The Progressive Physician - Management Features
UpToDate: A Lifesaver of a Tool for Physicians E-mail
Written by Alice LaPlante   
Tuesday, 05 February 2008 03:17

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Dr. Paul M. Wolf vividly remembers the day the woman came into the emergency room of the hospital where he was serving his residency. She had a severe rash that was getting progressively worse in front of his eyes. “Clearly, we didn’t have time to mess around,” says Wolf, an internist who has a solo practice in Austin. He thought there was a chance that it was Stevens-Johnson syndrome (SJS), an extremely serious and frequently fatal illness in which cell death causes separation of the epidermis from the dermis.

But the syndrome is very rare, and no one at the hospital had ever seen a case before. Because treatment was so specialized – they couldn’t treat her on site, but would have to transfer her to a burn center, involving considerable red tape – Wolf knew he had to act quickly to convince everyone of the urgency of the situation.

Luckily for him, he says, the hospital subscribed to UpToDate, an evidence-based online clinical information system.

“We looked up SJS in UpToDate, and there it was – described exactly and complete with photos,” says Wolf. “We didn’t need to go to a bunch of books, didn’t need to call in a dermatologist or other specialist. We were able to intervene really quickly, and we saved her life.”

Available on a CD-ROM, via the Web, and on personal data assistants (PDAs), UpToDate provides doctors with an online library of articles, research papers, studies, and diagnostic and treatment recommendations. Actual clinicians and medical educators have authored the entries, which include descriptions of the symptoms, and diagnoses of and treatments for a broad range of disorders in medical specialties and subspecialties ranging from adult primary care to pediatrics to rheumatology. Hyperlinks allow users to move through bibliographical references, and from one article to other, related, articles. All the content goes through an extensive peer review process before being published on UpToDate.

A number of independent studies have found measurable benefits to using UpToDate:
  • The Mayo Clinic studied how UpToDate affected the knowledge of internal medicine residents as measured by the Internal Medicine In-training Examination (IM-ITE). The study correlated how much UpToDate was used by each resident with IM-ITE scores. Using UpToDate for 20 minutes a day turned out to be equivalent to a full year of residency in terms of its efficacy in improving IM-ITE scores.
  • The University of Missouri asked faculty, students, and residents to rate UpToDate after 45 days and then again a year later. The study found that the “overall usefulness” of the tool was rated excellent by 68% of respondents initially and by 75% after one year; in both time periods, more than 90% of faculty rated it good or excellent for teaching and more than 95% of students and residents rated it good or excellent for learning.
  • The University of Chicago studied how 10 physicians in four primary care clinics used UpToDate. Five of the physicians were randomly chosen to use UpToDate; the control group was instructed to rely on their usual sources of information to diagnose and treat patients. Data was collected on more than 670 patient visits. The UpToDate users were able to answer their questions significantly faster – within minutes rather than up to three days for the physicians who did not use UpToDate.

Today, Wolf, who uses the CD-ROM version of UpToDate, simply carries his laptop into patient examination rooms and refers to it whenever he has a question about a diagnosis or treatment plan “I just looked at it today to consult it about a breast-feeding woman with high blood pressure – something we don’t frequently deal with in internal medicine,” he says. “I just typed “post partum hypertension” into the search field, and up came the information. It was just like consulting another doctor.”

Alice LaPlante
About the author:
Alice LaPlante is an award-winning business and technology writer with more than 20 years experience producing articles for national publications including Forbes ASAP, Discover, InformationWeek, ComputerWorld, InfoWorld. She is the author of five books, including Playing for Profit: How Digital Entertainment is Making Big Business Out of Child's Play (Wiley, 1999). She lives in Palo Alto, California.


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