1. 1 Trends and the Future: Physicians and Patients in a Connected World

2. 2 Research Methodology Fielded online in Q2 2012 among 1,819 U.S. practicing physicians who are ePharma physicians. The survey was released in Q3 2012 Final data set is compared to the known universe of practicing U.S. ePharma Physicians by age, gender, region, practice setting, and specialty; the research is accurate and reflective of the population of U.S. practicing ePharma Physicians ePharma Physician ® 2012 Taking the Pulse ® U.S. 2013 Fielded online in February and March 2013 among 2,950 U.S. practicing physicians across 25 specialties Final data set is compared to known universe of practicing U.S. physicians by age, gender, region, practice setting, and specialty; the research is accurate and reflective of the overall population of U.S. practicing physicians Research Overview

3. 3 PHYSICIAN INFO SEEKING EVOLVES

4. 4LICENSED FOR INTERNAL USE ONLY In 2013, Physicians have Full Digital Access Cellular networks Satellite networks High-speed and Wi-Fi at work and home Public networks Source: ManhattanResearch

5. 5LICENSED FOR INTERNAL USE ONLY Reach of source (yearly) (among all) Influence on Clinical decisions* (among those accessing/using source) Colleagues (in person or on phone) Pharma sales rep (in person) Conferences (recorded or live) Websites for HCP Audience Are Top Digital Source in Reach/Influence *% of physicians ranking source with a 4 or 5 on a 5-point influence scale Offline Online Prof. journals Conferences Prof. journals CME eCME Colleagues (message boards, communities) Websites for HCP audience Government websites Pharma websites Source: Manhattan Research, Taking the Pulse® U.S. 2013

6. 6 Online Textbooks Surpass Print Day-to-Day Among all physicians Source: Manhattan Research, Taking the Pulse® U.S. 2013 Occasional sources (yearly use) Day-to-day sources (weekly or daily use) References and textbooks Professional journals CME Conferences Pharma or biotech sales rep Colleagues Online 54% 44% 89% 71% 32% 3 Offline 50% 55% 89% 92% 4 38% 72% 2 News55%39% 1 (1)Health/medical information in the newspaper or on television (2)In person or on phone (3)Online professional message boards, communities, social networks, or blogs (4)In person

7. 7 Physicians are Moving Their Professional Journal Reading Online Current percentageExpected percentage in the next 12 months Percentage of time reading journals for professional purposes: Source: Manhattan Research, ePharma Physician® 2011

8. 8 Strong Growth in Frequency of Online Journal Access 72% 95% Any use 2007 Any use 2013 74% 88% 2007201320072013 Physician professional journal use online and offline - weekly and overall use Source: Manhattan Research, Taking the Pulse® U.S. 2007, 2013

9. 9 Pharma Visitation Remains Relatively Low on Weekly Level Among all physicians Source: Manhattan Research, Taking the Pulse® U.S. 2013 Pharma Non- pharma Online resources/destinations (weekly or daily use): Search engines Websites for a HCP audience Wikipedia Professional society websites Government websites Any pharma websites Pharma product websites Pharma customer service websites Pharma corporate websites 23% in 2012 64% in 2012

10. 10 Non-print Content Sources Garner Significant Reach Nearly 80% of physiciansAbout half of physicians About a quarter of physicians About one in four physicians About one in ten physicians About one in four physicians Source: Manhattan Research, Taking the Pulse® U.S. 2012

11. 11 Professional App Use Common, However Adoption Remains Concentrated among Top Apps Source: Manhattan Research, Taking the Pulse® U.S. 2013, Medscape, Epocrates, Wikipedia, PubMed, UpToDate Mobile apps Top 5 professional apps used on smartphone: Epocrates Apps (includes Epocrates or Epocrates Essentials) UpToDate Sermo QuantiaMD 81% of smartphone owners use any 1 [1] Use any specific professional mobile app (Epocrates, WebMD Professional Network, etc.) or any pharma mobile app [2] Browse any mobile websites related to work on smartphone Mobile websites 67% of smartphone owners use any 2 Top 5 prof. websites used on smartphone: The WebMD Professional Network* Epocrates Wikipedia NIH Websites** UpToDate * The WebMD Professional Network includes eMedicine, Medscape or WebMD. ** NIH websites (rollup) includes Medline/NIH, PubMed, National Cancer Institute (NCI), or NIH. Among smartphone owners

12. 12 Search Engine Ranking is Key For Attracting a Physician Audience Online Frequency of using search engines for medical info Daily Monthly Weekly Yearly Never Drivers of high search engine ranking of online destinations Inhibitors of high search engine ranking of online destinations Search engine optimization (SEO), e.g. by … coding to increase relevance to specific keywords promoting a website to increase the number of backlinks optimizing for general content as well as specific image or video search requests Barriers to indexing activities, e.g. … password protection Firewalls lack of popular inbound links Source: Manhattan Research, Taking the Pulse® U.S. 2013

13. 13 70% of U.S. physicians watch online videos for professional purposes Online Video Is a Key Format for Online Learning *The WebMD Professional Network includes Medscape.com and TheHeart.org Among all physicians Source: Manhattan Research, Taking the Pulse® U.S. 2013, WebMD, YouTube, QuantiaMD, American College of Cardiology 29% The WebMD Professional Network* 25% YouTube.com 16% QuantiaMD.com 16% A professional association website

14. 14 Changing Expectations for Content among Today’s Docs

15. 15 TODAY’S MULTISCREEN PHYSICIAN

16. 16 Dr chrono Heart Pro III Air Strip Mobile MIMs Skeleton System Pro III PubMed on Tap Source: Drchrono, Air Strip, Mobile MIMs, drawMD, Epocrates, PubMed on Tap, Heart Pro III, Skeleton System Pro III Both Smartphones and Tablets Serve Many Roles in 2013 Practice Management Remote Patient monitoring Patient Education Quick Reference Professional Education drawMD Epocrates

17. 17 Three-device Ownership Is Now the Norm Devices owned or used for professional purposes Percentage of physicians in 2013 72% 83% Desktop/laptop computer Mobile phone (includes smartphone) eReader 98% 91% 19% Tablet Smartphone* 64% own/use a Tablet, smartphone and desktop/laptop *(Includes smartphone, PDA or send email from mobile device) Source: Manhattan Research, Taking the Pulse® U.S. 2013 Among all physicians

18. 18 Its Still an Apple World, but iPad Mini Not As Disruptive as Hoped #1 #2 Smartphone OS Ranking Tablet OS Ranking #1 #2 #3

19. 19 Smartphones and Desktops Lead in Frequency, Tablets Resemble Desktops for Overall Duration Times per day using each device to access professional info Minutes using each device in a typical session Source: Manhattan Research, Taking the Pulse® U.S. 2013 Among those using their respective devices during or between patient consultations Problem-solving, quick hit Immersion, learning, lean-back Lean-in, multi- tasking, content creation

20. 20 Have used this device to access an online professional journal Use this device most frequently to access online professional journals 86% 76%9% 36% 33% 13% Desktop/laptop SmartphoneTablet Among those accessing journals online Device use for online professional journals: Source: Manhattan Research, ePharma Physician® 2012 Mobile Devices Used to Access Journals but Larger Screens Still Preferred

21. 21 Source: Manhattan Research, ePharma Physician® 2012 In which of the following ways do you expect to be able to access professional journals on mobile devices? Ways to Access Professional Journals on Mobile Devices

22. 22 Methods of accessing online professional journals by device: Among owners of these respective device Age Under 35: 35% 35-44: 23% 45-54: 19% Tablet Docs Prefer Accessing Journals through a Browser, while Smartphone Docs Have No Preference Mobile app: 26% Mobile website: 22% Source: Manhattan Research, ePharma Physician® 2012 No preference: 52% Under age 35: 33% Age 35-44: 32% Age 45-54: 29% Among tablet owners Among smartphone owners Tablet owners: Smartphone owners:

23. 23 Switching devices when reading a journal: Started reading a journal on a smartphone and switched to a laptop/desktop: 23% Started reading a journal on a tablet and switched to a laptop/desktop: 22% Started reading a journal on a smartphone and switched to a tablet: 13% Among those accessing journals through multiple types of devices Source: Manhattan Research, ePharma Physician® 2012 Multiple Device Usage while Accessing Online Journals

24. 24 EHR Adoption Growing Steadily Electronic health record (EHR) adoption: *Question was asked in a different manner in 2011, 2012 and 2013 Among all physicians Source: Manhattan Research, Taking the Pulse® U.S. 2013 Devices used to access EHRs: (among physicians with an EHR) Desktop EHR dedicated desktop Tablet Smartphone

25. 25 Personal devices and platforms Enterprise devices and platforms ? Screenflow in 2013 How Will Personal and Enterprise Platforms Coexist

26. 26 Next gen EHRs Pharma Trying to Understand How to Get Closer to EHRs & Publishers that Partner with EHRs

27. 27 EHR #1 #2 Among all physicians Source: Manhattan Research, Taking the Pulse® U.S. 2013 EHRs are a Dominant Platform, But Driving Use of Open Digital Sources Open Digital Sources

28. 28 Among all physicians Source: Manhattan Research, Taking the Pulse® U.S. 2013 Through 2015 EHRs and Open Digital Access will Run in Parallel, with Accelerating Integration EHRs Open Digital Access 2013 2015 Growth in integrated content

29. 29 Searchability – easy to find what they want, when they need it Shift toward Outcomes-Based Reimbursement: What are the new content needs? Expectation of truly interactive content that allows users to dive deeper, across screens Physicians are accustomed to information on demand – evolving learning styles – what are expectations of doctors whose med school textbooks were on their iPads? Considering the role of EHR and its effect on POC content consumption Looking Ahead – Key Trends for HCPs

30. 30 CONSUMER TRENDS

31. 31 Consumer Devices and Technology Impacting How We Consume and Share Information Apple and GoogleTV Wi-Fi Cameras, 8 Mgapxl chip in iPhone 5 Payment alternatives Sensors: GreenGoose Multi-device access to cable subscription BMW Wi-Fi Hotspot Smartphones, 7 inch and larger tablets and eReaders

32. 32 Source: Manhattan Research, Cybercitizen Health® U.S. 2012, Google TV Blog, gallery4gadget, myfirst5k.wordpress.com 35% of all online consumers access the Internet or online content via TV sets Avg age: 36yrs Avg income: $56K 35% of all online consumers access the Internet or online content via TV sets Avg age: 36yrs Avg income: $56K 25% of consumers watch TV or movies streamed or downloaded online Avg age: 36yrs Avg income: $64K 25% of consumers watch TV or movies streamed or downloaded online Avg age: 36yrs Avg income: $64K Content Flows Freely across Devices

33. 33 86% Mobile phone* 79% Desktop or laptop 48% Smartphone** 20% Tablet Gaming console 42% Technology owned or used *Includes smartphone by definition ** Includes smartphone and send email from mobile device Smartphones Becoming Mainstream, Tablets Rising Up from 38% in 2011 Up from 10% in 2011 16% eReader 83% of U.S. adults are online 19% iPod touch Source: Manhattan Research, Cybercitizen Health® U.S. 2011-2012

34. 34 Percent of consumers in each segment who are online for health 60% + across conditions Source: Manhattan Research, Cybercitizen Health® U.S. 2012 Majority of Patients across Conditions Online for Health

35. 35 Source: Manhattan Research, fitbit, mobihealthnews, tribeswell, Bits, Phoenix Business Journal, coxhealthconnection Fitbit Proteus’ Ingestible Electronic Pill BodyGuardian Remote Monitoring System CVS Minute Clinic American Well remote consults Humana workplace wellness The Clinic at Walmart Health360: Multiple Touch Points for Care and Services Intel® Health Guide

36. 36 Resources used for health info or services in the past 12 months 73% of U.S. adults use the Internet for health info or services Source: Manhattan Research, Cybercitizen Health® U.S. 2012 Fragmented Consumer Health Resource Mix Pharmacist at Walgreens Consumers ages 65+ top age cohort to use (85%) Black/African American consumers top ethnicity to use (67%) Hispanic consumers top ethnicity to use (17%)

37. 37 Scenarios prompting consumers to use online health resources Age Factors Source: Manhattan Research, Cybercitizen Health® U.S. 2012 Among online consumers Internet Used throughout Patient Journey Type of Condition

38. 38 Scenarios prompting consumers to use online health resources Source: Manhattan Research, Cybercitizen Health® U.S. 2012 Among online consumers Online Patient Journey Varies by Condition and Age RA patients: 40% MS patients: 61% Fibromyalgia patients: 48% Age a factor only early in continuum Condition pushes Internet use throughout continuum Depression patients: 29%

39. 39 75 29 In millions of U.S. adults (ages 18+) 55% of consumers feel more in control of their health as a result of using smartphones for health or medical info. Among those online who are smartphone health users Source: Manhattan Research, Cybercitizen Health® U.S. 2008-2012 Mobile Health Grows; Gives Consumers Sense of Control

40. 40 Smartphone adoption includes send email from mobile device in 2011-2012 Tablet adoption only asked for iPad ownership in 2010 Source: Manhattan Research, Cybercitizen Health® U.S. 2011-2012 Triple Screen Consumers Consumers with smartphone + laptop/desktop + tablet 16% of all consumers in 2012 Marketers Facing a Growing Multiscreen Reality

41. 41 Key Insights The digital landscape for is rapidly evolving, especially for an information-hungry, technologically advanced audience like the physician population. Digital has been a way of life for physicians for over a decade. Mobile devices are changing physician expectations for portability and access to content – however at the same time the EHR will be consuming increasing time during the workday. Considering screenflow and use cases in content delivery will be critical. Digital content is changing physicians expectations for content delivery. Searchability, ease of access, quick reference and fitting into physician workflow are all key to attracting a viable audience of doctors online. Today’s E-Empowered Consumer is engaging with online content and their physician in new ways – creating new needs for tools and information that will continue to evolve as more of the onus for healthcare cost management is shifted to the consumer. The world is changing under our feet even as we talk about it – 2010-2013 has seen some of the most dramatic shifts in health and technology behavior in the past decade. In addition to technology; the practice of healthcare will be undergoing rapid change in the coming years, changing physician and consumer needs with it.

42. 42 THANK YOU Meredith Ressi mressi@manhattanresearch.com