HealthAugust 10, 2021

UpToDate Success Story: Kobe University Hospital

Kobe University Hospital was established in 1872. Today, it functions as a base hospital for coordinated cancer care, and Japan’s first center for disaster and emergency medicine research. It also provides highly advanced medical care with 39 departments and 14 centers. In 2005, UpToDate® was introduced to meet the needs of a hospital that serves a core medical function in the Kansai medical region and is also an educational institution.

From clinical practice to education and Drug Information, UpToDate has become like a lingua franca for all medical professionals

Kobe University Hospital has introduced UpToDate, a clinical decision support resource, throughout the hospital and boasts one of the highest usage rates in Japan. UpToDate is used as a common reference tool by medical professionals in various positions, including actual medical treatment, education, and sharing of drug information. In this issue, we asked four professors to talk about their respective usage scenarios and how UpToDate is used in cross-functional collaboration.

In what situations do you use UpToDate?

Dr. Yano: In our hospital, there are pharmacists assigned to each ward, and they often search for information specific to the field where they are assigned. The actual frequency of use is about five to six times a day, and the drug interaction powered by Lexicomp® is the most used content. I use it to check for interactions that are not listed in the Japanese package insert, or when considering dosage for children or the elderly. The other use is in the Drug Information Office. We also use it when we receive inquiries about drugs from various departments and outpatient clinics, and when we need information about overseas drugs.

Let’s say you get information about what you think is a side effect. The doctor has already diagnosed the problem, but if there is a concern about side effects, I may suggest another drug to the doctor using UpToDate and Lexicomp. Whenever I have a question, I do my own research and make a suggestion to the doctor, which is a good way for the pharmacist to learn.
Dr. Ikuko Yano, Professor, Director of Pharmacy, Kobe University Hospital

Dr. Minami: Since we cover all types of cancer, I sometimes refer to the information in UpToDate when I treat cancers in areas where I have little experience. For cancers that are too rare, there may not be enough information even on UpToDate, but if I can confirm the information, I can be sure that my knowledge is correct.

Another area where UpToDate is valuable is education. For example, there are various treatment methods for cancer, and it is necessary to educate people about treatment methods other than the one I am practicing, so I use it to organize my knowledge. The main reason I use UpToDate is that it is easy to reach the evidence-based articles. It is convenient because you can trace the evidence from the content of the article and easily reach the original publication. There is not just one source of information, but multiple evidence papers, which can be used as a reference when making educational slides.

Dr. Sakaguchi: Since I am a general internist, I sometimes see patients with diseases that I have not had much experience with before. When I want to know about disease concepts, recent topics, and front-line treatment, I find UpToDate very useful because it is like a compilation of articles. I once heard that a patient with a disease that is only found in Okinawa was found in Hyogo.

Also, even though I have been a general physician for a long time, I sometimes come across cases that are difficult to understand. When what I thought was “the right thing” turns out to be wrong, I use the patient’s main complaint as a search word and look it up on UpToDate. For example, when the main complaint is diarrhea, if diseases that cause diarrhea come to mind, the correct answer is usually one of them, but if you search in UpToDate, there are infections, hormonal diseases, and so on. Sometimes, things like candidate diseases are listed and you find something you hadn’t thought of.

How about from an educator’s point of view?

Dr. Kono: I am in charge of pre- and post-graduate education. Doctors in their 40s and 50s who have a clear specialty may often get information from specialized journals in that field. However, I think that UpToDate has very useful content for those who want to experience a variety of cases, such as late-stage residents. In addition, some of the hospitals where post-graduate training is conducted also provide training using UpToDate. In other words, there is probably a part of UpToDate that is now like a common language in many institutions. If university hospitals have the same content, continuity of training can be maintained. Even before graduation, some students who want to learn on their own may want to use UpToDate.

Dr. Minami: In my teaching, I focus on bedside teaching. I try to teach in the form of mini-lectures based on the patients. However, I also use UpToDate for classroom lectures, and some residents and students use it themselves.

I tell students and residents, “Do your own research before you ask. It’s easy to ask questions, but it’s important to do your own research first.” I think that many people start by looking up disease outlines and treatment methods from the guidelines, but I also make sure that they refer to guidelines not only in Japan but also in other countries, and I make sure that they look up in UpToDate and eventually go through the evidence papers.

Physicians also get information about new treatments and drugs from the evidence-based content in UpToDate, and they can make clinical decisions based on scientific information. We use a method where pharmacists and doctors get their information from the same sources, and pharmacists are asked to research in more detail.
Dr. Hironobu Minami, Professor, Department of Oncology and Hematology, Kobe University Hospital

UpToDate as a common language among medical professionals

In terms of information sharing among medical professionals, how do you use the system?

Dr. Yano: Between doctors and pharmacists, Lexicomp is still often used from the perspective of drug interactions. For example, Lexicomp provides information that the Japanese package insert alone lacks, such as ranking contraindications and concomitant precautions. As a pharmacist, I also use it to check the effects of new drugs when I add them to the list of medications that patients bring with them when they are hospitalized. There are references in the information, as well as PubMed IDs, so I think the fact that I can read the linked information immediately leads to a comprehensive search for information.

In the past, it was common for doctors to issue prescriptions and for pharmacists to check them, but now pharmacists are routinely stationed in hospital wards, and they make recommendations to doctors from the stage of prescribing. Nowadays, pharmacists are routinely stationed in the wards, so they make recommendations to the doctors from the stage of prescribing. The current style is for pharmacists to be involved from the stage of making prescriptions, and for different professions to cooperate with each other. It is the physician who decides on the drug, but the pharmacist’s role is to check the dosage, interactions and contraindications of the drug.

Dr. Minami: For example, just the other day, when I was considering a prescription for a patient with a pre-existing condition, I asked the pharmacist to suggest a prescription.

Some drugs can cause a serious arrhythmia called QT prolongation. At that time, the drug I tried to prescribe was listed as having the potential to cause QT prolongation. Even if I tried to choose a different drug, it would be difficult to find out more during the outpatient clinic. However, if a pharmacist is present, he or she can provide information such as the name of the disease and the patient’s medical history and suggest an appropriate drug.

Dr. Yano: Isn’t it also an advantage that doctors and pharmacists can talk in a common language from the same source?

Dr. Minami: Doctors are provided with a lot of information by the medical information officers of pharmaceutical companies, but there is also the question of how far impartiality is maintained. Physicians should also get information about new treatments and drugs from science-based UpToDate and many papers and make decisions based on evidence-based information. It is important for pharmacists and doctors to get information from the same sources.

Do you find that you can learn things that you didn’t know before?

Dr. Sakaguchi: I often have more questions and interests after reading the information in UpToDate. It’s like I can’t stop, or I get more and more deeply involved once I start researching. With electronic media, it is difficult to know how much information is available beyond that. For example, when you read a textbook or a medical journal, you have a book in front of you, so there is a limit. However, when it comes to electronic media, there is a contrary concern that the research will spread as much as possible. If you don’t stop somewhere, you will end up spending so much time only searching in UpToDate.

Dr. Yano: Pharmacists oversee patients in the wards and check evidence such as guidelines to verify whether the actual treatment is standard or not. We also present this information to the doctors, saying, “This kind of information is also available.”

For example, let’s say a pharmacist meets with a patient and gets information about a possible side effect. If the doctor has already diagnosed the problem, but there is a concern about side effects, we may suggest another drug to the doctor using UpToDate and Lexicomp. Whenever I have a question, I do my own research and make a suggestion to the doctor, which is a great learning experience for me as a pharmacist.

Nowadays, UpToDate content is also available on smartphones!

Dr. Minami: I think you can use it to do some research and organize your knowledge whenever you have time, even when you are on the move. However, the text is too detailed, so I find it easier to read on a larger screen.

Since I am a general internist, I sometimes see patients with diseases that I have not had much experience with before. When I want to know about disease concepts, recent topics, and front-line treatments, I find UpToDate useful because it is like a compilation of articles.
Dr. Kazuhiko Sakaguchi, Associate Professor and Chief, Department of General Medicine, Kobe University Hospital

Dr. Sakaguchi: Now that I can use my smartphone to look up information, I can look it up whenever I think of it, or even on the train when I am suddenly curious. When we looked at the rate of smartphone use in the general internal medicine department, we found that 60% used their own PC in their room, 30% used their smartphone or iPad while traveling, and 10% used their iPad in the hospital. This means that nearly half of the patients use their smartphones, iPads, and other portable devices. I don’t use UpToDate in front of my patients, but I do sometimes use my smartphone to do a little research while they are going for CT or other tests in the outpatient clinic.

Expectations for the future

What do you expect from UpToDate and Wolters Kluwer in the future?

Dr. Sakaguchi: I still use UpToDate from time to time for educational purposes. The information is updated frequently and there are many new parts. I hope that the images will be updated as often as the texts.

Dr. Minami: Another point for me to use UpToDate is the speed of information. Books take several years to be revised, but UpToDate is an electronic medium, so the information is updated quickly. For example, if a new treatment method or a paper that changes the standard of care is published, the information in UpToDate will be rewritten in a few months. You can literally get the most up to date (the latest) information. This is very important, and I hope that this sense of speed will be maintained. I also hope that the information on rare diseases will be covered, as this is the information we want.

At present, UpToDate is probably a part of the common language in many institutions. If university hospitals have the same content, continuity of training can be maintained.
Dr. Seiji Kono, Director, Comprehensive Clinical Education Center, Kobe University Hospital
Dr. Ikuko Yano
Dr. Ikuko Yano
Professor, Director of Pharmacy, Kobe University Hospital
Dr. Hironobu Minami
Dr. Hironobu Minami
Professor, Department of Oncology and Hematology, Kobe University Hospital
Dr. Kazuhiko Sakaguchi
Dr. Kazuhiko Sakaguchi
Associate Professor and Chief, Department of General Medicine, Kobe University Hospital
Dr. Seiji Kono
Dr. Seiji Kono
Director, Comprehensive Clinical Education Center, Kobe University Hospital
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