Annual Report and
Financial Statements
2021
Machine
learning
Clustering
Entity
resolution
Forward-looking statements
This Annual Report contains forward-looking statements within the meaning of Section 27A of the US Securities Act of 1933, as amended, and Section 21E of the US
Securities Exchange Act of 1934, as amended. These statements are subject to risks and uncertainties that could cause actual results or outcomes of RELX PLC
(together with its subsidiaries, “RELX”, “we” or “our”) to differ materially from those expressed in any forward-looking statement. We consider any statements that
are not historical facts to be “forward-looking statements”. The terms “outlook”, “estimate”, “forecast”, “project”, “plan”, “intend”, “expect”, “should”, “could”, “will”,
“believe”, “trends” and similar expressions may indicate a forward-looking statement. Important factors that could cause actual results or outcomes to differ
materially from estimates or forecasts contained in the forward-looking statements include, among others: the impact of the Covid-19 pandemic as well as other
pandemics or epidemics; current and future economic, political and market forces; changes in law and legal interpretations affecting RELX intellectual property
rights and internet communications; regulatory and other changes regarding the collection, transfer or use of third-party content and data; changes in the payment
model for RELX products; demand for RELX products and services; competitive factors in the industries in which RELX operates; inability to realise the future
anticipated benefits of acquisitions; significant failure or interruption of RELX systems; exhibitors’ and attendees’ ability and desire to attend face-to-face events and
availability of event venues; changes in economic cycles, severe weather events, natural disasters and terrorism; compromises of RELX cyber security systems or
other unauthorised access to our databases; failure of third parties to whom RELX has outsourced business activities; inability to retain high-quality employees and
management; legislative, fiscal, tax and regulatory developments; exchange rate fluctuations; and other risks referenced from time to time in the filings of RELX PLC
with the US Securities and Exchange Commission. You should not place undue reliance on these forward-looking statements, which speak only as of the date of this
Annual Report. Except as may be required by law, we undertake no obligation to publicly update or release any revisions to these forward-looking statements to
reflect events or circumstances after the date of this Annual Report or to reflect the occurrence of unanticipated events.
RELX
is a global provider of information-based
analyticsand decision tools for professional and
business customers, enabling them to make better
decisions, getbetter results and be more productive.
Our purpose is to benefit society by developing products
that help researchers advance scientific knowledge;
doctors and nurses improve the lives of patients;
lawyers promote the rule of law and achieve justice
andfair results for their clients; businesses and
governments prevent fraud; consumers access financial
services and get fair prices on insurance; and customers
learn about markets and complete transactions.
Our purpose guides our actions beyond the products
that we develop. It defines us as a company. Every day
across RELX our employees are inspired to undertake
initiatives that make unique contributions to society
andthe communities in which we operate.
About us
Annual report and financial statements 2021
1
RELX Annual report and financial statements 2021
Overview
*
2 2021 Financial highlights
3 Chair’s statement
4 Chief Executive Officer’s report
5 RELX business overview
Market segments
*
14 Risk
20 Scientific, Technical & Medical
26 Legal
32 Exhibitions
Corporate responsibility
*
39 Corporate responsibility overview
Financial review
*
60 Chief Financial Officer’s report
66 Principal and emerging risks
Governance
72 Board Directors
74 RELX Senior Executives
76 Chair’s introduction to corporate governance
77 Corporate governance review
97 Report of the Nominations Committee
100 Directors’ remuneration report
122 Report of the Audit Committee
125 Directors’ report
Financial statements
and other information
130 Independent auditor’s report
138 Consolidated financial statements
185 RELX PLC annual report and financial statements
190 Summary financial information in euros
191 Summary financial information in US dollars
192 Alternative performance measures
201 Shareholder information
IBC 2022 financial calendar
* Comprises the Strategic Report in accordance with The (UK)
Companies Act2006 (Strategic Report and Directors’ Report)
Regulations 2013.
Contents
To download the full Annual Report and Financial
Statements, and for further information about
our businesses visit
relx.com
Market segments
Governance
Financial statements and
other information
Financial review
Corporate Responsibility
Overview
2 Annual report and financial statements 2021 | Overview
RELX
§
Underlying revenue growth of +7%
§
Underlying adjusted operating profit growth of+13%
§
Constant currency adjusted profit before tax growth of +15%
§
Reported operating profit £1,884m (2020: £1,525m)
§
Reported profit before tax £1,797m (2020: £1,483m)
§
Adjusted EPS 87.6p (2020: 80.1p), constant currency growth +17%
§
Reported EPS 76.3p (2020: 63.5p)
§
Net debt/EBITDA 2.4x; adjusted cash flow conversion 101%
§
Proposed full year dividend 49.8p (2020: 47.0p) +6%
RELX financial summary
REPORTED FIGURES
2021
£m
2020
£m
Change
Change at
constant
currencies
Change
underlying
For the year ended 31 December
Revenue +2% +8% +7%
7,244
7,110Operating profit
1,884
1,525 +24%
Profit before tax
1,797
1,483 +21%
Net profit attributable to RELX PLC shareholders
1,471
1,224 +20%
Net margin
20.3%
17.2%
Net debt
6,017
6,898
Reported earnings per share
76.3p
63.5p +20%
Ordinary dividend per RELX PLC share
49.8p
47.0p +6%
ADJUSTED FIGURES
2021
£m
2020
£m
Change
Change at
constant
currencies
Change
underlying
For the year ended 31 December
Operating profit
2,210
2,076 +6% +13% +13%
Operating margin
30.5%
29.2%
Profit before tax
2,077
1,916 +8% +15%
Net profit attributable to RELX PLC shareholders
1,689
1,543 +9% +17%
Net margin
23.3%
21.7%
Cash flow
2,230
2,009 +11% +20%
Cash flow conversion
101%
97%
Return on invested capital
11.9%
10.8%
Adjusted earnings per share
87.6p
80.1p +9% +17%
The shares of RELX PLC are traded on the London, Amsterdam and New York stock exchanges. RELX PLC and its subsidiaries, joint ventures and associates are together
known as ‘RELX’.
RELX uses adjusted and underlying figures as additional performance measures. Adjusted figures primarily exclude the amortisation of acquired intangible assets and
other items related to acquisitions and disposals, and the associated deferred tax movements. In 2020, we also excluded exceptional costs in the Exhibitions business.
Reconciliations between the reported and adjusted figures are set out on pages 193 to 197. Underlying growth rates are calculated at constant currencies, excluding
the results of acquisitions until 12 months after purchase, and excluding the results of disposals and assets held for sale. Underlying revenue growth rates also
exclude exhibition cycling. Constant currency growth rates are based on 2020 full-year average and hedge exchange rates.
2021 Financial highlights
3
RELX Annual report and financial statements 2021
I am delighted to succeed Sir Anthony Habgood as chair of RELX.
Anthony stood down in March 2021 having served the company
since June 2009. Throughout his tenure he provided strong
leadership to the Board and exemplary counsel to the executive
team. On behalf of the Board, I would like to thank Anthony for
the outstanding contribution he made to the success of RELX
during his tenure.
During my first year at RELX, I have been impressed by RELX’s
resilience, the strength of our strategy and business model,
as well as our ability to innovate and continue to deliver value
to our customers. As I met more members of the leadership
team, the depth of talent at RELX quickly became apparent.
I am particularly proud of the company’s response to the global
Covid-19 pandemic. Over the last few years, the health and
well-being of our employees has been paramount, a reflection of
RELX’s strong culture and values. At the same time, our business
has also contributed hugely to the understanding of Covid-19 and
its public health implications, helping our customers and broader
society mitigate its effects. Elsevier’s free Novel Coronavirus
Information Centre provided over 175million downloads during
the year while a product from LexisNexis Risk Solutions provided
researchers, academics and the public with a dashboard that
analysed open-sourced data from Johns Hopkins University
and other sources.
During 2021, RELX continued to execute on its strategic priorities
aimed at achieving better customer outcomes, a higher growth
profile, improving returns and ensuring a positive impact on society.
Underlying revenue growth was 7%, with underlying adjusted
operating profits up 13% as we continued to grow revenues ahead
of costs. Adjusted earnings per share grew 9% in sterling to 87.6p
(80.1p), and 17% at constant currencies. Reported earnings per
share were 76.3p (63.5p).
Dividends
We are proposing a full year dividend increase of 6% to 49.8p.
The long-term dividend policy is unchanged.
Balance sheet
Net debt was £6.0bn at 31 December 2021, down from £6.9bn last
year. Net debt/EBITDA including pensions was 2.4x, compared
with 3.3x in 2020. Capital expenditure represented 5% of revenues.
Share buybacks
The share buyback was suspended in April 2020. In 2022, we
intend to resume purchases by deploying a total of £500m on
share buybacks.
The Board
Linda Sandford, who has been on the Board since 2012, will be
stepping down as a Non-Executive Director after the annual
general meeting in April 2022. Linda served with distinction
on the remuneration and corporate governance committees,
and I would like to thank her for her exceptional service to
RELX and her support and advice.
Environment, Social and Governance
RELX has recognised the importance of corporate responsibility
(CR) for two decades. The Board prioritises the highest standards
of CR as an integral component of the overall performance of the
company. Accordingly, throughout the year, the Board discussed
CR issues and tracked performance on annual and longer-run
CRobjectives.
For the first time, we held a CR teach-in to help investors who
are increasingly engaging with us on Environmental, Social and
Governance (ESG) issues. The event provided an overview of
CR governance at RELX and insights on our unique contributions
to society which is at the heart of our business. When I met with
investors afterwards, they expressed their appreciation for the
insights provided.
During the year, our ESG performance was again recognised
by third parties. RELX held a AAA MSCI ESG rating for a sixth
consecutive year and was weighted fourth in MSCI’s UK ESG
Leaders Index; ranked 11th out of 14,000+ companies globally
and first in our sector by Sustainalytics; came fourth in the
Responsibility100 Index, a ranking of the FTSE 100 on performance
against the UN Sustainable Development Goals; was third in
sector in the Dow Jones Sustainability Index; and was one of 38
LEAD companies of the UN Global Compact among more than
12,000 signatories.
We challenge ourselves every year to ensure that we continue to
meet the highest CR standards now and in the future and that we
continue to improve on our key measures (full details are available
in the 2021 RELX Corporate Responsibility Report).
Finally, I would like to thank all RELX employees for their
achievements in 2021. I have every confidence that with their
efforts, RELX will continue to grow and prosper in the years to come.
Paul Walker
Chair
Chair’s statement
I have been impressed by RELX’s
resilience, the strength of our
strategy and business model,
aswell as our ability to innovate
andcontinue to deliver value to
ourcustomers.
Paul Walker, Chair
Market segments
Governance
Financial statements and
other information
Financial review
Corporate Responsibility
Overview
4 Annual report and financial statements 2021 | Overview
RELX
2021 progress
RELX delivered strong financial results in 2021 and we made
further operational and strategic progress. Our strategic direction
remains unchanged. We remain focused on the development of
increasingly sophisticated information-based analytics and
decision tools that deliver enhanced value to our professional and
business customers across all market segments. Our primary
focus is on organic growth, supported by targeted acquisitions.
Byexecuting on our strategy, we are striving to deliver better
outcomes for our customers, a higher growth profile for the
company, improving returns for our shareholders, and a positive
overall impact on society.
Underlying revenue growth was 7%. Underlying adjusted
operating profit growth was 13%, and adjusted earnings per
sharegrowth was 17% at constant currencies. All four business
areas delivered improved underlying revenue growth in 2021, with
underlying adjusted operating profit growth in line with, or ahead
of, underlying revenue growth in the three largest business areas,
and a return to profitability in Exhibitions.
The group remains highly cash generative and our priorities
foruse of cash are unchanged. Our first priority is organic
development, and we continue to invest consistently in the
business with capital expenditure around 5% of revenues; second,
to augment that organic development with selective acquisitions;
third, over the longer term, to grow dividends broadly in line with
earnings per share while targeting cover of at least two times;
fourth to maintain leverage in a comfortable range; and finally to
use any remaining cash to buy back shares. For 2021, our adjusted
cash conversion was 101%, our leverage ratio was reduced to 2.4x
and we are proposing an increase in the pound sterling full-year
dividend of 6%. While no share buybacks were made in 2021, we
intend to deploy £500m on share buybacks in 2022, reflecting our
strong financial position and cash flow profile.
Corporate responsibility
We continued to build on our strong corporate responsibility
performance during the year, further improving on our
keyinternal metrics and extending the scope of our unique
contributions. This was again recognised in the high ESG
ratingsascribed to us by a number of external agencies.
On internal metrics, RELX employs over 33,000 people and the
workforce is split evenly between men and women. In 2021, the
number of women in managerial roles increased to represent
44%of the total. In the supply chain we have a rigorous supplier
code of conduct following applicable laws and best practice in
areas such as human rights, labour and the environment. 2021
saw a further increase in the number of signatories to the code.
Onthe environment, our emissions have declined for a number
ofyears. Staff working remotely for much of the time has clearly
impacted the last two years, with 2021 emissions again showing
adecline. As well as reducing our gross emissions, we have
extended our offsetting, now being net zero across scopes 1 and 2,
and from scope 3, net zero for business flights, cloud computing,
home working and staff commuting.
We believe we have the most significant impact when we focus on
our unique contributions. They include applying our expertise to
areas such as universal, sustainable access to information,
advancing science and health, protection of society, promotion of
the rule of law and access to justice, and fostering communities.
In2021, we expanded the research material available on the free
Elsevier Novel Coronavirus Information Centre, which saw over
175m downloads in the year. We significantly increased the volume
of content on the RELX SDG Resource Centre and Risk extended
the ADAM missing child alert service in the US.
Our commitment to corporate responsibility is recognised by
external reporting agencies. We rated AAA with MSCI for a sixth
consecutive year, achieved the top ranking among media
companies globally with Sustainalytics and maintained our
4thposition in the Responsibility100 Index.
Outlook
Following the improved performance in 2021 across the company,
we expect 2022 full-year underlying growth rates in revenue and
adjusted operating profit, as well as constant currency growth in
adjusted earnings per share, to remain above historical trends.
Erik Engstrom
Chief Executive Officer
Chief Executive Officer’s report
RELX delivered strong financial
results in 2021. By executing on
ourstrategy, we are striving to
deliver better outcomes for our
customers, a higher growth profile,
improving returns, and a positive
overall impact on society.
Erik Engstrom, Chief Executive Officer
5
RELX Annual report and financial statements 2021
RELX business model
RELX is a global provider of information-based analytics and
decision tools for professional and business customers. We
leverage deep customer understanding, combining leading
content and data sets with powerful global technology
platforms, to build sophisticated analytics and decision
tools that deliver enhanced value to our customers.
These products are generally sold through dedicated sales
forcesdirect to customers and are priced on a subscription
ortransactional basis, often under multi-year contracts
andarepredominantly delivered in electronic format.
Our products often account for less than 1% of our customers‘
total cost base but can have a significant and positive impact on
the economics of the remaining 99%. Our objective is to continue
to enhance the value that we deliver to our customers and over
time to grow our own total cost base below our rate of revenue
growth on an underlying basis.
RELX business overview
Strategic direction
Our number one strategic priority continues to be the organic
development ofincreasingly sophisticated information-based
analytics and decision tools that deliver enhanced value to
professional and business customers across the industries
thatwe serve.
Our goal is to help our customers make better decisions, get
better results and be more productive. We do this by leveraging
a deep understanding of our customers to create innovative
solutions which combine content and data with analytics and
technology on global platforms.
We aim to build leading positions in long-term global growth
markets and leverage our skills, assets and resources across
RELX, both to build solutions for our customers and to pursue
costefficiencies.
We are systematically migrating all of our information solutions
across RELX towards higher value-add decision tools, adding
broader data sets, embedding more sophisticated analytics
andleveraging more powerful technology, primarily through
organic development.
We are transforming our core business, building out new products
and expanding into higher growth adjacencies and geographies.
We are supplementing this organic development with selective
acquisitions of targeted data sets and analytics, and assets in high-
growth markets that support our organic growth strategies,
andare natural additions to our existing businesses.
By focusing on evolving the fundamentals of our business we
believe that, over time, we are improving our business profile
andthe quality of our earnings. This has led to more predictable
revenues through a better asset mix and geographic balance; a
higher growth profile as we expand in higher growth segments,
and gradually reduce the drag from print format declines; and
improved returns by focusing on organic development with
strong cash generation.
R
evenue by
fo
rmat Revenue by g Revenue by type
eo
graphi
cal market£7,244m £7,244m £7,244m
Electronic
Face-to-face
Print
7%
7%
86%
North America
Europe
Rest of world
20%
20%
60%
Subscriptions
Transactional*
42%
58%
* Includes long-term contracts with volumetric elements
Develop increasingly sophisticated information-based analytics and decision tools
that deliver enhanced value to professional and business customers across market segments
Primary focus on organic growth, supported by targeted acquisitions
§
Better customer outcomes
§
Higher growth profile
§
Improving returns
§
Positive impact on society
Risk
§
Sustain strong long-
termgrowth profile
Scientific, Technical & Medical
§
Continue on improved
growthtrajectory
Legal
§
Continue on improved
growthtrajectory
Exhibitions
§
Capture growth
opportunityfrom
reopeningand digital
Market segments
Governance
Financial statements and
other information
Financial review
Corporate Responsibility
Overview
2021
2017
2019
2020
2018
2021
2017
2019
2020
2018
2021
2017
2019
2020
2018
2021
2017
2019
2020
2018
2021
2017
2019
2020
2018
2021
2017
2019
2020
2018
+4%
+4%
+4%
+6%
+6%
+5%
+7%
+7%
+7%
13.2%
13.6%
12.9%
96% 96% 96%
+7%
+9%
-15%
-9%
-18%
10.8%
97%
+3%
+10%
Percentages represent underlying growth Percentages represent underlying growth Percentages represent constant currency growth
Percentages represent growth
£bn
£bn
Pence
15%
120%
8 8
100
0%
0 0
0
+
17
%
+7%
+13%
Pence
100
0
0%
11.9 %
101%
+6%
R
evenue
R
et
urn on inv
es
ted ca
pi
tal Adjusted operating profit
Adjusted cash flow conversion
Adjusted earnings per share
Div
ide
nd per share 6 Annual report and financial statements 2021 | Overview
RELX
Key performance indicators
RELX’s key performance indicators (KPIs) track progress against long-term priorities. At the group level, given the diverse nature of
our end markets, we look at the continued migration of the business towards electronic delivery, the increasing introduction of electronic
decision tools, group level financial metrics, and corporate responsibility and sustainability metrics. The executive directors’ remuneration
policy includes measures linked to the financial KPIs and may also include non-financial metrics (see pages 100 to 121 for details).
In addition, we track KPIs within each market segment, at the product level, relevant to the performance of the specific business areas.
Significant group financial KPIs are set out below.
For non-financial KPIs a summary of the corporate responsibility and sustainability performance metrics and targets are set out
on pages 39 to 58 in the Corporate Responsibility overview.
Revenue by format
Financial KPIs
Prin
t
Face-to-fac
e
Electroni
c
20012000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 20182017
22%
22%
28%
30%
32%
35%
37%
48%
50%
59%
61%
63%
64%
66%
66%
70%
74% 74%
14% 14%
12%
12%
12%
13%
12%
15%
17%
14%
14%
15%
15%
15%
16%
15%
15%
64% 64%
60%
58%
56%
52%
51%
37%
33%
27%
25%
22%
21%
19%
18%
15%
11%
16%
10%
202120202019
75%
16%
9%
86%
7%
7%
87%
5%
8%
72%
15%
13%
7
RELX Annual report and financial statements 2021 | RELX business overview
Segment position
Risk
provides customers with information-based analytics and decision tools that combine public
and industry-specific content with advanced technology and algorithms to assist them in evaluating
and predicting risk and enhancing operational efficiency
Key verticals #1
Scientific, Technical & Medical
provides information and analytics that help institutions
and professionals progress science, advance healthcare and improve performance
Global #1
Legal
provides legal, regulatory and business information and analytics that help customers
increase their productivity, improve decision-making and achieve better outcomes
US #2
Outside US #1 or 2
Exhibitions
combines industry expertise with data and digital tools to help customers connect
digitally and face-to-face, learn about markets, source products and complete transactions
Global #2
Financial summary by market segment
Revenue
Adjusted operating profit
2021
£m
Change
underlying
2021
£m
Change
underlying
Risk
2,474
+9%
915+10%
Scientific, Technical & Medical
2,649
+3%
1,001+3%
Legal
1,587
+3%
326+5%
Exhibitions
534
+44%
10nm*
Unallocated items
(42)
7,244
+7%
2,210+13%
*The change in underlying adjusted operating profit growth is not meaningful (nm) for Exhibitions.
RELX uses adjusted and underlying figures as additional performance measures. Adjusted figures primarily exclude the amortisation of acquired intangible assets and other
items related to acquisitions and disposals, and the associated deferred tax movements. In 2020, we also excluded exceptional costs in the Exhibitions business. Reconciliations
between the reported and adjusted figures are set out on pages 193 to 197. Underlying growth rates are calculated at constant currencies, excluding the results of acquisitions
until 12 months after purchase, and excluding the results of disposals and assets held for sale. Underlying revenue growth rates also exclude exhibition cycling. Constant
currency growth rates are based on 2020 full-year average and hedge exchange rates.
Market segments
RELX is a global provider of information-based analytics and decision tools for professional and business customers. RELX serves
customers in more than 180 countries and has offices in about 40 countries. It employs more than 33,000 people over 40% of whom
are in North America.
£7,244m
Scientific,
Technical
& Medical
Risk
Legal
Exhibitions
R
evenue
7%
34%
37%
22%
£2,210m
<1
%
41%
44
%
15
%
Adjusted operating profit
Scientific,
Technical
& Medical
Risk
Legal
Exhibitions
Market segments
Governance
Financial statements and
other information
Financial review
Corporate Responsibility
Overview
8 Annual report and financial statements 2021 | Overview
RELX
Harnessing technology
across RELX
ThreatMetrix: combatting
unemployment fraud in America
The Kansas Department of Labor and Ohio Department of Job
and Family Services were tasked with managing their respective
state’s unemployment programmes as part of the federal
Pandemic Unemployment Assistance program.
In 2020, Kansas had the highest rate of identity theft in the country
and suffered more unemployment fraud than California and
New York combined.
Meanwhile, in December of 2020, Ohio state officials identified
morethan 56,000 fraudulent claims worth $330m. Of the roughly
1.4m applicants for Pandemic Unemployment Assistance there,
more than half were flagged as potentially fraudulent. Even
Governor Mike DeWine, the state’s First Lady Fran DeWine,
and Lieutenant Governor Jon Husted became victims with
fraudulent claims filed in their names.
Both organisations needed solutions providing much needed
benefits to Kansas and Ohio citizens while keeping fraudsters
out. Each harnessed intelligence from LexisNexis Digital
Identity Network to identify fraudulent activity in
unemployment applications.
Lexis Nexis Digital Identity Network on an annual average
analyses more than 200 million transactions daily from consumer
interactions including logins, payments, and new account
applications across thousands of global businesses. Using
this information, ThreatMetrix creates aunique digital identity
for each user by analysing the myriad connections between
devices, locations, and anonymised personalinformation.
Behaviour that deviates from this trusted digital identity can
be accurately identified in real time, alerting customers to
new users who may be using stolen identity data or
obfuscating their location.
LexisNexis Risk Solutions was among the suite
of technologies adopted by the Ohio Department of
Job and Family Services to combat unemployment
insurance fraud during the pandemic. These tools,
including enhanced identity verification, helped
better deflect fraud and resulted in a dramatic
decrease in initial claims being filed.
Ohio Department of Job and Family Services statement
About LexisNexis ThreatMetrix:
With deep insight into anonymised digital identities, LexisNexis
ThreatMetrix processes over 75bn annual authentication and
trust decisions annually, to differentiate legitimate customers
from fraudsters in real time.
65%
In Ohio, fraud in initial Pandemic Unemployment Assistance
applications was reduced by more than 65% in the first
week of implementation
240,000
The Kansas Department of Labor’s website was able
to block over 240,000 fraudulent logins and bot attacks
in the first day of implementation
Around 10,000 technologists, over half of whom are software
engineers, work at RELX. Annually, the company spends $1.6bn
on technology. The combination of our richdata assets, technology
infrastructure and knowledge of how to use next generation
technologies, such as machine learning and natural language
processing, allows us to create effective solutions for our customers.
Centre Hospitalier Universitaire
Grenoble-Alpes (CHUGA)
Model-based prediction
of individuals’ risk profile
Machine learning models enable clinicians
to predict a patient’s individual risk for health
care related adverse events at admission,
to efficiently target resources and improve
patient’s outcome
Source: Result from DEME TER, a
retrospective and observatory study
between CHUGA and Elsevier
Predictive model based on
• Lab values
• Procedures
• Diagnoses
• Social determinants of health
• Entry and exit mode
Hospital acquired
ESBL infection
Prolonged hospital stay
30-day
re-hospitalization
ThromboembolismIn-hospital death
patient A
patient B patient C patient D patient E patient E
9
Applying machine learning and AI
onreal-world patient data to reduce
adverse health events in hospitals
Healthcare, by definition, is supposed to make you better.
Butsometimes, an infection is contracted at the hospital or a
complication occurs after surgery. Such health-related adverse
events occur in 8% to 12% of all hospitalisations. According to
the World Health Organization, there are 750,000 health-related
adverse events in the European Union each year which amounts
to more than 3.2m days of hospitalisation that could have been
prevented. A 2017 report from the Organisation for Economic
Co-operation and Development shows that more than 10% of
hospital expenditure is related to the treatment of health-
related adverse events that occur duringhospitalisations.
In 2019, Professor Jean-Luc Bosson, Head of the Public Health
Department of the University Hospital of Grenoble (CHUGA),
France teamed up with Elsevier to apply machine learning to
their historical patient data with the aim of creating models that
identify patients at higher risk for healthcare-related adverse
events. Todo this, a single multi-source dataset, or a ‘data
warehouse’, that combined all the hospital’s internal data sources
needed to bebuilt. This complex task involves sourcing datafrom
different places such as laboratories and radiology departments,
and incorporating various types of sources such as diagnoses,
notes and orders from nurses and physicians. The task also
requires resolving data mismatches and codinginconsistencies.
Over the course of the pandemic, the project teams from Centre
Hospitalier Universitaire Grenoble-Alpes and Elsevierworked
together remotely to set up the pre-conditions for big data analysis
using modern machine learning methods. Bosson’s ambition
is now almost in place: simultaneous modelling of hundreds of
variables to uncover relationships, look for patterns and define
populations at risk. This will allow the hospital to flag patients
that fit the risk profile and provide more directed care.
“Thistype of project benefits the patients first, but also the
organisation. Before, I viewed Elsevier essentially as a publisher
of scientific journals. With this project, I discovered and understood
Elsevier’s openness to a world we share – medical informatics
and health analytics” said Bosson.
Without Elsevier’s data science teams, we would
never have had the expertise and availability of
sufficient staff to complete this project. Or we
would have done it in five to six years and the
project would have been obsolete before it
was finished. In this field, you have to have
quick results, because things move very fast.
Professor Jean-Luc Bosson
Centre Hospitalier Universitaire Grenoble-Alpes, France
RELX Annual report and financial statements 2021
Elsevier is increasingly positioned at point-of-
care decision science where we combine data
and content to help streamline the care process
in hospital. This project demonstrates our ability
to understand a data stream, gain insights from
it and make something better, all the while
respecting data privacy and GDPR compliance.
Dr Sigurd Prieur
Vice President Analytics, Elsevier’s Clinical Solutions
5%
Models identify the top 5% of patients with a 4.7x increased
risk for life threatening event like thromboembolism, or a
40% risk of a prolonged hospital stay.
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