At a recent MM&M Leadership Exchange, participants were ready to declare that the great digital channel shake-up may have reached its peak. “When it comes to online promotion, even engaging in different assets, mobile apps, things like that, we haven’t seen growth and not too much decline,” said Monique Levy, VP of research at Manhattan Research.

According to Levy, it may be time for marketers to stop looking at the phone, tablet or “phablet” as the Holy Grail of physician engagement. Pharma brand managers need to move where their audience does. Their next frontier: the EHR.

“EHRs will become the dominant context for physicians,” said Craig DeLarge, global leader, multi-channel marketing strategy and innovation, Merck. “We’ve been slow to internalize the idea and engage in the EHR format.”

Because the EHR is the center of physician workflow, accompanying e-prescribing data with the right information should be the new thrust for HCP engagement, DeLarge said at an MM&M Skill Sets Live event in September.

Pharma risks blowing the opportunity, though, by rushing into promotional mode, which could then trigger regulation, he cautioned.

As Paul Ivans, president/CEO of consultancy Evolution Road, noted, “We [the industry] can’t even get into the workflow. We have to learn to leverage EHRs, communicate through them, to get our assets in front of doctors and get our messages in front of doctors.”

It’s no secret that with insurance pools growing by 25 million under ACA, doctors have less time for patients and pharmaceutical reps and fewer minutes to stare at their phone between appointments. Pharma’s counter to that trend has been to declare that they need to better integrate within a physician’s workflow, and shift the mindset from “disruptive” to a kind of partnership.

The billion-dollar question is, how? Aren’t there privacy concerns? What doctor wants information sprayed in their face while trying to make a clinical decision? And how exactly do you integrate with EHRs? The short answer is that it’s already being done, and some consultants and vendors say it might not even be that difficult.

Another hurdle is the large number of vendors, which complicates partnering. Merck’s DeLarge predicted that there will be a shakeout in the 400 or so EHR companies.

“A relative few will own the space and will own the access,” he said, “and we need to think how we can appropriately and compliantly be in that space.”

Doctors, he said, are saying, “‘Don’t promote to me. Help me to sustain in this ACA environment.’” Striking the right balance could help restore trust in the industry.

“Now it’s the carrot, later it’s the stick,” Mark Heinold, CEO of LDM Group—which provides a messaging platform for EHRs—told MM&M. “It comes down to relevance. Physicians don’t respond to advertising. They respond well to clinical information at the right time.”

LDM Group works to solve the problem of disparate EHR systems by consolidating the process of getting their content into many EMRs. It lets pharma place their message into their software so that it can then connect to any of a bevy of platforms. “We’re designed as an aggregator. We’re currently connected to 135 EMR systems. It acts as a central node,” Heinold said.

He says adoption is climbing for aggregation systems, and the way they’re being using is changing. “It’s not just physicians filling their seats; it’s the amount of utilization we’re seeing by physicians,” Heinold said. “They’re using it for the tools, and the more information physicians are using through this system, that’s more opportunity for us to provide value.”

Vendors, too, are designing ways for pharma to get its message across. Physicians will be spurred by government incentives to want the industry in their office. When stage 2 of Medicare and Medicaid EHR incentive programs comes into play on January 1, in order to ensure a compliant EHR, physicians will need to provide 10% of their patients with specific education material.

EHR messaging as a vehicle for patient education may offer HCPs the promise of a better brand experience. “Patient engagement is terrible right now,” said Ryan Howard, CEO of Practice Fusion, an EMR vendor which offers its software for free in return for connectivity, and which currently serves 75 million patients.

“It’s not traditional media where it’s ‘spray and pray’ and you don’t even know if you’re getting your point across to the right people,” Howard said. “We can offer pharma the most engaged community online on a daily basis—and they’re making decisions at the point of care.

“Pre-visit, we provide up-front awareness, and then we can run a compliance message at the point of care in the doctor’s office,” he added. “Then, post-visit, we’re running follow up messaging to assist with adherence. We believe we can do this in a highly ethical way,” he said. “We give the doctor data, and we let the doctor opt-in, and we SMS the patient.”

Not only do EHRs offer more significant touchpoints. They can also change how brand managers view the market and their patients. The data which flows through these systems today may become a way for brand managers to inform tomorrow’s marketing plan.

“It’s all de-identified, of course,” said Howard, and “we’re not selling that data either. But this data can be used in a number of macro ways, without identifying patients and doctors.” The system—dubbed Insight Pharma—offers a bird’s eye view of an Rx population, prescriber’s profile and risk profile, among other parameters.

Howard posits that it can be used to answer questions like, “How is my drug actually performing, how is my market share changing, where am I losing customers?”

“With these data sets,” he said, “you can pull a drug and see what your patient actually looks like.”

Practice Fusion plans to expand the platform to allow people to query a de-identified data set. “The current version is for a brand manager that knows what their questions are,” added Howard. “We’re about six months away from them being able to simply ask any question.”