Speaker 1:
From the library of the New York Stock Exchange at the corner of Wall and Broad Streets in New York City, you're inside the ICE House. Our podcast from Intercontinental Exchange on markets, leadership, and vision and global business. The dream drivers that have made the NYSE an indispensable institution of global growth for over 225 years. Each week we feature stories of those who hatch plans, create jobs, and harness the engine of capitalism, right here, right now at the NYSE and at ICE's exchanges and clearing houses around the world. And now welcome, Inside the ICE House. Here's your host, Josh King of Intercontinental Exchange.
Josh King:
My dad, Dr. Howard King, who passed away about a year ago at the age of 92, was essentially the town pediatrician of Newton, Massachusetts, the town where I grew up. Dad took care of kids from the surrounding neighborhoods and the surrounding cities as well, but his curiosity about the world of medicine expanded well beyond the practice of pediatrics. He loved probing peer reviewed articles and journals for the latest in psychology, addiction, and domestic abuse. That had an effect on our home because, as the years passed, the subscriptions to medical journals to which he subscribed brought into our mailbox hundreds and then thousands of issues that he refused to recycle, always thinking there could be an extra kernel of digestible information to be gleaned at some point from one of the back issues. At the top of the pile was the New England Journal of Medicine, launched by Boston physician John Collins Warren in 1811 as the New England Journal of Medicine and Surgery and the Collateral Branches of Medical Science.
And then there was the Journal of Pediatrics owned by Elsevier. Published monthly since 1932, promoting the latest developments in pediatric medicine, child health policy, and advocacy. Elsevier's most perhaps best known title is The Lancet, which in 2022 overtook the trusty New England Journal of Medicine as the medical journal with the highest impact factor according to Clarivate's Journal of Citation Reports. Alas, the olden days of piles of magazines taking up desk space in doctor's offices and night tables has given way to electronic digital archives, and increasingly, artificial intelligence to help make doctors, nurses, and healthcare givers smarter and more nimble to address the medical issues of today. In healthcare information sector, RELX, that's NYSE ticker symbol RELX, and its subsidiary Elsevier are leading the integration of AI into medical research, education, and patient care. With recent innovations leveraging the capabilities of gen AI, Elsevier Health is transforming the approaches to patient treatment, drug discovery, and how nursing and medical students learn.
Leading the positive AI disruption is our guest today, Dr. Jan Herzhoff, president of Elsevier Health. Aided by the input of clinicians worldwide, Jan is leading Elsevier's Health's AI innovation, helping to make these medical professionals more efficient and more knowledgeable. In today's episode, Dr. Herzhoff and I will discuss some of the recent AI products and services launched by the company. We're also going to explore how the business is ensuring that all patients are represented equally, allowing up and coming medical professionals to practice and prepare as the generation inheriting healthcare from practitioners like my dear old dad. Our conversation with Dr. Jan Herzhoff, president of Elsevier Health, is coming up right after this.
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Josh King:
Welcome back. Please remember to subscribe wherever you listen and then rate and review us on Apple Podcasts so that other folks know where to find us. Our guest today, Dr. Jan Herzhoff, is president of Elsevier Health, a subsidiary of RELX, that's NYSE ticker symbol RELX. Jan joined RELX in 2012, and prior to ascending to his current role in 2020, spent time in London and Singapore in various leadership positions with the company. Jan has more than 20 years of global experience in the healthcare sector, holds a PhD in information systems from the London School of Economics. Jan, thanks so much for joining us inside the ICE House. Welcome to the New York Stock Exchange.
Jan Herzhoff:
Thanks so much for having me here, Josh.
Josh King:
Your first visit to the NYSE?
Jan Herzhoff:
It is the first time today.
Josh King:
Thoughts as you enter the building and think about this place where your company has been listed now for some time?
Jan Herzhoff:
I love it. It's a very, very impressive building. I like the small, little items that you have, the basketball, the cars. It's a very special place.
Josh King:
We need to put some issues of The Lancet downstairs.
Jan Herzhoff:
You should, yeah. I would love that.
Josh King:
What would be the iconic thing to represent RELX that we could have down in one of those boxes?
Jan Herzhoff:
Well, I think clearly one of the issues from The Lancet would be amazing. Probably it could even be one of the recent articles around COVID, which triggered the whole development of the COVID vaccine. That could be one very exciting.
Josh King:
How often does The Lancet publish?
Jan Herzhoff:
I think it's on a weekly basis.
Josh King:
I mean there are so many times in my youth and in my career and just watching television and the news when the latest issue of The Lancet contains some incredible news breaking story. What are some of the more recent ones that folks in the publisher's office say that really helped people a lot?
Jan Herzhoff:
Well, that's a good question. I mean, we have our team in The Lancet is based out of London. I don't interact that much with them, but there's always very, very interesting content they bring up.
Josh King:
I gave this quick overview of the company in the intro, but delve a little deeper for our listeners beyond what comes top of mind for a guy like me, The Lancet or the Journal of Pediatrics, what is Elsevier Health?
Jan Herzhoff:
So when you look at Elsevier Health as part of Elsevier, what we do is our mission is to support students, faculty, and clinicians to be the best version of themselves to really help to improve patient outcomes. And we do that throughout the life journey of a clinician, starting right with the first book they usually would have, Gray's Anatomy, for example, one of the first anatomy books that are out there. They would learn anatomy, they would learn it with us, and moving more and more into practice, would then look at the journal.
So what we help them to create is their scaffolding over the years to really become a very, very good physician or nurse. And we help them throughout that time, and then when they move into practice, we are there to help to improve and to help them to make sense of the latest medical knowledge that comes out. It accelerates at such a rapid pace, all the medical knowledge. We help them to use this knowledge, the latest evidence-based knowledge, to bring it to them at the right point in time at the point of care when they need it for their patients. And then finally help them with their conversation and communication to the patients as well with various materials.
Josh King:
Of course there is my dad's addition of Gray's Anatomy somewhere in my mom's house sitting on a shelf. I don't know what year the addition is from, but it has to be one of those first tomes that an aspiring doctor gets and begins to pour through. For more than 150 years, Elsevier Health has helped the work of research and healthcare communities, certainly helped my dad become a more knowledgeable, thoughtful caregiver, but a lot can happen in 150 years. How has the approach to this support over the last century and a half evolved in response to advances in medical knowledge and technology?
Jan Herzhoff:
That's an excellent question, Josh. When you look at in the past, it started obviously early on with the printing press, when the documents were printed, when books were printed, moving to journals, the journal distribution. And then in the late 1980s, early 1990s, Elsevier created the platform called Science Direct, which was the first database really for medical insights, medical knowledge, and also other domains as well, and providing them to researchers, to clinicians globally. And from that databases, it moved more and more into clinical decision support, into workflows, and now most recently into artificial intelligence.
Josh King:
And we're going to get to that in great detail. Elsevier Health's client base, as you imply, spans medical professionals around the globe. A doctor like my dad practicing in Newton, Massachusetts has really different needs and approaches than a doctor treating patients in Nuremberg, Germany, for example. To meet the diverse needs of each country's individual healthcare system, how are Elsevier's resources and technology been tailored, ensuring equitable and effective use across different geographies and cultures?
Jan Herzhoff:
That's a great question. When you look at the needs per country, various differences stand out. So obviously one is it can be the language, it can be drug information. For example, here it's of course FDA drug approved, of course in other countries you have other drug agencies that approve certain drugs. There might be different metrics systems, there might be very different evidence based on certain environmental factors. So they all change per country very often and that's where our team come into play. We have in all major geographies local teams that localize the content, that look at the latest evidence, also create networks. One great example is our team in Japan, for example, many years ago they worked together with the former head doctor of the former emperor of Japan and created with this gentleman a network of the top 1000 physicians across Japan and created a network of the latest evidence-based content that is then now used by most of physicians in Japan. So that's how we operate.
Josh King:
I mean you're talking about Japan and the healthcare system there. Your own global reach may not extend as far as the company's, but your career has taken you from the consulting firm, McKinsey, based in Germany to various roles with Elsevier overseeing markets in Asia, but also Latin America, Europe, to now being located here in the United States. How have these experiences shaped your leadership approach since taking over the current role?
Jan Herzhoff:
So one of the interesting points in a business like ours is how you scale certain ideas, products, ideas, and it's really interesting when you reflect on that and when you look at it, how can you bring specific products and bring them into global markets? And for that you need to have that understanding of different cultures, how different countries operate. A lot of difference between developing emerging countries and more established countries, how you create these products, how do you bring them to market, and that's one of the things that really help you when you have the variety of different experience in different countries. And that helps you and you see suddenly links that you would otherwise not see.
Josh King:
Was this a particular expertise that they taught you at McKinsey? How did that develop for you personally?
Jan Herzhoff:
For me personally, that developed actually much more over time and actually even more within Elsevier. And it was one of the reasons when I thought about, okay, where should I move on after McKinsey? And what I really liked about Elsevier and RELX is that very global footprint. A company that is in so many different countries, so many different cultures and how we operate. I think I learned this here, I learned it in this company.
Josh King:
I look at my fast facts about Elsevier that I got off your website; 2,900 digitized journals, you published 99% of Nobel Laureates, you've got 190,000 open access articles that people like me can read if I could get through them, 4.5 million registered users worldwide, just to name a few of those fast facts. You're doing this with 9,500 employees, three of whom are in this room. What is the broad span of the expertise underneath you? What do they do during the day?
Jan Herzhoff:
So in the division that I lead is basically all of our health businesses. And there are different groups. We have a content organization; they would usually engage with our authors. It would be a technology organization that really works together with our product teams, with our customers, and co-create the products. Our sales and marketing organization that would think about go-to market approaches, scaling, bringing our products to different markets. So it's a really broad range of teams and expertise. What's really interesting about Elsevier overall is that the teams and the people are here because of the purpose, the strong purpose of the company, and that's one of the core reasons that drives everybody, including myself, gets up in the morning. It's about really how can we help the medical students, nursing students, faculty, future doctors, how we can help them to be the best version of themselves.
Josh King:
I mean, being the best version of themselves, the purpose of the company. You've been part, Jan, of RELX since 2012. Did you always have a passion for the healthcare industry? Where did this desire to support clinicians and other medical professionals come from?
Jan Herzhoff:
I think very similar, we can go back to a very similar parallel to what you shared about your dad, Josh. I was born in a very small town, actually a village, in rural Germany just north of Frankfurt. And my family comes from a background of health professionals and entrepreneurs. And at that time when we had at the dinner table, either it was with the family or family friends that came over, a lot of discussions were always about healthcare system, healthcare overall. My dad is a pharmacist in Germany. He had his pharmacy there. And it was always a big, big topic and I started to evolve that over time during school and later on, but that was where it all started.
Josh King:
We have a wonderful Germany based listed company that just went public here last year, Birkenstock, NYSE ticker symbol BIRK. Also the spawn of entrepreneurs and foot care specialists and cobblers in a small German town, so I can visualize what you're talking about. Jan, you got your master's degree and your PhD in information systems from LSE. While this field might not seem immediately associated with supporting medical professionals, how has your area of study in London at LSE influenced your approach to integrating healthcare and business at Elsevier?
Jan Herzhoff:
So it all started, first I had a startup with a friend of mine during school where we worked on solutions for pharmacies in Germany. So I already linked technology with healthcare at that time. Then moving to London at the LSE, they had a very interesting approach to technology. They looked at it much more through a social lens. A social lens in terms of thinking about when you look at a piece of technology, it always really enacts or powers up when you have it obviously linked up with people. In the case of healthcare, of course when you think about the clinician, it's about when you look at most the latest technology around artificial intelligence, it's about how a clinician, how a physician can bring in their expertise combined with this new technology and obviously help then patients to improve their outcomes. So it's always that link between the person and the technology that I found very interesting.
The other approach that really helped me to think through at the LSE was about infrastructures and large scale infrastructures. So when you look at our business, it's really about creating a lot of very large scale platforms that support our various customer groups, and it's about how you make these platforms successful. That was another very interesting part that I learned at the LSE.
Josh King:
Talking about the latest technology of artificial intelligence, in a recent conversation with Authority magazine on AI disruption, you said, and I'm going to quote you here, "With the recent AI boom across industries, many companies and organizations are trying to keep up with the pace and determine how to best implement AI into their products and work streams. We are already there," you said. So Elsevier has been using AI in its products and services for the last 20 years. Generative AI has enabled recent innovations. Before we dive really into these new products, how has the company's longstanding use of machine learning positioned it as a leader, given the AI explosion that we've been experiencing over the past couple of years?
Jan Herzhoff:
Yeah, we have used AI indeed for more than a decade in many of our solutions, a lot for data extraction, for information extraction in our operations. Now what is different now is more this element of generating answers leveraging generative AI, but we have been using AI for a very, very long time already.
Josh King:
Now, to be fair in this room, Elsevier is not the only company using generative AI in its workforce or leveraging machine learning technology over the past couple of decades. How does Elsevier distinguish itself from its competitors?
Jan Herzhoff:
So one very big difference is in that, especially in the healthcare domain, very, very critical, and you brought up up at the very beginning when you talked about your dad, it's about the evidence-based content, high quality, the highest quality content. When you think about any of the technological solutions, if you don't combine them with the highest quality of content, it always becomes like an empty shell. It doesn't really help you with that. Now what stands out for us is that we curate that content over so many years. We build these networks with physicians across the globe. It is constantly improving that content base, and this content is of course powering a lot of the platforms.
Best example is when you think about textbooks. Textbooks in the past, you obviously had a print book like Gray's Anatomy, it moved to databases, it moved into a 3D space. Now what you have is, even in the world of large language models, these textbooks are incredibly valuable, not just only for providing the answers, but also for training the models. And because of the way how they are structured, for example, it's a very, very, very important insight and we are basically the biggest, we have the biggest medical content base from this very structured content and can use that and stand out compared to many other players who don't have that.
Josh King:
As we talked about earlier and your own history, Elsevier is a subsidiary of RELX and it's led by your CEO, Erik Engstrom, and its CFO, Nick Luff. I want to listen to a recent interview that Nick did with Bloomberg Markets talking about RELX's investment in AI innovation.
Nick Luff:
So we've been working with AI technologies for such a long time, a lot of what we do in terms of investment or our operating expenditure is already directed at these sort of innovations. So we've had a bit of a shift in where we're focused and these large language models has meant that we've really gone after the opportunities that generative AI have created, but it hasn't really been a reallocation of resources. So we're doing that. We're a relatively low capital intensity company, so it's really about where we're directing the people and the resources inside the company.
Josh King:
So Nick talks about a reallocation of resources towards generative AI inside the company. How much support has RELX given Elsevier Health to develop new products and plans for future innovation?
Jan Herzhoff:
A couple of interesting things. So one is when you think about RELX overall, as you mentioned, we have different verticals. We have our sister company, LexisNexis for example-
Josh King:
I know it well.
Jan Herzhoff:
... Who then has launched Lexis+ AI just about a year ago. What we do here is we learn from each other constantly. We have constant sharing of insights. When you think about how the platforms are created, how the AI products are created, which go-to market approaches work, when you think about different costs and revenue and pricing models. So we do a lot of exchange here that help us all to basically overall as a group to move much, much faster.
Josh King:
In addition to LexisNexis, the RELX umbrella includes brands like LexisNexis Risk Solutions, LexisNexis Legal and Professional. I think of the first time that I did a Boolean search on LexisNexis and it was like a whole new world opened up to me when I saw everything that it provided back to my screen. How does Elsevier and Elsevier Health collaborate in a little more detail with those other branches to support and enhance the overall RELX valuation?
Jan Herzhoff:
So we have links on the engineering side, on the product side, on the go-to-market side where we have regular exchanges between the groups, and that actually works extremely well. And also really learn about, when you look at leveraging large language models, it's also about understanding which technologies are good for which use cases specifically. And there are a lot of parallels and similarities, especially when you think about some of the legal search use cases are very, very similar to search cases also in the medical field. So we do a lot of exchanges there on multiple levels.
Josh King:
Generative AI has been making waves since the launch of ChatGPT in I think November of 2022. But Jan, when did you first recognize the potential impact of how AI technology might impact your products and the healthcare sector as a whole? When was the aha moment for you?
Jan Herzhoff:
So I have a long, long-term actually relationship with artificial intelligence. The most funniest example was in one of my first lectures at the LSE, it was about neural networks and genetic algorithms. And I remember the lecture really well because it was a lecture where I met my future wife and we have been together ever since. When you look at over all these years, I think where it became really, really critical was actually the moment when ChatGPT launched. At that moment in time, that was a moment where when you look at the challenge that we were facing, and that's a really, really good pivot actually to it is when you think about, we always thought about how can we improve the search for clinicians to find the right information in this huge ocean of information that we have, how we help them with that. And when we saw this technology coming out, one interesting thing was, the aha moment was this technology could help us to find or to help the clinician to find the needle in the haystack.
That was the moment and the big aha moment was there because that was one of the biggest challenges that we were facing. It would always take, with the current solutions for simple questions, it would take you perhaps five, 10 minutes to find an answer as a physician. If it's about medium or hard questions, 30% of the questions you would never find an answer or it would take you a very long time. Now when you see this type of technology, especially vector search powered large language models, they help you to find this information much, much faster. And when you have that huge content base, then it becomes extremely powerful. That was for me the aha moment that was early last year.
Josh King:
For some of us, searching for that needle in that haystack can be part of the fun, but doctors don't always have that time to find needles in haystacks. There's no more important, perhaps, relationship for human health than the doctor to patient relationship. How is Elsevier Health communicating the role of AI as a tool to compliment and enhance the human work of the doctor rather than really replace it? This was not an issue that faced my dad, but AI can't tap a knee with a reflex hammer. It can't probe the health of an eardrum with an otoscope or apply a stethoscope to hear the beat of a human heart.
Jan Herzhoff:
So I would consider when you look at, I mean there are different ways to see it, but one very good way to visualize it is to see a physician more as a detective. You have potential crime story, you have a situation and you need to look at all the evidence. You obviously need to look at the patient as well. You need to look at the vitals of the patient, but the patient, the interactions, the question that you probe and ask the patient are critical. Next to it is it's using databases. And where I can see AI as extremely effective is in that part to help you with that information, retrieve that information from the database. But at the end of the day, you as a physician, you need to bring all of these different pieces together and assess them and then link them up. And that type of is very, very difficult. And we believe it's not the right approach to replace, we believe that with AI, and responsible AI specifically, you can enhance the capability of the doctor and the nurse and the overall clinician in that space to make them much, much better, much more effective, but they play the absolute critical role in that equation.
Josh King:
I mentioned how the emergence of generative AI has helped Elsevier Health create new products and support healthcare providers. One of the most advanced products launched this past February, recently, was ClinicalKey AI. I want to listen to a part of a clip from Elsevier Health detailing the importance of this product.
Speaker 5:
In a world of too much information, finding the right answer can be daunting, especially for care providers and students in their most decisive moments. That is why we believe in placing the latest evidence-based content directly in the hands of every clinician. And by pairing world-class, trusted clinical information with artificial intelligence, we can take a giant leap forward in the way clinicians find and use information at the point of care. Today, Elsevier proudly presents our next step in helping you make the most informed clinical decisions. ClinicalKey AI.
Josh King:
She's got a great voice, it makes you wonder whether she's AI generated. But pick us a little deeper into ClinicalKey AI. How does it help doctors and patients at the point of care?
Jan Herzhoff:
So starting with the problem we are trying to solve, the problem we are trying to solve is to help the physician in a moment when they need to figure out an answer or have a specific question in mind and to figure out an answer to that question quickly and also when you have a very complex medical case as well where you need to have follow-up questions, that's exactly where ClinicalKey AI shines. So what we are doing here is we have created this platform where we combine our content with a cutting edge vector search together with a partner startup called OpenEvidence. And what we are doing here is we have our curated content, the clinician can ask the question in normal conversational tone, we ensure that the content that has initially been indexed is only curated content, so it's not coming from public internet sources, so to ensure it's trusted.
All the answers are then based on that content from these journal articles or clinical overviews that have been created. And the vector search finds these content pieces, these specific paragraphs, and place them back. Now, these are all from trusted sources that physicians would use and would've learned from over decades based on textbooks or journals that they have been using. So it is trusted content, its specific paragraphs are directly linked to the deep content, so you can always go back to the evidence and double check that it's accurate and works. And in addition, we have an evaluation framework where we constantly evaluate that the results from ClinicalKey AI is accurate and if we see any challenges, issues, that we can immediately intervene. When you look at the multiple levels of importance, especially what you said about how important this relationship is between the patient and the doctor to ensure that the support engine that is here is trusted and of highest quality.
Josh King:
All the journal articles in human history and the way in which it is sifted through and organized and represented through generative AI isn't of much great use if you don't have enough physicians at the frontline in the doctor-patient relationship. The National Center for Health Workforce Analysis projects a shortage of over 130,000 physicians by 2036, which could exacerbate the already present feelings of fatigue and exhaustion among healthcare professionals. And to stay on the example of my dad for a minute, although he had a long and rewarding career, I know he rued the plight of today's physicians; limited reimbursement by insurance companies for the time spent to take a medical history and listen to patients, and wouldn't perhaps recommend the profession to STEM students considering medical school as family practitioners. How can ClinicalKey AI mitigate some of these burnout issues and support healthcare professionals in managing their workload more effectively?
Jan Herzhoff:
So I can see two separate topics here. So one is about increasing overall capacity in the system for both physicians and nurses. One big challenge especially that we have here in the United States is we don't have enough nurses. There's a nurse shortage. And it's actually crazy when you think about it that there are enough candidates who would actually like to join a nursing program, but they can't be supported because there are not enough faculty or not enough clinical placements for them. So it's all about how can we help nursing schools or medical schools to increase the number of placements and also have the faculty there to support that. So there we are actually helping quite a lot also where we have specific AI products that support this educational use case.
Now on the clinical side, it all is again linked to, it's similar to when you think about your own day-to-day work. When you use your normal tools, you want them to work. You don't want to have frustrations around it because if you use your normal day-to-day workflow tools, if they don't work, if the computer doesn't shut down or whatever happens, that creates frustration and we to remove all of that. So one big one is indeed when you think about search, when you search and it takes a long time, you don't find the answer, that creates additional anxiety and it creates additional pressure. We want to remove that. That's one of the ways of how we want to help to reduce that, but we have a lot of other things we are doing in this space, but this is especially for generative AI where we work on.
Josh King:
The press release that was distributed when Elsevier Health launched its global launch of Elsevier Health and OpenEvidence, which is your partner in creating Clinical AI, it said that you'd collaborated with over 30,000 physicians across the country. How did the input of healthcare professionals working in doctor's offices or hospitals nationwide shape the development of the product?
Jan Herzhoff:
So we also have various design partners we work with and we are constantly getting feedback from them about the design of the product, the responses to the questions, the accuracy level, so all of that helped. Initially in that very first step, specifically around the 30,000 tests, it was all about the underlying technology, the search technology, where they provided feedback and input that it actually works and is highly effective. That was one of the key insights that we also gained earlier last year, it was. When we made the decision around partnering with OpenEvidence around it, we tested it ourselves, we tested our own approach, we tested then the OpenEvidence approach, and we tested then a combined approach with both of us and the accuracy of it was so high that we believe, okay, this is now ready to go for primetime.
Josh King:
Given ClinicalKey AI's impact on the point of care decision-making, accuracy, reliability, and responsibility are really paramount in all of these decisions. Where does the content for the product come from originally and how does Elsevier Health along with the technology staff ensure that the data provided meets your stringent standards and really can be relied on and trusted by the clinicians?
Jan Herzhoff:
So the underlying content of ClinicalKey AI really comes from our journals, our books, many, many of them are peer reviewed content from clinical overviews that have been curated over a very, very long time. It takes an incredible amount of effort to actually get to that level of quality. Usually we have people who actually check on that together. It's a very, very sophisticated process, similar to all the other content that we have created. It also doesn't only come from Elsevier sources, but also from other publishers as well where we have the rights to use the content. So it's a very, very broad range of content assets, but only the highest quality content that's out there.
Josh King:
After the break, we're going to continue to discuss Elsevier Health's integration of AI and more of the recent innovations that have helped the business ascend to the forefront of the industry. All that and more is coming up right after this.
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Josh King:
Welcome back. If you're enjoying our conversation, want to hear more from guests like Dr. Jan Herzhoff, president of Elsevier Health, a subsidiary of RELX, that's NYSE ticker symbol RELX, remember to subscribe to Inside the ICE House podcast wherever you're listening to your podcast, please give us a five star rating and a review on Apple Podcast so more folks know where to find us. Before the break, Jan and I began our discussion on Elsevier Health's implementation of AI into its services and how one of the recent innovations, ClinicalKey AI, is helping clinicians directly at the point of care. Jan, as we transition from talking about ClinicalKey AI to Elsevier's wider portfolio of AI products, can you describe the process involved in determining when and how to innovate? How does your team evaluate a problem, figure out where to go to, where to deploy your resources, and how to proceed to find AI based solutions to the problems?
Jan Herzhoff:
We work and we co-create everything with our partners, with our customers to really understand where are the biggest, biggest pain points they have. In that case of ClinicalKey AI, the big pain point was around the search and how quickly you find information. So we would look at what is the biggest challenge. We would also always look at, the big focus is on monetizable innovation. We can't solve everything, we also need to look at what are the areas where the biggest value is put behind from our customers. That really is a good proxy, really, for the biggest challenges they have. So we would look at both combined. We would look at the problems, how big they are, what is the value attached to it. We would also look at it from a global scale perspective. Is it something that only can help in one specific country in a setting or is it something that we can scale up? Because one of the key capabilities we have as a company is really the scaling up from something that starts small to bring global.
Great example is we had a couple of products in the education space. We launched them in 2018, six years ago, from zero, and they're now in 1,600 institutions globally. So that's one of our capabilities is to scale up something when we have found a problem, when we understood that the value is there, and then working together with our customers and then with our sales and marketing teams to really scale it and bring it to all the markets across the world.
Josh King:
A month prior to the launch of ClinicalKey AI, Elsevier launched the Scopus AI product. That's designed to help research and research institutions. What functionalities does this service provide and how does it leverage the database of over 27,000 journals and close to 2 billion citations to provide accurate and relevant information?
Jan Herzhoff:
There are multiple use cases. One very interesting one is when you are a researcher at a very early stage, you want to understand a specific problem domain. It's still something that's very, it's new to you and you want to understand that domain, you can use Scopus AI to get a very, very quick overview of the entire domain and it would show you the most important papers, et cetera, and where to really then advance your research into. It's a very powerful tool for exactly that.
Josh King:
Jan, we've talked about Elsevier Health's AI products that enhance efficiency for clinicians, researchers, and scientists. Shadow Health and SurePath AI are two services that specifically cater to nurses, nursing students. I want to listen to a segment from an Elsevier health clip introducing the Shadow Health Technology.
Speaker 5:
Virtual patients have diverse personal and medical histories and can answer hundreds of thousands of questions, so the responses are as varied as the patients themselves. Conversations in real life aren't scripted or multiple choice. So Shadow Health's digital clinical experience creates real life situations for students to apply clinical judgment when addressing each patient's individual needs. It's from these virtual patient interactions that instructors can truly quantify students' critical reasoning skills and the instructor's detailed assessments are what differentiate Shadow Health Simulation experience from any other.
Josh King:
So Jan, how do Shadow Health and SurePath AI collaborate to enhance the knowledge and skills of these emerging health professionals in the nursing space?
Jan Herzhoff:
So both products are part of our nursing education business. What's interesting about Shadow Health is Shadow Health supports exactly to help the future health professional build their communication skills with the patient, and it's extremely, extremely good at that. So it's about bringing very different diverse patient situations to, in this case, the nursing students engaging with these simulations, really, with this digital characters and ask the right questions. It's a multitude of questions that you can ask. It's a very free flowing conversation that you can have. And what's interesting about it is that when you ask these questions, the patient would react obviously very differently and you have to find the path which helps you to identify the right challenges or the right evidence, again, that help you to then think about the right treatment plan for the patient. It's a great tool, was developed by a company in Florida that we acquired a few years ago during COVID.
Josh King:
The world's first heart education experience in spatial computing, something called Complete HeartX, was launched in February, offering users a unique way to explore the heart. How does this technology differentiate itself from traditional education tools and create a novel learning and interaction experience when you're talking about the thing inside you?
Jan Herzhoff:
Yeah, this is actually a very, very exciting technology actually going much more beyond traditional simulations. So when Apple launched the new Apple Vision Pro, we were one of the very first apps that actually were there, and in fact by enterprise customers and the press, we were considered to be, that tested it, actually one of the most advanced simulation products on this new device. Now, what's incredible about it is you might remember the movie The Matrix. Yeah, so it actually supports you with that type of learning experience. It's about understanding a concept. You go into, basically you see, let's say for example, the heart. You see it in 3D through the glasses. You're able to engage, you are able to understand it.
When you have understood it, then we push you into a simulation, completely virtual simulation where you then have to deal with the patient who has a heart situation. So you learn, in an incredible way you actually help students to engage with specific, sometimes very challenging concepts that many years ago they were only able to look into a 2D book to see the heart or later in a 3D version. Now they can engage with it and it's a much, much, much richer learning experience that is possible with a device that can move really from a extended or mixed reality setting into a virtual spatial relation situation.
Josh King:
I assume you've played around with the Apple Vision Pro a couple times?
Jan Herzhoff:
Many times, yep.
Josh King:
When you put that on, and I got the basic demonstration at Apple's offices up in Midtown, and they show you, well, you can travel to any place on the planet, you can interact with dinosaurs, you can engage with your family, my dad, who may not be living anymore, but use some of those images and videos of him living and that can create sort of an interactive environment. As you put those goggles on from where you sit, what is your experience thinking about how it can be applied?
Jan Herzhoff:
I think it's incredible, especially in a medical setting. Other devices that we have tried it on in the past, they would not give you that type of resolution that you need in a medical setting and that type of quality. So for us as a company, it's a game changer of how we can bring in, again, the latest insights, the latest knowledge in a way that is extremely engaging and gives our customers completely new insights that they didn't have in the past. You could imagine also in a clinical setting where if there's a situation, you could directly push the latest journal articles specifically on a situation. It's a very, very powerful tool, and from our perspective, extremely rich to use.
Josh King:
You think about what it can do as you stare into and move through an actual beating heart, and yet we are well aware that there's so much more to the anatomy than that. It began with those early publications of Gray's Anatomy, but the launch of Complete HeartX follows Elsevier's introduction of Complete Anatomy, touted as the most advanced full female anatomy model globally. What's the significance of these two innovations in terms of promoting equitable representation of the female body in medical education?
Jan Herzhoff:
If you would ask me what would be one of the proudest moments of basically our entire team, what we have created over the years, we would say this is exactly it. It's about when you think about it, just a few years ago you had, when we acquired Complete Anatomy, that was in 2019 December, it was basically a white male and you would learn the anatomy on that. And most of the other solutions, and it might have been all of them, were actually very similar to that. So we put a lot of focus on to ensure that we actually had a female model and also different diverse characters as well to be able to have a much better representation.
What's interesting is about this technology is, so this application, Complete Anatomy, is now used by a third of all future doctors globally. Every third future doctor is trained on this tool, and what they have is in the past, it was really just one single way of how you could get the representation. Now, our latest data showed that of these future doctors, 77% chose a different representation. That really helped them to understand different anatomy, female anatomy, and also when you think about skin cancer, how, for example, it would look on a different type of skin. It's a big, big change that we were able to drive also through this offering and with global impact.
Josh King:
I mean, you're talking about skin cancer with different types of skin, Jan. How do you think that innovations like the ones that we've been talking about are going to positively impact the medical field moving forward, especially considering the current medical students that they now have access to switch between both male and female anatomy, dark and light skin, all the different variations that a doctor might encounter during his or her career?
Jan Herzhoff:
For me, I mean one important thing is it helps them when they see a patient in the room, that they, for example in the context of heart diseases, would be sensitized to think about, well, for example, a female might have very different, show different reactions to a heart disease than a male does. If you're not sensitized to it, you would not pick it up and, well, 50% of the population are females, so you would really risk a lot of heart cases if you don't have that. And in fact, it's one of the biggest, if not the highest reason for death across the United States is exactly heart diseases and especially for female patients. So that's one of the things we believe we can really help to change, of course always together with our customers, but it's a big thing.
Josh King:
Shifting away, Jan, from AI products, late last year, Elsevier Health conducted its 2023 clinician of the Future Report. Surveyed over 2000 clinicians worldwide, exploring the latest trends in their perspectives. How does this report influence the strategic direction of Elsevier Health, the conversations you and your colleagues have in the conference room, and your efforts to adapt and support clinicians in the future?
Jan Herzhoff:
Actually, it's a very substantial input because here we look at it's a global survey, it looks at different countries, different geographies. What's very interesting is one of the key insights was how open clinicians are actually to the use of AI as part of clinical decision support. So in that last year, about 7 to 8% globally of physicians were using AI technology to help them with clinical decision support, but up to 50% actually said over the next two, three years, they would actually switch to this type of technology. And that helped us a lot to understand, okay, this is the time horizon and this is also the share of customers who actually are very open to it and the other half who is less open to it and where we need to understand what are the blockers really. And it's also interesting by geography. So for example, in China, physicians are much, much more open to use AI technology than for example in the United States or in the UK. So we also see geographical differences, which are very helpful when we think about the resourcing and in which markets you would go.
Josh King:
As we begin to wrap up, Jan, the products and technologies that we've been talking about have been developed relatively quickly if you think about the dates that I've been mentioning and your tenure at Elsevier sort of tracked along with that, so so much progress in such a little time. With the continuous advancement of AI, how do you plan to ensure that existing in future services from Elsevier Health remain updated and aligned with where the technology is going from here?
Jan Herzhoff:
About a year ago, I attended a program at Harvard where we had Professor Tushman who has a very interesting concept called the ambidextrous organization. And this is actually one of the biggest challenges that I can see for leaders in this time, especially in global organizations, is how do you ensure that you move fast on the innovations while also able to drive the core and ensure that the core is working really, really well? You need to balance it, and it's not only about the leadership level, it's actually across the entire organization how you're able to do that and to balance it. Now, how we do it within Elsevier Health is we actually have a lot of mechanisms that bring both the innovation teams and the core teams very, very closely together, but it's a constant readjustment. You constantly need to look at how is it with the team? How is everybody working together? How can we ensure that we move fast but not break the system? It's a big balance and it's a challenge that never stops, really.
Josh King:
Challenge that never stops for an ambidextrous organization. As you reflect on your four years in your current role, Jan, what do you think will happen and what are your aspirations for the next four years in the future of Elsevier Health?
Jan Herzhoff:
For us, I think the big thing is now indeed ensuring that we can leverage and identify the right use cases for artificial intelligence to bring our insights in in a very responsible way to our customers and giving them an alternative to offerings that are out there and really help them on their journey. And that's really the number one priority. It's also about how we can then bring in these technologies into different countries, how we can scale them. Very excited about technologies like spatial computing and how we can bring here very cutting edge technology into the education space, again, in a very responsible way. So these are some of the key challenges and actually things that also excite me a lot for the next few years.
Josh King:
Helping doctors and nurses on their professional journeys no matter where they may be practicing around the world. What an incredible tour that we've already had. Look forward to you coming back to the New York Stock Exchange. Thanks very much, Jan, for joining us inside the ICE House.
Jan Herzhoff:
Thank you so much for having me, Josh.
Josh King:
That's our conversation for this week. Our guest was Dr. Jan Herzhoff, president of Elsevier Health, a subsidiary of RELX, that's NYSE ticker symbol RELX. If you like what you heard, please rate us on Apple Podcasts so other folks know where to find us. If you've got a comment or a question you'd like one of our experts to tackle on a future show or to hear from a guest like Jan Herzhoff, make sure to leave us a review or email us at [email protected] or tweet at us, @ICEHousePodcast. Our show is produced by Lance Glinn, with production assistance, editing, and engineering from Sam Iannotti. Pete Asch is the director of programming and production at ICE. And I'm Josh King, your host, signing off from the library of the New York Stock Exchange. Thanks for listening. We'll talk to you next week.
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Information contained in this podcast was obtained in part from publicly available sources and not independently verified. Neither ICE nor its affiliates make any representations or warranties, express or implied, as to the accuracy or completeness of the information and do not sponsor, approve, or endorse any of the content herein, all of which is presented solely for informational and educational purposes. Nothing herein constitutes an offer to sell, a solicitation of an offer to buy any security, or a recommendation of any security or trading practice. Some portions of the proceeding conversation may have been edited for the purpose of length or clarity.
