high profits are what drive entry, which is made all the more attractive if there is a good product.
With a specific type of drug already on the market, a competitor will need time to research and develop its own version of that drug and patent any technological advances that arise during this phase. It also requires a talented group of lawyers to create the patents and be prepared to litigate in order to enforce them11.

In addition, the competitor will need to prove to doctors, hospitals, and health care professionals that the product is as good, if not better, than the original product.
With regards to a new type of drug, a company first needs a marketable product, which means either a successful and large research and development team, or quite a bit of serendipity. A large amount of capital ($800 million on average to bring a drug into the market) and time are necessary to take the drug from its conceptual stage to the final production and distribution. This includes animal and human testing, passing government regulations (FDA approval), and convincing people that the product is both effective and necessary11.

In addition, existing pharmaceutical companies can lobby the government against new entrants to make it more difficult to gain access to the drug market. Pfizer has one of the largest lobbying arms in the industry today and should be able to exercise this muscle further to keep entrants out.
A new entrant lacks the strong brand name and reputation, as well as the necessary connections that could help to facilitate this process and reduce cost. They also lack the economies of scale and distribution networks already in place for existing players in the industry.
Again, the company will require a group of lawyers to protect this novel drug from encroachment.

Effect of Substitutes and complements
Substitutes (Medium-High)
When a drug is in its period of exclusivity, there aren’t (by definition) many viable substitutes. Once the period of exclusivity has ended, there are a variety of substitutes as generic drugs come into the picture. Prolonging this exclusivity period then is a desirable strategy to keep a pharmaceutical company profitable.

Complements (High)
For a specific drug, the main complement is whatever the drug is designed to treat, prevent, or cure, whether it is a disease, an illness, an injury, or a side effect caused by another drug.
If the health issue is capable of mutation, the complements can include related drugs since an increase in a drug’s usage could lead to immunity to that particular drug, resulting in the increased usage of a related drug (e.g. the high turnaround time associated with AIDS and cancer drugs)12.

In general, complements also include well-educated doctors, favorable government policies (thus the necessity for strong lobbying), and insurance companies including Medicare.

Rivalry (medium)
For a drug that is within its period of exclusivity, the company that distributes it can exercise monopoly pricing since it is the only drug available to treat a certain condition.
This patent tends to reduce competition between pharmaceutical industries during this phase. However, companies can try to subvert the patent law by developing a similar drug to treat the health condition that goes about the problem in a different manner; this will undercut the monopoly and increase the rivalry between the companies. Patents offer monopoly pricing once approved by the FDA, bur rival firms can re-engineer therapies to get around patents and enter market (e.g. Eli Lilly exploring other mechanisms to break into erectile dysfunction market currently owned by Viagra (Pfizer).

Several companies have prescription drugs in a specific category such as second generation painkillers or prescription stomach acid reducing drugs – these products can usually be substituted with one another, increasing the rivalry in this market. Several conditions have multiple players in the same market that are relatively substitutable (e.g. Claritin and Allegra) 12.

Price competition is not particularly strong in this industry due to pressure from insurance companies and government regulation. Price cutting will not increase revenues or units sold significantly because each drug possesses a unique set of attributes, i.e. targets and side effects. In general, such drugs are prescribed by physicians who will not factor price into their decision of which drug a patient should receive.

In addition, a number of companies can have the same type of drugs in development. For highly publicized types of drugs, such as those designed to cure AIDS, this increases the rivalry, as it soon becomes a race to whoever can patent the drug first.

Pfizer competitive advantage and role of Strategic Information Systems (SIS)
Investing on ongoing research, always be the first
For Pfizer to maintain its competitive advantage it has to protect and control sensitive information regarding its research and development according to Steve Nyman, director of information security at Pfizer Inc. in charge of protecting the research, chemical formulations and financial information at the $35 billion research-based pharmaceutical company. The company's portfolio also includes eight $1 billion prescription medicines, including arthritis medicine Celebrex, the antidepressant Zoloft, Zithromax, an oral antibiotic, and probably Pfizer's most talked-about drug, Viagra, for erectile dysfunction. With that kind of financial, market-share and research power under its belt, Pfizer's most valued commodity is easily its information. And safeguarding relies on strategic information systems13. Pfizer spends 4.7 billion dollars in research and development every year and safeguarding your innovations relies on the use of secure technology.

Market dominance-Skimming strategy, Information quality and large sales force
Pfizer Inc is using Ardent(TM) DataStage(R) to build a fully-integrated business intelligence infrastructure for its U.S. Pharmaceuticals Group. The infrastructure will help the leading pharmaceutical company maintain its competitive advantage by allowing decision-makers in Pfizer's U.S. Pharmaceuticals Group to obtain the most up-to-date information on marketing and sales trends, enabling them to make informed decisions based on customers' purchasing habits. Pfizer's U.S. Pharmaceuticals Group executives require immediate access to data to gain a complete understanding of product profitability and emerging market trends in the pharmaceutical industry13. As Pfizer continues to grow at an unprecedented rate, Ardent DataStage will provide a comprehensive data integration solution allowing executives in the group to make faster and more informed business decisions based on quality enterprise data.
Pfizer deploys the largest sales force in the pharmaceutical industry. To maintain a competitive edge in such a high-risk, high-reward industry, it is crucial that marketing and sales professionals within Pfizer's U.S. Pharmaceuticals Group have a data warehouse that enables access to accurate and timely data. It is also important for all group personnel to work with a single set of data at all times to best produce consistent reports.

Competition is getting stiffer with Viagra treatment for erectile dysfunction, is losing sales to Cialis, from Lilly. This is prompting Pfizer to cut prices but still keeping the margins high by keeping it costs low.

Acquisition of other pharmaceutical firms
Global Pharmaceutical Group is focused on creating applications that can be shifted and shared as services to get more out of IT resources, a so-called service oriented architecture14. Pfizer has a flexible IT infrastructure that allows for integration as Pfizer shops for acquisition targets. Integration allows for products and services to move faster through Pfizer’s pipeline resulting to lower costs and faster product launch. A flexible IT infrastructure allows for future strategic agility such as the acquisition of an organization with different business processes.

Diversification of both products and regions
Information technology is a fundamental aspect of diversification of products and also regions. The Pfizer IT team, called Global Business Technology, is an integral part of the planning teams in efficiently managing a global enterprise in 35 countries and many products that Pfizer offers.

IT contributions range from the ordinary, which system to select and how to merge disparate systems, to the extraordinary, how to unwind shared business service across 35 countries. These services included HR, IT, Financial, and other services shared across Pfizer’s companies. Along the way, IT has found a way to position itself for future business growth by building out best in class systems in areas that matter most to a consumer business, specifically trade and forecasting systems15.

SWOT Analysis
Strengths
Pfizer has a number of advantages. Pfizer’s strengths lie in its strong pipeline of innovative pharmaceutical compounds and strong marketing capabilities. It has a strong and large sales force that is capable of effectively marketing their products.

Pfizer, whose top drugs have lost sales to generic rivals, is planning a bigger push into the generics market itself. Pfizer even plans to sell cheaper versions of its competitors' branded drugs when they lose patent protection

The company also has a strong reputation in the industry, which confers a threefold advantage – a) it eases the approval process by the FDA, b) makes the drug more likely to be recommended by doctors and approved by insurance carriers, and c) gives Pfizer an edge when trying to convince others to license new products to it.

By holding the top position in the industry, Pfizer has the most fluid capital to reinvest into research (about $5 billion per year), take risks in high return type products, or outbid rivals on a crucial product.

In addition, Pfizer already has large research facilities and production capabilities, while also spending the most in research and development of new products.

Weaknesses
As the leading pharmaceutical company in the industry, Pfizer also has the largest overhead cost and must spend a sizeable fraction of its revenues filing and defending lawsuits on its existing products.

Although Pfizer has a wide variety of drugs, it is dependent on a handful of drugs for the majority of its revenues. When patents on these drugs expire, Pfizer will face severe losses in profit unless the company can time the release of a new product when the patent on an older product runs out. For example Pfizer will lose exclusive rights for Lipitor production in 2010, which currently accounts for about 25% of its revenues worldwide. This product timing is largely a function of research and government approval, which makes it difficult for the company to plan ahead. To take measures into its own hands, Pfizer must have a strategy for the development of products and maintain healthy relations with the government.
As a late entrant into the biopharmaceuticals market, Pfizer enjoys very little market share and revenue compared to what it generates in traditional pharmaceutical drugs. Without strategic action, Pfizer risks losing ground on competitors of comparable size with a mature biopharma portfolio.

Insurance companies can pressure the company to lower prices on their products or risk being denied coverage, and therefore use by the final consumer.

Opportunities
Pfizer, whose top drugs have lost sales to generic rivals, is planning a bigger push into the generics market itself. Pfizer even plans to sell cheaper versions of its competitors' branded drugs when they lose patent protection (Loftus, 2008).

As the baby boomer generation grows older, this graying population will require an assortment of prescription medicines and services as the average life expectancy increases due to the improvement in healthcare. By catering to this demographic, Pfizer can lock in a number of these customers, who will be around for a while and will be dependent on these therapeutic drugs.

Pfizer also has an opportunity to expand globally and enter new markets such as India, China, and South Korea that have a large population base that is expected to get wealthier and older over the next few years. At present, many of Pfizer’s drugs are priced outside of the range of the average person in these countries.

Threats
The Food and Drug Administration said it may upgrade warnings on the Pfizer Inc. antismoking drug Chantix after a nonprofit safety group cited a new spate of road-traffic accidents and seizures involving people on the drug (Mundy, 2008).
Pfizer is also a huge target for lawsuits because of its natural position in the industry. Pfizer has had to settle many lawsuits because of safety concerns. In fact, “has paid $894m to settle most outstanding litigation around its two painkillers sparked by safety concerns after the withdrawal of Merck's similar drug Vioxx in 2004" (Jack, 2008).

Pfizer faces a number of threats to its premier market position. High gross profits across the industry attract entry, which, in principle, is feasible for an entrant with a novel idea or application.

Each new entrant into the industry could potentially become a long-term competitor – for instance, new startups that do not want to merge with a larger company may grow to competitive size. As an example, Amgen began its entry into the industry in 1985 and has since become a major rival to Pfizer. There is also a long-term threat from generic drugs produced by such companies as Teva and Barr that creates competition when Pfizer’s drugs come off their period of exclusivity.
Established companies can displace Pfizer as market leader in this volatile market.

Value Chain
The typical pharmaceutical value chain consists of research and development, supply chain management, manufacturing, and marketing and sales. Research and development understandably makes up a large percentage of the time spent in this value chain. In order to manage the phases of research and development, pharmaceutical companies need meticulous methods of documentation. Pfizer achieves this with Enterprise Resource Planning (ERP) systems.
Pfizer calls the research and development chain its ‘pipeline’. This pipeline consists of four main phases.
BioCommercialization Blog http://www.biocommercialization.com/

Phase 1 – this is the phase where low doses of an experimental medicine are given to humans, to ascertain safety. Most of the trial subjects are typically healthy, and are constantly monitored as doses are increased, to test absorption levels, blood medicine half life, and what doses are best tolerated.

Phase 2 - this phase includes a much wider base of trial subjects, up to several hundred, who typically have the condition that the medication is designed to treat. In this phase, different forms of the medicine are tried out, to see which is the best, as well as which is the most effective dose.

Phase 3 – At this phase, the trial subjects can number up to several thousand, and is where the ‘double-blind’ studies are done. The double blind study has several sets of subjects, who are taking either the drug being tested, a placebo, or another drug, to determine effectiveness.

In between Phase 3 and Phase 4, is the Registration to bring the drug to market. This registration includes information on the manufacturing process and the trial results.

A new drug approved for marketing is in the Recent Approval part of the pipeline.

Phase 4 – During this phase, long term results and risks are watched, during what Pfizer calls its “Post Marketing Studies”. Other uses for the drug are also researched during this phase.

Figure 1: Typical Value Chain for a Big Pharmaceutical Company


As the number one pharmaceutical company, Pfizer could not achieve its part without its alliances and acquisitions. This process took time in order to reach Pfizer's main goal. Pfizer's operations are based in several countries around the world, Brazil, Belgium, Canada to name few. Until now, Pfizer has acquired the most beneficial pharmaceutical drug companies. Pfizer thinks that it can improve the compound and marketed to the right people, and get patented pretty easy. However, there has been some downfalls where it Pfizer lost 6% of its earnings per share (12). Pfizer anticipated its loss because it knew that its acquisition of Pharmacia two years earlier. However, what made it worse was the Cox-2, that was facing several safety concerns. Moreover, since Pfizer was facing several patents expirations from 2005, in its 2007 annual report Pfizer mentioned how optimize their patent and how to protect them. As any other products, medicine has a life cycle that ends when the paten ends, and generic brand start to be in the market. What Pfizer wants to do is to extent its medicine's life cycle; this process is described from the annual report as "patent-protected marketed medicines and compounds in development". This process is done by focusing on their investments in research and development in a clear market, where Pfizer's compound can rise as a competitive advantage over its competitors. In addition, Pfizer is rebuilding its Phase III portfolio being sure that they can advance some molecular entities and new ways for late-stage compound that can get improved for new treatments (17). This is just some of Pfizer benefits gained by its value web.

Several mergers and acquisitions were made by Pfizer that increased its core competencies some of these pharmaceutical companies are:

In 2000, Pfizer has acquired Warner-Lambert, gaining competitive advantage over its competitors by getting full rights for Lipitor, a medicine that is accepted by customers and doctors.

In 2002, Pfizer acquired its competitor Pharmacia, becoming the largest pharmaceutical
company around the world.

EUGEN that merged with Pharmacia was acquired by Pfizer when it owned Pharmacia.
EUGEN was "The focus of the enterprise was to develop drugs targeting intracellular
signaling pathways to treat cancer. Specifically, the company sought to discover competitive
ATP small-molecule kinase inhibitors which would block common cancer pathways" 20

The Pfizer's Incubator (TPI), "An entrepreneurial Approach to Drive Innovation". It provides
funding for research and labs for early stage work that is done by academics and small
biotech companies. Fabrus LLC joined TPI, partnering with this novel technology.16

Pfizer and Bristol-Myers Squibb "collaboration on metabolic disorder research. Pfizer and
Bristol-Myer Squibb are collaborating on bringing new treatment to for obesity and diabetes.
The International Association of Fire Fighters (IAFF). Pfizer and IAFF are collaborating on
smoke stopping, and making IAFF the first tobacco-free association.

References
1.http://en.wikipedia.org/wiki/Pharmaceutical_companies
2.http://en.wikipedia.org/wiki/Clinical_trial
3.http://www.pfizer.com/about/
4.http://pharmexec.findpharma.com/pharmexec/data/articlestandard/pharmexec/302008/531367/article.pdf 5.http://www.informationweek.com/news/business_intelligence/showArticle.jhtml?articleID=6503836
6. http://h71028.www7.hp.com/ERC/downloads/4AA1-7698ENW.pdf
7. http://www.hp.com/sbso/serverstorage/article/virtualization-oct.html
8. http://www.pharmacytimes.com/issues/articles/2007-08_4955.asp
9. http://www.globalaging.org/health/us/curb2.htm
10. http://www.syl.com/bc/brandnameandgenericdrugsisitworthsavingonhealth.html
11. http://www.duke.edu/web/soc142/team2/social.html
12. http://www.mcafee.cc/Classes/BEM106/Papers/UTexas/2003/JandJ.pdf
13. http://itmanagement.earthweb.com/secu/article.php/1378211
14. http://www.forbes.com/2005/04/05/cx_mh_0405pfizer.html
15. http://www.cwhonors.org/search/his_4a_detail.asp?id=5175
16. http://media.pfizer.com/files/annualreport/2007/annual/review2007.pdf
17. Loftus, Peter (2008).Plans bigger push into the generics market. The Wall Street Journal.
18. Mundy, Alicia (2008).FDA may revise warning for Anti smoking drug. The Wall Street Journal.
19. Jack, A (2008, 10, 17). Pfizer pays $894m to settle painkiller cases. FT.com, Retrieved October 20,2008, from www.FT.com
20. http://en.wikipedia.org/wiki/Pfizer#Merger_and_acquisition_activity
21. http://media.pfizer.com/files/research/pipeline/2008_0228/pipeline_2008_0228.pdf

An Introduction to ePrescription

http://www.emrworld.net/emr-research/articles/eprescribing.ppt#256,1,SureScripts

U-M to offer free online health professions educational materials

By Richard Pizzi, Associate Editor

ANN ARBOR, MI - The University of Michigan has launched a pilot project to make comprehensive pre-clinical health curricula available worldwide via the Internet.
The project addresses the education of healthcare providers in developing countries in Africa and other parts of the globe.
It also enhances the access for health science schools around the world to materials that can be used to help educate health professionals.
The University of Michigan Medical School is leading the project and working with U-M health science schools and partner institutions in Africa - namely, the University of Cape Town (South Africa) and the University of Ghana. U-M officials say a key part of the effort will be converting existing educational materials into Open Educational Resources which will be available online to anyone.
Open Educational Resources, or OER, are teaching, learning and research resources that are in the public domain or have been released under a Creative Commons intellectual property license that permits their free use or re-purposing. They include full courses, course materials, modules, textbooks, streaming videos, tests, software and any other educational tools, materials or techniques.
The Medical School and the schools of Public Health and Dentistry will provide materials for the pilot. Other U-M health science schools and the School of Information are supporting the OER program. The initiative is funded by a grant from the William and Flora Hewlett Foundation.
"This is an exciting opportunity for our University," said James O. Woolliscroft, MD, dean of U-M Medical School."The Health OER program provides the opportunity for the University of Michigan health science schools and the School of Information to collaborate in an innovative, comprehensive approach to work with others to improve education opportunities for health care providers globally."
Woolliscroft said the project will help improve medical education in developing countries, transform the health curriculum at U-M and strengthen students' ability to practice in a global health context.
Cathy Casserly, director of Open Educational Resources at the William and Flora Hewlett Foundation, said the Michigan project is a valuable experiment in learning how to make educational materials relevant to a specific target population
"Michigan's pilot project is smart in that it works back from the population they want to help to ensure the content is designed to meet demand," said Casserly."We're excited to see how it unfolds."
In addition to the Hewlett Foundation, the University of Michigan, the Open Society Institute and the Foundation for Advancement of International Medical Education and Research are providing financial support for the pilot project.
"We believe this important grant will help us respond to an imperative global need to help train health care providers - particularly in Africa, where they are desperately needed," said David Stern, MD, director of UMHS Global REACH. "At U-M, we train healthcare providers - nurses, doctors, pharmacists, dentists, public health professionals and public health workers. That's what we do best. With this grant, we will be using, adapting and co-creating educational materials with partner universities to collaboratively solve the human resource crisis in Africa."

U-M officials say several major universities have undertaken OER projects at considerable expense, but the U-M project is unique for its use of dScribe, a low-cost, scalable and sustainable method developed by the U-M School of Information to convert educational materials into OER.
The dScribe method involves a close working relationship between students, faculty and staff to assess the quality of materials and clear the intellectual property in course materials. U-M is also developing software tools to aid the faculty in quickly choosing materials to be posted to the OER site.
Health OER will be developed for the pilot program with participation from many parts of the University of Michigan. A larger, future OER effort is expected to include educational materials beyond the health sciences.
"The medical school has taken an important leadership role in launching the University of Michigan's initiative in OER," says John King, U-M vice provost for academic information. "This grant award enables the medical school to collaborate with a number of university programs, including those in dentistry, pharmacy, nursing, public health, kinesiology, social work and information. There is also an important role for the university library. This is the university's first major step into OER, but it is only the beginning of much more exciting things to come."
U-M officials say several major universities have undertaken OER projects at considerable expense, but the U-M project is unique for its use of dScribe, a low-cost, scalable and sustainable method developed by the U-M School of Information to convert educational materials into OER.
The dScribe method involves a close working relationship between students, faculty and staff to assess the quality of materials and clear the intellectual property in course materials.
U-M is also developing software tools to aid the faculty in quickly choosing materials to be posted to the OER site.
Health OER will be developed for the pilot program with participation from many parts of the University of Michigan. A larger, future OER effort is expected to include educational materials beyond the health sciences.
"The medical school has taken an important leadership role in launching the University of Michigan's initiative in OER," says John King, U-M vice provost for academic information. "This grant award enables the medical school to collaborate with a number of university programs, including those in dentistry, pharmacy, nursing, public health, kinesiology, social work and information. There is also an important role for the university library. This is the university's first major step into OER, but it is only the beginning of much more exciting things to come."

http://www.healthcareitnews.com/story.cms?id=9119&page=1

Electronic Medical Records

Information gathering and analysis has been central to the effective delivery of healthcare. Most of the information generated in healthcare organisations is centred around the patient and such information about individual patients are kept in confidential records known as medical records.

The information contained in these records include the patient details (such as name, sex, date of birth, occupation and address), the patient’s medical history and any other relevant history, and a complete report of each event with the patient, from signs and symptoms when first presenting, through diagnosis and investigations to treatment and outcome. Other relevant information and documentation also need to be added.

For a long while, healthcare organisations have kept paper-based records but they have their shortcomings, some of which include:
An increasingly mobile society means that people now change their family doctor more often and these paper records have to be physically to the new doctor’s practice.
It is difficult to find specific information in paper-based records, increasing the possibility of missing vital information that might be hidden within a cluster of non-relevant data.
Paper records are hand written and these might be difficult to read or interpret by healthcare professionals other than the author.
Paper records make the use of decision support systems extremely difficult especially during consultations.

Electronic Medical Records (EMRs) have been introduced to address these issues and it is now possible to store part or whole of a patient’s record on a computer.

To continue reading this article, please click on this website:
http://www.biohealthmatics.com/technologies/software/emr.aspx

HOSPITAL INFORMATION SYSTEMS

A hospital information systems (HIS) is a computer system that is designed to manage all the hospital’s medical and administrative information in order to enable health professional perform their jobs effectively and efficiently.
Hospital information systems were first developed in the 1960s and have been an essential part in hospital information management and administration. Early systems consisted of large central computers connected to by dumb terminals, which are now being replaced by networked microcomputers. The systems were used to manage patient finance and hospital inventory.

Hospital information systems now focus on the integration of all clinical, financial and administrative applications and thus could also be called an integrated hospital information processing systems (IHIPS).
Components of a hospital information system consist of two or more of the following:
Clinical Information System (CIS)
Financial Information System (FIS)
Laboratory Information System (LIS)
Nursing Information Systems (NIS)
Pharmacy Information System (PIS)
Picture Archiving Communication System (PACS)
Radiology Information System (RIS)
A look at the list above shows how complex a hospital information system can be. Advancement in computer technology and the development of information exchange standards such HL7 and DICOM, make the task administering and integrating such systems a little more easier.
No hospital information system can be regarded as a success unless it has the full participation of its users. Thus human and social factors would have to be considered in its design, more often than not, they can be easily addressed by providing adequate training and education about the system.



http://www.biohealthmatics.com/technologies/intsys.aspx

What is Pharmacy Informatics?

What is Informatics?
In our own words, it is the study, invention, and implementation of hardware, software, and algorithms used to improve communication, understanding, and management of information.

What is Pharmacy Informatics?
Pharmacy Informatics is the realization of informatics in a cost effective environment that benefits the Pharmacist and the practice of Pharmacy through utilization of efficacious systems and tools.

Pharmacy Informatics for the Pharmacist
The Pharmacy Informaticist can streamline the work for a pharmacist. Whether it be a hospital, clinical, or retail setting, the pharmacist relies on computer systems to make the work more manageable. These systems can be streamlined, even enhanced, to improve work flow. A system that is developed with the pharmacist in mind--reducing keystrokes, linking comprehensive patient data, providing a complete drug interaction database--is a system that will support a pharmacist's work. Why should the Pharmacist spend 5 to 10 minutes flipping through references for a particular answer to a question? Why not have the references stored on a database of information that is cross-referenceble? The answer needed could be attained in less than half the time, be printed out in a nice patient friendly form, and give the Pharmacist the extra time to counsel the patient properly instead of racing back to the filling counter.
Is it such a radical idea to make pharmacy systems that are friendly to the Pharmacy Tech? Why not have the DUR and drug interactions screens pop up on a totally different screen in the counseling area where the Pharmacist can look at them one at a time between counseling, instead of calling the Pharmacist to come look at the screen or having the technician simply bypass the system because they happen to know the Pharmacist's code? And why not have these interactions screens give you immediate and easy-to-use information as a cross reference instead of giving you cryptic responses to a rejected claim?
In an institutional or organization setting, the Pharmacy Informaticist can better arrange information for students or members that provides an increase in the quality of learning. Educational materials that are indexed, cross-referenced, and reviewed properly is easily converted to a database that can be distributed via the Web, in a slide-show format, textbooks, or pamphlets. Publishing these materials, following HL7 standards, on the Web provides opportunities for a vast multi-link engine to access these materials. Implementing and teaching students to adopt technology on a proactive basis and even provide training so that the student is prepared to handle these new technologies can make the difference in the real work place. For example, requiring students to use the new PDA or handheld technologies while in school familiarizes them with its uses before entering the work place where a growing number of hospital physicians and pharmacists are using these devices.

Pharmacy Informatics for the Patient
The Pharmacy Informaticist can create new information databases that allow the patient to access their particular information in an easy to understand format. It can be simple to use, yet not lacking content, by providing an index and cross-referencing it with other related information via the Web. A patient that understands their particular disease state is a patient that is likely to take a more active role in their own well-being. This enhances the outcomes tremendously. And understanding is the key.... Multimedia--videos, animated pictures, sounds--can be utilized to create interactive learning experiences for patients. Video teleconferencing can become an instant source of information for a patient that has trouble staying mobile, yet can't afford costly visits to the emergency room, and still retain the quality of patient confidentiality and the feeling of interactivity with another person. Giving the patient more control over their health is key.

Pharmacy Informatics for the Health Care Provider
By improving the computer/information systems for the pharmacist, the Pharmacy Informaticist assists other health care providers both directly and indirectly. Directly, information becomes more readily available in many forms, such as a comprehensive hospital system that allows physicians, nurses, and pharmacists alike to view patient profiles thoroughly or even provide a centralized location for other providers to learn, review, or study a particular drug. Again, if these systems are arranged properly, a virtually inexhaustible resource for drug information can be created. Indirectly, pharmacists that spend less time dealing with below standard computer/information systems are free to spend more time actually being a pharmacist and dispensing knowledge of drugs to providers. The Pharmacist should be unlatched from the dispensing counter and free to move about with the Health Care Team, on the floors or with the patients, where the Pharmacist belongs. There is no other professional that holds the understanding and knowledge of drugs as the Pharmacist. Getting that Pharmacist back into the health decision-making role is key.

http://www.pharmacyinformatics.com/informatics3.html