A Review of UpToDate
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Allison Erlinger, RN/BSN, MLIS, AHIP
Reference Librarian
Grant Morrow III MD Medical Library
Nationwide Children’s Hospital 

Content         

UpToDate is a major point-of-care resource, offering evidence-based, physician-authored topic summaries designed to assist practitioners in making appropriate clinical decisions. The bulk of UpToDate content is organized into structured summaries, or “Topics,” that include discrete sections such as General Principles, Epidemiology, Etiology, Clinical Manifestations, Assessment, Diagnosis, Therapy, Complications, Practice Guidelines, Summary & Recommendations, and References. Additional content areas include Practice Changing Updates, What’s New, Patient Education, Calculators, and Drug Information. Continuing Medical Education (CME) credit is available for practitioners with accreditation through numerous worldwide associations, colleges, and other practice authorities and is automatically tallied when a user reads Topics while logged in to a personal account.

UpToDate content is authored by physicians who are identified by the editors and participating societies as experts in their fields. A dedicated editorial staff and peer-reviewers for each specialty area review all content for accuracy and completeness. Topics may be revised when relevant new information is published rather than on a set, time-based schedule. Content is updated based on a continual review of the published literature and, theoretically, changes may be made on a daily basis. The dates of the most recent updates and currency of literature review are displayed at the beginning of all Topics.

Topic authors and physician reviewers perform comprehensive literature reviews and select studies for inclusion based on the quality of the study, the hierarchy of evidence, and clinical relevance. UpToDate does make clinical recommendations, based on the evidence, and uses the widely accepted Grading of Recommendations Assessment, Development and Evaluation (GRADE)[1] system to rate the strength the recommendation and the quality of evidence supporting it. UpToDate began using GRADE in 2006 and the process of grading all recommendations in UpToDate is ongoing.

Users can access content either on the web-based platform or through the mobile app. For individual users accessing content through an institutional subscription, personal registration and login credentials allow access to the mobile app and the full web version on any internet-connected computer using UpToDate Anywhere. Personal credentials are required in order to earn CME credit; only the topics read while a user is logged in to a personal account will be tallied for CME. UpToDate also has collaborated with a number of electronic health and medical record vendors to allow for integration and access within those systems.

Features & Functionality

Information in UpToDate is accessed using a single search box, which offers responsive suggestions as queries are entered; no advanced search feature is available. Results include listings for both major Topic headings and section subheadings, making it easy to quickly access the most relevant content. Basic filters for All, Adult, Pediatric, Patient (education), and Graphics are also available.

An integrated set of foundational Lexicomp drug monographs is available to all UpToDate subscribers, with results displaying automatically using the UpToDate single search box. For institutions that subscribe to Lexicomp, integration of the full database is also available. Interaction with additional resources, including VisualDx, ProVation Medical, Sentri7, OvidMD, and full-text linking can be enabled for institutions subscribing to these services in addition to UpToDate. External links to publicly available resources, such as PubMed and selected guideline authorities, are included when appropriate.

Overall, simple searching in UpToDate quickly leads to concise topic summaries that are very useful for background information and point-of-care reference. Topic reference lists provide a selection of literature on a given topic, but these are not meant to be comprehensive and may not contain the most current references unless recent advances have significantly changed understanding or management approaches.

Business Model

Several subscriptions options are available for both institutions and individuals.[2]

Individual subscriptions are available at three levels:

  • medical professional: full access to UpToDate content
  • resident, fellow, or student: full access at a reduced price
  • patient or consumer: free access to basic patient education and short-term (weekly or monthly) paid subscriptions to full content

Institutional subscriptions are available for both hospitals/institutions and smaller group practices, with two further subsets based on the number of providers. Institutional licenses are available on a multiyear basis. Pricing is based on hospital data, and those interested in learning more are encouraged to contact UpToDate for detailed information. This resource, while valuable, requires a significant financial investment and can be cost-prohibitive for the smaller medical library budget.

General usage data is readily available through downloadable online reports. More detailed usage reports are available by request.

Breakthrough

UpToDate is best suited for hospitals, particularly academic medical centers supporting either graduate medical education or other professional educational programs. The concise topic summaries, written by recognized experts in their fields, combined with the opportunity to earn CME credit, make UpToDate a favorite among physicians, particularly residents and fellows. However, many library and information professionals are less enthusiastic about this resource, owing in large part to its potentially cost-prohibitive pricing.


[1] The GRADE Working Group. Accessed 05/16/2018. http://www.gradeworkinggroup.org/

[2] UpToDate. Product, Editorial, & Subscription Options pages. Accessed 05/16/2018. https://www.uptodate.com/home/help

 

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