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The Future ofMedical Publishing
Dr Maria Kouimtzi
Editorial Director Pharmacy & Informatics
Global Clinical Solutions
Wiley-Blackwell
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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
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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
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The pharma model
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• 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
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Future trends
• How in how the content is delivered:
OA, Handhelds
• Changes in the type of content:
CDS products, ‘clever’ content, CPD
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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)
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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
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•Reference
•Clinical Decision Support (CDS)
•Access to EHR
•Clinical data input/output
•Rich data sharing
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OS
VS. VS.
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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.
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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.
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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...
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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
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Patient on Glitazonetreatment and cardiacinsufficiency diagnosed
= input to DS engine. = output from DS engine
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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
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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
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‘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
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Featured articles
Read the original
Hear the author
Attend the lecture
Earn CME points
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• Podcasting– Based on journal content– Feedback and commentaries– Interviews with authors
• Blogging– Editor Correspondence– Society leader blogs
• Webinars
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Social networking
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e-newsletters• Quarterly e-newsletter• Shop window • Editorial• Free articles• Book chapters• Fun stuff• Learning Centre
content
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CPD
•4-6% growth
•compulsory CME in many
countries
•electronic solutions, tailored for
students faculties, health
institutions, educational institutions
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