More and more healthcare companies are building their presence on Twitter. Johnson & Johnson, Novartis, Roche, Astra Zeneca, GE Healthcare and Boehringer Ingelheim are all tweeting and being tweeted at. Some companies are even using Twitter to promote specific branded treatments: Novo Nordisk call attention to their Novolog and Levemir diabetes treatments.

In spite of all the hype surrounding Twitter, it looks like these early adopters might be on to something. Whilst still small in comparison to Facebook, Twitter offers something unique: it attracts a lot of content creators and critics – the minority of people who actually create content on the internet as opposed to the majority who merely browse and consume content. These creators are the ones most likely to discuss your brand, either on Twitter itself or on other social networks, such as blogs, message boards, YouTube and so on. For companies, the benefit of Twitter is clear: it’s about seeding your message to the creators so that it finds its way all over the web. It’s all about PR.

Creating engagement

The challenge for healthcare companies is to create a presence that twittering creators want to engage with. If achieved, this engagement means that a seeded message by a company is more likely to be shared over a wide network. In cases when the company is faced with negative press, strong online engagement gives it the opportunity to respond in such a way that it can influence the PR outcome and repair (or even offset) damage to its reputation.

Of course, this works both ways: a weak or badly-managed Twitter presence can damage the reputation of a company. UK furniture store Habitat tried to use Twitter as a promotion tool, but ended up spamming users who were tweeting on entirely unrelated subjects. After Twitter users expressed outrage at the hijackings, the tweets were withdrawn… but the damage had been done.

So how do you begin using Twitter? A key starting point is to ensure that Twitter is the right tool for achieving your objectives. Using Forrester’s social media strategy framework is a simple way to determine this. In summary, the framework ensures companies think clearly about their target audience and how best to reach them before diving onto Facebook just because the chairman’s daughter uses it. A good strategy should also identify the types of twitterers that a company wants to target, whether they are healthcare professionals, patients, key opinion leaders, patient opinion leaders, disease awareness organisations, or journalists.

Taking risks

Before starting, it’s also vital to be aware of the dangers. Social media is very different to the one-way methods of communication that most healthcare companies are used to. There are many horror stories of corporate social media forays gone wrong due to a lack of understanding of social media etiquette.

Many articles about Twitter etiquette (or ‘Twetiquette’) have been written and can be found easily on Google.  Perhaps the most important rules are the following:

1. Start off by simply listening to the conversation. Understand the tool and how your audience uses it.
2. Be clear and upfront about who you are. Try and be personal, not corporate.
3. Don’t just plug products and post press releases. Join the conversation. In healthcare terms, this often means talking about the challenges of the disease you treat, not the treatment itself.
4. Re-tweet people you follow and they will re-tweet you, enabling you to build your network of followers.

Healthcare companies must think about compliance risks too. There are two main risks that keep healthcare companies off social networks but these can – and should – be overcome.

Risk number one is that a healthcare company could, by engaging on Twitter, break the strict rules set by regulatory authorities, particularly when it comes to off-label promotion. Like all significant risks, this one needs to be managed. However, it’s likely that healthcare companies are already doing this for traditional communication channels, and thus have the framework in place to do so. In a recent Eye For Pharma eMarketing summit, John Pugh from Boehringer Ingelheim made the point that, as with all communications, pharmas need to focus more on their message and less on the channel.

Discussing adverse events

Second is the risk of being inundated with consumer claims of drug side-effects and adverse events. These each need to be logged and reported to the pharmacovigilance authorities. In the internet age, companies need to resource this and find ways to streamline and automate adverse event reporting wherever possible. They also need to understand that true adverse events are perhaps not as widely discussed on social networks as expected. A 2008 study of disease related discussion boards by Nielsen found that only one post out of 500 constituted a true adverse event that would need reporting.

In the US, FDA guidance stipulates that various pieces of key information must be included when submitting an adverse event report. If all pieces are not available, there is no need to report it. In Europe, the guidance is more stringent. For example, the UK’s ABPI adverse events guidance requires that a company must gather what content it can and report it, even if key pieces are missing. But even this should not be so difficult if the correct resources, systems and processes are in place.

Wisely, healthcare companies such as Johnson & Johnson and Boeringher Ingelheim carefully control who can represent them online: they’ve given the task of managing their Twitter presences to corporate communications staff. Other companies work with agencies who understand compliance and the rules of the Twitter game. Many companies have developed new media guidelines to ensure communications build the company’s image rather than destroy it.