Special Episode: Osmosis and Elsevier Join Forces to Raise the Line!

Shiv Gaglani: Hi, I'm Shiv Gaglani, the co-founder and CEO of Osmosis, along with our chief medical officer, Dr. Rishi Desai. Today, we have a very special episode of Raise the Line. I'm delighted to welcome Jan Herzhoff, who is the president of Health Markets, and Elizabeth Munn, who is managing director of Global Medical Education at Elsevier, which is the publisher of over 2,500 digital journals -- including The Lancet, and Cell -- and many important reference works including ones that my co-founder Ryan Haynes and I used when we were medical students at Johns Hopkins, such as Gray's Anatomy, Netter's, and Robbins Pathology. Many of our audience members obviously use these as well. In addition, they have a whole portfolio of amazing companies like 3D4Medical, Shadow Health, and several others including now, Osmosis.

So, today is a very special episode because this is the first episode we're doing of Raise the Line as part of Elsevier. You may have seen that announcement if you follow our YouTube channel or if you are a regular listener of the podcast. We're very excited about this. It's been a long time in the works. I first met folks at Elsevier eight years ago when Ryan and I were just leaving Johns Hopkins Medical School to start Osmosis, and we moved to Philadelphia. All the people I had met back then are still at the company and still growing and raving about working there. 

We could easily spend a lot of our time today reviewing the enormous impact that Elsevier has had in 140-year history, and we'll be doing some of that, but we also want to talk about what this acquisition means and why we decided to join forces in the first place. Regular listeners of the podcast know that a year ago we had on Dr. John Danaher, a former colleague of Jan and Elizabeth on the podcast. He was the president of Clinical Solutions at Elsevier and has moved on to Adtalem, which is also a client of Osmosis. So, Jan and Elizabeth, thanks so much for taking the time to be with us today. 

Elizabeth Munn: Thank you, Shiv.

Jan Herzhoff: Thanks for having us here.

Rishi Desai: To echo Shiv, obviously we've gotten a chance to know you a little bit better over the past few months. It's been an absolute delight! But many of our audience haven't, and so maybe we can start, Jan, with you and then Elizabeth. Tell us a little bit more about yourself. What got you into Elsevier, and what is your role there day-to-day?

Jan: Sure, Rishi. Thank you. And again, so excited to be here and to welcome Osmosis to the Elsevier family! So yeah, a little bit about myself. So, born in Germany. A small village. A lot of family members were from healthcare backgrounds, so I got an early exposure to it. In fact, I founded -- with a school friend of mine -- a startup in the healthcare space and then I spent my last twenty years in professional life in healthcare. I joined Elsevier in 2012 and the main reason is I'm very, very interested in research. Super keen in information systems technology -- I'm a Ph.D. in that field -- and yeah, it was a perfect fit. A lot of things have changed over the last ten years and it has been a great, great journey.

Elizabeth: So, one of my first jobs coming out of school was as a teacher. I've always been interested in the education side of things. Then I wanted to move into publishing and I happened across this medical publishing company. At the time, it was Harcourt, which was the Saunders imprint. I started to work there and just really, from the first moment, fell in love with the kind of high-quality product that we were creating, how well respected it was, interacting with all of these incredible authors, and really finding this mission which has been really important to me. I guess that's why I stuck around. 

I'm still with Elsevier now, as it is, many, many years later. But in particular, I've really enjoyed working on the education side, and I think it does stem from those first years teaching, as well. I've always been passionate about learning and thinking about students and helping them. It's a really nice way of combining both of those passions.

Rishi: It's very clear that both of you are extremely humble. Obviously, Elsevier is very lucky to have the two of you working there. I'm curious, in addition to the background on Elsevier that Shiv just shared, are there things about the company that most folks may not know about? In fact, I'll call one out for myself...the One Health concept that you've described very eloquently in the past. What are things that resonate with you that people may not know about the company?

Jan: I'm happy to go first. So, when you ask people, the first thing they think about, obviously, is the publications, the big titles -- both on the journals and the book side. But especially in healthcare, what many people don't know is we really have an incredible footprint in the healthcare sector, covering more than 9,000 hospital systems across the globe, a lot of medical institutions, medical schools, nursing schools. It's really always linked to the content that we have, but there's more and more advanced clinical decision support. 

For example, when you think about oncology, we support twenty-four percent of all of the clinical oncologists in the United States with the right pathways for the patients, and it's pretty cutting-edge technology. It's one of the things people might not realize. So, there are a lot of really, really great things on that. And then, of course, the global footprint. We do a lot in localizations, because we believe it's really important that medical professionals have the information very quickly in hand, very customized, very localized. 

I'll give you an example. In Japan, our team there develops a lot of very cutting-edge products for healthcare professionals -- both in education and in hospitals -- localizing what we have globally but also inventing for the healthcare professionals there. So, we do a lot of localizations because we believe it's really important to leverage the global insights but also, especially in health care, include the local guidelines, the local insights, the local language.

Shiv: Elizabeth, before you start, I was going to comment on one thing. That stat about oncologists was really interesting because right before we started this podcast, one of our longest supporters, a radiologist named Dan Durand who is the chief clinical officer at LifeBridge Health -- which is one of the largest health systems in Maryland -- sent me a message congratulating us on joining forces with Elsevier. I actually didn't even know you guys have STATdx as part of the Elsevier portfolio. 

Elizabeth: No, it's a great point. I've been with Elsevier now for over twenty years, and I'm still uncovering new opportunities and new people to me. I had a meeting last week with our colleagues in the Science Division who want to set up an education program there. So, every day, a new opportunity, absolutely. 

Going back to your original question, to me, it's also about the people and the integrity of the people who work at Elsevier. I think that's something that people perhaps don't know. I've never met such a group of individuals committed to presenting the highest quality content and solutions. They care deeply about that, but they also care deeply about creating a common understanding, a trusted, fact-based, constantly moving forward place where people can get trustworthy information. I think that's so important. It's always about the people that you work with.

Shiv: I love that. Go ahead, Rishi, you were going to say something?

Rishi: I was just going to say that's an interesting issue because today, trust and integrity in science has never been more important. I'm just curious how that feels as employees at a company where that is the cornerstone of what you do and what you present in the world?

Elizabeth: Well, it's never felt more important, and it does make you feel very proud of the organization that you work for. That's something we talk about a lot. It's obviously a very timely and topical issue. I think in a way we're loving it. It's kind of given us a new lease of life and enthusiasm. Actually, I think it's something that the team is really engaged around and wants to participate in. So, yeah, there's a lot of energy around those discussions, but good energy.

Shiv: I'm really glad to hear that. The emphasis on people, Elizabeth, was one of the two major criteria we had when we were deciding on a partnership. Osmosis prides itself on how we treat our teammates like customers, and we treat our end-users and partners like teammates because we all ultimately are trying to raise the line and improve health care capacity. So, we take that very seriously. 

The second thing I really wanted to consider when we were looking at this partnership was longevity. We spent a lot of years building the Osmosis audience and the brand and the partnerships, and wanted to make sure that the next partner we chose to work with cared about that and wanted to maintain a strong legacy of what we've built long after any of us are gone. 

Elsevier certainly has proven that. Only forty-five out of every one million companies have lasted for over one hundred years -- so less than 0.005% -- and Elsevier is one of them. So, my next question -- maybe Jan you could start with it, and Elizabeth, you can add if there's anything else that he hasn't covered -- what is the secret behind that legacy? How does a company last for over 140 years?

Jan: You know, Shiv, there's a really interesting article, I think it was in 1995 in Forbes magazine, where they asked the question about Reed Elsevier -- so, another company but Elsevier was a big part of it -- whether Reed Elsevier would be the first victim of the internet. It was 1995, shortly after the first electronic resources came out. Now, looking across the company, 80% of all what we do is fully digital. I think it's all about reinvention, and I can give you a very concrete example from medical education.

I started to be responsible for the medical education business that Elizabeth is now heading in 2016. At that time, most of the tools that we provided to faculty and students were really in book format still on medical education side. We started to do our first workshops with students and faculty at different universities in 2016, and I remember one was at Leicester University. Leicester, you might remember, was the famous football club that won the Premier League that year. I don't know what the comparison would be in the United States in American football, but I guess it would be the very unlikely winner of the Super Bowl! 

We had these sessions where we had our designers there, and we had faculty members, we had medical students from different years, and one of the pictures that we started to draw was really the foundation of our future vision of how we can support and help to transform medical education for both the educators and the students. We then continued to interview and discuss with medical students and faculty across the globe. We had design partners. Our first digital offering in that space was built after that and that enabled us to then transform but then also enabled us to further look beyond. That was, in fact, also the first time when I heard about Osmosis. 

So, we looked at that. Looked at different offerings. One big one was indeed around anatomy, where we have Gray's Anatomy and Netter's, and how we can further visualize that and further improve how students learn and help them to learn and have faculties to make it most engaging. That's when we came across 3D4Medical and it was one of the companies that we then partnered with a few years ago. But it's one of the examples of reinvention, and I can give you countless examples of that throughout the history. So, we constantly reinvent and challenge ourselves.

Shiv: I really like that. Actually, while you were talking about the Leicester example, which is interesting, I looked up on our admin page that we have over 1,000 students at Leicester registered on Osmosis and they've watched 22,000 videos. So, it's no surprise that you heard about us during that whole experience. 

You preempted my next question... obviously, we're thrilled to be joining Elsevier given all the things we talked about today and in the announcement video, but how did you first learn about Osmosis and what are you most excited about with regards to the potential? Elizabeth, you can start and then we'll go to you, Jan.

Elizabeth: So, I first heard about Osmosis maybe about three or four years ago and it was really because of the incredible reputation you had with students. We were talking to a lot of students at the time. We were thinking about our own digital platforms, and we just kept hearing your name being mentioned and mentions of the videos. You were clearly doing something that we weren't doing, and it was something that was incredibly unique. 

Actually, you did an incredible thing. You started to create a fan base within Elsevier, which is unusual for a competitor. We would be like, "What's Osmosis up to? We just were really impressed with what you were doing and how you were approaching the whole idea of boiling down complex topics and this increasing breadth of information surrounding health education, and breaking it down into these very easy learning micro modules. Just incredibly clever. You know, other people -- including us -- write whole chapters on a topic, or someone would video a lecture on a topic, and you can get it covered in five minutes. So, look, that's magic! That's actual magic. So, we just think it's the best thing since sliced bread to now have you within the team.

Rishi: Well, the love definitely flows both ways. You've got a huge fan base inside of Osmosis for Elsevier, and probably the fan leader is myself because I grew up on these products that you guys created. It's trained me. I was thinking about this. It's not just trained me, it's trained all my mentors, and frankly, it's trained all my mentors’ mentors! And so, as a company goes, it's a pretty impressive thing that you've put together, and that longevity that Shiv was speaking to and Jan was speaking to, as well. 

You know, with transitions, there's always a lot of curiosity around what's to come and you've gone through this before. We, as a company, have not. I'd love to understand with 3D4Medical and Shadow Health, what were some of those early wins that you all enjoyed when those partnerships first came about?

Jan: I can start a little bit, and then please chip in, Elizabeth. When we look at capabilities like what Osmosis has -- and to build on what Elizabeth said one of the key capabilities you guys really mastered is the brilliance of simplicity.... it's just incredible, and what 3D4Medical has done is created an incredibly engaging tool to study anatomy that's more than just changing from a normal model to a 3D model, but it's so much more and with beautiful designs. So, when we look at these capabilities, one big thing is that our plans are always about where we can invest, where can we help more students with these tools and capabilities. 

So, for example, with 3D4Medical's Complete Anatomy, a few things that we did were leveraging the localization capabilities that I mentioned before. The team looked at what is the toughest localization, and what's one that is fairly easy, and said let's do both so then we are able to actually do anything. They chose to localize Complete Anatomy for the Chinese market and for the Spanish markets. In a really, really short period of time, the teams worked together on these localizations to then enable students from Mexico City to Beijing to really enjoy the capabilities of Complete Anatomy.

Another example is when we think about inclusion and diversity…for 3D4Medical, given that it was a startup, it was for a long time very challenging to actually have enough resources on the product roadmap to create a female model for Complete Anatomy that would deliver on their highest standards. So, what we then ensured is that on the roadmap, we put enough investment behind it so that the team can actually fulfill that vision and do it. In fact, in a few days, we will launch for Complete Anatomy the first female model, which is a really, really exciting piece of news! 

These are just some of the examples of how we think about how can we make it more accessible through localizations, etc, but also how can we look at it from an inclusion and diversity perspective? How can we leverage these capabilities? What's in our other products? You mentioned STATdx for radiologists. You can do a lot of really great innovation if you link up these different parts of the portfolio. We do that together with the medical students, with the medical faculty, with the physicians, with the nurses, globally across different countries.

Shiv: On that -- before you answer that same question, Elizabeth -- that's one of the major appeals for us, that specific example. I spoke to Niall, one of the founders of 3D4Medical who's still at Elsevier over two years later -- and we're excited about him and several managers that came in through that acquisition -- and that example of both investing in diversity, equity and inclusion for their product, as well as the localization. 

As you know, our “big, hairy audacious goal” at Osmosis is to educate one billion people by 2025 and it's much easier to educate a billion people by 2025 if you can get your content localized into Chinese, Spanish, Portuguese, Japanese and other languages because you'll get more people who can consume it. We have a lot of organic initiatives in Chinese and Vietnamese and Arabic, but having the expertise and resources that Elsevier brings, I think, will hopefully make this a reality at Osmosis, something we've dreamt about for a long time. Back to you, Elizabeth.

Elizabeth: Yeah, I was just going to say I think what we bring to the table, obviously, is that money to invest and the scale. But we learned a lot from 3D4Medical, too. We got as much out of it as they got from us. I think they've helped change our culture. Their focus and emphasis on research and development has been fantastic and also the way that they approach customer problems and think differently about customer problems. And it's just a genuinely, incredibly nice, and really creative bunch of people to work with, and I'm already getting that vibe from the Osmosis team, as well.

Those intangible things are often just as important. The added energy to the group is kind of an X factor that spurs everyone else on to be more creative. That dynamic is just incredibly important. That initial feeling is something that's so important for us to develop with Osmosis and Elsevier and 3D4Medical as well.

Shiv: Totally. All our interactions have reinforced that as well, so we're very thrilled about all of that. So, the reason we launched the Raise the Line podcast during the heart of COVID was because we were seeing transformational shifts in healthcare, education, society and the economy in real-time. It's one of those few moments that you live through that you're going to really remember for the rest of your life. Overnight, COVID made institutions -- medical schools, nursing schools -- go online, go digital. Osmosis certainly benefited from some of that, where we went from 40 schools at the beginning of 2020 to over 120 school partners in that one year -- a 3x growth there -- and we were able to serve many of these students and faculty. Similarly, hospitals have had to make major adjustments in their education and their staffing, etc. How has COVID affected the work that Elsevier does and the global medical education team specifically? So, maybe broadly we'll start with you, Jan, and then go to the GME team with Elizabeth.

Jan: Yeah, absolutely, Shiv. When you look back one and a half years ago when COVID hit, the top priority was really how can we provide remote access or any form of access to institutions -- be it nursing schools in the United States where the students were preparing for final exams, or how we could set up, for example, our simulation offerings because nursing students were not able to do their clinical hours. So, it was a lot of focus on that. 

Also, on the clinical side, we created resource centers for clinicians globally to access any type of research knowledge directly and they, in fact, are still very much alive and constantly updated. But the thing was really about how can we, especially on the medical and nursing education side, immediately provide access to our applications and content. I think Elizabeth, you can share much more detail of what the team has done there. It was a really, really challenging time, but we hope that we were able to support all these students and faculty globally during this very challenging time.

Elizabeth: When I think back to those initial days of COVID, we were struggling with working from home and we could see how much students were being affected, but also the way that they were rising to the challenge as well and putting themselves out there in the front line. It's amazing when something like that happens, how incredibly simple life becomes in some ways. 

It was just like, "Well, there's not really a commercial imperative, there's not really any need to launch a new product or do a new marketing campaign. We just need to help and we need to get in there." It was amazing that's what everybody on the team decided. It was very simple. It wasn't about free trials; it wasn't about trying to push anything. It was, "We should just give this away. They need to go to school with something remotely and we've got something here that will help. So, no strings attached, let's just hand it out." 

It was very popular. We had a great take-up. But you know, it was also really great for us because it gave us a sense of purpose. We felt as if we were we were making a difference somehow. It was a very small difference in the big scheme of things, but we just wanted to help. We wanted to be there for our students. Actually, it was an incredibly positive thing for us, and I hope it helped in some small way to keep the classrooms going for a while.

Rishi: I've spoken to so many students and faculty who struggled as you guys are describing. You're seeing it as a small thing, but I think for an individual who's struggling in that situation, it's a huge thing, right?  I think that sense of feeling like you're part of something bigger, and fighting a bigger battle...I mean, in no small way, humanity right now is struggling for survival. Many people have already died as we fight this scourge. 

I'm curious to know what you think are some other ways in which we might more generally flatten the curve, as well as raise the line of healthcare capacity? How do we both help to reduce illiteracy and misinformation on the patient side, and then also how do we as Elsevier -- and I'm including myself and Shiv in this, of course -- how do we also help to increase healthcare capacity because it's now needed more than ever?

Jan: I think this is a great, great point, Rishi. We have, obviously, access to a lot of medical information. It's concerning. Before COVID, it took about 70 days to double medical knowledge, so it was already at that time credible. Now, of course, with a lot of focus on COVID and the research and real-world data as well that you can see constantly -- now we have the Omicron variant -- there's so much information that it's overwhelming, plus it's also very complex information. 

I remember at the beginning of the pandemic -- I think, Elizabeth it was like a month or just a few weeks in -- the 3D4Medical team launched a short video clip to explain COVID in a very accessible way to people. In fact, we launched also in the Chinese language at the time. But I think what you guys bring, again, is that mastery of simplicity which can actually help more and more. I think that's another area where we can give something back to society to indeed help "Raise the Line".

Elizabeth: It's such a big question, and the hubris of thinking that we alone could do that...but I tell you, as Jan says, in partnership with Osmosis and the skills you have at conveying complex information and topics in bite-sized, engaging, meaningful ways, I think that increases our ability to get our message across as well. We've got the reach, the passion, and these incredible trusted brands. There's still a lot of trust in many of the brands that we have. I think combining your communication know-how with our systems and our trust, hopefully, we can make a difference.

Shiv: It's definitely inspiring to think about. I know we're coming up on time, and we don't want to take your whole day so you can go back to flattening the curve and raising the line through the work you do, so we had just two more questions. The Osmosis audience primarily skews towards younger, early-stage healthcare professions students, as well as patients and their family members, the caregivers. What advice would you give to them about meeting the challenges of the COVID pandemic and beyond as they begin their careers, or just want to take care of the health of themselves and their family? And we'll start with you, Elizabeth.

Elizabeth: I think I would say to students in particular, but actually patients, too, you're not alone. You're part of a global community and that's something that I've appreciated so much working at Elsevier with all of our different offices and healthcare communities around the globe. We see common trends both in terms of education and in learning across the globe. I think feeling part of that community -- because it's an incredibly stressful thing, being a medical student...we hear that all the time -- so I think learning from people and feeling part of that community is important. 

I would also say that I find your story, Shiv, and obviously Ryan's story as well about how you started Osmosis to be incredibly inspiring. You thought of new ways of tackling the problems that medical students were facing. You didn't just say, "Okay, well, that's it. We find this challenging, but it's just the way it is." You went out there and changed things. We talk to students all the time, and they're always coming up with -- I love this actually, about medical students -- they're the most innovative and entrepreneurial people. We run hackathons, and they're always coming up with new ideas for new apps, and really good ideas. So, I would encourage the students to keep innovating, keep pushing, keep changing.

Shiv: How about you, Jan, what advice would you give?

Jan: It starts first with -- from a purpose perspective, especially in the world we are living in -- there's probably no better profession. It's so critical every day what you do, and what you're going to do after your studies. It's incredibly hard, as Elizabeth said. Especially now, it's incredibly tough in many parts of this world. So, it's also about not giving up. 

Elizabeth mentioned the hackathons. In some of the challenges we do globally, we see all the time that when you link medical students that are in India and the United States and Iceland -- wherever -- we get a lot of messages after those initiatives from people about how much they value these global links and global collaborations, and that's another important thing. 

I think the key is, we are here. You have us as a partner on your side. Now here together with Osmosis and others, we want to work to really support you through the educational journey, through your professional journey. We want to be there and support you. We're also looking forward to your ideas and your suggestions about how we can make your life easier and better. For the entrepreneurial-minded people, if you're interested in products, we always look for incredible people… 

Elizabeth: Absolutely! (laughs).

Jan: We have a lot of healthcare professionals now on our teams, so that's, of course, always another venue. But I would also really thank you for all the work that you're doing day for day, and also going forward in the future. We are there.

Rishi: We have a lot of entrepreneurs in the audience. You heard it here first: Jan and Elizabeth are ready to welcome your ideas, so that's great to hear. I'd like to end with anything that we might have missed, anything that we haven't covered in this conversation that you feel like our audience would definitely miss out on if we didn't cover it. Feel free to share.

Elizabeth: Maybe just building on what you were saying before, Jan, about those ideas, and I think it's about rethinking how we use technology as well. I think that's very interesting. Whether we're harnessing the power of video or 3D visualization or whatever is the next thing, how can we make it easier for you to learn? The textbook has done a really phenomenal job for the last couple of hundred years, but we are beginning to move away from that now. I'm thinking about visual reality opportunities...what are your ideas? Where are we going to go next? How can you change the narrative, change the way that you learn? Because it will come from students. I'm convinced that it won't be something that Jan or I come up with in the head office. So, you drive that. We're here to listen and partner with you to make life easier.

Rishi: Awesome. Anything to add, Jan?

Jan: I think we have covered it all. It really, really was a great conversation with you guys. And again, I'm very humbled to be here and also very excited to see what we can create together with the audience's help. Really looking forward to how we can raise the line.

Shiv: That's a great note to end on. Well, again, we really are very excited about beginning this next chapter of Osmosis with you and your teams at Elsevier, and becoming part of it. 

We'd also like to end by thanking our audience for all the support they've given us at Osmosis...whether you're a faculty member, a student who's interested in going into a career in healthcare and raising the line, or even a patient who's just interested in the general healthcare system and education system that we play in. 

So Jan, Elizabeth, thanks so much for taking the time to be with us today. "Watch this space" for everyone who is following along. And with that, I'm Shiv Gaglani with our chief medical officer Rishi Desai, saying thank you for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.