Middle East Health speaks to Dr Denise Basow, President & CEO, Clinical Effectiveness, Wolters Kluwer, Health, about the company’s advanced clinical healthcare solutions designed to assist doctors, pharmacists and patients.
Middle East Health: Can you give us a bit of background about Wolters Kluwer?
Denise Basow: Wolters Kluwer is a large multinational company based in the Netherlands. It has four main verticals in the health, tax and accounting, governance risk and compliance, and legal and regulatory fields. The one thing that unites all these types of businesses is that we provide best-in-class information that helps professionals do their jobs better. Within the health division, which accounts for about a quarter of the overall revenue, we have three main businesses. One is called health learning, research and practice which is our global books and journals business. The second is a small business that manages our clinical terminology and surveillance tools. And third is the clinical effectiveness for health business.
Our mission is to improve the quality and reduce the cost of healthcare globally, by trying to reduce the problem of unwanted variability in care. We do this with four main products: UpToDate, which is a clinical decision-support resource primarily for doctors. It’s sold around the world and is designed to help clinicians answer clinical questions in an evidence-based way. We also have two products under what we call ‘clinical drug information systems’ aimed at helping doctors, pharmacists and nurses reduce prescription errors which are a big problem globally. Our fourth product is called Emmi, which is a multimedia tool with patient interaction to help patients engage with their healthcare.
Middle East Health: Looking at these four healthcare solutions, do you continue to develop them?
Denise Basow: Yes. UpToDate has been around since 1992. It’s our largest product in terms of customers and is sold in 180-plus countries. Although it is very well established, it is in a sense still in development as we continue to innovate and build new products around it. For example, just over a year ago we launched UpToDate Advanced, which doesn’t replace UpToDate, but provides next generation clinical pathways, based on our UpToDate content, to continue to help drive clinical decision making. Lexicomp and Medi-Span, which are in our clinical drug information sector, have been around for almost as long as UpToDate. Emmi has been around for more than 15 years, however, as the patientengagement market in general has been slow to evolve, it is the smallest in terms of customers. It is only sold in the United States.
Middle East Health: Are you planning to expand Emmi to other countries?
Denise Basow: We are, although we don’t have a specific timeline.
Middle East Health: How are the solutions provided to your customers?
Denise Basow: UpToDate and Lexicomp are fully software service solutions. We often package these together, although they can be bought separately. Medi-Span is a package of embedded drug data which sits within the Electronic Medical Record (EMR) and, for example, if a physician prescribes a drug it performs automatic screening for drug interactions and correct dosage. So this requires implementation that we sometimes do in combination with EMR vendors. Emmi is a very different solution and it requires implementation with customers.
Middle East Health: What is the difference between Lexicomp and Medi-Span as they both deal with drug information?
Denise Basow: Lexicomp we call our drug reference. It is like UpToDate for pharmacy. It’s been embedded in UpToDate for many years. That information is accessed through a simple search interface on the web and mobile devices. Medi-Span has similar content, but instead of being searchable with a web or mobile interface, it’s a series of data files that are embedded in EMR systems and operates in the background, so that our customers are often unaware of it, because they simply get an alert if there is a problem with the drug they are prescribing.
As countries begin to implement
EMRs, often one of the first
decision support systems they
put in their EMRs are solutions
like Medi-Span. While all types
of medical records are important,
studies show that what really
enhances their effectiveness
is when you embed decision
support systems in them.
Middle East Health: Are you working with clients in the Middle East?
Denise Basow: Yes. We have a strong footprint in the Kingdom of Saudi Arabia (KSA) and the UAE. We do business in other countries in the region as well. Lexicomp is growing in these countries. Medi-Span has a very strong presence in KSA. As countries begin to implement EMRs, often one of the first decision support systems they put in their EMRs are solutions like Medi-Span. While all types of medical records are important, studies show that what really enhances their effectiveness is when you embed decisionsupport systems in them. So, as these countries adopt EMR, Medi-Span tends to grow along with that, as it is a very natural addition to an EMRs. We’ve seen very good success in KSA and we are developing relationships with EMR vendors in other countries in the Middle East. Medi-Span requires us not only to have relationships with hospitals, but also with EMR vendors so we are very active in developing these relationships.
For example, among others, we work with a company called Easy Care Tech in KSA. They’re from South Korea and specialise in implementing EMRs. Medi-Span is being used by the National Guard hospitals in KSA, among others. In the UAE, King’s College Hospital and Mediclinic Middle East are also using UpToDate.
We’re actively expanding our business in the Middle East. We recently held a think tank in Dubai attended by company CEOs and hospital administrators who showed great interest in our products. The UAE healthcare scenario is interesting. It is changing rapidly and there is a lot of funding enabling it to develop in leaps and bounds. The think tank had a focus on innovation and it was a lively discussion. What came out of it was that although innovation is key, it is important not to lose sight of basic healthcare and keeping the patient at the centre of care while improving patient engagement. In other words it is important to strike a balance between innovation and sticking to the core of healthcare – taking care of the patient. 
About UpToDate
Doctors need help sifting through all the evidence and keeping up with new information. That is where UpToDate comes in: we synthesize the evidence and provide original topic reviews. UpToDate places the new information in context and provides graded, evidence-based treatment recommendations.
More than 6900 doctors from 50 countries, all of whom are leading experts in their fields, serve as UpToDate authors and editors. They seek out and evaluate the latest evidence presented in more than 435peer-reviewed journals, online medical resources, and guidelines published by major international societies. The editorial team updates content continuously and is transparent about the rigorous editorial process: all topics include the authors’ and editors’ names, specialties and academic affiliations. In addition, UpToDate accepts no advertising or sponsorships.
With UpToDate, doctors can quickly answer even their most difficult clinical questions and determine how to best care for their patients.
UpToDate at Dr Sulaiman Al Habib Medical Group
Dr Sulaiman Al Habib Medical Group (HMG) operates several regional facilities in the Kingdom of Saudi Arabia, United Arab Emirates, and the Kingdom of Bahrain Dr Bilal Ahmad Bhatt, Medical Administrator for HMG, currently manages the physicians in one hospital and one medical centre located in the UAE, with a total of 200 beds and 135 clinicians. In October of 2018, Dr. Bhatt supervised the integration of UpToDate for use by all of HMG’s facilities across the region.
Commenting on the integration of UpToDate, Dr Bhatt said: “We believe that UpToDate provides a vast amount of evidence-based information, and it is also really user-friendly. Physicians are able toaccess best practices and acquire the relevant evidence required for any clinical scenario that they may have in order to optimize patient care.
“Personally, this is how I benefit mostly from UpToDate, as I am able to get the right information easily, and I am able to transfer my knowledge to other people in the hospital – which ultimately results in the patient receiving the best care.”
He added: “If a doctor is using UpTo- Date he will provide the most appropriate care. Ultimately UpToDate can help improve healthcare quality by avoiding complications, re-admissions, and length of stay in the hospital – all of which helps to minimize healthcare costs.”
UpToDate Research
Because it is so widely used, UpToDate is one of the most studied clinical decision support resources. In fact, more than 80 studies from around the world demonstrate the benefits of using UpToDate, which include improved patient care and hospital performance. All UpToDate research can be reviewed at: www.uptodate.com/research
1. A 2011 study by researchers at Harvard University, published in the Journal of Hospital Medicine, showed an association between the use of UpToDate and improved outcomes. UpToDate hospitals demonstrated:
• Lower mortality – 11,500 lives saved over a three-year period
• Shorter lengths of stay – 372,500 hospital days saved per year
• Improved hospital quality – better quality performance for every condition on the Hospital Quality Alliance metrics.
2. In a retrospective study in Japan published 2018 (doi: 10.1016/j. ijmedinf.2017.09.010) study authors identified 100 patients who visited an outpatient department in a communitybased hospital from July 2014 to June 2015. Half the patients were seen by physicians equipped with UpToDate and half were seen by physicians without UpToDate access. They compared diagnostic error rates between the two groups. The diagnostic error rate for the patients seen by physicians equipped with UpToDate was 2%, while for those seen by physicians not equipped with UpToDate it was 24%.
3. A study conducted by the Mayo Clinic is of particular interest to academic medical centers committed to training the next generation of doctors: the researchers found that use of UpToDate for 20 minutes a day resulted in knowledge acquisition equivalent to the benefit of a year of residency training, as measured by a standardized examination (Internal Medicine In- Training Examination (IM-ITE)).
4. Researchers at Singapore’s National University Hospital found that use of UpToDate led to changes in investigations, diagnosis or management 37% of the time.
