The Analytical Approach
Question: How do we use data to make informed content decisions across digital channels?
In 2008, about five months before the Lehman Brothers collapsed as a result of the subprime mortgage market, Richard Thaler and Cass Sunstein published Nudge: Improving Decisions about Health, Wealth, and Happiness. It was the first formal use of the term “choice architecture.” Nudge, (pronounced like fudge), is the design of different ways choices can be presented to consumers related to decision-making. Taking the concept further, Daniel Kahneman published the best seller, Thinking, Fast and Slow, questions our general confidence in natural, human judgement.
An effective 'Nudge' theory example is the push to gain more acceptance and an increase of organ donation rates in the United States. A 'choice program' was put in place as part of driver's license renewal. Opting in as an organ donor could also be prodded by a wider community support of people who have become organ donors, as well.
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Decision making has various levels. Not every decision takes deep thought or rational processing. Majority of our decisions are made quickly. The brain finds ways to make rapid decisions to navigate life and often with inadequate information. Fast and automatic decision making can almost be on ‘auto-pilot’ or unconscious, in a way. It is about efficiency; energy efficiency. As the decisions become more habitual, it takes less focus and active thinking. Important to note is that as we consider these easier decision habits there is also a lack of focus. This is a natural brain reaction for habitual decisions. As such, it can be prone to bias and error. On the other hand, a decision that is unique and requires cognitive energy, can be slower and more effort is given. It can become overtaxing and as Kahneman referred in his book, Thinking, Fast and Slow, human cognitive capacity has limits which can lead to error.
This can happen when physicians perform multiple, unrelated tasks while making decisions, simultaneously. It takes 22 minutes for physician burnout, according to one study, when the physician experiences fatigue working with electronic health records (EHRs). The use of EHRs is directly linked to physician burnout and the main complaint physicians have regarding click-intense and data-busy EHR requirements. While managing several patients at once, manually entering data into a computer fulfilling the obligations and requirements for documentation can be excessive. Sometimes the requirements to evaluate and document include irrelevant history, review of systems, and physical exam points. These activities do require cognitive energy but may not support the correct diagnosis or prognosis.
Thaler and Sunstein referred to 'nudge' being effective through 'choice architecture.' The choice architecture is a way to design and structure options to make the decision easier for the decider. An example would be inside the school cafeteria, putting the healthier snack choice at eye level versus the unhealthier choice harder to reach and not in line of sight. In that case, and with the experiment referred to in the nudge study, kids chose those healthier snacks. Clinicians’ and patients’ are also influenced by subtle design of information and choices to effect decisions and behavior. When the “choice architecture” is designed to influence behavior in a predictable way but without restricting choice, it is often called a “nudge.” Inside the EHR, physician nudges are influential. The direction and force must be aligned with professional standards, regulations and those standards may evolve over time.
This can happen when physicians perform multiple, unrelated tasks while making decisions, simultaneously. It takes 22 minutes for physician burnout, according to one study, when the physician experiences fatigue working with electronic health records (EHRs). The use of EHRs is directly linked to physician burnout and the main complaint physicians have regarding click-intense and data-busy EHR requirements. While managing several patients at once, manually entering data into a computer fulfilling the obligations and requirements for documentation can be excessive. Sometimes the requirements to evaluate and document include irrelevant history, review of systems, and physical exam points. These activities do require cognitive energy but may not support the correct diagnosis or prognosis.
Thaler and Sunstein referred to 'nudge' being effective through 'choice architecture.' The choice architecture is a way to design and structure options to make the decision easier for the decider. An example would be inside the school cafeteria, putting the healthier snack choice at eye level versus the unhealthier choice harder to reach and not in line of sight. In that case, and with the experiment referred to in the nudge study, kids chose those healthier snacks. Clinicians’ and patients’ are also influenced by subtle design of information and choices to effect decisions and behavior. When the “choice architecture” is designed to influence behavior in a predictable way but without restricting choice, it is often called a “nudge.” Inside the EHR, physician nudges are influential. The direction and force must be aligned with professional standards, regulations and those standards may evolve over time.
In 2016, Penn Medicine launched the Penn Medicine Nudge Unit. It tests approaches to improve health care delivery, value and outcomes. For example, as part of the hospital systems EHR, physicians must decide between brand-name and generic formulations when prescribing medications. Penn Medicine's Nudge Unit set generics as the default choice. Prescribing and ordering the generic became a 'path of least resistance' even as the ability to opt out and order a brand-name drug was offered as a choice. As this was implemented, a significant increase of generic prescribing was realized of 75% to 98%. An area that was strongly effected was for patients referred to cardiac rehabilitation after myocardial infarction. At the beginning of the study, only 15% of eligible patients were being referred to these services because the process was manual when the services were opt-in versus an opt-out. As an EHR system redesign to opt-out by the Penn Medicine Nudge Unit, plus additional steps in the process added, the referral rate increased to more than 80%.
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In health care, effective 'nudges' driven by choice architecture does guide clinical and patient behavior. The digital environment is the location where decisions are made, standards are set, through the use of offered suggestions. Clinical decision support systems are becoming more essential as we integrate artificial intelligence and machine learning into the health environment to augment information and data analytics. However, not all these nudges are artificially controlled. Matter of fact, most are based on common sense process but testing is required in order to evaluate effectiveness and unforeseen impact.
The creation of the 'choice architecture' for 'nudges' are driven by common sense but expertise is required to:
Identify 'Nudge' Projects and Programs
Develop The Concept and Approach
Map out the Technology and Implementation
Assess Training Development and Execution
Obtain Stakeholder Buy-In and Manage The Politics
Direct The Process and Evaluate The Impact
Adjust Where Necessary
Identify 'Nudge' Projects and Programs
Develop The Concept and Approach
Map out the Technology and Implementation
Assess Training Development and Execution
Obtain Stakeholder Buy-In and Manage The Politics
Direct The Process and Evaluate The Impact
Adjust Where Necessary
An example of
Success with The Analytical Approach
For pharma clients to transform HCP experiences by building unique branding solutions that 'Nudge' at Point of Care inside EHR and eRx.
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To 'nudge,' engage and transform physician experiences at the time of prescribing, at the point of care, inside the EHR and eRx, with targeted messages for pharmaceutical brands.
Tactics: To maximize brand exposure for clients like Janssen, Novartis, BI, Pfizer and other pharma and rare disease biotech, by targeting HCPs, using point of care data to trigger and deliver messaging at the exact time of diagnosis, e-prescribe and patient engagement, within the EHR, in office and through streamed services. Messaging inside the EHR and eRx, at specific timing of patient diagnosis, e-prescribing and patient education, tactical implementation relies on a complete understanding of the physician workflow inside the EHR to include:
The triggered message is designed with business rules wrapped around clinical knowledge like patient demographics, patient history, geography, physician specialty, ICD codes, prescription history, tests and procedures, prognosis, etc. The non-advertisement, triggered message focuses on delivering clinical information of value.
The system can be set for dispense as written (DAW) and provide information to the physician from log-in through patient education as a non-invasive, point of care messaging that offers personalized care to the patient and value-based care for the provider.
Outcomes: Produced strong results of engagement / CTRs with EHR and account based marketing programs for pharmaceutical brands exceeding 35% improved interoperability communications for physicians at point of care and with direct-to-patient communications. Managed portfolio through building and integrating digital models by applying data, technology, and analytics to develop strategy, strategic go-to-market recommendations, and strategic solutions. Execute on key performance matrices to maximize brand exposure. Evaluate and measure communications (data analytics) and track and report on matrices. Clients market brands for chronic diseases to include cardiovascular, diabetes, gastrointestinal, renal failure, macular degeneration, respiratory, and rare and genetic diseases. |
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