Answering Clinical Questions at the Point of Care An Introduction to UpToDate

1. Answering Clinical Questions at the Point of CareAn Introduction to UpToDate

2. UpToDate Asian Office • Direct contact • Responsible for all Asian countries excluding Japan • Regional offices in other areas including; • = Holland for Europe, Sydney for Oceania, and Tokyo for Japan • No representation and dealers • Communicate smoothly between hospitals and head office • Operational since December 2003 • To date, 5 confirmed site subscribers • = 2 in Taiwan, 2 in Singapore, 1 in Thailand

3. UpToDate Mission • Identify important questions that arise in the practice of medicine • Adult Primary Care --Family Practice, OB/GYN, Pediatrics (in development along with Neurology & Allergy & Immunology) • Nine Subspecialties • Recruit a faculty of experts to answer these questions • Continuously update the material as new data are published or practices change • Make it fast and easy to use

4. UpToDate: Comprehensive and Current • Comprehensive • Nearly 3,000 Expert Physician Authors • 6,000 topics • More than 60,000 pages of original text • 100,000+ abstracts • 10,000 pictures • 150 movies • Drug Database • Patient Information • Current • Completely updated every four months

5. Multiple studies have shown In 1/3 of office visits . . . a doctor identifies a question. . . butdoesn’t look up the answer. . . and the answer would have changed their management of the patient. Covell, DG et al. Ann Intern Med 1985;103:596. Green, ML, et al. Am J Med 2000; 109:218. Gorman, PN, et al. Med Decis Making 1995; 15:113.

6. Increasing Demands on Clinician Productivity… Less Time… Lack of confidence in finding answers with the resources andtime available Increasing Focus on Quality and Error Reduction… Sheer volume of published information, causes immense stress How can we support our clinicians ?

7. UpToDate Changes the Paradigm Independent Surveys show that clinicians who use UpToDate know they CAN ANSWER three-quarters of their questions in 30 seconds or less, and therefore: THEY USE IT. Because clinicians use UpToDate… They deliver better care They make better decisions about patient management They make better diagnostic decisions

8. Access to UpToDate, A free Site Trial in China Medical University Hospital • Access is possible through either individual or enterprise (site) subscription • A free trial can been arranged in your hospital for up to 60 days: please try it and find out how UpToDate can help you in your clinical doctors’ daily practice • No username and password required • Unlimited access • We will monitor the usage during the trial

9. To Access UpToDate • Go to www.utdol.com or www.uptodateonline.com (a user name and password is not needed) • Just ‘ENTER’ the license agreement and you are brought to the Search page, ready for your use; within a few seconds

10. How to use UpToDate based on a Clinical Scenario • You have a patient who becomes depressed while taking a beta blocker. The question from your patient or yourself may be: “What is the likelihood that the beta blocker is contributing to his depression?”

11. Search for “beta blockers”

12. 5 search terms match “beta blockers”. Select the most generic – ‘Beta blockers’

13. 250 titles match “Beta Blocker”. Too many titles, so you can now quickly narrow your search by clicking on the “Narrow Search Results” button

14. You can narrow your search by putting in a secondary search term, a key term in your question, such as “depression”

15. Choose topic most relevant to the search. Thus “Major side effects of beta blockers” is the most relevant

16. Click on the name of the author to show his or her affiliation. Each topic review will also show you when it was last updated On the left is the outline – a very good way to navigate through the topic review. FOCUS here to find answers to the questions or problems.

17. Using the outline, you can quickly locate the answer. Click on “Adverse Non-Cardiac Effects Due To Beta Blockers” and then click on the section of “Depression, fatigue and sexual dysfunction”. This takes you to the answer: “The best available data on this issues…and sexual dysfunction [29]”

18. Clicking on reference number 29, will take you to the Medline abstract supporting that recommendation.

19. By clicking on the highlighted drug name will bring you to the integrated Lexi-Comp. drug database. Another way to access the drug database is to put in the name of the drug in the search field at the beginning of the search session

20. UpToDate includes over 10,000 graphics and photos. Simply click under the graphics heading in the table of contents. The graphics can be easily exported into PowerPoint by right clicking on the graphic and saving it to your computer.

21. At the top right of the topic review you can choose to either print a topic and / or email the topic to a colleague. In the top navigation bar is a link to the table of contents…

22. The table of contents includes: • The “What’s New” section which points out highlights of what’s been added to the latest release. • Patient Information can be printed and given to patients (in development). • List of Authors – shows 3,000 contributing authors.

23. The Net Result of Using UpToDate: • 96-99% said UpToDate makes them more comfortable with their decisions • 97-100% said it helps them provide the best care for their patients • 88-99% said it makes them a better doctor

24. The Clinicians who use UpToDate and their usage make the best case for the value of having UpToDate in your institution.Thus for most IT enabled hospitals with good access to the internet, UpToDate is a service that one cannot afford to ignore for the benefits of both doctors and patients.