1. Elsevier Content Enrichment Center (CEC) NFAIS Annual Conference 2013 February 25, 2013 Helen Parr Moran Vice President, Smart Content Elsevier Operations, CEC h.moran@elsevier.com Smart Content for Clinical Practice: EMMeT and ClinicalKey

2. Elsevier is the largest Science, Technical and Medical (STM) Publisher in the world. In the area of Health Sciences, Elsevier publishes leading brands including The Lancet, Braunwald’s Heart Disease, Gray’s Anatomy, as well as leading online clinical support tools and products including ClinicalKey, Mosby’s Nursing Consult and Gold Standard Drug Database. The Content Enrichment Center (CEC) in Elsevier Operations has more than 25 years of experience in creating and maintaining terminologies for use in manual and automated Abstracting and Indexing (A&I). Current taxonomies include EMTREE, Genetree, Geotree, and EMMeT and support products in a wide range of domains, such as life sciences, medicine, chemistry, pharmacology, and engineering. Copyright © 2013 Elsevier, Inc. | All Rights Reserved About Elsevier

3. The Challenge Copyright © 2013 Elsevier, Inc. | All Rights Reserved

4. No current offering delivers on all three components doctors need in a medical information product The Physician’s Dilemma The Challenge: Getting doctors the right information to make the best decisions and provide the best clinical care Copyright © 2013 Elsevier, Inc. | All Rights Reserved

5. Keeping Current Conferences/ society meetings Reading current literature Collateral Workflows 2 2 ClinicalKey Complements Physician Workflows Diagnosis 1 1 Create Care Plan After-Treatment Care Plan Patient Education & Compliance Surgical Treatment Procedures Treatment Patient Care Management Workflows Medical Treatment Sharing Information Patient specific information Case presentation (within dept) Presentation to other bodies (eg, treatment committees, drug committees, etc.) External presentations (grand rounds, association presentations, etc) 3 3 Copyright © 2013 Elsevier, Inc. | All Rights Reserved

6. The Approach: Smart Content Copyright © 2013 Elsevier, Inc. | All Rights Reserved

7. Copyright 2011 Outsell Gilbane Services, Inc. http://www.outsellinc.com http://gilbane.com/xml/2009/11/what-is-smart-content.html#ixzz0hnuRhaBc Taxonomy-Powered Content = Smart Content Content with structured XML Content with applied taxonomy Copyright © 2013 Elsevier, Inc. | All Rights Reserved

8. Role of Smart Content Product Development & Enhancement More accurate search results Faceted navigation Improved content discoverability Content Analytics Greater insights into what we publish Identification of co-occurring terms Link to related external content & data Personalization Individual content recommendations Targeted individual marketing Contextual advertising Editorial Productivity Flexible product types – new collections, image banks, etc. Increased speed to market Copyright © 2013 Elsevier, Inc. | All Rights Reserved Smart Content is Infrastructure

9. ClinicalKey Workflow Copyright © 2013 Elsevier, Inc. | All Rights Reserved

10. Introducing EMMeT (Elsevier Merged Medical Taxonomy) Medical Name Malignant Neoplasm of the Breast Consumer Friendly Name Breast Cancer Synonyms Malignant Tumor of Breast Malignant Breast Neoplasm Breast Ca Codes ICD9 – 174.9 MeSH – D001943 SNOMED-CT – 190121004 Semantic Type/Group Neoplastic Process/Disease Breast Disorders Cancer of the Thorax Mammary Neoplasms More…. Breast Sarcoma Familial Breast Cancer Malignant lymphoma of the Breast Malignant Neoplasm of the breast outer quadrant More… Symptoms Diagnostic Procedures Treatment Procedures Medications Risk Factors Prevention Complications Breast Lump, Nipple Retraction, ….. Mammography, Breast Biopsy, ….. Chemotherapy, Mastectomy, …. Tamoxifen, Doxorubicin, ….. Family History, Genetics, Predisposition, …. Screening, Preemptive Mastectomy, …. Metastatic Cancer, …. Parent Terms Semantic Relationships Children Terms 4 23 1 Copyright © 2012 Elsevier, Inc. | All Rights Reserved

11. Automated Indexing: Weighted Tags for Better Search Paragraph-level SMART Content tags uncover highly-relevant information not necessarily evident from the title or abstract alone. Article-level SMART Content tags help confirm relevance and provide a topical overview about a piece of content. Copyright © 2013 Elsevier, Inc. | All Rights Reserved

12. Testing Quality: Multipronged QA 1.Technical Test Set Validate the field selection and delivery format 2.Representative Gold Test Establish recall, precision, and harmonic mean versus a manually tagged set of content 3.Query Set Compare product results with expected results from established search queries 4.Search Logs Analyze search logs for candidate terms and noise 5.Linguistic Intelligence (NLP) Use Cases Test language parsing by rules engine using test cases (e.g., hepatitis B/C)

13. Semantic Enrichment Poll Is your organization semantically enriching your content? 1.Yes 2.Not yet, but we’re working on it 3.No 4.Don’t know Copyright © 2013 Elsevier, Inc. | All Rights Reserved

14. Smart Content In Action: ClinicalKey Copyright © 2013 Elsevier, Inc. | All Rights Reserved

15. EMMeT Powered Auto-Suggest Copyright © 2012 Elsevier, Inc. | All Rights Reserved

16. Speed to Answer: Content Filters & Previews

17. Workflow: Presentation Maker, Reading List & Saved Searches

18. User Response Copyright © 2013 Elsevier, Inc. | All Rights Reserved

19. Smart Content for Doctors = Clinically Relevant Search Actual Use-Case: Non-invasive cardiologist wants the latest information on the use of biomarker guided therapy in treating congestive heart failure. He enters search term: BNP guided therapy in CHF Actual Use-Case: Non-invasive cardiologist wants the latest information on the use of biomarker guided therapy in treating congestive heart failure. He enters search term: BNP guided therapy in CHF

20. 310,000 results—mostly news summaries Requires Google Scholar to produce a sublist of journal articles 10 results in reverse chronological order, burying several key papers 2nd result is an unwanted editorial comment Result set misses several key publications due to lack of term expansion and acronym confusion 1 relevant result, last updated in 2009 Clinical Search Results *Based on an actual case study. Search conducted in March 2011. Google is a trademark of Google Inc. TM BNP guided therapy for CHF Search

21. 128 results Results from various 12 content types appear in rank order based on their currency and clinical impact 1st four results are journals citing the most relevant and current studies Highly relevant and current content from various information sources: Clinical Trials Books First Consult ClinicalKey: Finding the Needle in the Clinical Haystack

22. What’s Next? Copyright © 2013 Elsevier, Inc. | All Rights Reserved

23. Internationalization: French EMMeT (FrEMMeT) Copyright © 2013 Elsevier, Inc. | All Rights Reserved BETA

24. Curation: Smart Collection Tool & Specialty Collections Copyright © 2012 Elsevier, Inc. | All Rights Reserved

25. Questions? Copyright © 2013 Elsevier, Inc. | All Rights Reserved Helen Moran Vice President, Smart Content Elsevier Operations, CEC h.moran@elsevier.com