The Cloud and Beyond

Technology and communication go hand-in-hand. Facebook, Twitter, e-mail, instant messaging, and the smartphone—all of which are usually within arm's length—tell us that technology is all about connecting. In the pharmaceutical industry as much as anywhere else, new technology leads to new ways to keep in contact: sales reps with providers, physicians with patients, and marketing departments with payers. Although the technology behind cloud computing is now well understood, pharma is still struggling to identify the best and most practical ways to leverage its potential in line with the standard regulatory and confidentiality concerns.

Getty Images / Chad Baker

The most important element in assessing possible applications of the cloud is to establish a clear definition of what it is. With service providers and pharma companies tossing around phrases such as "software as a service" and "multi-tenancy" and defining those terms in whatever way casts their own business in the best possible light, how can Big Pharma make sense of what we're hearing? Here is Pharm Exec's take: At its most basic, "the cloud" is a server—stored on the Internet and accessed via a service provider—used for delivering, deploying, and running any number of software applications, from clinical trials to drug distribution to automated call centers. To coin a useful analogy, if you've ever been in an apartment complex, you already have a basic understanding of the cloud.

"You have a house and I have a house," explains Matt Wallach, chief strategy officer of Veeva Systems, a cloud-based business solutions provider for the global life sciences industry. "You own a lawnmower; I own a lawnmower. You have a rake; I've got a rake. You have a shovel; I've got a shovel." However, explains Wallach, "Multi-tenancy is the thing that makes cloud computing special. If you live in an apartment building, we share things. We share the exterior of the building, and we don't own tools anymore. If you ever meet someone who lives in an apartment building, they don't own a shovel. They don't have a lawn mower." They don't need to; either they can borrow one from someone else in the building or they can just let the building's maintenance staff handle an issue, should it arise. The point is, you'll have the right tools you need for the job at your disposal, but they won't be taking up space in your closet, shed, garage, and so on.

From here, it's pretty easy to see how Wallach's apartment analogy translates to the benefits of something like cloud computing for Big Pharma. "If they put in a new elevator, you as a tenant on the tenth floor don't have to install the new elevator. You just step into it. You've got to look at it from the customers' perspective. It's really good for the customers if they don't have to pay for upgrades." In other words, the cloud is a major source of efficiency by providing common platforms that allow for a sharing of costs related to the production and dissemination of useful information.

Benefits to Big Pharma

Why is such a pay-as-you-go model useful, particularly to the healthcare industry? With patent cliffs approaching fast, healthcare reform and aging baby boomers adding more patients (but not more physicians) into the mix, and R&D costs skyrocketing, it's no secret that saving money has become crucial to the industry. And cloud computing saves costs in a number of ways, from initial setup of productive technologies, to long-term maintenance, to upgrades and troubleshooting. Storage of data, too, has become more efficient with the cloud. Gone are the days of filing cabinets, of storing everything on your computer and then backing it up on the server, and of giant, bulky towers taking up space in your office: "The cloud" (storage on the Internet) is now your filing system—light as air, with nothing to update, troubleshoot, or maintain.

It's not just IT (information technology) costs that make the cloud a worthwhile investment. The ease of use and the ability to communicate with a team across the globe can be crucial when it comes to stopping or turning on a dime, as the regulatory environment of pharma often requires. "In a highly regulated market like pharma, the ability to be up and running quickly and then make changes whenever regulatory requires them is one of the big keys to the cloud," explains Don Keane, VP of marketing and product strategy for Angel, a provider of cloud-based customer engagement solutions to pharma and healthcare companies.

"We believe cloud computing will significantly reduce the barrier of entry or the upfront costs [of understanding competitive challenges or opportunities], which is why we think it's so attractive to make these technology investments in emerging markets," says Kevin Julian, technology lead for Accenture Life Sciences Analysts. "I think the primary budgetary benefit of the cloud is to smooth the costs of the IT investment over time, making it easier to adopt the technology in the first place."

"What we're seeing in the last 12 to 18 months is that pharmaceutical companies have tremendous cost pressures on them, not just because of patent expirations, but because of the increasing regulatory climate that they're finding themselves in, not only for advertising and marketing their products in the commercial sector, but also in the clinical and medical sectors," says Greg Henry, life sciences client partner at consulting firm Model Metrics. "There's an increasing demand for more advanced signal detection, more advanced pharmacovigilance around the long-term safety profile of a product."

"Industry's in the business of discovering pharmaceutical products and bringing them to market. They're not in the business of IT. That's not their core competency—it's our core competency," says Mike Naimoli, worldwide managing director of Microsoft Life Sciences. "They want to focus their energy on innovation around product discovery, product management, and innovation of pharmaceutical products, which is tough enough as it is. I think what cloud computing can provide is an opportunity to get it right once and then provide the industry access to it."

On top of budget and regulation restraints, the potential for open and effective communication is one of the most-cited benefits of bringing pharma to the cloud. "When one person is working to solve one problem, they may discover information that isn't relevant to what their task is," explains DJ Edgerton, CEO and co-founder of digital innovation agency Zemoga. "But when they're aware of challenges in research that someone else is trying to achieve, that 'Aha!' moment happens a lot more quickly when information is shared. It was difficult to share it before the cloud, before technology allowed for this sort of global collaboration; now it's happening."

From cloud service providers, to healthcare ad agencies, to life sciences analysts, everyone Pharm Exec spoke with unanimously boiled down the benefits of the cloud to one word: collaboration. "I think there's a nice convergence of opportunity there when you look at some of the collaborative technologies that exist. I think the primary benefit in that regard is the speed with which one can assemble collaborative capability with internal and external partners," says Julian.

"Every CIO that I know of or have heard of in the life sciences industry is seriously evaluating how they can migrate ... to a cloud infrastructure," confirms Henry.

Safe and Secure

Of course, we are still often wary of the unknown. And with good reason: Industry sales and marketing materials, R&D procedures, or clinical trial results in the wrong (competitor's) hands could prove disastrous. So what are some of the fears and doubts about security and confidentiality in the cloud? Are they grounded?

"When we tell customers that all of their proprietary, compliant, secret, special sauce that they've kept inside their firewall is now going to be floating up there in the cloud, they think that anyone can hack in," says Edgerton. "There are a lot of people who own gold that they've never put their hands on, but they know they own it. You can buy and sell gold, oil, and all of these things that have huge value, and you never touch them. It took a long time for the financial community to come to terms with that. People think when they own gold, it's a bar of gold and it's sitting in some safe somewhere, probably on their property."

"If you now consider the The Health Insurance Portability and Accountability Act (HIPAA) compliant patient information or the R&D data as that gold bar," continues Edgerton, "pharmaceutical companies have to understand that the protections, just like the thickness of the steel on the safe, have been transferred to the cloud. That desire to keep everything internal and hold onto it because you want to protect it—we need to get over that fear."

The general consensus seems to be that, while such fears are natural initially, most of these companies have been working with cloud-based technology long enough that the bugs have been worked out; cloud computing seems to be no more or less risky than ordering Star Wars memorabilia off of eBay. Firewalls, encrypted data, and security codes have calmed many of the industry's fears. "We don't generally run into security concerns. Part of it is that the cloud is a proven model now ... it's really a non-issue at this point for us," says Mario Martinez, CEO and founder of 360 Vantage, a provider of cloud technology for the life sciences industry. "I think overall, most executives and CIOs that we're working with are pretty comfortable at this point with the security level."

Dynamics of Change

Pharma is increasingly using the cloud to get its sales messages across to physicians, hospitals, and patients. "Being able to connect with a patient or an HCP in a variety of different venues that the target chooses—on a mobile device, through an interactive experience at a convention, or an interactive sales aid delivered by a rep in the physician's office—the ability to change the sales dynamic from a monologue to a dialogue has a lot of benefits for pharma," says Matt Collins, director of interactive development at healthcare ad agency AbelsonTaylor.

Agencies like AbelsonTaylor are deploying branded websites through the cloud, and cloud service providers are working with their healthcare clients to develop cloud-based mobile applications designed specifically for sales reps in the field, to make the sharing of accurate and vital information in real-time the rule, rather than the exception. "One of the features in our products is a very comprehensive way to ensure that sales representatives only talk about relevant products. When they're talking to a physician, they should only talk about products that are relevant to that physician's specialty; there are certain products you shouldn't talk about to a pediatrician, for example," explains Peter Gassner, CEO of Veeva Systems. In this way, says Gassner, cloud-based technology helps keep the reps compliant and efficient.

"One of the major benefits with the solutions we deploy for the sales force is ease of use. We incorporate direct reps and feedback into the process, but the primary aspect of it is how they access the systems, and how easy it is to get to the information that is most important to them," agrees Martinez.

Some companies are even looking beyond convenience for sales forces, at how cloud technology can really help position and leverage a brand. "You have the brand teams, the marketing, the franchises that can leverage it to generate campaigns, and this is all connected," explains Henry. "All these use cases can be connected in the commercial setting. So a doctor signs into a portal; he requests medical information. He wants to enroll in a Phase IV trial. He wants more information about a new product. He wants off-label information about a drug. All that information can reside in this cloud platform."

"We have a very large pharmaceutical company that is using a mobile sales force empowerment tool and leveraging the cloud, and their sales forces are absolutely ecstatic. What we've done is made them more effective and made their jobs easier," says Edgerton.

R&D in the C-L-O-U-D

While leveraging the cloud for sales and marketing may seem like the most obvious use for pharma, there's some benefit to be had in R&D as well, even if it just means more seamless communication for pharma companies internally, across the office, across the nation, or across the globe. "Using the cloud for the initial stages of experimenting and building the drugs that the pharma companies are working on makes a lot of sense, because they can get to information that other scientists are using and sharing out there," explains Joe Doyle, interactive services director at healthcare marketing agency HCB Health.

"R&D is now very collaborative, both inside and outside the four walls of the company," says Gassner. "So the nice thing with a cloud-computing-based system is you can easily give access to people inside and outside your company. So, for example, if you have specific research agencies that are collaborating with your research department on a document, a policy, or a procedure, in a cloud-based system it's very easy to share this information."

Greg Henry calls cloud computing for clinical trial management "obvious." "In the distributed environment of a clinical trial, you have multiple centers across multiple countries all generating patient information, tracking the payments to the physicians, screening patients, enrolling patients, creating case report forms, and submitting safety reports," he says. "We've developed solutions that include patient recruitment, site qualification, the actual management of the trial as it's active, and the closeout of the trial."

"If you look at the clinical trial landscape, it's an extremely fragmented landscape that is really ready for somebody to come in and offer an integrated platform to pull all these applications together in one place and to provide access across the industry," says Naimoli.

Harnessing the Power

There are other, more behind-the-scenes facets of the industry that could also benefit from cloud computing. For example, getting drugs from the distribution centers to the pharmacies that need them is a time-consuming process full of complicated paperwork ... until you leverage the cloud. Application service provider Legisym, for example, creates cloud-based solutions for drug manufacturers and distributors to help facilitate the process of getting those drugs to the pharmacies and hospitals without all the traditional headaches.

"When hundreds or thousands of pharmacies all over the nation are supplied by a single distributor, it's very difficult to install software on all those client machines, all those desktops around the nation that communicate with your server. Instead, allow the Internet to be the network, the backbone," explains David Kessler, chief business officer of Legisym. "In the past, every time a pharmacy needed to purchase morphine, they would have to fill out a form and send it to their supplier. And their supplier couldn't fill and ship that order until they received that hard copy form. Now they get to toss the paperwork out and that order comes electronically."

That ability to work seamlessly—across borders—is something pharma should not underestimate. "As people in Asia end their day, teams with whom they are collaborating in Europe can wake up, respond to requests, and continue the work; then, as they end their day, teams in North America can take the baton and keep things progressing despite the fact that their Asian and European colleagues may be asleep. As the Asia teams wake up, they will see answers to their questions, progress on tasks, and pose new questions—all of which occurred in the cloud," says Linda Bowers, vice president of life sciences product marketing for IntraLinks, which delivers technology solutions to clients across many industries, including life sciences. "This allows pharma to move at a faster pace, have critical insight required to make important decisions, and to course-correct in a way that simply isn't possible in a traditional, paper-based environment."

Other companies, such as Angel, use cloud technology to make customer service for their healthcare clients run more smoothly. Angel uses a cloud platform for services like Interactive Voice Response (IVR) technology, which is the stuff automatic call centers are made of. "If you're somebody like AstraZeneca or Pfizer with a large call center of agents, the Angel platform helps you manage your calls and those agents and how customers interact with those agents," says Keane. AstraZeneca started using Angel's cloud-based technology for its customer satisfaction surveys, and has since branched out, using cloud technology for everything from call center management to branded discount and coupon codes.

Dave Tolliver of Angel explains: "When a brand has a savings card, which can be used to help get medication into the hands of a consumer, it allows the patient to get a discount on their first prescription fill or a set of fills. They call in to an Angel phone line and activate that savings card, walking through an automated system. It captures the patient's name and other contact information and passes that to AstraZeneca, and the consumer can then use the card to have a prescription filled with the discount."

Angel and AstraZeneca are both aware of sensitive patient privacy issues when it comes to collecting such information for savings cards. The patient is asked for information including savings card number, date of birth, name, and address. If the information is intended for use for any purposes other than the activation of that particular savings card, such as future coupon offers, the patient is offered an opt-in option. The data is passed from Angel to AstraZeneca in an encrypted format to ensure complete confidentiality and compliance to privacy regulations.

"By virtue of the cloud-based technologies and the platform that Angel has, pharma companies have expanded to other methods of communication that they've never even had before, such as Click to Call, Click to Chat, e-mail notifications ... all these multichannel modes of interacting with their consumers. And their goal is really to provide any channel for their consumers to interact with them," says Tolliver.

Other uses for the cloud in healthcare include nonprofits tracking grant requests and applications, patient data management, intranet communication websites, and video conferencing software. While these elements might not be as glamorous or as high profile as R&D, these functions are still vital cogs that keep the healthcare machine running smoothly.

"Microsoft certainly has bet its future on the cloud," confesses Naimoli. "I think it's a hugely disruptive source of innovation, and that's not bad. Disruptive technology is technology that allows you to do things differently and changes the fundamental way in which things are done. It's really going to change things for the industry. The industry is under such pressure right now that they're really looking for anything that can help give them the advantage they need."

Pharma Above and Beyond

Though pharma has been traditionally slow to adapt to new technologies, in large part because of the strict regulatory environment, it seems that cloud computing is the way of the future for the industry. "I think that cloud computing will grow over the next decade because it's going to allow a much more niche market—much more focused best-of-breed applications—to reach a much bigger audience," says Kessler.

In fact, all the experts Pharm Exec spoke with agree that cloud computing will eventually become a vital part of the way industry does business. But some caution that it is not going to be an overnight process. "Because this is relatively new, and we know how long it takes to go from the test tube to the market, we're not going to really start seeing the benefits from this tool for a few years," predicts Edgerton. "I think that pharmaceutical companies are less willing to take a chance until they see the mistakes that everyone else in other industries make."

Fast or slow, first to adopt or last-minute knuckle-draggers, there's just no doubt that pharma is on its way to becoming a cloud-based industry. "We're always a little bit behind when it comes to using the latest and greatest because we are such a heavily regulated industry, and that makes a lot of sense—we have to be conservative," says Doyle. "But we're starting to get to the point where cloud computing is really becoming the norm."

So, what is next for an industry typically behind the tech curve? "The future will offer us the opportunity to look at cloud solutions in a different light," says Neeraj Singhal, vice president of product strategy and innovation, at Cegedim Relationship Management, "beyond just being a higher ROI, a lower cost structure, or a faster time-to-value enabler, which is perhaps the most common business case today to leverage the cloud. One likely scenario is that businesses will seek a more integrated experience along a business process where components of the process operate in different or multiple types of cloud environments. Cloud computing is here to stay and it will become as common as ice cream or apple pie."

And there will be plenty of spoons to go around.