Alper says a gap exists in healthcare between a systematic review that answers a question ad nauseam and nothing. "You can't do a systematic review for every possible question," he says.
To fill this gap, DynaMed has developed a process by which it monitors the literature, evaluates each article as it's published, and selects the best information available. The result is a tool that takes an evidence-based approach to answering questions.
"That answers more questions with the best evidence than putting the same effort into just doing systematic reviews," Alper says. "It's a different basic strategy, but it's the one that makes the evidence-based medicine practical on the scale of medicine."
The tool provides clinicians with three evidence levels to help them judge the validity of the content that's selected. Level 1 evidence (likely reliable evidence) represents the most valid reports addressing patient-oriented outcomes. Level 2 represents mid-level evidence, and level 3 represents reports that lack direct evidence.
"In DynaMed, not only do they provide the top level of evidence, but they provide links to all the primary resources within the text as you're going through it," says Yeaman. "It gives me further confidence that they've truly met that level of evidence, and I can click and read the synopsis of what that primary source was."
According to Alper, DynaMed presents clinicians with facts, not opinion, which is a novel approach in clinical referencing. He adds that clinicians need to ask themselves whether they're only looking at somebody's opinion and trust it because it's their opinion or because it's based on evidence.
"The traditional approach to evidence-based medicine doesn't cover enough information, and the traditional approach to medical publishing doesn't really pay attention to the evidence," Alper explains. "It's weighed too much by opinion. We're the only ones that have put it both together."
However, if a clinician notices something amiss in the information presented within DynaMed, he or she can simply click on a link at the bottom of the page to send a comment to the editor and provide feedback.
"We make it easy for people to give us feedback," says Alper. "That's something that might be unique to us, al¬though I think it should be basic customer service."
Giving credit where credit is due
It stands to reason that if clinicians are going to problem-solve and conduct research at the point of care, they should receive CME credits for their efforts. DynaMed provides them with CME credit when they complete a form based on the information they've accessed.
"If you look in DynaMed to answer your own question, that can count for CME, which is better for adult learning than if you sit in class," says Alper. "If you solve your own problem, you learn better."
If an institution, such as NRHS, has its own CME coordinator, he or she can use the tool to keep track of the credits clinicians receive through DynaMed. EBSCO also provides this service to institutions that may not have their own designated coordinator.
Unique subscription policies
DynaMed currently offers subscriptions for individuals, institutions and groups, and contributing authors and reviewers.
Institution subscriptions provide users with unlimited access via the Web, PDA, or wherever the point of care may be for the clinician—at work, at home, or while traveling. By comparison, other tools typically only offer access at the facility.
Alper says "point of care" is wherever the clinician may need the information—even if that means he or she is not physically at a facility.
"If you get a phone call from a nurse and something has happened to your patient, then you're making the decision and verbally deciding what to do," he says. "That is the point of care. How many people rush at three in the morning to go to the library? It's not the way we practice medicine."
The savings NRHS achieved when it stopped purchasing Physician's Desk References and manuals for its nursing stations nearly paid for its institutional subscription, says Yeaman.
In addition to institution and individual subscriptions, EBSCO offers subscriptions to clinicians who participate in its peer review process—a "pay or play" model. It provides them with access to the database and acknowledges their contribution.
"Now we have researchers thanking us for keeping them current," says Alper.