Here’s the big question: How does an industry with regulatory constraints around how it communicates with the public successfully engage on social media through robust, timely, and helpful interactions?

There’s not a simple answer, but creating clear and consistent “rules of engagement” can make for a good first step forward.

As a digital and social media strategist for C3i Healthcare Connections, I help pharma clients build out their social presence and extract meaningful information that can be gleaned from social media. While ongoing monitoring of conversations is a key component of any pharmaceutical brand’s social strategy (see my previous article here), companies need to be well-equipped to participate in those conversations, too. Five broad steps can help you get started.

1. Develop engagement strategies

Take the time to outline your plan of attack, along with the ways your team can apply these principles to their everyday interactions. Doing so will benefit everyone involved by making operations more efficient and streamlined, your customers more satisfied, and your brand more favorable.

Start by assessing the engagement opportunities available to non-regulated industries and rule out those activities which regulations prohibit, such as providing off-label information, soliciting or prompting users to share content that might lead to off-label questions, and recommending or directly promoting the use of a product to a user. After implementing compliance safeguards for handling Adverse Events (AEs), Product Quality Complaints (PQCs), and Privacy Violations (see this article), you can begin to develop your own engagement strategies and practices.

As part of this process, you should:

• Work with key stakeholders — including marketing and branding, public relations, medical information, and pharmacovigilance — to identify the objectives of engagement
• Be prepared to identify and report any AEs and PQCs on owned properties (e.g., branded or unbranded Facebook Pages) and any properties over which the pharma company has control or influence
• Evaluate the current social media space and your role in it
• Develop workflows and escalation guidelines, perhaps considering third-party technologies that help streamline workflows and support operational evaluation
• Establish community guidelines — besides guidelines for posting and commenting, this may include a statement that explains the purpose of the property, links, and contact information

2. Be consistent … but human and flexible, too

After you’ve decided to move beyond monitoring and begin engaging on social media, many companies often start with a simple first-step strategy of responding to AEs and PQCs with a “contact-us reply.” For example: “Hi Sarah. Thank you for bringing this to our attention. We take product safety seriously and are interested in learning more about your experience. Please call us at 800-555-5555.”

A standardized “contact-us reply” can sometimes feel robotic. While remaining consistent is important, it’s equally necessary for brands to consider how to bring the human element to their interactions. Beyond AEs/PQCs replies, teams can add a personal touch by taking the initiative to respond to on-label inquiries or consumer sharing of experiences: “Thank you for sharing, John. We’re glad that you’re taking steps to manage your health.”

Being more human means listening carefully to what is being asked and acknowledging what has been stated. Text can be difficult to interpret sometimes, but you can take cues from emojis, emoticons, and images. While providing accurate on-label information is critical, so too is the emotional tone of an interaction, especially in the sensitive area of health.

3. Establish KPIs

If something can be observed, it can be measured. Two kinds of key performance indicators (KPIs) help assess the performance of your interactions and resource needs of your initiatives. They are productivity KPIs and volumetric KPIs.

Productivity KPIs include metrics such as:

• First Response Time — the time between the consumer’s first contact and the company’s first response for all engagements over a period of time
• Response Time — the total time from the consumer’s first contact and the company’s last response
• Handle Time — the time from the consumer’s first engagement and the completion of all tasks required to process a case
• Resolution Rate — the ratio of the number of resolved posts to the number of those that needed resolution

In today’s world, consumers expect swift responses. In an ideal world with infinite resources, response times on social media could be less than a minute. In reality, however, resources can limit optimal response times. Establish your initial KPI standards based on the number of people on your staff, hours of labor, and average number of posts per hour they can handle. Often vendors can assist in the heavy load of supporting customer care in cooperation with your company.

Volumetric KPIs might include the total of all posts in a given period for a given property (e.g., total Facebook posts in May), or the volume of posts for which the company responded, which can be further organized by type of post (AEs, PQCs, product inquiries, etc.). Third-party technologies can assist with these KPI measurements, although some are better suited for monitoring and reporting, while others are built to support consumer care and interaction. Your technology selection depends on the objectives of your engagement strategy.

Besides supporting the initial stages of your engagement efforts, tracking KPIs after they have been established helps to identify areas of improvement and opportunities within your operations.

4. Prepare for the unexpected

No matter how refined your social strategy, there are always surprises. While you can’t control unexpected events, you can prepare for them.

Before launching your social media initiative, carefully document the process for escalating an issue depending on the situation presented. Establish escalation criteria and communication protocols to avoid last-minute panic. Be transparent, and continually monitor the situation until it resolves.

Keep in mind that a response isn’t necessarily an answer. Make sure your teams can distinguish legitimate consumer concerns from spam content. If a consumer posts an inquiry and an immediate answer is not available, it’s OK to acknowledge the question and inform the consumer that he or she will receive a follow-up response. Suggesting a private message can be another effective way to handle, or public responses that benefit the community.

5. Evaluate performance, apply insights, and adjust practices

In social media, as in any initiative, there is always room for improvement, refinement, and course-correction. For example, if average response and handle time goals are not being met, is it due to a lack of staffing (a volume issue), or a need to coach your representatives? On the flip side, if response times are quicker than anticipated, are there other activities that can be added to the initiative, such as improving the quality of responses?

A big advantage social media has over traditional media is the ability to more immediately measure and evaluate the performance of content. As experience is gained and insights are gleaned, proceed to evolve from a passive/reactive model to an active approach that seeks out opportunities for engagement.

Consumers are eager to receive information and support from all parties in the healthcare system. Those pharma companies or brands that have established the foundations for social media processes and, ultimately, build up to higher tiers of engagement, not only have a greater opportunity to meet or exceed patient expectations — they’re also able to earn long-term trust and favorability among patients.

By developing and implementing solutions for handling adverse events in social media, your company has the opportunity to leverage key information from the largest focus group in the world.

In my previous column, I discussed how social media can be viewed as a “perpetual focus group.” The sheer and ever-expanding volume of these conversations represent a virtually infinite set of data that can be transformed into valuable information. All of this information — even Adverse Events (AEs) and Product Quality Complaints (PQCs) — can provide insights that power decisions and support action.

The role of adverse events on social media

Social media, like any other media, is a source of AEs and PQCs. Given the immense volume of tweets, Facebook status updates, Instagram photos, blog posts, and conversations on forums, it is to be expected that while people are sharing their health experiences, AEs and PQCs are bound to be mentioned. These can occur either intentionally (for example, “I took Drug Rx and I woke up to a rash on my leg”) or incidentally (“I’m so grateful for the nurses who took such good care of me when I was in the hospital after my car accident. Also, Drug Rx has been working well for me.”).

Since the early days of social media, there have been two opposing schools of thought on the best ways to handle AEs on social media. One school of thought views AEs as an absolute obstacle to any pharmaceutical company getting involved in social media. The other school does not view AEs as a problem, but rather, in my opinion, projects a nonchalant attitude about the nuances of social conversations and the identification of AEs.

I am not a student of either school of thought. Based on my professional experience within clinical settings and my knowledge of drug safety, I believe the best stance is to acknowledge the challenges that AEs present while, at the same time, to develop and implement practical day-to-day solutions — systems that ensure proper identification and triaging of AEs, as well as the ability to leverage AEs for analytics and insights.

How to monitor and categorize adverse events

Fundamentally, AEs can yield useful information when monitored closely, safely, and properly. Over a period of several months, for instance, thousands of AE posts can be classified according to an objective-based process. Then, identified and triaged appropriately, these AEs can be classified into categories.

Let’s explore one example: “Drug Rx has been a life-changer for me. So far, it’s been doing what my doctor says it’s supposed to do. Occasionally, I get a little rash on my right arm, but other than that, I’m truly grateful.”

In this scenario, we have an AE (assuming we can identify the person reporting it). We also have references that can be classified. “It’s doing what my doctor says it’s supposed to do” could be classified as Effectiveness, and “a little rash” could be classified as, say, Immunity. Over time, these AEs can help companies better understand conversations. At the end of the set time period, a company may find that 50% of AEs were Immunity-related, 25% were Cardiovascular, 15% were Respiratory, and so on — providing valuable information for understanding the adverse side effects of a particular agent.

Furthermore, if these posts were also categorized by other data, such as the social media outlet, the topics discussed and the behaviors expressed, the aggregate data offers information beyond purely clinical, perhaps even helping to inform a company’s messaging or marketing strategy.

Establishing well-defined protocols for success

The above example illustrates the basic concept of leveraging social media AE data. In essence, the close monitoring and careful categorization of social media AE data can transform a seemingly complex and vast landscape into a navigable road. But that’s not to ignore the challenge of scalability. The best approach is to start small, evaluate results and evolve incrementally.

Companies need to plan for how they will monitor social media for AEs, because the greatest pitfall is missing AEs altogether and risking patient safety. Training staff in the identification of AEs and the enterprise’s triaging protocol is crucial. In my company’s training program, our agents receive training in the nuances of social media, in addition to traditional AE and PQC training, to ensure they do not miss AEs. After identification, the documentation and communication protocols need to be established and clearly understood by all team members.

The first step of merely identifying AEs can be challenging within itself, as information related to AEs or potential AEs are often ambiguous or sparse, especially due to the word or character limitations on certain social media platforms, such as Twitter. Furthermore, a company cannot publicly respond to a tweet that simply says, “My inhaler isn’t working” by asking, “What do you mean by working”? So the company is left wondering, is this an AE (lack of efficacy), a PQC (a malfunction), both an AE and a PQC, and/or an opportunity for patient education? In the inhaler example, the company could respond with, “We’re interested in learning more. Please contact us at 800-555-5555.” This is where the pharmaceutical company’s ability to interact publicly in social reaches its limit, but still presents an opportunity to demonstrate a caring, human voice, while adhering to regulations. Training must include steps for evaluating an AE and how to extract the key data.

Exploring ethical implications

Because the general principles of monitoring for AEs also apply to social media, compliance with FDA regulations is, for the most part, straightforward. Yet beyond the regulatory responsibilities of AEs, ethical issues arise. For example, it is inevitable that companies may stumble upon mentions of a competitor’s agent with a potential AE, either on their own branded properties or within the broad social media space. Companies are not required to report another company’s AEs to the FDA, but should they? Well-established processes, understood by all within a company, can help guide these and other ethical decisions.

Pharmaceutical companies are committed to patient safety, product safety, and effectiveness. By investing in and developing resources to ethically and efficiently manage AEs on social media, companies can transform the fear of these AEs into mutually beneficial results. In the long run, better understanding of all AEs — social media or otherwise — can help expand the knowledge of drug researchers, providers, and marketers; advance the industry; and improve the well-being of the patients we serve.