PEDIATRICS Vol. 119 No. 4 April 2007, pp. 661-669 (doi:10.1542/peds.2006-3432)
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Pediatrics on the Web: 10 Years of Innovation and Discovery
Executive Editor, Pediatrics, Elk Grove Village, Illinois
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ABSTRACT |
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 TOP ABSTRACT ORIGINS AND MILESTONESHIGHWIRE PRESSACCESSING THE ELECTRONIC JOURNALUSAGE AND CITATIONPEDIATRICS IN CONTEXT: THE...CONCLUSIONSREFERENCES |
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The electronic edition of Pediatrics celebrates its 10th birthday this year. This article describes the origins and evolution of the online edition of Pediatrics, which, after launching in 1997, featured the world's first online-only section of a medical journal. Over the proceeding 10 years the journal introduced numerous innovations, including e-mail alerts, postpublication peer review, video supplements, online classified advertisements, Web-based manuscript submission, early release, and the development of the eJournal Archive. This article also describes the use and reception of the electronic journal. Whether measured by article accesses, citation rates, or the number of manuscript submissions, the electronic edition of Pediatrics has proven to be a success. It has allowed the journal to publish a larger number of articles and reach a wider audience than would have been economically possible with a print-only publication. Yet, even as Pediatrics recreates itself online, it is clear that there is much more that can be done to fully realize the potential of the new medium to facilitate professional communication.
Key Words: electronic journals • journalology
Abbreviations: AAP—American Academy of Pediatrics • PDF—portable document format • BMJ—British Medical Journal • JAMA—Journal of the American Medical Association • HINARI—Health InterNetwork Access to Research Initiative
The electronic edition of Pediatrics celebrates its 10th birthday this year. At the time it was launched, this was a groundbreaking innovation. In today's world, in which everyone over the age of 12 seems to have his or her own blog or podcast, it is amazing to think that only 10 years ago the Electronic Pages, introduced by Jerold Lucey, MD, and Kent Anderson, were the first and only electronic-only section of a medical journal available on the planet. So much has changed over the last decade that the editors thought it would be worthwhile to take the occasion of this anniversary to look back over the landscape traversed, catalog some of the more notable milestones in the journal's recent history, and hazard some speculation as to what may lie in the terrain ahead.
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ORIGINS AND MILESTONES |
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The online-only section of the journal, titled the Electronic Pages, debuted on January 6, 1997. The Electronic Pages were originally conceived of as an online-only supplement to the print journal. This electronic feature of the journal contained articles that could not be found in the print edition, and, at least initially, the print articles could not be found online. In hindsight, dividing the journal into electronic-only and print-only components seems a bit strange. However, the Electronic Pages were begun as an experiment. The American Academy of Pediatrics (AAP) wanted to test 2 hypotheses: (1) whether the online edition might allow the journal to publish more articles at a lesser incremental cost than printed articles (for this reason, it made sense to keep both the accounting and the online-edition entirely separate), and (2) whether the online edition could reach a wider international audience than the print edition.
Both hypotheses proved affirmative. Although each online article still incurred the associated costs of peer review, copyediting, and typesetting (electronic portable document format [PDF] files still must be typeset to facilitate desktop printing), just as with printed articles, we found that the cost of online production was more than offset by the savings in printing and postage. Over the course of the next year, the journal was able to expand the number of original research articles published by one third without an equally dramatic increase in costs. By 1998, the Electronic Pages were recording more than 20000 unique visitors from more than 80 countries each month. Expressions of gratitude and interest began to pour in from readers and pediatric societies as far away as Hong Kong, Burma, and Brazil. Eighteen months after it began, the experiment was so successful that the AAP decided to expand its scope. In July 1998, the electronic edition of Pediatrics was expanded to include every article from the print journal. Given that the electronic journal contained more material than the print version, it was now, less than 2 years after it launched (and regardless of whether we were ready for this change), the journal of record.1
More innovations were to follow. In 1999, e-mail alerts were developed and allowed readers to track published material by subject, author, keyword, or citation. One simply sets up an alert, and whenever Pediatrics publishes an article matching those criteria, the journal sends out an e-mail alert with a link directly to the relevant article. This alert system can even track articles published in hundreds of other top-tier medical journals. In addition, one can elect to simply receive the table of contents of each issue as it is published via e-mail. Links are embedded in the e-mail to take the reader directly to any article he or she finds interesting.
Later that same year, the journal introduced "postpublication peer review." This feature allows readers to rapidly respond to articles that were published in the journal. Next to the online version of every article is a link that invites a response. Readers may click on that link and write a comment, which is rapidly reviewed by an editor for relevance and professionalism and then, if appropriate, posted online within 48 hours. Although the naming of the feature was criticized in the British Medical Journal (BMJ) for excessive use of the letter "P," it was a name carefully chosen by the editors.2 Many journals offer similar features, which are typically referred to as "e-letters" or "rapid response." Such terms adequately describe the medium or format of such mechanisms but not the purpose. Peer review does not does not stop with an article's acceptance by a journal. The medium of electronic publication offered a mechanism to shorten the delay between publication and the receipt of feedback from the wider medical and scientific communities. In implementing this mechanism, Pediatrics wanted to make explicit the notion that postpublication responses, which include these rapid electronic comments as well as more formal letters to the editor and subsequent studies or reports on the same topic, are part of the overall continuum of peer review.3
Fundamentally, online-only articles and postpublication peer review, although innovative means of expanding and expediting scientific communication, are nothing more than new and more efficient means of old forms of communication. These online-only devices are digital versions of old-fashioned articles, letters, and other written communication. The ink has been replaced with pixels and paper fiber with the liquid crystals of the modern computer screen. Other than this shift in medium, however, these articles do not appear notably different from the articles that first appeared in Pediatrics in 1948 (or, for that matter, in Philosophical Transactions in 1665). However, the World Wide Web is not confined to the limitations imposed by ink and paper. Why, the editors asked, should journal articles be so constrained? In March 2000, Pediatrics introduced the journal's first article with video.4 The article, by Rich et al,5 reported on the role of video intervention/prevention assessment in the management of asthma. The authors asked 23 children and adolescents to record video diaries of how they live with and manage disease in the context of their lives. As part of the article, Rich et al provided excerpts from these videos. In one video, a child's mother is seen, after the child has left the room, turning off the video camera with a lit cigarette in one hand. In another, we see the dust from a nearby construction site coating the walls and windows of the child's apartment building. In addition to making a compelling case for the use and value of video intervention/prevention assessment, the videos provide the reader with insight into the lives of young patients who are living with asthma in environments beyond their control—insight that could not be conveyed as effectively by other means.
Since these first videos appeared in 2000, Pediatrics has published numerous articles with online-only photographs, audio files, and other supplemental data. In theory, as long as data are captured in a digital format that is readable by the majority of computer users, there is no limit to the type of data that can be included in an article. (Given the rapidly decreasing cost of electronic storage space, there is no practical limit either). The publication of these data sets marks the first true departure from the print edition of the journal in terms of the article's form—the beginning, perhaps, of the evolution of the article and the journal—to a format native to the digital environment.
Classified advertisements have long been a staple of the journal-publishing business. They have appeared in the print edition of Pediatrics since 1948. They consist largely of advertisements for vacant positions and announcements for fellowships or other career opportunities. Classified ads were part of the online edition of Pediatrics, just as they have long been, and continue to be, part of the print edition. However, to take full advantage of the rapidly developing medium of the Internet and the rapid shift in behavior of those who seek career information to electronic resources, the AAP realized that it needed a site dedicated to this purpose if it was to stay relevant to members and other readers of the journal. It was no longer sufficient for classified advertisements and announcements to merely be online. They needed to be fully searchable and enable readers to filter search results by geographic area, position description, subspecialty, and so on. In addition, those seeking employment should have a way of efficiently creating and disseminating their curriculum vitae, and these curriculum vitae should, likewise, be fully searchable by employers. Therefore, in June 2001, the AAP launched a new Web site called PedJobs, which was specifically designed to support career-oriented classified advertisements and announcements.6 At this point, the classified advertisements were removed from the online edition of Pediatrics, and readers interested in reading the classifieds online were directed to PedJobs. PedJobs proved to be remarkably successful and, therefore, was completely redeveloped in 2005 to provide readers with more sophisticated tools such as customized e-mail alerts. In addition, the scope of the site was expanded to encompass a number of pediatric health care professionals including nurses, nurse practitioners, and physician assistants.
In January 2004, Pediatrics launched a new feature that was to have a significant impact on both the print and online editions of the journal: Web-based manuscript submission. Although the journal's editorial office had been tracking manuscripts for years via specialized computer software, it became possible for authors to simply go to the journal's Web site, click on a link, and upload their manuscripts along with supporting data including figures, tables, videos, audio files, and any other electronic media. The reasons for offering this functionality were twofold: to save both time and money. Before Web-based submission, authors had to prepare multiple printed review copies of their manuscript, develop any photographic images, put electronic files on a disk, write a submission letter, and mail the whole package (at their expense) to the journal's editorial office. With Web-based submission, authors would be able to save both time preparing manuscripts and the cost of postage (which, if the author was located outside North America, could be substantial). In addition, the journal staff spent inordinate amounts of time opening packages, reviewing materials, and then repackaging manuscripts for review, revision, and editing. Decision letters and other correspondence needed to be drafted and mailed, and all of that shipping and correspondence had to be tracked and paid for. Web-based submission would allow the journal staff to focus more time and energy on supporting the peer-review and editorial process and less time tracking mail. In addition, eliminating all of those postage costs would, we suspected, offset the cost of the new technology.7
Most of our assumptions proved correct. The savings in postage costs for the journal were indeed significant enough to offset the cost of the new system. Also, as the journal staff became more familiar with the technology, we began to see some efficiencies emerge. However, any time savings gained from the technology were quickly redirected to managing a side effect of the new system for which we were largely unprepared: a rapidly increasing volume of submissions. Although we suspected, on the basis of anecdotal reports from other journals that had implemented similar technology, that the new service would result in a modest increase in submissions, we were totally unprepared for what followed. Over the next 24 months, the rate of manuscript submissions to Pediatrics rose by a staggering 65%. The editors, who initially suspected this sudden increase would be a temporary anomaly, were eventually forced to become more selective as a result of a growing backlog of manuscripts. The journal's acceptance rate plunged from 28% to less than 20%. Even with this reduction of the acceptance rate, the size of issues has nearly doubled over the last year. Although this is a nice problem to have, it does come with certain economic consequences: we are still printing more than half of the articles we accept, and paper and postage rates have risen considerably in recent years. In addition, readers have complained about the decreasing portability of the print issues. Although one might take a slender journal issue along on a plane ride, one thinks twice about packing an object that resembles the local telephone book. To save the journal's bankbook and the backs of our readers (to say nothing of the planet's forests), we are making efforts to publish more articles online only and to become even more selective in accepting articles. This last part is exceeding difficult because the field of pediatrics is quite healthy, which leads to a cornucopia of interesting research, reports, and commentary arriving from around the world via our Web site on a daily basis.
To further expedite the dissemination of scientific information, Pediatrics introduced a feature called "early release" in October 2004. The term refers to articles that are published online in advance of the issue in which they ultimately appear. For example, an article might be published in the early-release section of the journal's Web site in January. That same article will eventually appear in the February or March issue of the print and/or online editions of Pediatrics. As we work on copyediting, typesetting, proofreading, and electronically preparing each article for publication, it is inevitable that some articles are completed before others. Why not, we asked, publish the articles that are completed early? If an article is ready to be published 3 weeks before the issue in which it is scheduled to appear, why not simply publish it in advance on our Web site? Because there was no technical reason that this could not be done and we could find no editorial argument against it, we set up an early-release section in the online journal and began publishing these articles. At first, we limited the early release of articles to twice per month, primarily to keep the schedule simple for the journalists who report on articles published in the journal. After 1 year, we adjusted the schedule to allow for weekly releases. Thus far, reporters and readers both seem to be able to keep up.8
As these various features and functions were developed, they were added to the journal's Web site and placed wherever we thought they would best fit. The Web site was designed in 1996 before anyone knew much about Web design. There was no such thing as "user-centric design" because no one had any idea how people would end up using journal sites. As it turned out, we did some things well from the outset by keeping the journal's homepage very simple (Google would shortly prove how useful a simple, functional Web site could be). However, over the years, as new features were added, the site became increasingly cluttered and difficult to navigate. In addition, we were not sure which features were most useful or how to best display them. To remedy this deficiency of information, we spent a year researching how readers of Pediatrics interact with the journal, both in print and online. We conducted a series of focus-group sessions, sent out surveys, conducted interviews, and closely studied our usage statistics. After analyzing these data, we sat down with a designer and developed a new design, which would be closely synchronized with a new print design that was being developed simultaneously. Both designs, print and online, were launched in January 2006. The online design aimed to make navigation more intuitive, make the journal's features more accessible, and bring the journal's content front and center.9 The reception of both designs by readers has been overwhelmingly positive. We have received a few excellent suggestions for additional improvements (such as ways of making tables more readable) and are assessing the feasibility of implementing these ideas.
January 2007 witnessed the official release of the latest, and one of the most important, milestones in the journal's online history: the Pediatrics eJournal Archive. Readers who have happened to look under the "past issues" tab on the journal's Web site recently, or looked closely at the date range on search results generated by the journal's search engine, may have noticed that there is suddenly a lot more to look at—more than 100000 pages more. Over the past 3 years, in partnership with Google and Stanford University's HighWire Press, we have collected, organized, scanned, and digitized every issue of Pediatrics ever published, back to volume 1 issue 1. All of these issues have been converted into PDF files and separated into articles. Readers now have access to every article ever published in Pediatrics, from 1948 until the present. In addition, we have keyed in every title, author, keyword, and abstract and processed the full text of every article with sophisticated optical character-recognition software to enable search queries across the journal's entire publication history. In the months to follow, we will be adding every nonarticle page of the journal ever published, including advertisements, classified advertising, special announcements, the journal's masthead (which lists the editorial-board membership), and anything else published in the journal that was not, strictly speaking, considered editorial content.
Several years ago, Kent Anderson, who was at one time the managing editor of Pediatrics (and, later, director of medical journals at the AAP) before departing for the New England Journal of Medicine, argued that publishers needed to develop what he called "useful archives."10 He defined a useful archive as one that is designed primarily for readers of today, providing access to both new and older material to researchers, clinicians, and other readers from wherever they choose to work. Pediatrics now has such archive. We hope today's readers find this new eJournal Archive as useful as those in generations to come.
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HIGHWIRE PRESS |
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The journal and the AAP have been very fortunate in selecting technology partners, and several of them have been instrumental in the development of the online journal. Foremost among these partners has been HighWire Press. HighWire is a division of Stanford University's library system and operates as a cross between a Silicon Valley start-up and a university think tank. Launched in 1995, HighWire hosts the Web sites of many of the most highly regarded scientific and medical journals in the world, including Journal of Biological Chemistry, Science, New England Journal of Medicine, Journal of the American Medical Association (JAMA), Proceedings of the National Academy of Sciences, the BMJ, Blood, Journal of Clinical Oncology, Circulation, Chest, and Radiology, among hundreds of others. Pediatrics, Pediatrics in Review, NeoReviews, AAP Grand Rounds, AAP News, AAP Policy, and the Red Book are all hosted by HighWire. HighWire is an innovation-focused not-for-profit organization, the mission of which is to support the development of scholarly communication by providing technology solutions for (primarily) not-for-profit publishers such as professional societies and university presses.
Nearly all of the technology on the journal's Web site was developed by HighWire. In some cases, HighWire developed the technology directly for Pediatrics. In other cases, technology was developed initially for other publishers and then was later adapted for Pediatrics. In still other cases, the AAP, in consultation with other organizations and HighWire, co-developed mutually applicable innovations. There is a remarkable spirit of collegiality and cooperation among the not-for-profit organizations whose publications are hosted by HighWire and who meet twice annually to discuss ideas, share data from publishing experiments, and debate the issues that impact the rapidly changing scholarly publishing landscape. It is this spirit that makes possible large-scale innovations such as "reciprocal toll-free reference linking." This rather inelegant term refers to the very elegant ability of a reader to be able to follow a hyperlink from the reference list of any journal article hosted by HighWire to any other cited article hosted by HighWire, without any subscription barriers. In other words, if one is reading a Pediatrics article, and that article cites an article published in JAMA, one can simply click on the hyperlink in the reference list and be taken instantly to the JAMA article, even if that reader does not have a subscription to JAMA, and vice versa. This scale of barrier-free linking between journals from different publishers is unique in the publishing world.11 As Pediatrics enters the second decade of partnership with HighWire Press, we aim to continue this tradition of collegiality and innovation and work to create the journal of the future while bringing the research of today to more people than ever before.
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ACCESSING THE ELECTRONIC JOURNAL |
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By the opening years of the current century, nearly all of the world's peer-reviewed scientific and medical journals had developed online editions. As the spindles of the World Wide Web extended into the far corners of the globe at a breathtaking rate, more people found themselves with access to high-quality, peer-reviewed health care information than at any point in history. With the old barriers to information eliminated (eg, the costs of printing, shipping, storage, and retrieval), the AAP explored ways to provide access for anyone interested in reading the journal, anywhere in the world, regardless of financial resources. To this end, the AAP, along with dozens of other medical organizations, partnered with the World Health Organization's Health InterNetwork Access to Research Initiative (HINARI). Through HINARI, people at institutions in
120 developing nations around the world can access Pediatrics at little or no cost. We have also installed software on the journal's Web site that recognizes from where in the world a reader is accessing the Internet. For those readers in the 60 poorest nations in the world, there is no need for registration with HINARI—they are simply provided full access at no cost and with no registration.12,13 In addition, the AAP realizes that the Internet has not reached everywhere. There are still parts of the world in which Internet access is unavailable or available unreliably or at such low speeds that browsing the journal is impractical. To reach these areas, the AAP partnered with the Satellife Network. Satellife editors identify relevant articles from Pediatrics among other journals and e-mail text-only files to individuals known to have Internet connectivity. These individuals then print out multiple copies of these e-mails and deliver them to even more remote regions. Therefore, at least some level of relevant, timely health care information is able to reach even the most remote regions of the globe.12
Finally, the AAP decided to maximize access to Pediatrics even for those fortunate enough to live in more developed economies. Since 1997, all online-only articles have been freely available the moment they are published, as are all AAP policy documents and any articles that the AAP or the editors think may have broad public or interdisciplinary appeal. All together, nearly half of every issue of Pediatrics is available without a subscription on the day it is published. After 12 months, 100% of each issue is made freely available online. By adopting this publication model, Pediatrics is able to provide the high-quality peer-reviewed information it publishes to the widest possible audience while remaining financially stable and self-sufficient.
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USAGE AND CITATION |
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The question of whether the online edition of Pediatrics would be used was put to rest long ago. Usage, as measured in terms of article downloads, has also been growing steadily each year. Over the period of 1999–2005 (the only years for which complete usage data were available as of the writing of this article), usage climbed from 1.1 million to over 11.5 million annual article accesses (see Fig 1). Article accesses are probably the best indicator of usage for a journal site. Other indicators such as "hits" or "page views" reveal total Web-site usage, including use of the home page, tables of contents, help pages, search pages, subscription-ordering pages, etc. If the purpose of the journal Web site is to provide readers with information of interest to them, and that information comes largely in the form of articles, then measuring the number of times those articles are viewed by readers should be a journal's primary yardstick. We want to measure how many times the reader succeeds in finding information of value to him or her. If one were measuring hits, a search that did not result in finding relevant information would be counted among one's statistics. By measuring article accesses, we track the instances when readers actually view an article or abstract and filter out for separate analysis the times when they fail to do so.
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One obvious reason that the usage is going up year after year is simply that there is more to look at each year. At the end of each year, the articles published in the preceding 12 months remain on the site. So, each year the volume of articles in the archive grows. Although the usage for any 1 article decays over time, starting with peak usage in the months immediately after publication and then steadily tapering off, it never reaches zero. This is the "long-tail" effect noted by Chris Anderson in his famous Wired Magazine article.14 As more and more articles are added to the archive or "tail," overall usage rises. It will be interesting to look at the impact on usage attributable to our eJournal archive. By this time next year, we should have data that describe the effect of adding 50 years of content to the site at once.
In addition to more articles being read online, we are able to tell, from looking at the number of IP addresses from which the site was accessed, that more people are visiting the journal each year. In January 1998 we recorded traffic from 25460 different IP addresses. In January 2006 traffic from 338991 IP addresses, representing readers from over 130 countries, was recorded. These IP addresses are registered all over the world, from Argentina to Zimbabwe and Switzerland to Swaziland.
We are frequently asked whether online-only articles are read as frequently as those articles that appear both in print and online. That is a difficult question to answer. From 1999–2003, online-only articles were accessed more often online than those articles that also appeared in print (see Fig 2). This is not surprising, however, given that there is no other way to access these articles. Even those people who prefer to read from the printed edition of the journal must access online-only articles online, if only to print them out on their desktop printers. What is surprising is that in 2004 online accesses of print-and-online articles were approximately equal to those of online-only articles, and then in 2005 the trend reversed, with online-only articles being accessed less than print-and-online articles. One possible explanation for this trend is that more people are relying exclusively on the online edition of the journal. Readers at universities, for example, may be relying exclusively on the online subscription to the journal provided by their university and not reading from print at all. Similarly, those accessing the journal through HINARI or any of the open-access initiatives supported by the journal are likely reading exclusively online. Also, because there are typically more print-and-online articles in each issue than online-only articles, it stands to reason that overall accesses for the category would be higher.
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Although more readers may be relying exclusively on the online edition of Pediatrics, it should be noted that those who do receive the print edition of the journal still prefer to do much of their reading in print. As mentioned above, in preparation for redesigning both the print and online editions of Pediatrics, we undertook studies to better understand how readers interacted with the journal and the constellation of other professional resources they regularly consulted.15,16 Because AAP members receive both the print and online editions of the journal as a benefit of membership, we studied the ways in which AAP members used both formats. Far and away, the most cited purpose for reading Pediatrics was current awareness. Other prominent reasons cited were treatment, diagnosis, and teaching. In a series of focus-group sessions and interviews, we heard members repeatedly tell us that they prefer the print edition for keeping current, because it is more convenient and portable. It simply arrives in their mailboxes and can be read anywhere. However, even those who receive the print edition reported increased usage of the online edition for purposes such as research or preparation for teaching. Although the print edition is very convenient for reading current articles, the online edition is more useful for conducting searches or for finding older material.
In addition to online usage reports and surveys of readers, another key indicator that we track regularly are citations. Overall citations to Pediatrics have risen steadily since launching the online edition. In 1997, the first year in which the online edition was available, the journal's impact factor jumped nearly 1 point, from 2.748 the year before to 3.466. (The impact factor is calculated by taking the total number of citations to a journal in the current year and then dividing by the number of articles published during the previous 2 years). Since then, the impact factor has continued to rise steadily, to 4.272 in 2005, the most recent year for which there are available citation data.
In addition, total citations to the journal have risen dramatically. In 1997, there were 16800 citations to the journal. By 2005, this number nearly doubled to 31633, which almost accounts for more citations than the next 2 most-cited journals in the field combined.
More important than absolute numbers, Pediatrics has risen from third to first in the field of pediatrics as measured by impact factor, which means that the rise in impact factor has been an increase relative to other publications. It is difficult to ascribe this improvement directly to the presence of the online edition, although we do speculate that having a strong Web presence increases the likelihood of being read and, hence, cited. We also know that having a Web-based submission system embedded in one's Web site leads to more submissions and, therefore, the ability to be more selective. Although nearly every other journal in the field now has an online edition and Web-based manuscript submission, Pediatrics may have benefited from a first-mover effect.
Periodically we have looked at the citation rates of individual articles to compare how online-only articles are cited relative to print and online articles.17 Our most recent delve into the citation data was 1 year ago. We found that citations to online-only articles continue to lag print-and-online articles by a significant margin, although they are growing at a quicker rate. In 2003–2004, the last period for which we have mature data (one needs to allow 1 to 2 years after an article's publication for citations to accrue), citations to online-only articles increased by 15%, from 1.20 citations per article in 2002 to 1.41 citations per article in 2004. Citations to print-and-online articles increased by 7% during this period, from 3.63 to 3.89 citations per article. So, although there continues to be a notable gap 10 years after launch, citations to online-only articles are increasing at a faster rate of growth than print-and-online articles.
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PEDIATRICS IN CONTEXT: THE ELECTRONIC PUBLISHING LANDSCAPE |
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In the decade since Pediatrics launched its online edition, nearly every peer-reviewed medical and scientific journal in the world has followed suit. HighWire Press recently launched the 1000th journal on its hosting platform. Large publishers such as Elsevier and the newly merged Wiley-Blackwell host even more titles on their respective platforms, and nearly every major university press now publishes their journals on the World Wide Web. As Schriger et al noted in their excellent survey of the online functionality of medical journals published in the January 2007 issue of Pediatrics, today "there are many Web-only journals but very few print-only journals."18 This is a seismic shift from 10 years ago, when the reverse was true.
Schriger et al reported some other interesting findings that bear repeating here. Pediatrics continues to lead in terms of online-only publication. Among prominent medical journals, Pediatrics publishes the largest number of online-only articles. This will undoubtedly change at some point in the future, because there is a growing number of online-only journals (including the AAP's NeoReviews). In addition, weekly journals such as Circulation and New England Journal of Medicine have doubled and tripled, respectively, their output of online-only articles over the last few years. In addition to online-only articles, Schriger et al examined online-only supplemental material that is included alongside articles that appear both in print and online (such as the Pediatrics video article described above). They note that, although such supplemental material is still relatively sparse, its presence increased by more than threefold during the period surveyed. In 2003 only 2% of articles had such supplemental material, but by 2005 they accompanied 7% of surveyed journal articles.
A third finding by Schriger et al that is relevant here was that rapid response (or postpublication peer review) has not been widely adopted among medical journals. Only 12% of the journals surveyed offer such a feature, and among the journals that do offer a rapid-response mechanism, reader participation has been mostly dismal. Among the 12% of journals with a rapid-response feature (including Pediatrics), 82% of articles received no reader responses—with a few notable exceptions. Chief among the exceptions is the BMJ, which boasts an average of 6 responses per article on the 80% of their articles that receive postings. As Schriger et al do not offer a compelling explanation for this extraordinary reader-response rate (nor have I been able to locate one elsewhere), a case study of the BMJ's rapid-response feature might yield information relevant to other journals.
The most interesting finding reported by Schriger et al was a negative one. They reported that there is "little evidence of journals using the Web to provide readers an interactive experience with the data or with each other."18 This finding can be easily confirmed by a tour of journal Web sites. The only interactive feature that one is able to find (and that only in a minority of titles, as discussed above) is rapid response, which, with a few exceptions, has not been embraced enthusiastically by readers. Nowhere are there other functions that allow readers to interact with either published data or each other. Although other spheres of human endeavor have developed robust interactive Web sites that have revolutionized such activities as dating, news reporting, selling that old box of memorabilia found in the attic, and sharing vacation pictures, journal sites have been very slow to develop and integrate interactive forms of communication. On the one hand, this is puzzling given that medicine is such a collaborative discipline and physicians have been quick to adopt new diagnostic and therapeutic technologies. On the other hand, perhaps it is precisely because the practice of medicine is so collaborative that physicians have not seen the need for additional communication channels. However, it is only a matter of time before a generation that was reared on interactive, multimedia Web sites will graduate from medical school and expect this sort of functionality as a matter of course. If scientific and medical journals do not adapt to these expectations, they will quickly find themselves in the position of scriptoriums after the introduction of Gutenberg's printing press.
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CONCLUSIONS |
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TOPABSTRACTORIGINS AND MILESTONESHIGHWIRE PRESSACCESSING THE ELECTRONIC JOURNALUSAGE AND CITATIONPEDIATRICS IN CONTEXT: THE...CONCLUSIONSREFERENCES |
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Ten years ago, Pediatrics launched an online edition as a modest experiment. It is clear now that it is no longer an experiment but, rather, a transition to a new paradigm of professional communication on par with—or perhaps even greater than—the transition from scriptoriums to the printing press that took place 550 years ago. It is interesting that printed materials before the year 1501 are referred to as "incunabulum" (singular) or "incunabula" (plural), which is a borrowing from Latin and means "swaddling clothes." It connotes the idea that printed matter was, during this time, in its infancy or early period. Taking a long view, we have only begun the transition to online journals and are clearly in our incunabula period. Over the last 10 years we have essentially replicated the printed journal in the electronic format. And although a number of online-only features have been introduced, we have only begun to truly reinvent the journal in a form native to the digital medium. Features such as video supplements have added something to the article that cannot be replicated in print, and postpublication peer review has created an infrastructure for rapid interactivity that would not be possible off-line. However, with these exceptions, the online journal is still largely a simulacrum of the print edition.
There are some good reasons for this. The print edition of the journal is very successful and continues to be heavily used: 92% of AAP members have indicated they still wish to receive the print edition. For those members and other subscribers who continue to receive the print edition, the large majority of reading still takes place in print. This is not unique to Pediatrics. Most medical journals have continued to maintain print editions despite having developed Web sites. Print is still easier to read and causes less eye strain than all but the best and brightest monitors. It is more portable in some ways than the electronic edition. One can read the electronic edition from any computer, but the print edition can be read easily on a plane, on the couch, or at the breakfast table. Laptops are still somewhat cumbersome, and one must still worry about spilling coffee or other breakfast table detritus on them. The print edition is automatic: it simply shows up in one's mailbox. One does not have to go online, log-in, perform a search, download an article, or even press a "print" button. One simply opens the journal and starts reading. In addition, one can write on a print copy or highlight notable passages. The print edition will likely continue to be more convenient for many readers until a new device is invented that replicates these attributes in electronic form—a digital paper that can be written on, easily shoved in one's briefcase, automatically download one's reading materials, and is resistant to coffee and other professional hazards.
While we wait for such a device to be developed by the technical wizards of our day, there is still a great deal that can be done to improve and expand electronic journals using current technologies. Functionality can be developed to allow readers to better interact with data. Data sets could be placed online with tools that facilitate data modeling and analysis. The use of audio and video can be greatly expanded. Above all, means of enabling and encouraging more reader-to-reader communication can be expanded. The online medium opens the possibility for journals to become far more interactive and to engage professionals to a degree that simply was not possible in print. Given this potential, the next 10 years are shaping up to be just as interesting as the last 10. Pediatrics has every intention of continuing to evolve, experiment, and lead this electronic transition, ensuring that the journal is as relevant to the readers of tomorrow as it is to those of today.
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ACKNOWLEDGMENTS |
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I thank Carol Tenopir (University of Tennessee Knoxville) and Donald King (University of North Carolina, Chapel Hill) for work on the design and analysis of the survey of AAP members noted herein; Cara Kaufman (Kaufman-Wills Group) for conducting focus-group sessions; and Chris Beckett, Simon Inger, and James Culling (Scholarly Information Strategies) for analysis of Pediatrics citation data.
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FOOTNOTES |
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Accepted Dec 13, 2006.
Address correspondence to Michael T. Clarke, MA, c/o American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007. E-mail: mtclarke{at}alumni.uchicago.edu
The author has indicated he has no financial relationships relevant to this article to disclose.
Mr Clarke served as Senior Managing Editor and, later, Executive Editor of Pediatrics from 2002 to 2006. His current affiliation is with the American Medical Association, Chicago, IL.
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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
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