Sermo in the Blogsphere

PHYSICIANS/HEALTH2.0: Sermo AMA interview

The Health Care Blog

June 18, 2007

This is the transcript of my interview last month with Sermo's Daniel Palestrant on the announcement of the deal between Sermo and the AMA

Matthew Holt: This is Matthew Holt with The Health Care Blog and a quick impromptu podcast today, because I have on the line with me Daniel Palestrant. Daniel's the CEO of Sermo, and we've had Daniel on the blog before a couple of times. Those of you reading the blog know that Sermo is one of the leading online physician communities, and Daniel of course will be at the Health 2.0 Conference coming up in September. Daniel, how are you today? And after you're done with that, you have some interesting news. So tell us.

Daniel Palestrant: That's right, Matthew. Thank you for having me. I really always appreciate the opportunity to speak with you and the many readers of the Health Care Blog. As you mentioned, we're very much looking forward to the conference later in the year; it sounds like it's going to be quite a show. As far as the news that we're talking about on this particular interview, it's a strategic announcement being announced between Sermo and the American Medical Association.

Matthew: So tell us a little bit about what that's going to mean for Sermo, for the AMA, and for the future of doctors in communities online.

Daniel: Well, this is a relationship that's actually been in the works for several months now; I'd almost say going on a year. There's many different ways to look at the relationship. Sermo, of course, is the largest online physician community. Now, with almost 16,000 physicians, growing at anywhere between 500 and 1000 physicians a week. The AMA, as I'm sure most of your readers know, is the premier physician advocacy organization in this country. Indeed, it probably has the exclusive franchise as being the voice to represent all physicians in the United States. So, as Sermo gained more and more momentum, it became more and more logical for us to look to have some sort of a partnership with the American Medical Association. Indeed, it was the members of the Sermo community who started putting more and more clarity around what that relationship would look like.

So it is multi-faceted, but to touch on some of the key points, I'd say first off that this is a powerful way for the American Medical Association to tap into the voice of Sermo. If you think about it, there's an interesting dynamic: You have the American Medical Association, which is among the oldest of the associations in this country, well over 150 years old and the essence of establishment institutions. Then you have Sermo, which is this grassroots - what some people might describe as Web 2.0 - phenomenon. Physicians in all walks of life and all phases of their career coming together and having a voice. So what Sermo does very effectively is create a place for those people to come together and for those voices to be heard - and then, within the unique Sermo architecture, for specific messages to come out. What the AMA does very well is to advocate for the messages of the physicians. That was the first cornerstone of this relationship: Sermo being a mechanism of allowing physicians to have their voices heard, and the AMA being an organization that's uniquely suited to act on that voice.

The second aspect of the relationship is a new paradigm in information and publishing. As many people might know, the American Medical Association is a publisher of several of the top medical journals, including the "Journal of the American Medical Association," or "JAMA." And then the "Archive" series, including the "Archives of General Medicine" and the "Archives of Surgery." Through the Sermo relationship, for the first time ever, Sermo members will be able to gain free full-text access of those journal articles, both current and archived versions, through Sermo. This will be free of charge; it will be part of being a Sermo member.The hope is that this will herald a new era in physicians' being able to contribute to the academic literature and being able to comment in real time on the academic literature.

The third component of the relationship is what you might call a co-development, where Sermo and the American Medical Association will be endeavoring to develop certain technologies for facilitating group discussion and group communication among AMA groups and AMA subgroups.

Matthew: That's pretty interesting. Let's go back to the second one. I get the first one. People have looked at my analysis somewhere on the blog before; there's a mechanism which is very clever for filtering through and ranking and rating answers and that kind of thing. And I can imagine that that works for the first one, the hot topics. It's an information source for the AMA folks when they're doing their advocacy.

The second one is quite interesting, though, which is the commenting on journal articles. It's been a little tricky to this point to comment on JAMA articles and to think about how the clinical trials and clinical medicine analysis done in these articles relates to everyday practice. I assume you're suspecting there's going to be significant interaction around some of those. There probably already is, within Sermo, but I suspect there's going to be more interaction generally around those articles.

Daniel: I think there are many trends coming together to make the publishing aspect of this so exciting. The first trend would be this phenomenon that the moment something is published, it used to be that that's when the discussion would end. But indeed, today, that's where the discussion begins. We see this phenomenon well reflected in great organizations like Digg or the new Netscape model or Newsvine, where many people find as much or perhaps even more value in this sort of ripple-effect discussion around an initial piece of information. This is perhaps accentuated in the medical community, where publication might be a new piece of clinical data, or it might be a new guideline. But in many cases what physicians want the most is to get a sense of how their peers are interpreting this.

Matthew: Right.

Daniel: So the first thing I think the relationship will get is a way for the Sermo community, in real time, to be able to recognize and respond to what had been static publications. The second aspect of this is another trend. The moment something hits the press, there's this increasing recognition that it's almost old news. The idea is, "How can publishing organizations like the American Medical Association better link themselves to the here-and-now concerns of physicians?" Sermo, by its very nature, is almost a bearer of what is of most interest and most concern to the American medical community. And so Sermo can act as a very powerful springboard for those publishing mechanisms to take information and then pursue it further, whether it's with actual clinical research, editiorialization, or perhaps an in depth article. So it's a push or pull model.

Matthew: That's pretty interesting. Let's talk about a couple of other things briefly. First off, let's talk a little bit about the business relationship between the two organizations. Obviously you have a large, established institution (as you mentioned) that's very old and it has a membership-driven focus. Then you have a startup, for-profit software community company that's a technology company. Tell me a bit about the business relationship between the two of you. Just explain how it's unfolding.

Daniel: Of course. As you alluded to, Matthew, Sermo is a for-profit venture. We're actually very, very excited about our business model. It's worth noting it and explaining it. I can discuss the AMA and our relationship in that context. Sermo is entirely free to physicians. We don't charge the physicians. We also provide a medium which is completely free of any advertising or any outside influence. The way we make money is we create almost an arbitrage between our physician community and our clients. The way our community is structured is that information is able to bubble up, and then our clients are able to very quickly and effectively, through a completely separate product, see that information - albeit anonymized, so they don't see the actual physician's names or the physician's contact information. But they are able to see trend data forming in real time, and indeed, to be able to ask questions of that community. You might imagine for an organization like the American Medical Association, that's extremely exciting. The AMA is constantly looking for topics to advocate for, or what sort of is on the zeitgeist of the American medical community. Those exact same tools that our financial services customers, current pharmaceutical customers, find interesting. And valuable are extraordinarily valuable to the American Medical Association. Interestingly enough, they're using the exact same tools but they're using them to look at very different data and ask very different questions.

Matthew: Yeah, I'd say that within the stuff I've seen on Sermo, there's a lot of stuff about clinical issues but there's also a lot of stuff about business and politics issues. I assume if you're a pharma company you care about the clinical stuff, and if you're the AMA you probably care a lot about the political and business stuff.

Daniel: Yeah, Matthew, you're 100% right. That's perhaps what's most exciting about this. Take for example, last week; one of the hottest topics on Sermo was physicians' perception of nurse practitioners and physician assistants. And it's very clear that it's turning into a very incendiary topic among physicians. While that might not be data that's particularly of interest or value to a pharmaceutical company or a Wall Street organization, that's literally the essence of what the AMA is very interested in and they're able to see that in real time. So an aspect of the relationship is that the AMA is becoming a Sermo client; they will have access to the Sermo client product within all of the restrictions and guidelines that our other clients use it by.

Matthew: But you're also going to be promoting - and this perhaps strays into the second point I want to raise - while the AMA is going to be promoting this to their members --and I mean you're already promoting this to all American physicians, but now you're getting a membership organization that has a third of American doctors in it--that's presumably a big fillip to you as well. I assume they are going to be promoting this to their members and using some of the tools on their other publication sites?

Daniel: Absolutely. Again, one very exciting aspect of the relationship is Sermo and the American Medical Association will be jointly working to engage all physicians. And it means, you might imagine on top of that, that this might be the AMA's existing body of physicians. So there are about 150,000 AMA members in this country, and Sermo and the AMA will be working in concert to engage them through several mediums.

Matthew: And that raises sort of... The interesting point for Sermo, I think here, is that the AMA - those people who read my blog know - doesn't always have a political outlook that may be shared by some non-physician groups, but also, in particular, hasn't necessarily over the years been shared by all physicians. Although it's a leading physician organization, it's tended to skew in its membership to certain types of physicians. Typically the main divider is between the typical solo physician member of the AMA, versus the big group doctors who have perhaps different political and economic interests.

And over the years the AMA has been trying to promote itself. It's trying to promote its membership and reach out to do other things within the physician community. But still nonetheless it has a fairly, if you like, stereotyped political identity among physicians. Do you see that as being an issue for Sermo? And the other question, is this kind of the first of many? Are there other, either specialty organizations or other physician organizations, that you're also going to be going after? Or does this relationship preclude that?

Daniel: Let me answer the first part of you question first, and then perhaps we can run through it to the second part. Indeed, less than one-quarter of physicians in this country are members of the American Medical Association. If you look at Sermo's membership, I believe it's less than 10% of our members are AMA members.

Matthew: Right

Daniel: As excited as we are with the phenomenal growth that Sermo has seen, and the fact that we're, without measure, now the largest physician community, or online community, we have to also recognize the fact that we are still what you would call an early adopter or an early stage phenomenon. To move into sort of the broader body of the American American medical community, I think it's important to say, "What are the types of relationships and the types of partnerships that allow you to enter into that arena?" And in that regard I think the American Medical Association is a very, very powerful ally. To the point that you're making, the types of physicians who are attracted to Sermo seem to be not the same population of physicians who have historically been attracted to the American Medical Association. Indeed, I'd actually think that's one of the strengths of this relationship and one of the most exciting parts. If we were all targeting and working with the exact same groups of physicians and appealing for the same reasons, there wouldn't be a whole lot of reason for a partnership. What became very, very clear from the start between the discussions between Sermo and the AMA is that we were appealing to different types of physicians in very different ways. But there was no question that together, the whole could be more than the sum of the parts.

Matthew: Do you anticipate doing similar relationships with other physician organizations?

Daniel: Well, the AMA is the only nationwide physician organization.

Matthew: I'm thinking perhaps about some of the big specialty societies or perhaps some of the other - either the statewide ones or some other combination; getting to more doctors that way.

Daniel: Correct. So, insomuch as AMA is, I think both literally and figuratively, an institutional voice for US physicians, the AMA/Sermo relationship is a mutually exclusive relationship between Sermo and the AMA. Having said that, your point is very well taken that in the last 10 or 15 years, the so called specialty societies - the American College of Cardiology, the American Heart Association, the American Society of Clinical Oncologists - have risen in prominence and now they are ready to enroll in advocating for physicians. And indeed, I think you'll see some announcements in this space in the very near term. I think it's important then to recognize, though, that those specialty societies classically advocate for very different things than the AMA has advocated for. So whereas the American Heart Association understandably advocates more towards cardiovascular and heart type issues, or American College of Cardiology has cardiology interests as its first interest, the American Medical Association is the only organization that's looking out for the overall good and well-being of the physician profession. And insomuch as that's a key element of healthcare in this country, no one else plays that role. So I think to answer your question in summary: yes, we will be making some announcements in that space. But I think it's also very important to say that we don't see those as being competitive to what we're thinking of trying to examine.

Matthew: That's very exciting. Well, Daniel, you've certainly got a tiger by the tail here. I'm looking forward to seeing how this plays out. Again, I've been talking with Daniel Palestrant. He's the CEO of Sermo, which just today announced a big relationship with the American Medical Association. More proof that this Health 2.0 stuff is moving into the mainstream, and perhaps rather quicker than some of us might have thought it would do. So, Daniel, congratulations on the announcement and thanks a lot for talking with us today.

Daniel: Likewise, Matthew, and I thank you for the opportunity to speak with you.

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