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Point-of-Care Tool Helps Clinicians Answer Questions, Make Decisions

Cynthia Johnson, April 22, 2010

There may be no better way for a clinician to problem-solve than by analyzing all of the information at hand and making an informed decision when it's most needed—at the point of care.

Fortunately, clinicians have more recent and relevant medical data at the ready with the availability of a clinical reference tool called DynaMed by Ipswich, MA-based EBSCO Publishing.

DynaMed is an evidence-based tool that can help healthcare professionals answer the clinical questions they encounter in hospitals, medical schools, residency programs, and in their own practices. It contains timely, clinically organized summaries for more than 3,000 topics. The tool, which is updated daily, monitors hundreds of journals and evidence-review databases.

"It really ought to be wherever the clinical question comes to mind," says Brian Yeaman, MD, chief medical information officer at Norman (OK) Regional Health System (NRHS). "Because if you wait even 30 seconds, the probability that you're going to look up a question goes down significantly as a provider. And if you wait until the end of the day, that probability is likely in the single digits at that point in time."

Physicians research familiar and not so familiar topics
Physicians at NRHS have embraced the tool, which was implemented approximately two years ago, says Yeaman. Emergency and family medicine physicians in particular have benefited from it, since they see patients with a broad variety of symptoms.

When a patient arrives at the emergency room (ER), physicians can now look up particular diseases that they may not have thought of in a while. With DynaMed, Yeaman says doctors in the ER can search for a term, such as "hemochromatosis," and learn more about the complications of the disease process at the point of care.

Physicians also find the tool's medication information helpful. They can right-click on a particular medication to read an overview and learn more about its interactions and adverse effects. Often, a patient may be seeing a specialist who has started the patient on a medication or chemotherapy regimen that may be unfamiliar to nonspecialists, Yeaman says. A nonspecialist can research the medication or regimen on DynaMed before embarking on costly workups to determine the source of the patient's current symptoms.

But what Yeaman likes most about the tool is the timeliness of its information. At the top of every page, DynaMed posts the date the content was last updated by the author, which reassures physicians that they are working with the most relevant data available.

When Yeaman wants to quickly search a topic, such as complex pneumonia, to check for any recent changes, he says the application's structure makes it easy for him to get to results quickly. "That's a huge benefit," he says. "They continually update topics based on evidence and literature review or maybe an FDA announcement that something has changed in a medication or treatment plan."

Yeaman admits that not all physicians have readily accepted the tool, since the way physicians approach problems may vary. Some physicians need to be reminded that DynaMed is available, because it doesn't "jump out" at them to use it, he says.

Overall, both new and experienced physicians at NRHS are pleased with the tool and use it regularly, Yeaman says. Younger users ask for tools such as DynaMed, whereas more experienced physicians are excited by the previously unmet needs that it fills.

As the hospital transitions to electronic medical records (EMR), Yeaman expects that DynaMed will play a big role in getting buy-in from physicians for advanced utilization of their EMR. He envisions being able to receive a progress note from a specialist through the EMR on a topic such as metabolic acidosis and being able to access reference content in DynaMed directly instead of through a separate lookup.

"As an end user, I think we're always going to ask for deeper integration into our native systems," he says.

Because you can't memorize medicine
Brian S. Alper, MD, MSPH, is the founder of DynaMed and is currently its editor-in-chief. He created it while he was a medical student at Hahnemann University School of Medicine in Philadelphia.

"At that time, I realized that I couldn't memorize medicine," Alper says. "As a physician, I needed to be able to find the information when I needed it. So in medical school, instead of jamming everything into my head, regurgitating it for a test, and forgetting it, I decided to organize information so I could find it when I was seeing patients."

Alper put this early version of DynaMed to the test in 1995 while he was on rotation in Tennessee learning what practicing rural family medicine would be like. He says that the information he had gathered made a difference in patient care every day during this experience, especially when it came to changing diagnoses and treatment plans.

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