Observations on Healthcare Publishing

October 2022

My Blood Pressure Writing Project

I had a co-worker at Explorys, a healthcare analytics company, who worked on the platform team that prepared and standardized data for the downstream analytic engines. ?He was extremely well-versed in unit of measure conversions as well as the developer of algorithms for identifying what was physiologically plausible data.? Such algorithms were needed as healthcare data can be a bit messy. ?One day he was talking about the history of blood pressure measurement and how things that are “obvious” today were anything but during its evolution.? As a vital measurement blood pressure was easy to take for granted, but also had hidden historical complexity with respect to data management and analytic interpretation. Something about that topic really piqued my interest.?

Jump forward nearly a decade to the Covid-19 pandemic. ?I started a hobby writing project publishing for the Association for Computing Machinery blog (BLOG@CACM) on a variety of software development topics that I had been thinking about for years. ?After roughly a dozen posts thought I had enough experience and confidence to try writing about the concepts from that blood pressure measurement conversation at Explorys.? But where to publish??I had never published anything in healthcare before. ?I wasn’t expecting any remuneration for this post - this was a hobby writing project, just like my ACM posts. ?I also wanted the post to be public and not behind a paywall.? What’s the point of a hobby writing project if nobody can read it?

HIMSS (Health Information and Management Systems Society) published my post “Non- Obvious Ways Medical Data Is Hard:?Blood Pressure” in September 2022 and I am happy with the result, and thankful for their support. ?I think the post found the right outlet and audience.?

But a lot more happened to get to that point.? This is a recap a few of the organizations and publishing entities that I had investigated for my post. ?I learned a lot about things called “open access charges” and “article processing charges.”

Journal of AMIA (American Medical Informatics Association)

AMIA (American Medical Informatics Association) was the first organization that came to mind, as I had more than a passing familiarity with it.?I had attended the big AMIA annual conference multiple times in the early days of Explorys in 2009, 2010, and 2011.?The conference was well organized and filled with great presentations.?In fact, Explorys was an exhibitor in 2010 and 2011 and I helped work the booth.

JAMIA is the publishing arm of AMIA: https://amia.org/news-publications/journals/jamia

The instructions for new authors are thorough and were on this page (https://academic.oup.com/jamia/pages/General_Instructions ), and there is a submission and review process. ?The “Charges” section caught my attention.

The open access fees for JAMIA would be approximately $4,000 USD if I was reading the spreadsheet correctly.? A traditional subscription model is an option where no fee would be required, but there would be pay-per-access.? In neither case would I be receiving any money.

The link to the details of open access licenses is: https://academic.oup.com/pages/open-research/open-access/charges-licences-and-self-archiving

As this was a hobby writing project I couldn’t justify spending that kind of money to publish a single article, even if they would have accepted it.

JAMA (Journal of the American Medical Association)

Anyone familiar with healthcare data management and informatics knows who the American Medical Association is, at the very least because of Current Procedural Terminology (CPT) code licenses. JAMA is the publishing arm of the AMA, and the JAMA Network Open seemed like the most appropriate JAMA outlet that might consider my post.? https://jamanetwork.com/journals/jamanetworkopen

The instructions for JAMA article submission are extensive.? There is a submission and approval process. https://jamanetwork.com/journals/jamanetworkopen/pages/instructions-for-authors

And I also came across a fee section:?$3,000 USD to publish open access.

Lancet

The Lancet Group is an old and highly respected medical publication.?Again, my post wasn’t “research” but the Lancet Digital Health sub-journal seemed like a potential candidate for my post as Digital Health covered a broad range of healthcare topics, and it seemed like an applied topic like mine might fit.? https://www.thelancet.com/journals/landig/home

The Lancet had very thorough documentation on the types of submissions it might accept. https://www.thelancet.com/what-we-publish … and… https://www.thelancet.com/pb-assets/Lancet/authors/tldh-info-for-authors.pdf, but there was of course no guarantee it would accept my post.

The article processing charges are $5,500 USD for the Lancet Digital health for open access: https://www.thelancet.com/open-access

Per the graphic, the Lancet does explicitly state that acceptance is not strictly related to the ability to pay, and it had an exception process for payment discounts and waivers.? Researchers from smaller institutions, students, and perhaps crazy hobbyist writers might be the target market for such a process.

Nature Medicine

Nature is also an old and venerable science publication, and Nature Medicine seemed like the most appropriate healthcare sub-publication in the Nature portfolio.?Quite frankly, I don’t think my post has any business being near this publication because Nature is for what I would consider “real science” and not “historical healthcare data management tidbits” which is what I was trying to write about.? Still, I had to check it out for curiosity’s sake. https://www.nature.com/nm/

The article processing charge for open access in Nature Medicine is 9,500 Euros. https://www.nature.com/nm/submission-guidelines/publishing-options

Note that the traditional subscription model is an option, where no fee would be required.?But there would be pay-per-access.

HIMSS (Healthcare Information and Management Systems Society)

HIMSS typically hosts it's publications in its Resources Center: https://www.himss.org/resources-all

And the submission guidelines are documented here: https://www.himss.org/himss-writing-guidelines

I joined HIMSS as an individual member for $200.?I had to submit the blood pressure concept for review, and it was accepted.?Then I submitted an article draft for review, I received some good feedback, and I took a month to revise and re-submit.?There were no article processing fees.

In Conclusion

It’s worth recalling a restriction I put on this process in the beginning:?open access.? I wanted the post to be public.?I didn’t have to do that, and I could have considered a “paywall” license - assuming that one of the outlets would have accepted the post.? If I had chosen that license-type I still wouldn’t have received anything for the submission (as expected), but I wouldn’t have had to pay anything for it either.

It's also worth examining my desire to be published in a "real healthcare publication.”?That was about ego and validation, but I don’t think I’m any different than anybody else in this respect as it is an accomplishment to have something published in such forums. ?Resumes and CV’s aren’t typically filled with personal blog posts.

Validation and accomplishments cost something, though.?It takes people to review ideas, review drafts –sometimes multiple times – and put their stamp of approval on it.? A publication is also two-way street:?it’s an accomplishment for the author, but it’s also an endorsement of sorts for the publisher. ?The publisher puts their own credibility on the line, because if an article happens to go sideways the originating source typically gets cited (e.g., “an article in <Insert Journal> claiming that Gummy Bears cure cancer has been proven to be a fraud”).? As healthcare literally affects everybody, there is also a societal responsibility to attend to as well. ?Healthcare publishing needs a review process and healthy skepticism, otherwise things like the opioid crisis happen when extraordinary claims aren’t examined closely enough.

Publishing in general has gone through great upheaval in the internet age, and I am empathetic to the disruption in revenue sources.? Relying on advertising is an option, but it also gives the appearance of being up for sale to the highest bidder. ?The other options are what they are already doing:?subscription access models and open access models. ?The problem is that paying thousands of dollars per article is a rounding error for a large company, but it’s a big deal for an individual author.? But I don't blame any of these entities for wanting and needing to charge something for open access. I thought the Lancet’s qualification for an exception process on open access payment for smaller/individual authors was noteworthy.? Maybe that’s a model that could be explored further, but the funding still needs to come from somewhere.

This is a hard problem.

?

Doug Meil

For most posts from Doug, see: https://www.dhirubhai.net/pulse/publications-doug-meil/