Content as Application:

1. Content as Application: Creating value with integrated digital solutions Scott L. Grillo Vice President, Group Publisher McGraw-Hill Professional

2. McGraw-Hill has been a leading medical publisher for 60 years -- our Access platform is increasingly embedded in medical institutions • McGraw-Hill has been selling digital medical services to the institutional market since 1999. • We have institutional customers world-wide in over 50 countries and have experienced consistent double-digit revenue growth • Our Access platform is a curriculum based learning environment designed specifically for the medical education market • Access combines our expert content with a unique set of learning tools that can easily be integrated directly into the teaching and learning environment in medical education and training • These media-rich platforms leverage the power of semantic tagging to provide context-specific reference material on-demand to end users

3. Digital Beginnings: The Bookshelf Online • 1999 Harrison’s Online • Online access to a single title with weekly updates from the Harrison’s editorial board • 2002 AccessMedicine • Library / Bookshelf approach • Multiple titles online • Semantic search • Online-only features, including grand rounds and differential diagnosis

4. In 2005 we started to think about expanding our digital offerings into key medical specialties • Published in a lot niche or highly specialized markets that placed a high value on premium content • Surgery, Emergency Medicine, Pharmacy, Anesthesiology • Published content that was widely recognized and well regarded • Competitors in the market, including third party aggregators, with a lot more content • Traditional players: Elsevier, LWW • Aggregators: Ovid, StatRef, Netlibrary • New Entrants: Up-to-Date, Dynamed Shift our product strategy from building aggregated content suites to providing customer-centric digital solutions that address points of pain for end-users and customers.

5. Examined the different types of end users we were serving to find underserved or emerging content needs in a target market End Users Residents Practitioners Medical Student • Textbooks • Reference • Instructional Media • Curriculum support • Primary Literature • Textbooks • Reference • Point-of-Care • Board Review • Instructional Media • Curriculum support • Reporting Tools • Primary Literature • Reference • Point-of-Care • Board/MOC Review

6. Identified particular points of pain for both end users and customers that we could address with content as application solutions Residency Market Points of Pain • Decreased training and hospital time due to the 80-hour work week restriction • Increased accountability and reporting to the Residency Review Committee (RRC) • Shift toward a standard curriculum of core topics and procedures • Lack of online sources for content needs and services that would track and manage required learning modules Deliver value by producing products and services that blend premium content with rich media and specific tools to address specific points of pain

7. AccessSurgery, our first platform in a subspecialty market, launched in 2006 and became the template for additional verticals Highly Structured: First site to have a strong core curricular organization system Media Rich: A online repository of surgical videos and animations focused on established core topics Embedded: First site to include a custom curriculum

8. Leveraging the power of Silverchair’s semantic tagging enabled us to provide context specific results to content queries Search results organized by content type: • Textbooks • Atlas • Videos & Animations • Board Review

9. In 2007 we introduced the Customer Curriculum Manager tool set to further embed our content and enhance the “content as application” model • Custom Curriculum Manger • Unique tool set allows program mangers to build learning objectives, build case narratives, and link to other resources • Curricula can be private or shared and adapted from other institutions • Adding an ability to customize tests based on semantically tagged questions to achieve greater granularity

10. Ease of use was key to adoption within residency programs By taking advantage of the semantic tagging on all content objects we make it extremely easy for administrators to search and/or clip content to build rotations while they are using the site • “Clip Chapter” assigns an entire chapter to a Topic or Activity • “Clip Section” selects only the current page

11. Introduced elements that borrow concepts from social networking and peer-to-peer sharing • Facilitating shared group work on activities • Streamlining communication between multiple learners and instructors • Gives end users an opportunity to create assignments for a two-way didactic process

12. Given program directors more control over how and when content is assigned, and to whom • Instructors can version select pieces of content in different ways for different audiences, manage them, and assign them out from one dashboard

13. Built in reporting functionality makes it easy to track students progress and generate customizable reports for accreditation

14. For end users Custom Curriculum Manager offers one complete interface for learner management of course materials and activities • More active learning environment • Management and creation of teams • Management of all group assignment work • Reception of instructor feedback on work

15. Based on the success we’ve had targeting residency programs we’ve recently introduced similar functionality for the clerkships • Clerks can sign in and identify themselves • If so, their homepage refreshes to the Clerk homepage. • Q&A for Clerks box appears • Case Files Surgery appears • Core Curriculum will be divided into two forms of organization: Core Topics and Organ-Systems (outward facing) • Search results change to clerk-only, clerk-friendly, and at the end, “For Further Reading”

16. By focusing on content as an application we have been able to transform our business by creating customer-centric digital solutions Our new digital platforms support core and custom curriculum Which require student, instructor, and institution-valued outcomes Constituents have defined needs • Points of Pain • 80-hour work week • Standardized curriculum • Residency Review • Committee reporting requirements • Customer-Centric Solutions • Custom curriculum option • Resident progress tracking • Usage capture & reporting Delivering student, instructor, and institution-valued outcomes …and rich reporting of students’ progress for program directors With student-specific assignments and tracking