Tuesday, November 17, 2015

Digital Marketing - A Marketing Game Changer in the Modern World


Digital Marketing is the use of electronic media to communicate with customers and to evaluate the success of marketing campaigns. It’s no longer means simply having a website, but includes customer interaction through mobile apps, digital television, interactive billboards, videos, blogs, social networks, reviews etc. Organizations can use this variety of online channels to communicate with customers and analyze marketing campaigns to understand what is working for them and what isn’t – typically in real time

What's different about marketing today?

Marketing has been around for quite a while said from the 1930s or '40s. The theory of marketing is well-established. But the practice has changed because of the new technologies, different devices/media, and the way people use marketing. A lot of the different devices mean, people behave differently with marketing, both the consumers and the marketers. A lot of traditional marketing principles like segmentation, positioning etc. are still relevant. Traditionally, it would be conducted by demographics. You'd look at age and gender and income. But now, with the information and data available, we can look at behaviors like how often people shop for some products, how often they visit a website and that has an impact on how segmentation is actually conducted in practice. Digital marketing is about appealing to a community. It's not so much about selling the product but really trying to establish credibility within an online community and that really makes a difference to how you approach marketing. So it's more sort of a sociological, consumer-behavior approach. Social networks weren't created with a commercial benefit in mind, but created with a social benefit in mind. Afterwards those companies started to think how to monetize. You could say marketers might think they are following what consumers are doing, and they're trying to catch up and utilize the different networks that exist for their benefit.


Challenge for marketers is to communicate with customers when, where and how they are most receptive to the message. This requires a consolidated view of customer preferences and expectations across all channels – online and offline.

Social media now become not a choice for people, now it has to be. It is a private space for every individual. Advertisements are disruptive for the users. Hence marketers have to go positively to that space to set the environment right. Traditional marking will not be effective here, instead be relevant and helpful, assist and really be giving. Proper segmentation is required to target the right audience, else we won’t survive. Relevancy is very important.

Multichannel customer journeys

The term ‘customer journey’ refers to the complex ways in which customers navigate the multichannel landscape to get from their first inclination to check out a product, to finally buying and consuming it. Customers shopping behaviors is different what we have seen 20 years back. So for example, if I go and want to buy a pair of shoes, I would, for example, speak to a friend of mine maybe first, then look online and try and get some information from different sources about what's trending at the moment, what's in fashion. And that would be maybe through social networks.

Impulsive Journeys

Impulsive journeys are often triggered by emotional response to product in a store, or familiarity with the brand. The purchase is then often made on the spot, through the channel the user is engaging with at the time – online or offline.

Balanced Journeys

Balanced journeys can be triggered by exposure to product – seeing a new product in-store, or seeing an ad on TV, but then seeking more information from other sources e.g. thorough reviews in blogs and YouTube as well as asking friends. The purchase can be made online or in store.

Considered Journeys

Many shoppers gather information all the time - they read forums and watch YouTube videos, without wanting to buy a product at the time. Then they consider the information once a purchase occasion arises at some point in the future.

Every customer engage in a different type of journey every time they shop, which makes research into this area important and complex. 

The principles are the same for digital marketing, regardless of the size of the organization. The way you execute them may well be different. And the tools that you use to do so may well be different, as well. But the principles remain intact.

Is digital marketing a force for good or evil?

There’s a huge sum of money involved in digital marketing. Interestingly 35% of advertising spend is now on mobile. We have a host of new marketing agencies all putting together new advertising packages, and selling them to marketers. It really doesn't tell us about the success of those particular techniques. So you look at something like banners, which even 10 years ago, were seen as the staple advertising platform. And now, it's widely recognized that they simply don't work. And yet, there are still banners everywhere, and there's still people buying them. And there are still lots of companies trying to sell them.

There's an endless series of innovations. Market seems to work on a new platform comes along. People adopt it, they try it. They actually end up getting bored with it often, and then they move onto the next one. And there's no real evaluation. It's very hard to find anyone who's ever declared one of those useful as useful to them or clicked on it other than by a mistake. So actually, what you're seeing here is a kind of sophisticated marketing of marketing going on, and lots of companies buying it.

Digital marketers preferable go for a step by step approach. Start with few digital marketing steps and gradually forayed in to more channels. Different marketing channels work for different companies, it cannot be same. It is important that we should select the right channel. Step by step approach also will help to stick on fruitful channel, learn from experience and optimize marketing cost.

Digital Marketing Components/strategy


This means how to distribute the product. If we have budget, we can go for traditional channels, otherwise explore organic areas like social media. Social is less expensive than paid search. Right customer experience is more important in distribution. Amazon is number one in that, one click can give the result. Instant gratification is very impartment. More click means, customer loose.


 Right product at right time to the right customer. 

Story telling

Story can be the thing that you remember when everything else just goes from your memory. Storytelling can show people what our brand stands for. Gardener of a property who's doing some amazing things with the rose garden, or the cook who's taking the produce from a garden and turning it into a special dish. These are the stories we want to bring to life about conservation, about wildlife, about properties. So it's empowering those people to do that, and doing it in a way that maintains quality, brand consistency, but also that human honesty to it as well

Tool for developing a strong narrative that connects you with customers at an emotional level
  •  Develop a good story that makes it absolutely clear what you do
  • Create some digital collateral that’s well optimized and positioned in the right places online
  • And then go out and tell your stories!
In marketing, we need consumers to take notice of our communication by various ways like surprise, delight or amuse. Digital marketers create content that people want to share and thus they can increase the impact massively. Digital marketing is not only about delivering ‘content’ to consumers, also about provoking conversations within your market that stimulate engagement, reflection and action. 

Responsive design

If I've got a mobile device like this, do I pinch and zoom on it to zoom in and out of websites, or do I scroll up and down? That's basically what responsive is about. It's about moving content to fit the screen. By going through the process of changing your website more responsive, you're actually just writing better content and you're providing better information. The experience the consumer goes through on your website now it is responsive.


Gamification is a marketing activity whereby elements commonly associated with games are applied in non-game contexts. It can drastically increase the level of engagement of a user. Examples of gamification include awarding users with badges, points or levels for achieving certain goals, showing leaderboards that allow users to compare their relative contributions to a cause, or even offering prizes for outstanding contributions. Cultural aspects are very important in gamification. in Wordsworth proper segmentation has to be done to get an optimum result. For example, on Amazon, if you submit lots of reviews that users find helpful, then you get a badge saying you're a top reviewer, and there's a leaderboard of the best reviewers on Amazon. It can really make a huge difference, in terms of getting users engaged, and it could be something very simple. For example, LinkedIn at some point had just a progress bar saying that if you add the school that you went to, you'll get five more percent, five more points, so you get closer to completing your profile.

Data, privacy and analytics

People may choose to move away from free services to keep their data more private. Companies are now emerging to manage and control the data access permissions that individuals have granted. Personal data is data that we reveal about ourselves as we use computers. Things like behavior, things you click on, words you put into a search engine, but also more traditionally it's seen as things like your personal address, your name, your email address, your telephone number, things like that.

Autograph, erstwhile nFluence introduced Self-declared profile for users. Autograph lets people realize their interest and
helping marketers drive response rates. Without knowing user name, email address or any personally identifiable information, autograph can figure out over 5000 dimensions about you - age, income, likes and dislikes - at over 90% accuracy, allowing businesses to serve what matters to you - offers, programs, and music, almost anything. Other emerging profile-building services include Handshake, DataCoup and YesProfile, which enable individuals to earn money from revealing their self-authored profiles to marketers.


Most of the companies think about investing on tools and keep it on shelf as they will not invest on how to use it. We should focus on free tools and invest our budget to learn how to use it effectively. Free tools that are out there to help marketers to analyze the effectiveness of their digital marketing activities: Screaming Frog SEO, it's a very straightforward tool. It basically looks at websites. It indexes websites and creates a spreadsheet. 

For large-scale organizations drawing data from various different sources, real-time and in volume there are services or software available such as SPLUNK and that can analyze data real-time.

Monday, February 17, 2014

Customer Experience Management (CXM) Implementation Approach for Dummies

We have discussed the overview and importance of customer experience management in the previous article Customer Experience Management(CXM): The New Frontier for Companies to Focus on. Here is the recommended approach/process for the implementation of customer experience management in your organization

1. Business Goal definition and Strategy Implementation

Align your business goals with your customer engagement strategies. You have to first define the intended customer experience in line with your business goals. Few examples are brand awareness, customer satisfaction and loyalty improvement, Cost reduction, Market penetration, New customer segments, Enterprise Growth, Increase Revenue, New Products / Services creation, Innovation and so on. 
It is important to think about customers as individuals and to treat them as individuals, rather than just looking at a mass of customers. In other words, your individual customers should be the heart and soul of your organization. Creating a customer centric culture in your organization is important in order to deliver your brand promise. Then everyone in your organization can effectively work together to improve the customer experience. You can put a strategy in place in line with your business goal that will include the processes you put in place, the people involved, training, analysis, governance, and the specific technology needed. 

2. Build a Seamless Experience across Multiple Touchpoints

A touchpoint is any and all interactions a consumer has with a company via physical communication or digital media. Examples are Social Media, email, mobile, word of mouth, campaign pages, call centers, online chat, trade shows, blogs etc. Consumers are using these channels to influence their buying decision. It can be to get information, or interact with the company or past purchasers. Ensure that you’re presenting your audiences with a cohesive, consistent and engaging experience across their customer journey. 
Customers must be presented with an experience where content and brand is in accordance to the user and their context, and will be encouraged to move forward to what best leads them to conversion. Follow below steps to achieve this.

  1. Map out the multiple paths your customers take
  2. Determine the different touchpoints in the path
  3. Understand what customers are trying to accomplish and the actions taken at each.
  4. Understand what could prevent customers from moving to the next stage and solve them.

Companies should present a cohesive experience at every stage of customer experience. By taking a look at the customer journey and understanding how each touchpoints are connected or overlaps with each other, an organization can then plan out cross channel experiences that they can deliver. 

3. Asses your CXM Solutions

Organization requires an ecosystem of technology products working together in order to provide a personalized experiences across the touch points. Digital channels are growing and will continue to do so, enabling digital marketing to become a huge influencer. Take an inventory of all your systems of experience your company has in place today. Who do you use for web content management, analytics, CRM, marketing automation, email marketing, social media monitoring, and other repositories? What other types of technologies do you use to help you in delivering the best customer experience to your audience? 
For example, analytics solutions provide a way for organizations to track data, which in turn allows them to be customer centric because, to have a good CXM platform, you need to have a strong data management strategy in place. You also have to be able to track customers and that is a tie to CRM solutions. Email remains important because it is one of the predominant methods of communication used to keep in contact with customers. Web Content Management platforms are also important because content is the cornerstone of cross-channel engagement.

Also Read Customer Experience Management(CXM): The New Frontier for Companies to Focus on

4. Integrate Customer Experience Management Solutions 

Companies will want to adopt the right technology framework in order to have a clear, holistic view of the customer and deliver them with the best customer experience throughout their journey. Email Marketing, Web Content Management, Customer Relationship Management, Social Media Monitoring, Web Analytics, Videos, Social Media and Networks etc. are some examples for CXM solutions that will Enable You to Achieve Success. Each touchpoint should be in sync - the website, mobile, in-person, email, call center - calling for the organization to take a unified approach when properly implementing a customer experience strategy. 
Your customers not only visit your website, but also visit your Facebook page, read your emails, and interact with you through their mobile device. They’re going to weave their way in and out of every channel, so ensure they’re having a consistent and integrated experience no matter how they interact with your brand. The foundation to a successful CXM strategy is content which comes in many forms like website content, eBook, webinar, video, podcast, infographic, blog, article, slides, research report, etc.
To create a holistic view of your customer as well as have a full account of their interactions, you’ll need to successfully integrate these applications and contents together since these accurately record who your customers are, how they’re reacting, what they’re saying, and what they would like to achieve. In order to accomplish this, companies need to integrate their existing technology applications and contents into one comprehensive digital experience hub.

5. Deliver the Best Customer Experience 

Understanding who your customer is essential to providing them with the best customer experience. Personalization and Content Targeting can be achieved by presenting, at the right time, the most relevant content to each unique visitor based on the information you know about them to ensure they take the desired next step. You can build a customer profile and target the right information to them. Some of the examples are purchase history, demographic data, social data, preferences, site behavior, search history, device types etc. The Widespread Growth of Mobile and Social media can boost your customer experience delivery more efficiently and effectively.  

Mobile: Companies need to be aware of the wide array of the potential devices their customers could be using when they start thinking about their mobile strategy. If you are not presenting consumers with information via the channel they’re utilizing, it could potentially have a negative impact on your company’s brand image and sales. A location based service can be a best example in this context. If a customer is around the corner from your store, send them a notification that you’re having a sale if they opted in.

Social: Social is becoming an integral part of a customer experience. Consumers are interacting with companies on Facebook, Twitter, LinkedIn, and YouTube. Social’s main advantage is the ability for anyone to have a conversation with a brand and let their thoughts and experience is known to a much larger audience. Managing the customer experience across social media is just as important as managing their experience in person or on your website. 
Adding social sharing buttons such as “Like,” “Tweet,” LinkedIn Share, or Google + can spread your content. Brands should also consider adding commenting and ratings of products, services, blogs, and articles. Social media monitoring gives companies the ability to analyze numerous media channels – online news sites, blogs, forums and posts, and social sites. They can monitor the pickup and buzz surrounding their brand, competitors and industry and respond in real-time.

6. Analyze, Measure, and Improve

Companies are always looking for ways to improve the customer experience. By tracking how customers are responding to your channels and interactions and analyzing that valuable data, you can make improvements to the customer experience. Know which marketing messages work fine and which is not fine to further drive your visitors to take action. Start measuring how your customers distinguish their interactions across channels through technics likes social media analytics, surveys etc. determine how there metrics and models performing against your set strategies and goals. Apply appropriate corrections based on the findings will help you to meet the objectives.

Related Article: Customer Experience Management(CXM): The New Frontier for Companies to Focus on

Most Popular

You Might Also Like

Sunday, February 16, 2014

Customer Experience Management(CXM): The New Frontier for Companies to Focus on

CXM Overview

You might have heard about the new motto ‘Customer Experience Management (CXM)’ in many professional and official forums. Now days many people seem to be talking about it, analysts are writing about it and conducting many conferences dedicated to it and so on. So, what is it?

Customer experience (CX) is the sum of all experiences a customer has with a supplier of goods and/or services, over the duration of their relationship with that supplier. This can include awareness, discovery, attraction, interaction, purchase, use, cultivation and advocacy in the customer lifecycle. 

According to Gartner, Customer Experience (CX) is the customer’s perceptions and related feelings caused by one-off and cumulative effect of interactions with a supplier’s employees, channels, systems, products and services. 

Amazon, Zappos, Apple, Disney, Nordstrom, Starbucks and Marriott are few examples who pioneered in customer experience management and proved number one in their business areas. Starbucks spent less than $10MM on advertising from 1987 to 1998 yet added over 2,000 new stores to accommodate growing sales. Starbucks' popularity is based on the experience that drove its customers to highly recommend their store to friends and family.

A company's ability to deliver a product or service experience to its customers helps to increase the consumer spending with the company and increase loyalty to its brands/products. Loyalty is mainly driven by a company's interaction with its customers and how well it delivers on their wants and needs. The function/entity within an organization having the goal of establishing and improving customer experience is called customer experience management or customer relationship management.

Building great customer experiences is a complex initiative involving strategy, leadership commitment, technology integration, formulating and fine turning business models and brand management. Customers have an experience every time they interact with a company/brand—whether it is shopping in a department store, using a mobile device, grabbing coffee or making bill payments. That experience can be good or bad or somewhere in between. This experience impacts their impression and loyalty to the brand/product/company. Customers feel more loyal to those brands and buy/use more when they have a delightful experience. Customers’ expectations are growing; companies that completely ignore CEM will be far behind. 

Critical Success Factors

Here are few critical Success factors for an effective CXM initiative in your organization.

1)Define CXM : Amazon and Starbucks provide totally different kinds of customer experiences, and both are successful. Define what CXM means in your organization. Each entity/function in your organization should be clear on how they contribute to CEM and how they can seek to improve it. 

2)Funding: Have a budget for CXM investments. Some initiatives may involve the purchase of software, resources, or other resources. 

3)Cultural Change: Managing the customer experience should be part of the company culture. Initiative requires full support from executives, division heads, and then all employees. 

4) Management Commitment: Strong management commitment is needed for implementing a sustainable CXM initiative. 

5)Incentives: If a company is placing their customers’ experience as a high priority, then its employees should be incentivized for the success in a way that aligns with the KPIs.

CXM implementation Approach

Customer Experience Management topic is very broad and complex, no one can really offer a universal approach that works for every company. The breadth of organizational coverage, along with the specific qualities/goals will decide the complexity of CXM implementation/improvement within the organization. The vagueness in definition and details gives each company the freedom to define and implement the customer experience in a way that best suits to their business model. Here is the recommended approach for the implementation of a customer experience management in your organization


Customers are more demanding now than ever. They feel that interacting with every company should be easy and personalized. For example, when I have already logged into my Amazone site, I shouldn't have to fill out my address again to request for a shipment. They already have all of my information. Why should I ever have to repeat it?
Customer Experience Management as a concept is important because it involves looking at the company from a customer’s perspective. Right digital tools, skill set, culture and processes can help your company to provide best in class user experience to your customers. Knowing who your customers are and presenting them with consistent, relevant content across all the touch points in which they interact with your company will help you to further engage your customers leading to business success. Start leveraging all your CXM technologies, and enable them to work together. This will allow you to deliver the optimal experience to your customers, thus increasing customer satisfaction and loyalty, bringing immediate impact to your brand name, as well as long term benefit to your company.

Related Article: Customer Experience Management (CXM) Implementation Approach for Dummies

Sunday, February 2, 2014

How to Initiate Social Media Analytics in your Organization? Here is the Simplified Implementation Framework!

As a prerequisite for social media marketing, you need to have a clear understanding of your overall vision, what your goals will be, and how you will track and measure the success of your social media initiatives. In other words, you must create a social media analytics plan.

The first step in a social media analytics initiative is to determine which business goals the data that is gathered and analyzed will benefit. Typical objectives include increasing revenues, reducing customer service costs, getting feedback on products and services and improving public opinion of a particular product or business division. This can be achieved by monitoring how the users are looking at your brand/products and how they are looking at your competitors. When we are talking about ROI, there is no single ROI we can point out. The business impacts of social media various at different levels in the organization. For example, the C-level executives care about metrics such as brand reputation, revenue, customer satisfaction etc. At the same time, the business unit heads and line managers are interested in more granular metrics specific to their goals.

Define Strategy

A successful social media strategy requires alignment with the strategic business goals of the organization, organizational alignment and required support/commitment to enable the execution. We have to define what we are trying to achieve and how we are going to approach it. Defining the success criteria will help to drive the initiatives and evaluates the effectiveness. Strong organizational commitment and support is needed to implement the strategies.

Define Measurements

Always advisable to begin with few key metrics that you believe are practical to deliver and actionable. They should give the most impact on your business. Formalize those metrics with process and dashboard and then expand further by adding other metrics in an incremental approach. Here are a couple of guidelines you should follow when defining KPIs:

  1. Select key performance indicator(KPI) metrics that translate into business context like sales, revenue, business leads, lead conversion, customer interaction, conversions, etc.
  2. Create specific social media analytics metrics for each social network site and specific elements of your website
  3. Define actionable social media analytics

The most important guideline above is to define actionable metrics and here are few examples
  • Reduction in support costs
  • Number of people in a specific location who follow your company on Twitter
  • Reduction in sales cycles
  • Increase in product reviews

Resources & Tools

You have to asses your readiness to measure social media in terms of present state of the organization, probable barriers and strategies to overcome it, resources, required analytical and tools expertise and communication strategies. A successful social media analytics implementation and operation depends on the integration and effective utilization of all means in the organization.


The organization identified financial performance improvement as a key objective. Identified call center operation cost reduction as one of the ways to improve the financial performance. In order to provide the same quality of service to customer, organization decided to respond proactively to users through social media like twitter and facebook. Here the call center cost performance becomes the business KPI and number issues solved via social media become the social media metrics.

Check list

Since social media analytics is in the early stage of adoption, there aren't any well-established frame works are published anywhere. However organizations have to follow the discussed minimum critical steps to build a business focused social media strategy.

Sunday, October 13, 2013

Social Media Analytics Overview and Value Metrics

Social media is a emerging medium to understand real-time consumer preferences, sentiments and intentions. Social media analytics is the tool to uncover the customer sentiments from social media dispersed across online sources.
According to Gartner’s Definition, Social analytics is monitoring, analyzing, measuring and interpreting digital interactions and relationships of people, topics, ideas and content. Interactions occur in workplace and external-facing communities. Social analytics include sentiment analysis, natural-language processing and social networking analysis (influencer identification, profiling and scoring), and advanced techniques such as text analysis, predictive modeling and recommendations, and automated identification and classification of subject/topic, people or content.

What your Management is Looking for?

The management wants to hear how the organization strategies, initiatives and business goals performing over a specific period of time. Social Media Analytic helps your organization answer many questions like:
  • What are consumers saying and hearing about my brand/Company? Is my reputation affecting?
  • Which initiative/effort has the greatest impact? 
  • What are the most talked about product attributes in my product category? 
  • Is the product/service feedback good or bad?
  • Competitor insights
  • Customer growth metrics
  • Customer Quotes
  • Customer Action Taken

Social Media Analytics Value Metrics

Social media analytics solutions in general can help your business by

  1. Capture consumer data from social media to understand opinions, attitudes, trends and manage online reputation
  2. Predict customer behavior and improve customer satisfaction by recommending next best actions
  3. Create customized campaigns and promotions that resonate with social media participants
  4. Identify the primary influencers within specific social network channels

Here is the Detailed Social Media Analytic value metrics

Brand Health and Awareness

This is nothing but the measure if how people feel about your brand, talk about and act towards your brand. By measuring the you can mitigate or block crisis and understand the scale of reputational threats and possible opportunities. The brand health can also be a measure of net promoter Score(NPS). NPS is the difference between percentage of promoters and detractors. You will have a positive brand health if the NPS is above Zero. 
  • Sentiment analysis
  • Competitive performance
  • NPS measurements

Sales & Marketing optimization

Marketing and sales divisions can measure how their marketing and sales promotion activities are performing in the market. Based on this organization can understand how the initiatives are influencing purchase behavior, brand perception etc and to plan future initiatives. Suitable correction can be applied for the ongoing initiatives as well for better benefits. Fe examples of marketing measurements are 
  • Campaign measurements
  • Influencer impact
  • Content Performance

Improved Revenue Focus

Social media cannot directly generate revenue. The revenue has to be considered as a combination of tangible components like real revenue and intangible components like generating loyal customers. Social media plays an important role in purchase process and understanding this, you can change the customer intents. But focused and continuous customer engagement and interaction, you can convert the detractors to promoters and probable customers to customers. All these efforts will be resulted in the overall revenue of the organization. Few example measurements are
  • Impact of social media search results
  • Loyalty measurements
  • Revenue

Operational Optimization

Social media interactions with customers improve not only customer experience, but also provide scale as solving one person’s problem is visible to others as well. This will help to reduce effort for repeatedly addressing the similar issue to other customers. In the same way, by effective social media customer interactions/engagement, organizations can reduce the call center call volumes and intern reduce the operation cost by answering through twitter page or similar social media forums. Few examples are
  • Cost containment opportunities
  • Potential cost savings from Contained calls
  • Super fan/Advocacy identification 

Better Customer engagement

Better customer experience will provide brand health, cost saving and revenue optimization. Social media can e considered as an early warning system. Whenever organizations found an issue in the media, they proactively fixed before the issues getting aggravated and customers keep informed. Examples of customer experience measurements are
  • Attitude
  • Intensity (Momentum of otpic)
  • Issues & crisis

Product/solution/ Service innovation

Companies can get innovative ideas from social web by monitoring feedback, comments, issues from own products and from competitors. So far companies used to get these ideas from their own websites (Eg. mystarbucksideas.com) and now they no longer need to depend on their own sites which can even shutdown for cost optimization. Few Measurement samples are
  • Opportunities and threats
  • Idea impact and response

Major companies adopted SMA

Dell Social Media Analytic Command Center 

Social Media Analytic is widely adopted organisations especially those who are in to consumer products, entertainment business and Service. Few examples are Dell, Proctor & Gamble, Warner Bros, Star Bucks, American Express, DIRECTV, JetBlue Best Buy, Royal Bank of Canada, Whirlpool, etc.

Popular Social Media Analytic Tools

Salesforce Radian6, Alterian SM2, Adobe, IBM, Oracle, SaaS Analytics, Social mention, scout lab, Trenderr, Blogplus, Apark, Collective Intelluct etc

Saturday, September 28, 2013

Cancer Detection by IHC Scoring Techniques: How Technology can Aid in Diagnosis/Prognosis Workflow

Immunohistochemistry (IHC) is one of the fast growing technologies for elucidating the diagnosis & prognosis of various cancers. Immunohistochemistry (IHC) refers to the process of detecting antigens like proteins in cells of a tissue section taken during biopsy. Identifying and scoring cancer markers plays a key role in oncology to characterize the tumor, determining the aggressiveness, predicting patient outcome for many cancer types and finalizing the treatment procedure. IHC staining of biopsy samples with antibodies to specific molecular markers is a major component in this process. It uses a scoring system (+1, +2, +3) which will help the pathologist to diagnose the cancer as well as aid the doctor to finalize the therapy. IHC is used in many cancer type detection like Breast, Prostrate, Lung, Ovarian, Liver, Pancreatic, Leukemia etc. 

What is Bio Markers?

IHC for Her2 (strong and diffuse,
 circumferential membranous staining, 3+)
A cancer biomarker refers to a substance or process that is indicative of the presence of cancer in the body. A biomarker may be a molecule secreted by a tumor or a specific response of the body to the presence of a specific cancer. Most Bio markers (tumor markers) are found to be proteins and some patterns of gene expression and DNA changes are also considered to be tumor markers. More than 20 tumor markers have been developed for clinical use. One kind of cancer is normally featured with one or more tumor markers. IHC Test menu for clinical diagnosis will increase when more bio-markers are discovered in the future. Here are few sample Biomarkers for better understanding.

  • Cancer types: Breast cancer, gastric cancer, and esophageal cancer
  • Tissue analyzed: Tumor
  • How used: To determine whether treatment with trastuzumab is appropriate
Estrogen receptor (ER)/progesterone receptor (PR)
  • Cancer type: Breast cancer
  • Tissue analyzed: Tumor
  • How used: To determine whether treatment with hormonal therapy (such as tamoxifen) is appropriate
Alpha-fetoprotein (AFP)

  • Cancer types: Liver cancer and germ cell tumors
  • Tissue analyzed: Blood
  • How used: To help diagnose liver cancer and follow response to treatment; to assess stage, prognosis, and response to treatment of germ cell tumors

Purpose of bio markers

By quantitatively measuring the biomarkers, doctors can efficiently predict oncogenesis and diagnose a cancer as benign or malignant, determine the stage and the grade of a cancer. Following are the main purposes

  1. Cancer Diagnosis
  2. Prognosis and treatment predictions: To determine the aggressiveness of an identified cancer as well as its likelihood of responding to a given treatment
  3. Pharmacodynamics and pharmacokinetics: To determine the most effective treatment for the identified cancer.
  4. Monitoring treatment response
  5. Recurrence: Predicting or monitoring cancer recurrence.

IHC Workflow

IHC Scoring Example :
 Breast Cancer Diagnosis flow by digital pathology
A lab receives a specimen from a biopsy and prepares a block from which an H&E (Haematoxylin and Eosin) slide is prepared. The typical IHC workflow starts with the diagnosis of cancer by a pathologist reviewing the H&E slide. After initial diagnosis, pathologist orders an IHC panel. An IHC panel consists of consecutively cut slides from the same specimen block that are then stained with different IHC stains. A typical IHC panel for breast cancer includes three IHC stains say, HER2 (Human Epidermal growth factor Receptor 2), ER (Estrogen Receptor) and PR (Progesterone Receptor). The pathologist then provides a semi-quantitative assessment of the IHC slides to determine the appropriate treatment option.
IHC Score 1+, 2+, 3+ at 20X zoom

HER2 is a membrane stain from which the pathologist assesses the intensity and completeness of the membrane staining of the tumor cells and determines a score of 0, 1+, 2+ or 3+ for the slide. HER2 is used specifically to determine the aggressiveness of breast tumors and to assess Herceptin® (Trastuzumab) as a treatment option. ER and PR are nuclear stains from which the pathologist assesses the staining intensity of the nuclei of the tumor cells and determines the percentage of positive stained nuclei as a percentage between 0 to 100% and the average staining intensity of the positive nuclei as a score of 0, 1+, 2+ or 3+.

NB: If the IHC HER2 test results are negative or borderline, patient may ask her doctor about getting the FISH(Fluorescence in situ hybridization) test, which uses different technology to measure HER2 status. If the FISH test results are borderline, she might want to ask the doctor if more than one pathologist reviewed the results. If the HER2 test results weren't reviewed by more than one pathologist, patient may ask if the results can be reviewed again to make sure the correct diagnosis/prognosis. FISH is considered more accurate. In many cases, a lab will do the IHC test first, ordering FISH only if the IHC results don’t clearly show whether the cells are HER2-positive or negative.

Method of cell detection

1. Visual observation by a health care professional : this the conventional method by which Pathologist is looking a the specimen using a microscope and performing the diagnosis.

2. Colorimetric pattern recognition (Microscopic examination of prepared cells by size, shape, hue, and intensity as observed by an automated computer controlled microscope and image processing tools. A combination of Whole Slide Imaging (WSI) digital microscope and approved IHC scoring image analysis tools enables this process. 

Image Capture by Digital Whole Slide Imaging(WSI) Microscope

The specimen slide will be scanned by a digital microscope and generate digital image for diagnosing. high zoom digital cameras are using for scanning the slide. The camera will take picture of the required ROI as decided by the pathologist or it takes picture of the entire slide. the number scanned images will be depends on the zoom selected. the typical zooming options are 10X, 20X, 40X, 80X etc. Finally the scanned images are  stitched by imaging processing tools and create the complete whole slide image. the images will be typically stored as JPEG files in the image repository. 

Whole SlideImaging WSI
digital Microscope
The Pathologist will access  the image using image viewer software are diagnosing the cancers. The image viewer will support typical image processing and editing tools to make the process more convenient. Once the manual diagnosis is completed, image along with the diagnosis results will be stored back to the laboratory information system(LIS). The digital microscope is supported by slide loaders, bar code readers, lenses, digital camera, slide loader and powerful computer. Olympus, Dako, Aprio, Ventana, Hamamatsu etc are market leaders in WSI microscopy.

IHC Scoring by Image Processing Techniques

IHC Scoring Image analysis flow

The pathologist has to select the Region of Interest(ROI) during the using the proper image editing viewer software. Pathologist can select multiple ROIs in a single slide. Based on the primary investigation inputs, perform the cell classification and then decide on the specific analysis based on the analysis.   Pathologist can select single/multiple algorithms depends on the bio marker to be counted say analysis for Her2, EP, PR etc.  The selected image and corresponding settings shall be will be stored in the image storage/LMS. 

IHC Scoring Tissue diagnostics workflow
The image analysis batch process will access the image and perform the analysis. the analysis will be performed for the marked ROIs. algorithm will count the specific Biomarker from the image and store the report in the LMS.   Finally the pathologist can access the report and perform the diagnosis/prognosis.  Typically the image analysis is a time consuming process due to large image size. Hence very high end systems are required to perform the activity. IHC test results are most reliable for fresh or frozen tissue samples. IHC tends to be an unreliable test for tissue that's preserved in wax or other chemicals. Many IHC analysis process conforms to CPT codes for computer-aided quantification of prognostic markers which will increase reimbursement opportunities. Examples of IHC scoring tools are

1)IHC Nuclear Image Analysis algorithm from Aprio

2)iAnalytics from Bioimagine(recently acquired by Roche)

3)CellMapTM algorithm from Bioscience.

4)ALK Scoring from Ventana

Regulatory Compliance requirements

Regulatory compliance and approval are required for the digital image acquisition techniques, IHC stains( e.g. HER2, ER, PR, Ki-67, P53, EGFR), reagents(e.g. Dako, Ventana, image analysis software etc. Specific approvals are required for research, diagnosis, prognosis etc. the approvals are required for target country requirements. For example, approvals are required from Food and Drug Administration(FDA) for US, approvals from Ministry of Health, Labour and welfare(MHLW) for Japan etc.