Wolters Kluwer – 30 years of UpToDate

The evolution of clinical decision support and the future of evidence-based medicine

Clinical decision support (CDS) is an essential tool ^[1] for empowering clinicians with immediate, evidence-based knowledge, no matter how quickly the evidence changes. Ubiquitous as CDS systems are today, it wasn’t all that long ago that providers had to go out of their way to track down answers to vital patient care questions.

A lot has changed in the world of patient care over the past 30 years. It’s hard to imagine that 30 years ago when clinicians had a question, they had no choice but to stop what they were doing and run out to the library to research the latest best practices. There was no guarantee the information was relevant to their specific needs, and even if it was, the content was likely at least a year old due to publishing timelines.

Building a better point-of-care solution for clinicians
That was the inspiration behind the very first clinical decision support tools like UpToDate® ^[2]. Over the years, having electronic access to clinical research has been a game changer for healthcare professionals, helping them keep up with the crushing number of new studies, best practices, and therapies. Thirty years later, UpToDate is the most widely used and universally respected resource for efficiently accessing clinical evidence at the point of care. The advantages of having UpToDate right by their side whenever and wherever clinicians and healthcare professionals have questions has helped it grow to:

• 44,000+ institutional sites
• 190+ countries
• 2 million+ users
• 650 million+ topic views per year

About 1.6 million times every day, a clinician turns to UpToDate for support with their
decision-making – and about a third of the time ^[3], it changes their practice. It could be in
a hospital ward; a doctor’s office; a lecture hall; an emergency room; a laboratory; or wherever else the point of care happens to be.

Today, clinicians around the world rely on UpToDate to support their confidence in clinical decision-making:

• “Having UpToDate in my pocket always gives me strength and confidence.” – Dr. Turgut Kacan, Associate Professor, Oncologist, Bursa Yuksek Ihtisas MOH, Turkey
• “It’s like an attending physician. When I have some clinical question, I always consult UpToDate.”
  – Dr. Hiroshi Sudo, MD, FACP, Department of Medicine, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
• “The clinical teams trust UpToDate. It gives them the confidence to make care decisions because they trust the information, because it’s evidence-based.”
  – Dr. Jonathan James, Chief Strategy Officer, Axis Medical Center, Minneapolis, Minnesota, United States
• “UpToDate has the value of a stethoscope and fever thermometer for us physicians. The tool has replaced quite a lot of textbooks and journals.”
  – Dr. Michael Zeller, Senior Physician, Pediatrics, Klinikum Dritter Orden, Munich, Germany

Clinical decision support during COVID-19
But what happens when there is no clear, actionable, evidence-based knowledge to share?

In the months leading up to the pandemic, CDS tools contained just a few topics on the coronavirus. And in the early months, there was little published literature to help clinicians understand the signs, symptoms, and consequences of being infected. Based on input and guidance from global experts in the field of infectious disease, the content in UpToDate has expanded ^[4] to 90 topics on the disease – and was refreshed more than 2,000 times to synthesize new learnings as quickly as it was being published.

Focused on a future of evidence-based medicine
While the delivery method and technology has evolved, the core principle of thoughtfully answering questions with actionable information at the point of care has never wavered.

At the heart of UpToDate is an unparalleled community of over 7,400 authors and editors from around the world who share a singular passion – writing and editing trusted evidence-based content and guidance to produce harmonized content.

One of the challenges the healthcare industry continues to grapple with is the potential patient harms and organizational inefficiencies caused by variability in care ^[5]. According to a New England Journal of Medicine study ^[6], only about 55% of recommended care is actually given to patients. Data ^[7] published in 2018 found that only 8% of U.S. adults over the age of 35 received all of appropriate, high-priority, preventive clinical services they required, while 5% received no such services at all.

With each year, UpToDate seeks to further reduce harmful variations in care by connecting healthcare professionals to the most recent standards of practice, latest literature and recommendations on treatment options and diagnostic tests, and clinical pathways.

As we look to the next 30 years, we know the speed at which new medical advances become available will only continue to accelerate. Distilling all that down into a discrete recommendation for a specific patient – while making the entire experience easy and transparent for clinicians – will be one of the most important things we can do to help ensure every decision at the point of care results in the best possible outcome for that patient.

References

1. https://www.wolterskluwer.com/en/expert-insights/in-an-increasingly-complex-healthcare-system-information-is-the-best-medicine
2. https://www.wolterskluwer.com/en/solutions/uptodate
3. https://assets.contenthub.wolterskluwer.com/api/public/content/fcaf3046dec8457fa898900b4380bfd4?v=72635d88
4. https://www.wolterskluwer.com/en/solutions/uptodate/resources/covid-19
5. https://www.wolterskluwer.com/en/know/healthcare-challenges/reducing-clinical-variation
6. https://www.nejm.org/doi/full/10.1056/nejmsa022615
7. https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1248