The Future ofMedical Publishing

Dr Maria Kouimtzi

Editorial Director Pharmacy & Informatics

Global Clinical Solutions

Wiley-Blackwell

The business

• comprised of significant commercial players, world-

leading university presses and a large group of not-for-

profit learned society publishers

• ex-UK turnover of around £1bn per annum, of which

80% will derive from subscriptions overseas

• UK is a world hub, alongside the US, the Netherlands

and Germany

The business

• publishing 1.7m peer-reviewed articles/ year in > 20,000

journals

• 40% of activity derives from the US (JAMA, NEJM), 25%

of activity from the UK (Nature, The Lancet, BMJ)

• no. of published articles grown consistently for many

years by around 4% pa

• journal submissions growing by 5-10% pa on average

The pharma model

• 2000-2005: sales of print books went into decline

• Picture is mixed, varies according to market

• UK: R&D budgets ring-fenced

• Germany: impressive 10% increase in R&D budget

• China: above inflation increase in R&D budget

• US: Obama’s pledge to double NIH budget over next

decade, extra $3 bn for NSF in stimulus package

Future trends

• How in how the content is delivered:

OA, Handhelds

• Changes in the type of content:

CDS products, ‘clever’ content, CPD

Open Access• Gold: author/funder/ institution pays a fee to the publisher to

make the peer-reviewed published article available on open

access immediately on publication

• Green: sponsorship with public or charitable funds. A version

of their article is accessible in an open repository, which

could be managed on a subject basis (e.g. UKPMC) or on an

institutional basis (e.g. the University of Southampton)

Handhelds

• 59% of all adults in the US are now mobile internet users

• 175,000 US physicians using an Apple device

• >250,000 apps for iPhone

• 30,000 apps for Android OS

• 6,000 apps claim to be delivering health, medical, and

fitness functionalities

• <30% are aimed to health professionals

•Reference

•Clinical Decision Support (CDS)

•Access to EHR

•Clinical data input/output

•Rich data sharing

OS

VS. VS.

0

50

100

150

200

250

Scholarlyjournals

Tradejournals

Books Reports Patents

Engineers

Scientists

MedicalProfessionals

Average annual amountof reading

Source: Tenopir C (2004) User Behavior Across International and Disciplinary Boundaries.

Proceedings of the American Society for Information Science and Technology. Volume 41,

Issue 1, pages 20–30, 2004.

Are journal articles read?

Work field Articles read

(per year)

Time spent

(hours)

Time per article (min)

Medicine ~322 118 22

Chemists ~276 198 43

Life scientists ~239 104 26

Physicists ~204 153 45

Soc Sci/Psych

~191 121 38

Engineers ~72 97 81

Source: Tenopir C (2004) User Behavior Across International and Disciplinary Boundaries.

Proceedings of the American Society for Information Science and Technology. Volume 41,

Issue 1, pages 20–30, 2004.

Presenting symptom

Dx: Tests

Dx: Diagnosis is made

Dx: investigations

Dx: consider differential diagnoses

Dx: History

Tx: First line (medical?)

Tx: First line (medical?)Co-morbidities Renal / hepatic impairment?Interactions?Side affects acceptable?

Tx: 2nd line (medical?)

Tx: failure

Tx: success

Ongoing: monitor condition, need for ongoing treatment (side-effects?)

Clinical pathway: decisions, decisions...

Presenting symptom

Dx: Tests

Dx: Diagnosis is made

Dx: investigations

Dx: consider differential diagnoses

Dx: History

Tx: First line (medical?)

Tx: First line (medical?)Co-morbidities Renal / hepatic impairment?Interactions?Side affects acceptable?

Tx: 2nd line (medical?)

Tx: failure

Tx: success

Ongoing: monitor condition, need for ongoing treatment (side-effects?)

Clinical pathway: with CDS support

Patient on Glitazonetreatment and cardiacinsufficiency diagnosed

= input to DS engine. = output from DS engine

CDS: why?

•Staying up to date with drug information

•Identifying therapeutic conflicts

•Managing large volumes of medical and patient

data often in different systems

•Reducing medical error and improving safety

•Improving productivity and assisting with coding

compliance and reimbursement

CDS: the market• approximately 10% of the medical publishing business relates directly to

clinical solutions

• 2 two key players in this market at present:

• Reed Elsevier: 20% market share, First Consult responsible for 21% (€ 21

million) of Reed’s health revenues

• Wolters Kluwer: 15% share, UpToDate responsible for 20% of Wolters’

health revenues (€ 15 million)

• CDS divisions within Reed and Wolters have shown the largest actual and

predicted growth rates of around 6 – 8% pa

• 10-12% predicted growth pa for overall business

‘Clever’ contentEditors’

commentaries

Reviewers’ comments

Correspondence / e-letters (moderated

blogs)

Authors’ postscripts

Links to podcasts

Multiple versions of images & links to image banks

related books, related websites

Featured articles

Read the original

Hear the author

Attend the lecture

Earn CME points

• Podcasting– Based on journal content– Feedback and commentaries– Interviews with authors

• Blogging– Editor Correspondence– Society leader blogs

• Webinars

Social networking

e-newsletters• Quarterly e-newsletter• Shop window • Editorial• Free articles• Book chapters• Fun stuff• Learning Centre

content

CPD

•4-6% growth

•compulsory CME in many

countries

•electronic solutions, tailored for

students faculties, health

institutions, educational institutions