The clinical opportunity is particularly important, given the inefficiencies that exist in the delivery of medical services and the limited resources that the typical patient has at their disposal. Hansen highlighted that the typical doctor in the U.S. has about six minutes of contact with a patient in a typical visit - an almost real-time window in which to make decisions about health care. No small surprise, then, that Hansen underscored the fact that only about 30 percent of people in the U.S. are actually getting proscribed treatments for their medical problems. This means, of course, that you're dealing with a type of content user that has not been the target of Elsevier services typically, one that has risks that your typical publisher's legal department will be wary to take on. As a questioner noted after Hansen's speech, there is also the question of who will be willing to pay for clinically-oriented services. But when you think of the number of questions that need to be answered on a given day, there are more potential points of interaction in clinical settings than typical research environments overall.

Hansen noted that the sales force incentives at Elsevier has been tuned to meet with some of this shift, but it's also a major shift to get products and strategy in line with what is in essence a real-time content integration strategy. For example, Elsevier has launched PageBurst, a platform that helps nurses and others in clinical settings to get access to critical medical information, a platform that Elsevier uses for their own content but is open to all kinds of content, including content from competitors. This underscores an emerging theme in enterprise content of many sectors embracing the content integration strategies that Wall Street publishers embraced decades ago to fight the commoditization of their content. It's a strategy that's not without its risks and revenue exposures, but necessary if scientific publishers are to improve their long-term outlook. Thanks to Michael for a great kickoff talk, getting to the heart of what major enterprise publishers must embrace to succeed in a time when "heresies" in STM publishing are becoming the new order of things quite rapidly.