UpToDate system proven to save time, lives

By Betsy Caron
02:03 PM

It's little wonder that at least one subscriber of Wolters Kluwer Health's UpToDate has described it as "the best medical tool ever." The system has helped hospitals save approximately 11,500 lives and 372,500 hospital days over a three-year period, according to new research from Harvard University, which was recently published in the Journal of Hospital Medicine Early View.

UpToDate, an evidence-based, physician-authored clinical decision support system, has been serving hospitals since 1992, when it was first distributed on floppy disks. Now, the system is used in 90 percent of academic medical centers and employs an editorial board of over 5,000 authors and editors who continuously write and update over 9,000 topics across 19 specialties.

[See also: Wolters Kluwer Health to acquire UpToDate.]
The new Harvard study, conducted by Thomas Isaac, MD, Jie Zheng, PhD, and Ashish Jha, MD, examined the relationship between UpToDate and three main hospital outcomes over three years: risk adjusted length of stay, risk-adjusted mortality and performance quality. The researchers compared data from 1,017 hospitals using UpToDate with 2,305 that were not, finding outcome benefits with the system in each category.
“What this study really does do for hospitals, clients and those who aren’t UpToDate users, is to fortify the message that having this type of resource is very important for patient safety, quality of care and even hospital efficiency,” said Peter Bonis, MD, a gastroenterologist and chief medical officer of UpToDate. “This is an important message for people to understand when we are increasingly in a period of strained resources, when we are having a migration to different types of payment systems that are generally value-based … and that people are really demanding that vendors provide bang for the buck.”
Bonis cited past studies showing that two out of three clinical encounters generate a question for doctors – but that but most questions are not perused or answered using the best available knowledge. He went on to say that if the knowledge was available at the point of care, a typical doctor would change what they do five to eight times a day.
“[Doctors] answer the question by relying on past knowledge, which is based on what they learned in training,” said Bonis. “Or maybe they ask the person next to them; or they simply don’t pursue, they just make it up. And that’s sort of scary when you think about it, and it’s bound to lead to bad care.”
While previous studies have shown the multiple benefits offered by UpToDate, Jha focused this study on hospital performance before and after adopting the system, looking to see if there was a correlation between the program and the improved measures of interest.
Bonis said the study’s findings relating to fewer deaths in hospitals using UpToDate was a surprising new piece of data that other, past research was not able to detect.
“Deaths in hospitals, they’re regular but they’re relatively rare,” he said. “So to be able to detect a benefit on mortality is extraordinary.”
UpToDate is already extremely widely used. The system has 13 million of its topics viewed every month and resides in 140 countries worldwide. But the team is working on improvements for the future, specifically focusing on “integration into electronic medical record systems and other means to leverage technology and clinical informatics,” said Bonis. “We want to be part of the fabric of improving the care in our country and in other countries in the world.”