Focus On: STM: Keeping Dr. Google Away
In an age of instant information access, professional and scholarly publishers have to get smarter when developing products to fit audience workflows. Simply having a large catalogue of titles is no longer enough; from finance to education to STM, users expect information to be tailored to their day-to-day needs and priorities. Meeting these requirements can spell the difference between a successful product and a dud.
In the medical field, semantic search technology has enabled targeted features that put information before users in new ways. Elsevier, the global publishing giant, has found a way to repurpose its vast stores of books and medical journals (constituting 25 percent of the world's research, according to the company) with a focus on the way doctors seek and use information in the course of providing clinical care.
"On the health science side, what we saw was we had this amazing data, but we found that practicing physicians, clinical physicians in the hospital weren't able to access it, to pull it out in a way that was as useful as it might have been," says Jim Donohue, Managing Director, GCR/Elsevier Health Sciences. "The days of a doctor thumbing through a large medical textbook are over."
The key, Donohue says, was to build in discoverability—though this is easier said than done. Exactly how do doctors search for information? What search results are most valuable to them, and when? The company talked to more than 2,000 doctors, had physicians keep diaries of how they used information and conducted over 20 focus groups in an attempt to understand exactly how content was used.
"We realized we had the content but probably not in the format that we needed," Donohue says. The result was ClinicalKey, an online search portal drawing from all of Elsevier's clinical content: every book, journal and content delivery mechanism related to patient care. Over 20 million pieces of content are semantically tagged down to the sentence level and linked to a proprietary taxonomy. "When a physician enters a search term into ClinicalKey, they get a clinically relevant response, versus a Google response or a Wikipedia response, where heaven knows what you get, there is no curating at all."
Launched in April, the service is "well on its way to meeting our expectations for the first year," Donohue says. ClinicalKey works on a two-tiered subscription model. A "flex model," which allows access to all content, ties price to usage (though charges are never increased more than 5 percent in a year). Such a model allows institutions to not feel they are paying for vast amounts of material they would never access. "They want to pay for the content that is relevant to [a particular] clinical workflow," Donohue says. "We are able to reflect that in the price."
This fall, Elsevier plans to launch an individual version of ClinicalKey, built around collections targeted to specialist areas and operating on a straight subscription model. "This is not built around access to all of our content, but around access to a series of collections in 46 specialty areas which allow a physician in individual practice or a specialist … to access the wide body of content and benefit from this taxonomy," Donohue says. The service is primarily for librarians and doctors who have very specialized interests.
Donohue says ClinicalKey is not meant to supplant or replace any of Elsevier's books or journals. In addition to drawing on existing content, the company is creating new content to support the service—e-abstracts to allow quick glances into surgical data, for instance. But the main focus is making core content more discoverable.
ClinicalKey is also not expected to drive book sales or journal subscriptions, though it could help facilitate such sales if physicians find themselves often using content from a particular publication. That said, there are some core publications (such as "Braunwald's Heart Disease," the "bible" of cardiology) which Donohue says doctors appreciate having both on the shelf (or on an e-reader) and in ClinicalKey. "The use case is different" on different platforms, he notes. "When we built it we thought journals use would be the highest [source used] by far. But what's happened is, especially in the surgical specialties … the book content has become really preeminent," because surgeons are able to do quick reviews and access multimedia content related to established procedures.
The driver of ClinicalKey is its semantic search algorithm. The goal of semantic search is to improve search results based on context and user intention. Built into ClinicalKey are 250,000 terms and 4 million semantic relationships within those terms, which are constantly being tested and updated. Because tags need to point to clinically relevant answers—and do so 98 percent of the time, Donohue says—the system is designed to learn from every search conducted, mainly by monitoring the number of steps taken by searchers to reach desired content. In addition, doctors are asked on an ongoing basis what responses should be for different queries in specific disciplines, which helps to improve and refine the algorithm.
Beyond semantic search, other tools are built in with an eye to how doctors actually conduct their day-to-day business. Elsevier's research found, for instance, that 20 percent of the research done on ClinicalKey and products like it (such as Wolters-Kluwer's UpToDate, see p. 29) is undertaken for presentations. As a result, Elsevier allows researchers to easily discover images and put them directly into powerpoint format with caption and rights information included. "This has been wildly received by our physicians," Donohue says. "If you can't find the image you want in the Elsevier database, it probably doesn't exist."
New journal content is constantly drawn into ClinicalKey through back-end CMS processes. "Every day the whole database is updated, and it's constantly being crawled for re-indexing, so a new journal article … goes right into the database," he says. By the end of the year, plans call for continuous updates of the top 200 books in Elsevier's catalogue through integration with the company's Expert Consult platform, which handles updates of the e-editions of these books.
Sophisticated tools for saving searches allow doctors to pull books and articles into personalized reading lists and email them to colleagues. While currently Web-based, iPad and mobile versions of ClinicalKey are planned for release before the end of the year. In developing these products, doctors were asked about their needs and "pain points" with mobile interaction (desired type size, when and where utilized, etc.)
Next steps for ClinicalKey include building "care team" products with content geared to nurses and technicians working in specialty areas. Also in the development stage is integration of the search service with individual medical records to create customized content buckets geared to treating specific patients, not just specific maladies. BB