Access granted

In April, industry personnel involved in medical peer-reviewed publications met with editors, publishers and medical communication agencies at the 6th International Society for Medical Publication Professionals (ISMPP) Annual Meeting, 'Delivering Value and Driving Advocacy in Medical Publications'. Among the key topics discussed was the emergence of new communication routes, such as social networks, live information feeds, enhanced web portals and open access publishing, along with the impact of these technologies and approaches on medical publications.

This article looks at the points raised by Michael T Clarke (Clarke Publishing Group), Tom Easley (managing director of the New England Journal of Medicine [NEJM]) and Natasha Bailey (BioMed Central) at the meeting and investigates how thinking must be adapted to maximise the value of publications to physicians and other healthcare professionals.

Open access
There is something very academic about opening up a new issue of your favourite journal that arrives via the postman and lands on your desk, after an additional journey via the internal mail system.

Consequently, when 'online' journals initially appeared, some traditionalists looked down their noses (and over their bifocals) at them. No longer is that true; some credible open access journals have established themselves alongside their decades-old (and sometimes centuries-old) hard copy, subscription counterparts. Add to this the commitment of many research institutes to utilise the open access approach as the sole means to publish their academic research, and the case for the open access approach becomes compelling.

Three models of open access publishing exist:
• Full open access publishing, where all research articles are freely available, usually on payment of an article processing charge by the author who holds the copyright under a Creative Commons licence. This accounts for 78 per cent of all open-access publishing
• Hybrid open access, where, in a subscription-based journal, authors may choose to make their article open access at the article level on payment of an article processing charge. This accounts for 14 per cent of all open access publishing
• Delayed open access, where articles in a subscription journal are made available by open access after an embargo period. This accounts for eight per cent of all open access publishing.

With a print journal, circulation figures or subscriptions can be used as a surrogate for how many people read content. But this crude measure assumes all subscribers will read this content and does not include those people who download a pay-per-view article from the internet. The added advantage of open access journals is the ability to analyse article-level metrics such as downloads, comments and related social media postings. Certain online journals actually tell you how many times your article has been downloaded or viewed. For example, PLoS Medicine's infamous article "Why Most Published Research Findings Are False", published in August 2005, remains its most viewed article, with over 270,000 total views, and no signs of this growth stopping.

Open access publishing provides not only wider dissemination of data and more information about that dissemination, but faster publishing, as online content is uploaded sometimes months before the print issue version. Additionally, the lack of space constraints, as found in the traditional paper journals, means there are fewer restrictions on the volume of manuscripts that can be published and the ability for all data from a trial, including its protocol, to be published in a single place. Overall, the growth of open access publishing has certainly given research more visibility and is becoming an increasingly attractive publication route.

Enhanced experience
As technology advances, so does the expectation of the medical community about the way in which medical information is provided. New approaches to communicating medical information have impacted how physicians learn and assimilate that information and publishers of forward-thinking journals are adapting to that new environment and taking advantage of the opportunities it provides.

The days of simple text, figures and tables have gone and healthcare professionals are enjoying media-rich, and sometimes interactive, ways of understanding new data. The New England Journal of Medicine (NEJM) is a prime example of how a traditional journal has evolved. Weekly content is summarised in a podcast and article downloads are supplemented by video, audio summaries and slides, author interviews and continuing medical education (CME) exams. There are approximately 128,000 downloads per month for NEJM video of all types, which demonstrates its popularity. In addition, the journal does not post information just on its own site, but also shares learning videos via YouTube.

Content is also being tailored for mobile devices, such as smart phones, tablet computers and electronic book readers.

Journals and medical societies have taken three different routes: configure an existing site for the mobile web; develop applications for existing content to deliver it via portable devices and develop new content specifically for mobile applications. The last of the three approaches gives a new opportunity to provide healthcare professionals with point-of-care information that has not been available to them previously.

The advent of social networking has changed the one-way nature of information delivery, enabling healthcare professionals from around the world to discuss cases, exchange ideas, and ask real-time questions of peers within the healthcare community. The audience of clinicians who use the 'awareness model' to synthesise new evidence is narrowing, while the audience of clinicians who utilise the 'community model' to synthesise new evidence is just starting to emerge. Therefore, the potential exists for the synthesis of new evidence to be increasingly interactive and social.

Social media is a common topic of conversation in the industry, so it is interesting to consider how this is affecting medical publishing, as well as how it may evolve over the next few years. Key aspects of this include use of blogs and immediate response/comment facilities on journal websites, use of general-purpose networks such as Facebook and Twitter and the development of specific custom-built networks.

Everybody seems to have something to say these days and we are seeing more and more 'blogging' journals. The Nature journal group has grasped the blogging concept, with blogs written by editors and journalists and members of Nature Network, as well as aggregating posts from third parties. PLoS Medicine and British Medical Journal (BMJ) are other examples of journals that supplement their official journal content with frequent blog posts.

The subsequent commenting on blog posts, or in response to a medical publication, provides a valuable, rapid, method of disseminating views to a wide audience, allowing readers to post comments, responses and questions to the author of the material in question. This approach enables immediate debate of the topic. Providing the target audience with the ability to comment and debate in an interactive manner should not only enhance the interest of the readers, but also increase the likelihood of their assimilating knowledge and information.

The use of existing networks, such as Facebook and Twitter, extends the potential for debate beyond the journal's own website and allows information to be discussed in a portal already familiar to a large amount of the target audience. The advantage of this approach is that it does not increase the number of places that must be visited to gain information, as people are likely to be accessing these networks for other reasons already.

A potential disadvantage, however, is the lack of focus of the audience that may be accessing the material, leading to a potential dilution of effort. Although developing a bespoke network has clear advantages, in terms of the specific focus of the site, the audience and the content, the downside is that it requires site hosting and maintenance, as well as promotion, to ensure uptake by the desired audience. So, while most journals have this 'bespoke' approach, many have also chosen to have some presence on either Facebook or Twitter, or both. 

Signficance
The advent and growth of social networking, mobile content, interactive web-based learning and communication, as well as open access publishing, herald a new era for medical publishing, and allow for the fast, effective and transparent dissemination of data and information, together with the subsequent real-time comment, discussion, and questioning by physicians worldwide.

Coined by the New York Times as the "First Law of Zuckerberg", Mark Zuckerberg, the CEO of Facebook, predicts that next year, people will share twice as much information as they share this year and the next year, they will be sharing twice as much as they did the year before. If this is true, having our medical publications readily accessible to all target stakeholders and utilising technology to share that information within communities is surely key.

In the old days of publications, journal print circulation figures, lead times from submission to print and impact factors were the parameters used to help select appropriate journals for manuscripts. There was no need to consider whether the selected journals might enhance that information by supplying media-rich content, increase awareness of the article through social media and enable debate about the data, or allow users to access the information without a subscription. In this evolving world, medical publication professionals now need to consider to what degree specific journals have embraced technology as a key parameter.

It is best to leave for another day the conundrum of how to determine the 'true' impact factor of a journal in the world of 'retweets'!

The Authors
Sarah L Feeny is head of scientific direction at Complete Medical Communications and chair of the European committee of ISMPP
Russell Traynor is strategic business unit head at UBC-Envision Group and on the board of trustees of ISMPP

The views expressed in this article are those of the authors and do not necessarily reflect the official views of ISMPP, Complete Medical Communications or UBC-Envision Group.

To comment on this article, email pme@pmlive.com