Alison Gehred, MLIS
Reference Librarian 
Grant Morrow III MD Medical Library
Nationwide Children’s Hospital   

This is an update of a review written by Allison Erlinger, RN/BSN, MLIS, AHIP that was published in the July 2018 issue of Doody’s Collection Development Monthly. You can find the original review here. 

Content  

UpToDate is a major point-of-care reference service to help physicians access evidence-based medicine anywhere. There are several facets of the product including sections like “What’s New,” “Practice Changing Updates,” “Patient Education,” “Patient Education Integration” (for EMRS), “Search Features,” “Graphics Search,” “Medical Calculators,” “Feedback,” “Drugs and Drug Interactions” (in partnership with Lexicomp), and “Links to Full Text Articles.” CME credit is also available through the platform, which benefits physicians, physician assistants, and nurse practitioners in helping with maintenance of certification. 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 (1). Currently (as of November 2020), the search page lists several links relating to COVID-19 information.  

UpToDate is known for editorial content written by experts in their fields of study. The content is updated daily from peer-reviewed journals, clinical databases, and other resources. Each UpToDate specialty has assembled a group of peer reviewers, often in conjunction with a sponsoring specialty society, who are responsible for reviewing selected topics in each specialty (2). However, practice changing updates are included in the “What’s New” and “Practice Changing Updates” sections and are focused on changes that have a broad application in practice. All evidence is rated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) (3). Grade 1 recommendations are considered “recommended” and Grade 2 evidence is considered “suggested.” UpToDate has been using this system since 2006. Evidence is procured from hand-searching, databases, practice guidelines, the expertise of authors, and various respected organizations. 

Users can access content either on the web-based platform or through the mobile app (1). The product can be accessed via a mobile app on Android, Apple, and Amazon products. Users can use institutional or individual accounts to log in via an internet connection using UptoDate Anywhere. A user must create an individual log-in for CME credit and to access information via the mobile apps. UpToDate is also integrated into some EMR software and can be accessed there as well.  

Features & Functionality 

UpToDate features a very basic search bar with a drop-down menu for intuitive searching leading to specific topics. An integrated set of foundational Lexicomp drug monographs is available to all UpToDate subscribers, with results displaying automatically using the UpToDate single search box (1). There are other programs that are available to be integrated in the search results (such as Visual Dx) if the subscription is institutional. The program also saves topics and dates searched for easy reference. Once taken to the search results, users can further narrow their topic down to adult, pediatric, patient, and graphics. The toolbar above the search results has quick links to “Contents,” “Calculators,” “Drug Interactions,” and “UpToDate Pathways.” Once the user arrives at the subject page, all the information is broken down into subgroups on the left side. The pages are very text heavy with navigation made easier by clicking the links on the left side. 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 (1).  

Business Model 

UpToDate is a product of Wolters Kluwer. It is a resource that is known for being a financial investment. The product prides itself on usability and quality. On the site’s Clinical Effectiveness page, the company states, “We help people make tough healthcare decisions to improve healthcare quality and reduce costs (4).” This product may be cost prohibitive for smaller libraries, but there are several pricing options. 

There are packages for individual subscriptions for (5): 

• Medical professionals 
• Groups of 2-19 
• Residents, fellows, and students 
• Patients and caregivers 

There are packages for enterprise including: 

• Hospitals, health systems, clinics, physician groups, or academic institutions 
• Healthcare business 

The package for hospitals includes EMR integration. 

Usage data can be found on the site and more detailed usage data can be requested when choosing a package to invest in. There are also trial subscriptions for users to see what they like about the product and if they want to continue using it.  

Breakthrough 

UpToDate is an excellent point-of-care resource. Even though the evidence is not comprehensive, it is an easy-to-read resource with concise, evidence-based recommendations and suggestions. The program is very transparent about where the evidence is from and how it is graded. The creators take feedback seriously and are updating the program to be as usable and relevant as possible. The COVID-19 resources are a good example of the program finding ways to be intuitive. Being available on many mobile platforms makes this product very accessible to users. The main issue with the product’s accessibility is the price. These are all important options for librarians to weigh when deciding to purchase this product. 

References 

1. Erlinger A. A Review of UpToDate. Doody’s Publishing. https://dcdm.doody.com/2018/07/a-review-of-uptodate/. Published 2018. Accessed November 16, 2020. 

2. UpToDate. Editorial Policy. https://www.uptodate.com/home/editorial-policy. Published 2020. Accessed November 16, 2020. 

3. Grading of Recommendations Assessment, Development and Evaluation. https://www.gradeworkinggroup.org/. Published 2020. Accessed November 16, 2020. 

4. UpToDate. UpToDate Clinical Effectiveness. https://www.uptodate.com/home/clinical-effectiveness. Published 2020. Accessed November 16, 2020. 

5. UpToDate. Subscription Options. https://www.uptodate.com/home/clinical-effectiveness. Published 2020. Accessed November 16, 2020.