Sharing Stories of Strategies to increase Diversity, Equity, and Inclusion in Peer-Reviewed Medical Publishing: JMIR Case Report

JMIR Publications publishes 30 leading journals in digital health. The main journal, Journal of Medical Internet Research, has been a lead in Open Access for over 20 years.

I'm delighted to be serving as the Chief Ambassador for JMIR Publications, and have a series of articled dedicated to highlighting interesting evidence-based medicine for my digital health readers. This week, I'm going a little off-script and talking about diversity, equity, and inclusion in peer-reviewed medical publishing.

Peer Review Week 2021: Identity in Peer Review

During September 20-24 and with over 35 organizations around the world involved, academic publishers, institutions, societies, and researchers are celebrating Peer Review Week 2021. This year's theme, "Identity in Peer Review," touches on the diversity, equity, and inclusion that's been omnipresent with the healthcare disparities highlighted by the pandemic that still rages well into year two.

Why are peer-reviewed publishing journals important to digital medicine and healthcare innovation?

Most people don't live in the lofty pastures of academic publishing, and why should you? If you follow me on social medis, then it's highly likely that you're in a start-up, running a start-up, funding a start-up, or simply like the idea of disruptive healthcare innovation (and healthcare's such a bear that who doesn't like that idea???).

When you drop a new solution into healthcare, you have to think about who will pay for the new product or service. And despite all our talk and movement towards bundles and value-based reimbursement models, we still heavily depend on CPT codes for documentation and billing.

Short for Current Procedural Terminology, CPT codes are published by the American Medical Association (AMA). If you have a disruptive innovation in healthcare, before it can be widely accepted and recommended for clinical practice, you or your reimbursement team will have to go through the process of filing for a new CPT code.

A fundamental piece of applying for a new CPT code is meeting the peer-reviewed literature requirements in the application for a new CPT code. You can click here to find the AMA peer-review literature requirements.

What is peer-review in academic publishing?

Peer review is a process whereby scientific experts evaluate a manuscript and provide feedback, offering a recommendation of whether the work is suitable for publication.

Peer review involves subjecting the author's scholarly work and research to the scrutiny of other experts in the same field to check its validity and evaluate its suitability for publication. The methods and results are compared to ensure the correct experiment design has been applied to draw a given conclusion, and for overall clarity of the ideas present. A peer review helps the publisher decide whether a work should be accepted.

Unique features of JMIR Publications that enhance Diversity, Equity, and Inclusion (DEI)

JMIR Publications has numerous unique features geared towards the democratization of scholarly publishing and the peer-review process. I’m proud to represent an organization that actively promotes Diversity, Equity, and Inclusion in research through their daily practices and offerings.

Open Access Policy

Most traditional journals are subscription-based. This means that your organization, often your educational institution, pays a regular subscription fee for you to read the journal. In the case of the research organization, there’s a good chance that your library is paying to access content your institution funded and produced! If you don’t have a subscription, then you pay per article that you want to read or you find a less scrupulous means of access. Typically, one article (and doesn't matter if it's 3 pages or 33 pages long) costs about $15, which is more than a month of Netflix. Is it really the best way to promote access to science if one article costs more than a month of Netflix? I may be biased, but how does the poor Mississippi kid read the latest research?

JMIR Publications was one of the first Open Access (OA) publishers in the world and a founding signatory of the Open Access Scholarly Publishing Association, who continue to convene stakeholders around exciting initiatives to improve the openness of science. We have more than 30 journals that are all Gold OA. This means that any person anywhere around the world can read any article, in full, that has been published in our journals under a Creative Commons license. The knowledge is no longer paywalled for those who either can’t or don’t want to pay for an expensive subscription - better circulation of results produces better science as more peers are able to evaluate a work’s merits.

Peer-review JMIR "Karma Credits" that Lowers Barriers to Publishing

It's well-documented in the literature that compared to their male colleagues, women in medicine are not paid or promoted equitably. Additionally, we are often encouraged to take on "citizenship" duties at work, or "voluntold" to serve on committees and engage in other unpaid work.

In comparison, most academic journals offer no financial compensation for peer-review work. On the one hand, we can argue that this keeps the reviewers unbiased. On the other hand, we can argue that this shuts out reviewers who don't have the extra time and money to donate to more "citizenship" duties. If you look at Dr. Julie Silver’s body of research and the reports highlighted there, women in medicine clearly have little time or money for more "citizenship" duties, which are fundamental to advancing their academic careers.

Launched in 2015, JMIR has a unique reviewer reward system called "Karma Credits," which is built on the idea that the universe does keep track of the good deeds that you do and wants to reward you for them. Karma Credits are earned by users for authoring, reviewing, or editing JMIR papers and preprints - all regular activities in a researcher’s workflow. They have a dollar value (1 Karma Credit = 1 USD), and can be redeemed to pay Article Processing Fees and knowledge translation services, and they can even be donated to other researchers who might not have OA funds available! JMIR actively sees researchers in developing countries use the Karma Credit system to publish their work in our high-impact journals, including the flagship title Journal Of Medical Internet Research,

Optional Open Peer-Review Process for Authors

JMIR Publications offers Open Community Peer-Review. JMIR Publications has been a leader in the push towards openness, participation, and equity in scientific discourse, and since December 2009, has offered participatory open/public peer review. Submitting authors can opt for their manuscript to be posted on JMIR Preprints for open, constructive feedback from registered peers at the same time the paper is under review by a conventional peer reviewer, inviting more diverse feedback and yielding better results. Reviewers are able to register for alerts (via keywords) for papers in their field of study, and are updated when a paper of interest to them is eligible for open review. 

Often, the system for becoming a traditional peer reviewer for academic journals is opaque, especially for early career scientists and those of different gender, race, and socio-economic standing. Open peer review not only lowers the barriers to participation, it invites authors to receive diverse feedback.

JMIR also acknowledges that the patient should have more of a voice in medicine and the medical literature that impacts them, and has a collaboration with the Society of Participatory Medicine to publish a dedicated peer-reviewed journal with this in mind, the Journal of Participatory Medicine. Participatory medicine is a movement in which patients and health professionals actively collaborate and encourage one another as full partners in care to produce better outcomes.

Self-Nominated Peer-Reviewers

JMIR Publications welcomes the self-nomination of peer reviewers! If you are involved in digital health and have a critical and constructive perspective to bring, we welcome it at JMIR. We encourage reviews from conventional avenues (namely those who have published in the field with a background in quantitative/qualitative methods), as well as from laypeople, patients, clinicians, and any other stakeholder. In the interest of identity for truly Open Science, you will need to substantiate your expertise and, of course, acknowledge any conflicts of interest.

Always Innovating, Testing, Measuring, and Learning

JMIR Publications is always testing new ways to approach a problem. Most recently, we've announced a pilot with Dr. Ebrahim Bagheri and his team at Ryerson University researchers to test and expand Reviewer.ly, an artificial intelligence-based peer reviewer identification system to improve the experience for our decision making editors and reviewers.

This project will employ data insights and AI to help expedite the process to identify, invite and match peer reviewers to appropriate papers. The goals of the project are to ensure rigorous peer review in a timelier manner, enhance matching of articles to reviewers’ expertise using myriad data points and automate reviewer assignments.

Joseph Pold, Head of Marketing Insights & Analysis at JMIR Publications, says, “With this pilot, we hope to address an almost universal pain point for anyone involved in the editorial process, using AI that has been purpose-built and already shown success. By removing some of the inherent personal bias of editors, we can test if AI allows us to better enhance diversity in our peer-reviewer community.”