Temple ID department’s feedback influences administrative decision
As notably high users of UpToDate® CDS solution at Temple, the ID department was singled out to test a new application the Philadelphia hospital and medical school was considering as an alternative.
“There were very strong feelings that the other application was appropriate for medical students where you just needed a yes or no. But infectious disease often lives in the gray zone,” explains ID specialist Brionna Matt, DO. “Things are not black-and-white, which is one of the joys of the puzzle solving of ID. But that also means we can’t just look at an algorithm and apply it to a patient. We need to have expert opinion and then be able to link that to primary literature to see the nitty gritty details of what data we have available and what we don’t. And then we have to make a decision based on our training. I personally feel very strongly that I do not want to lose my UpToDate access.”
UpToDate vs. alternative low-cost solution: A comparison
When she was asked to test out a low-cost alternative to UpToDate, Dr. Matt opted to run a real-life scenario. She had just completed a case in which she had used UpToDate to support her decision-making and research clinical answers, so she repeated the process of that case and ran the same searches on the new app.
“It was really cumbersome, and I didn’t actually find the same answer,” she confesses. “So that kind of sealed the deal right there for me.”
Her colleagues agreed, one writing: “As a physician, I'd rather try to understand something I'm not familiar with than be told what to do. I need to try to figure it out by myself using detailed literature rather than following a ‘do-this-do-that’ algorithm.”
Dr. Matt adds that she likes that UpToDate is constantly “being adjusted [to incorporate] new papers that come out with new guidelines.” She also appreciates that the new information is synthesized into a format that’s easy to search and “digestible” for busy clinicians, “so as a resident, you could pop on really quick before rounds and get an answer that you needed, and then it also [makes] available the primary literature if you need to do a deeper dive.”
Acknowledging clinician satisfaction and concerns: Retaining UpToDate
The ID team compiled its responses to the new app into a long email thread which landed on the desk of Chief Medical Information Officer Dr. David Fleece, who was surprised at the passion of his colleagues.
“I thought honestly most people would not know the difference,” Dr. Fleece says. “But UpToDate behaves like a consultant, not like an encyclopedia. You’re asynchronously consulting with the experts who wrote the article.”
The team’s voices were heard, and the academic health system decided to keep UpToDate as its CDS resource, accessed more than 724,000 a year by users at Temple.
“We certainly appreciate [the administration] taking this step to understand how we utilize it,” Dr. Matt says. “Bottom line, the [other] resource is not as strong a clinical resource for attending-level inquiries and would be detrimental to our clinical practice. So, it wasn’t like we just said, ‘I don't like it. I don’t want it.’ People felt strongly that it was going to impact their day-to-day ability to provide the best patient care.”