The Future of Medical Publishing Dr Maria Kouimtzi Editorial Director Pharmacy & Informatics Global Clinical Solutions Wiley-Blackwell

1. The Future of
Medical Publishing
Dr Maria Kouimtzi
Editorial Director Pharmacy & Informatics
Global Clinical Solutions
Wiley-Blackwell

2. 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

3. 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

4. The pharma model

5. • 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

6. Future trends
• How in how the content is delivered:
OA, Handhelds
• Changes in the type of content:
CDS products, ‘clever’ content, CPD

7. 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)

8. 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

11. •Reference
•Clinical Decision Support (CDS)
•Access to EHR
•Clinical data input/output
•Rich data sharing

12. OS
VS. VS.

13. 0
50
100
150
200
250
Scholarly
journals
Trade
journals
Books Reports Patents
Engineers
Scientists
Medical
Professionals
Average annual amount
of 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.

14. 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.

16. 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...

17. 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

18. Patient on Glitazone
treatment and cardiac
insufficiency diagnosed
= input to DS engine. = output from DS engine

21. 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

22. 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

23. ‘Clever’ content
Editors’
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

24. Featured articles
Read the original
Hear the author
Attend the lecture
Earn CME points

25. • Podcasting
– Based on journal content
– Feedback and commentaries
– Interviews with authors
• Blogging
– Editor Correspondence
– Society leader blogs
• Webinars

26. Social networking

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

28. CPD
•4-6% growth
•compulsory CME in many
countries
•electronic solutions, tailored for
students faculties, health
institutions, educational institutions