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SETTING YOUR “SITES” ON EFFECTIVE INFORMATION MANAGEMENT

SETTING YOUR “SITES” ON EFFECTIVE INFORMATION MANAGEMENT. Lynn Dunikowski & Mike Dillon 51 st Annual Scientific Assembly Manitoba College of Family Physicians April 20 – May 2, 2009.

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SETTING YOUR “SITES” ON EFFECTIVE INFORMATION MANAGEMENT

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  1. SETTING YOUR “SITES” ON EFFECTIVEINFORMATION MANAGEMENT Lynn Dunikowski & Mike Dillon 51st Annual Scientific Assembly Manitoba College of Family Physicians April 20 – May 2, 2009

  2. Haynes RB et al. How to keep up with the medical literature: V. Access by personal computer to the medical literature. Ann Intern Med. 1986 Nov;105(5):810-6. Your patient, a 23-year-old college student ... is developing early signs of retinopathy. She asks whether further retinopathy could be prevented ... You excuse yourself from the patient and step into the room that contains your office computer. You ... type in four letters that stand for the computer program that connects you with the National Library of Medicine`s current MEDLINE file. The system gives you a polite computer welcome, and then you type in the terms diabetic retinopathy and insulin infusion systems. MEDLINE replies that 38 articles are classified with both these descriptors. You then type in 1 and random allocation ... You ask for a printout of the titles, authors, and abstracts of these articles. The online search time for the session was less than 2 minutes, and the search charge was just $0.93 . One of the articles that MEDLINE selected is a recent issue of NEJM, so you direct your computer to contact the Colleague full-text service ... and ask for a printout of the complete article. ... You return to the patient, whose mild annoyance at having been kept waiting for 10 minutes turns to amazed admiration when you hand her a copy of the abstracts and indicate that you do not feel pump therapy has yet shown that it can be helpful in controlling diabetic retinopathy.

  3. Our objectives • See how far we’ve come! • Tour selected clinical resources to show your options • Review some ways of keeping current • Demo handheld use in practice • Collect information management tips and tricks from the audience

  4. Judging clinical resources • Content • Ease of use • Evidence based • Currency • Platforms/Formats • Cost • Special features

  5. Tour of options • Clinical Evidence • Dynamed • Essential Evidence • PEPID • UptoDate

  6. 1. Clinical Evidence • Systematic reviews on treatment & prevention of 240+ conditions • Rates interventions → • GRADE evaluations of quality of evidence • Other features • Links to guidelines • EBM tools e.g, Methods for calculating risk Beneficial Likely to be Beneficial Tradeoff between Benefits and Harms Unknown Effectiveness Unlikely to Beneficial Likely to be Ineffective or Harmful

  7. THREE WAYS OF SEARCHING CALCULATORS, SPECIAL REPORTS …

  8. SEARCH BY SECTION SEARCH BY REVIEW TOPIC

  9. Clinical Evidence: Interventions Tab TWO OTHER WAYS TO SEE INFO - KEY POINTS & ABOUT THIS CONDITION CLINICAL QUESTIONS FOR THIS TOPIC RATED INTERVENTIONS

  10. 2. Dynamed • Summaries for ~ 3,000 topics • Evidence summaries focus on patient-oriented outcomes and absolute risks (NNT, NNH) • Uses Strength Of Recommendation Taxonomy (SORT) • Quality of evidence labeled Grade A,B, or C • Includes Patient Information links • Kit to integrate with Electronic Health Record

  11. Dynamed: Search results CAN ALSO SEARCH BY ALPHA TOPIC OR BROWSE BY CATEGORY TYPE SEARCH TOPIC IN WINDOW & LIST OF HITS APPEARS CAN GO STRAIGHT TO THERAPY, DIAGNOSIS

  12. Inside Dynamed Summary JUMP TO SECTIONS SHOWS LEVEL OF EVIDENCE PATIENT INFORMATON

  13. 3. Essential Evidence Plus • Search multiple databases at once • EBM Guidelines; POEMs; Cochrane Abstracts; Selected Practice Guidelines; Decision Support & Diagnostic Calculators; Derm Expert; ICD-9 Lookup Tool • Archive and alerts of POEMS – Patient Oriented Evidence that Matters • Gives levels of evidence for some resources • Decision Support and Calculators • Handheld versions integrated with Lexi-Comp (must be purchased separately)

  14. Essential Evidence Plus: search screen SEARCH OR BROWSE BY SUBJECT POEMS BROWSE BY DATABASE OR TOOL

  15. Essential Evidence Plus: Search results ICONS SHOWING DIFFERENT TYPE OF RESOURCE SHOWS LEVEL OF EVIDENCE REFINE YOUR RESULTS IN DIFFERENT WAYS

  16. 4. UptoDate • ~7,400 topics in 13 medical specialties • ~76,000 pages of text, graphics, links to Medline abstracts, ~254,000 references • Integrated with Lexi-Interact™ Online • Some levels of evidence in Summary and Recommendations sections, began in 2006 • Patient information free at http://www.uptodate.com/patients/

  17. UptoDate: Search results SEARCH BOX TABS TO REFINE RESULTS

  18. UptoDate: Topic entry PICTURES

  19. 5. PEPID • ~2000 medical topics • Drug Database with ~7,500 drug, herbal and OTC generic and trade names • Drug interaction generator - simultaneously cross reference up to 50 drugs • ~ 250 medical calculators • Links to FPIN (Family Practice Inquiries Network) questions • Personal Notes - add a note anywhere

  20. PEPID EASY TO FOLLOW ICONS

  21. PEPID IMAGES

  22. Research • Bonis PA, et al. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Int J Med Inform. 2008 Nov;77(11):745-53.PubMed • King WJ, et al. Effect of point of care information on inpatient management of bronchiolitis. BMC Pediatr. 2007 Jan 24;7:4. PubMedProvision of clinical evidence from a reputable source at the point of care influenced bronchiolitis treatment choices by medical trainees • Goodyear-Smith F, et al. DynaMed, MD Consult and UpToDate. Aust Fam Physician. 2008 Oct;37(10):878-82. PubMedThis study was unable to show a clear preference or superior utility among three e-textbooks

  23. Research • Graber MA, et al. Answering clinical questions in the ED. Am J Emerg Med. 2008 Feb;26(2):144-7. PubMedPhysicians had 235 questions or approximately 5 questions per 8-hour shift. The 2 most commonly used information sources were drug information resources (Personal digital assistant [PDA], pocket pharmacopeia [37% of the time]) followed by electronic resources (Google, UpToDate [29% of the time]) • McKibbon KA, et al. Effectiveness of clinician-selected electronic information resources for answering primary care physicians' information needs. J Am Med Inform Assoc. 2006 Nov-Dec;13(6):653-9. PubMed For the primary care physicians studied, electronic information resources of choice did not always provide support for finding correct answers to simulated clinical questions ….

  24. Keeping current • Email alerts • RSS feeds • Podcasts

  25. Email alerts • Journal tables of contents • Clinical information • Evidence Updates (formerly BMJ Updates) • New articles about X • PubMed (and other databases) • News alerts • Google Alerts

  26. Journal Tables of Contents CLICK HERE

  27. Clinical information • Evidence Updates From BMJ Publishing • Evidence-based ratings of clinical relevance & newsworthiness of articles • Tailored to your interest profile & frequency • Critically appraised articles from ~ 130 journals & abstracted systematic reviews from ~800 journals • Free

  28. SEARCHABLE DATABASE

  29. Evidence Updates in your mailbox

  30. Evidence Updates entry SEE RATINGS FURTHER COMMENTS BY CLINICAL RATERS BELOW

  31. Tailoring your Evidence Updates SEE HOW MANY REFERENCES YOU WOULD GET

  32. Alerts - new articles about X • Example from PubMed but many other databases offer alerts • Topic, author, articles that have cited an article you like • 3 steps to alerts from PubMed • Get My NCBI account (free) • Do PubMed search & save it • Fill in dialog box with frequency & other info

  33. CLICK HERE TO SAVE YOUR SEARCH

  34. Customizing your PubMed Alert

  35. PubMed Alert in your mailbox

  36. Google Alerts

  37. Email alerts can be useful but feeds can be better!

  38. RSS Feeds • Feeds / RSS feeds / XML feeds / syndicated content / web feeds /Real Simple Syndication • Contain frequently updated content published by a website • Used for all types of digital content including pictures, audio, or video • Instead of you going to the website to check what’s new, RSS delivers it to you

  39. Feed readers • Also called Aggregators / Readers/ News Readers • Different types • Standalone programs • Part of other programs e.g. Outlook 2007, Internet Explorer 7+, Firefox 2+ • Web-based e.g. Bloglines, Google Reader • More information? Check Wikipedia or YouTube

  40. How to get feeds • See icons on many websites – this will be standard soon • Some browsers display icon in address bar if site has a feed • Visit a list or directory of feeds • Use your reader to search for feeds

  41. FEED ICON

  42. Some lists of feeds • MedWorm http://www.medworm.com/ • MedicineNet’s list of feeds http://www.medicinenet.com/rss/article.htm • CBC http://www.cbc.ca/rss/

  43. Subscribing to feeds • Click on icon of feed you want • If using Internet Explorer, click on Subscribe to this feed,and feed is added to the Common Feed List • Or copy feed address (URL) and paste into your reader window

  44. SEARCH FOR FEEDS THAT USE THESE WORDS EASY TO SUBSCRIBE WITH THESE DIFFERENT READERS

  45. Feeds in Internet Explorer FEEDS SUBSCRIBED TO ITEM FROM HIGHLIGHTED FEED

  46. Google Reader • Need a Google account first – highly recommended for lots of reasons • Accounts are free • Go to Google Accounts Creation page

  47. Inside Google Reader PASTE FEED ADDRESS HERE SHOW BRIEF OR EXPANDED VIEW OF ITEM FEEDS NO. OF NEW ITEMS

  48. Inside Google Reader STAR ITEMS FOR STARRED FOLDER TAGGED FOLDERS TAG ITEMSTO PUT THEM IN FOLDERS

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