e-Book Usage on the Rise Among Medical Students, Staff, Faculty

A recent study by the Journal of the Medical Library Association (“Assessing print and electronic use of reference/core medical textbooks,” April 2008) validates our mission and the mission of other electronic resource providers—e-book usage is on the rise among medical students, faculty, and staff.

As with other studies of e-book usage, the authors found that most people access books electronically when they want to read smaller portions of text. This is relevant for the medical field because, as the study states, “Considering that medical books are not typically read cover-to-cover in a single session, the electronic format seems perfectly suited for searching and retrieving relevant sections of such resources.” The authors also found increased use of clinical materials in an electronic format, as many medical students (and faculty and staff) are accessing information remotely during their clinical years.

The study tracked online and print usage of titles among three textbook packages, including AccessMedicine, designed by Silverchair. All three packages showed more electronic access of their textbook titles, but the results for AccessMedicine were especially impressive: users accessed titles 8,658 times on the website as opposed to 76 times for the same titles offered in print.

While there are varying reasons for electronic access versus print access, the sheer volume of titles electronically accessed speaks to the depth of this McGraw-Hill resource. The ease of use and advanced search functions of AccessMedicine certainly make the information easily accessible as well.

Whatever content package is being used, it seems that e-books are perfectly suited for the reading habits of the medical community. As information is needed on a faster, more accurate basis, access to a comprehensive online resource is more important than ever.

Amazon and Print on Demand

The blogosphere is up in arms over a new Amazon.com tactic described in a disturbing report in the latest Publishers Weekly. Amazon is forcing publishers to use Amazon's Print On Demand (POD) service, BookSurge, or have their "Buy now" buttons disabled on the site. Amazon has been battling LightningSource over the last year for POD business, but until this has been fighting fair.

Of the many blog posts on the subject, the most complete (with lots of links for further information) might be this one from Yvonne DiVita

Information wants to be good

A great article was posted on the ICG web site called "Information Wants to be Good." Among the many good points in the article is that sometimes bad or misleading information is worse than no information at all. Bravo!

The thing that caught my eye is the example used to lead into the point -- what is known as the "Palau" problem to us folks who reside in Pennsylvania. Some time ago, a programmer used a list of US states that inaccurately included the island nation of Palau among the states. It would be humorous if this just happened once, but it is downright frustrating how much this error has propagated throughout the web, especially for those of us who fill out web forms in the state of Pennsylvania. OK, maybe frustrating is too strong, but certainly annoying!

The importance of precise semantic markup is only increasing, and this post hints at a growing discontent among users for bad or disorganized information. The trend is definitely headed back in the 'quality' direction, and that's a good thing for anyone who takes pride in the quality of their content.

--Jabin White

Heuristics vs. Semantics

Many computer applications use heuristics to try to understand narrative text content. But how well is the term "heuristics" understood by those whose medical information systems heavily depend on them for discovery and retrieval? A common definition of heuristics exposes some worrying phrases from the point of view of medicine and medical information systems (I've highlighted):

A heuristic is a method to help to solve a problem, commonly informal. It is particularly used for a method that often rapidly leads to a solution that is usually reasonably close to the best possible answer. Heuristics are "rules of thumb", educated guesses, intuitive judgments or simply common sense.

In computer science, a heuristic is a technique designed to solve a problem that ignores whether the solution can be proven to be correct, but which usually produces a good solution or solves a simpler problem that contains or intersects with the solution of the more complex problem.

Heuristics are intended to gain computational performance or conceptual simplicity, potentially at the cost of accuracy or precision.

There is no doubt that heuristics are highly useful (and practical) methods to get close to the correct answer. There is a large role for them in many decision-making processes (human or machine). And in many fields "close" is sufficient. But in a field such as medicine, does "close" or "most of the time" cut it? On AHRQ's Patient Safety Network (http://www.psnet.ahrq.gov/), the editorial team of M.D.'s defined "heuristics" in the glossary with a worrisome conclusion (I've highlighted):

Heuristic - Loosely defined or informal rule often arrived at through experience or trial and error (eg, gastrointestinal complaints that wake patients up at night are unlikely to be functional). Heuristics provide cognitive shortcuts in the face of complex situations, and thus serve an important purpose. Unfortunately, they can also turn out to be wrong.

This also applies to medical information systems. Some information systems boast about the 70-80% text-matching accuracy of their heuristics (up from 65% a few years ago). But that 20+% margin of error, while only somewhat annoying for web surfers looking for Britney Spears photos, has a huge impact on the usability and efficient use of large health information systems. The information explosion in health care demands more accuracy and less noise from retrieval systems in order to save worker time and produce consistent health care delivery.

An alternative to using heuristics is to use semantics. Semantics harness the power of the human mind (they are editor-placed or automated with editor-review) and provide a nearly flawless level of topical accuracy. This is because the human brain is reading content that was written specifically for human brain comprehension and providing the topical cues to the computer system (rather than the other way around).

Semantics provide computer systems with a concise guide to the meaning of the content written in a language it can parse logically (structured form, not narrative form). At this time, only semantics create search results, content linkages, contextual integrations that are nearly 100% accurate.

I'll leave you with this picture--imagine opening up a large medical reference book (i.e. Harrison's Principles of Internal Medicine) and seeing this disclaimer in the index:

Readers: Please note that 20-30% of these index entries will lead to content of dubious relevance. The other ones are pretty accurate, though. We're not exactly sure which entries fall into each category, but we're sure you'll figure it out. Good luck!

Not very appealing, is it?

--Jake Zarnegar, Silverchair CTO

Semantic Web takes a step forward

NetworkWorld published an interesting article in its latest issue on the W3C's (World Wide Web Consortium) publication of SPARQL (pronounced "sparkle") as a recommendation, the highest form a standard can take from the W3C. If you think of the Semantic Web as a bunch of databases of information, SPARQL is a standard by which users can query that huge database. Just another step forward, and an important one, in the evolution of the Semantic Web.

At the PSP Annual Meeting

Several Silverchair executives are attending the annual conference of the Professional/Scholarly Publishing division of the AAP in Washington, DC.

Some interesting sessions and discussions have highlighted a packed agenda, including a very interesting keynote address by Chris Willis, Vice President of Social Media at Footnote.com. Chris reviewed all the ways in which social aspects of the web (wikis, blogs, social networking sites, etc.) are impacting how publishers provide information.

But the highlight for Silverchair was the awards luncheon, where McGraw-Hill's AccessPharmacy won the award for Best Electronic Publication or Product for 2007. Silverchair collaborated with McGraw-Hill on the product, and it is built on Silverchair's SCM platform.

Pictured here are Helen Parr, McGraw-Hill's Executive Editor, Medical Online (right), and Holly Auten, Silverchair Project Manager, who worked on the award-winning project together.

Just Double the Recipe

Since Silverchair started web publishing 10 years ago, we’ve been touting the benefits of simultaneity—the ability to publish a large content set to the web and a smaller subset in print at the same time. This model makes a lot of sense when there’s a substantial market for the book but there’s lots more excellent content than can be put on paper and still keep the book price accessible.

In December, McGraw-Hill published an excellent example of this model—the new 7th edition of Fitzpatrick’s Dermatology in General Medicine, edited by Klaus Wolff et al. This authoritative textbook of dermatology, respected for its integration of basic and clinical science, was published in print at a hefty 2,752 page count, including 3,344 of both four-color and halftone illustrations. Meanwhile, the online version of the book, available at www.accessmedicine.com, contains about 1,000 pages of additional text, more than 500 additional images, and 18,000 additional references.

McGraw-Hill awarded Silverchair the opportunity to play chef for this content feast; we provided full-service editorial production and composition services for the book, and we provided conversion, production, and development services for the web version. And the complete set of content was served up on AccessMedicine when the books were ready for sales and distribution. How did we do it?

When we composed the book, we coded the electronic-only material as “conditional text” and produced galleys that included all the material--print and electronic--so that the authors could review all of it for accuracy and corrections. We then made actual page proofs for the print version, though our files still contained the “hidden” electronic-only material.
Once the print book content was nailed down and final, we generated XML for the online version from our XML-friendly paging files. This data included all of the print text and the online-only materials.

Using XML-friendly paging software allowed us to work from one “superset” of content, with multiple outputs to different formats, with the print version containing a subset of the material to keep the size of the book manageable without compromising the breadth and depth of coverage of the important dermatology topics.

We’re proud of this example of our commitment to making the technology work for King Content.

--Kim Langford