Medical science liaisons (MSLs) are vital resources to execute industries’ medical strategies and deliver insights from the voice of the scientific and healthcare community. Peer-to-peer engagement supports the education of scientific exchanges with the medical community to ultimately improve patient outcomes and therapeutic decision-making. MSLs are the field force of the medical affairs department, which is the largest and most challenging medical affairs function to measure. The dilemma field medical continues to face is their ability to effectively show the impact their field teams have on the organization.
The mission of the industry as a whole is to improve the lives and outcomes of patients. Medical affairs, especially field medical, is one of the primary functions in the industry to embed patient outcomes as part of their measurable value story. However, metricizing patient outcomes within field medical’s value story or impact is still a challenge medical affairs leaders struggle with since balancing quantitative versus qualitative outcomes is inherent to this process. Focusing on field medical affairs, there are multiple outcomes that relate to impact and these include external interactions, insight generation, knowledge advancement for specific audiences, competencies (both externally and internally), patient outcomes, and public health.1 It’s vital for field medical affairs leadership to roll these outcomes (in the form of activity-based goals and objectives) into the medical strategy for the therapeutic area and develop strategic imperatives and listening topics for field medical or MSLs. With these imperatives, leadership can develop metrics for the MSLs. These metrics or key performance indicators (KPIs) must align to the medical strategy, which is aligned to product lifecycle-based priorities.
What is missing and still makes KPI building a challenging, and seemingly elusive task for field medical is the lack of standardization. Industry-wide standardization of terminology and process will allow medical affairs professionals and leaders to build robust metrics, which are vital to optimize the impact and elevate the performance of their teams. Multiple white papers and guidance documents 2 have been created by industry professionals to move in the direction of standardization. Aligning metrics to these standards set by experts is the first step in the process. Briefly, metrics can be divided into two buckets: outcomes-based and goal-based. Outcomes-based metrics are typically tied to external factors that demonstrate impact. These are generally broad in nature and usually involve cross-functional collaboration to achieve. Goal-based metrics measure the relationship between the activities or tactics and specific outcomes, which are often both internal and external as well as qualitative and quantitative. Many tools exist to aid leaders in creating goal-based metrics. Both outcome- and goal-based metrics must be tied to the strategic imperatives, defined by medical affairs leadership. Further, MSLs need to be ‘bought-in’ to the metrics for successful implementation, which can be achieved by involving the field team in the process.
When developing KPIs it is important to appropriately balance the use of both quantitative and qualitative metrics since quantitative metrics alone cannot truly measure impact and often do not lead to the desired outcomes. Examples of quantitative metrics include a number of thought leader (TL) engagements, number of insights gathered, number of medical information requests, and number of congresses attended; qualitative metrics include an increase in TL advancement (knowledge, practice change), peer introductions, the actions taken on the insights, and TL feedback through surveys. Qualitative metrics should inform on the impact field teams are having during their interactions and quantitative should inform on how the MSLs are spending their time so that the relationship between the two can be assessed. Therefore, balancing qualitative and quantitative metrics is as important as aligning the metrics to the organizational medical strategy.
One means of measuring the relationship between MSL activities and outcome, both quantitative and qualitative, is layering in real-world data to serve as a surrogate for clinical impact. Here we present a recent client case study using a common MSL initiative – healthcare provider (HCP) education.
TABLE 1: Case study overview
| Situation | Client launched a new later-line therapy for advanced-stage disease in September 2020 |
| Education initiative | New therapy required that a specific non-standardized test be ordered prior to therapy start for appropriate dosing. Percent of patients receiving this late-line therapy was expected to be low. |
| MSL activity | MSLs educated providers regarding the new therapy, including reasons for ordering the test. |
| The outcome to be measured | Client desired to know whether the providers started ordering the test at increased levels using real-world data, as a surrogate measurement of clinical impact. |
The client medical affairs leadership in this case study was attempting to link MSL activities with an external outcome using a surrogate endpoint. Specifically, they wanted to know if there is an increase in orders for the required testing post-product launch. As the MSLs played a significant role in the educational efforts pre-and post-launch, when combined with internal quantitative internal MSL metrics, the clinical impact of the MSL activities and potentially the educational content can be assessed.
The real-world study design required data from two data sources; the diagnosis data and longitudinal prescription data of patients who were also taking first-line therapies along with a percentage of patients with test orders (CPT codes) of interest. These data were collected over time from Q1 2020 to Q3 2021, which included six months of pre-launch baseline data and one year of post-launch data. As seen in figure 1, testing rates clearly increased over time, starting with a rate of 2.3% during Q1 2020, which remained constant for the six months pre-launch, and increased to a rate of 4.7% during Q1 2021 (t-test p-value <0.001). Testing more than doubled during the study’s time period. It’s important to note that the cause of the increase could include several factors occurring at this time. Additional analyses are required to provide a more direct correlation.
Figure 1: Testing rates as a surrogate for clinical impact
With greater access to real-world data and the growing volume of patient-level data, medical affairs leadership now has the means to incorporate more patient-linked quantifiable endpoints when assessing the complex nature of an MSL’s performance. Many of the metrics that were deemed qualitative, such as HCP education, can now be linked to external outcomes that aid in making these metrics more quantitative. Leveraging the use of real-world data along with additional internal metrics to show the impact of field medical is crucial in driving the medical strategy and ultimately improving patient care.
References:
- MAPS ECADAMY: https://medicalaffairs.org/wp-content/uploads/2021/05/Measuring-Impact.pdf
- 2. https://www.themsls.org/members-msl-guidelines-download/
- https://medicalaffairs.org/wp-content/uploads/2021/09/Field-Medical-KPIs-FINAL.pdf
Authors:
Linda Traylor, PhD
Senior Principal, Medical Affairs, Medical Affairs Center of Excellence
Current responsibility
- Leads client engagements and cross-functional delivery teams to develop innovative RWD solutions
- Leverages the full global digital health, research, and data science capabilities of IQVIA
- Based in South Carolina
Profile overview
- Linda has nearly 25 years of experience in clinical research and medical affairs across industry (pharma small to large, medical devices, biologics, diagnostics) with extensive cross-functional support know-how.
- Linda’s career has spanned multiple therapeutic areas including oncology, immunology, infectious disease, diabetes, cardiovascular and kidney disease as well as precision medicine.
Education
- BS, Chemistry, University of Arkansas
- PhD, Pharmacology and Toxicology, University of Arkansas for Medical Sciences
- Postdoctoral Research Fellowship in Cardiology, Duke University Medical Center
- MSL-BC, Board certified by Medical Science Liaison Society and Advisory Board Member
Areas of expertise
- Linda has held multiple medical and clinical affairs positions throughout her 24-year career from Medical Science Liaison to Dept Head for Clinical Development and Medical Affairs (CDMA).
- Linda’s medical affairs expertise spans FDA regulated drugs (3 first-in-class), devices (cell therapy), biologics (immuno-oncology), and non-FDA regulated laboratory-developed tests (genetics and complex and machine learning-based proteomics)
- Linda has developed an expertise in solving complex medical affairs challenges and developing data-based narratives to support clinical research and product adoption.
- As CDMA Department head, Linda as built teams supporting all traditional (and non-traditional) medical affairs functions.
Linda is passionate about distilling complex issues down to simple data-driven solutions for the healthcare industry.
Rina Patel, MD, Director–Medical Affairs, Strategy and Development, IQVIA
Current Responsibility
Rina is responsible for leading strategic planning and management of a team of Regional Medical Directors who will serve as Medical Affairs Project Leads for our clients and be responsible for tactical execution, managing the operations, and oversight of a given project. She leads and drives the implementation of the strategic vision, direction, and deployment of the Field Medical Affairs team. She also monitors and provides timely insights on emerging clinical and scientific trends to identify opportunities and potential issues that may affect medical affairs field roles and adjust strategy in response to changes.
Areas of expertise
Rina has strong a business acumen experienced in managing field medical affairs team, gathering and communicating insights to multiple stakeholders, providing a medical review in clinical development, identifying, and addressing safety concerns, along with developing and executing medical strategy.
Education
Rina did her undergraduate studies at Drake University and received her Doctor of Medicine from St. Matthews University. She recently received a Leadership and Management Certificate from Wharton School of Business.
Profile overview
Some achievements include successfully managing a national field medical affairs team with the implementation of a customer medical affairs strategy, along with creating customized dashboards for external stakeholder relationship advancement. Worked cross-functionally with real-world evidence, clinical development, medical information, safety, market access, and sales.
Relevant experience
Rina has more than 10 years of combined experience in the clinical, academic, and pharmaceutical industries in a variety of therapeutic areas.
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