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How the COVID-19 pandemic has changed how we use medical evidence and knowledge

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Wolters Kluwer clinical decision support tool UpToDate is provding decision-makers with the authoritative information they need.

The COVID-19 crisis presented health systems around the world with an unprecedented situation. Many clinicians found themselves working in an unfamiliar setting, treating an unknown disease. With relatively little known about COVID-19, and evidence changing daily, there was a lack of authoritative information to support these decisions. 

In this fluid and uncertain picture, the role of clinical decision support (CDS) technology came to the fore. The Wolters Kluwer clinical decision support (CDS) tool UpToDate®, with over 2 million users worldwide, is the leader in this fast-growing field. 

Mobilisation of information 

Two physicians using UpToDate on tabletOne of the key attractions of UpToDate during the pandemic was its ability to facilitate the faster mobilisation of information. As the most global CDS tool, with content curated by over 7,000 specialist authors and editors from around the world, UpToDate was uniquely positioned to keep up with the latest COVID-19 intelligence.

Few other organisations have the reach and expertise to sift through the ever-growing volume of COVID-19 information. This work is extremely important as it provides clinicians with the most authoritative and recent guidance and evidence, immediately available at the point of care anywhere in the world.

Even before the pandemic, doctors faced an uphill struggle staying on top of the latest medical literature. COVID-19 compounded the situation, creating an information race as the medical community strived to close the knowledge gap on the disease. 

Decision making in a fast-changing environment

To understand what it is like for a doctor in this age of information overload, Dr Steve Jackson, Consultant Physician, Diabetes and Endocrinology and Chief Medical Information Officer at University Hospitals of Leicester NHS Trust says: “There is so much new evidence and research coming out every day that doctors can’t possibly keep on top everything. The more experienced you get, the more you become comfortable with that. You realise there are inevitably going to be things you don’t know, and where the wisest course of action is to seek support, whether that’s from a CDS tool like UpToDate or the advice of specialist colleagues.” 

Dr Amad Khan, Neurosurgical Registrar, University Hospital Southampton NHS Foundation Trust says colleagues found it reassuring that the information in UpToDate was peer-reviewed and evidence-based.

“It’s good to know you’re not taking decisions in isolation, and that the information is underpinned by a vast and sound base of expertise. The app’s COVID-19 topics have been viewed more than 13 million times since the start of the crisis. This proves that other doctors in the same situation in thousands of hospitals across the world are receiving the same guidance. In a crisis, this can provide some peace of mind at time when you may be second-guessing yourself.” 

According to Dr Fatima Alsayyah, Endocrine Specialist, Dubai Hospital, Dubai Health Authority (DHA), clinical decision support was invaluable in the management of high-risk patients with long-term conditions during the height of the pandemic.

“UpToDate made a big difference during the COVID-19 pandemic especially for in-patient management. It has helped us to provide continuous education to patients who have uncontrolled diabetes and highlight to them the risk of severe infection, longer hospital stays and ICU admission. UpToDate changed our practice in relation to the management of COVID-19 and diabetes. It has kept us informed about the treatment changes and helped us to answer patient questions.”  

Untapped potential of CDS – future predictions

Just as the pandemic has highlighted the value of clinical decision support in treating COVID-19, it has also shown its potential for predicting future outbreaks – of this virus and others that might follow. 

Because UpToDate has 51 million topic views per month the app can provide a detailed picture of what doctors are searching for at any given time. As doctors commonly use UpToDate when faced with unusual symptoms or to double check guidance on a particular condition, it’s possible to see peaks in search activity around specific topics.

In the case of COVID-19, researchers were able to draw a clear correlation between search intensity for selected COVID-19 terms for a specific location with subsequent numbers of confirmed cases. 

In the U.S., Dr. Mauricio Santillana, Director of the Machine Intelligence Lab, Boston Children’s Hospital, and an Assistant Professor of Paediatrics and Epidemiology at Harvard Medical School, has taken this further, using UpToDate data to create an algorithm to forecast coronavirus outbreaks. It uses doctors’ search activity on UpToDate, combined with data streams from social media, internet search trends and mobile data from smartphones.

When data from these sources are aggregated, it provides a coronavirus early warning system that its developers say can forecast an outbreak two or three weeks in advance. 

Clinical decision support and virtual healthcare 

Another key medical trend that CDS is enabling is the rise of the virtual consultation – a clear consequence of the COVID-19 pandemic as many doctors switched to video-based appointments. 

Dr Jackson says this has had a big impact on how he works: “The more I do virtual consultations – and they are now the default option – the more I see an opportunity for patients to be engaged with information about their conditions. That’s far easier in a virtual consultation, when I can be looking at my screen to consult information sources and share information with the patient. 

“Working remotely also means my time is not limited in the same way as used to be in the consulting room. This means I can prepare better for each consultation. Now, before I see the patient, I can open the patient’s record, laboratory system, radiology system, and also my previous notes. If I’m not sure about the plan of action, I can use the CDS to support my decision-making.”

The potential for CDS to be used with the patient to engage them in their treatment also facilitates the trend towards remote, home-based care. Research shows that engaged patients have better outcomes and CDS is responding to this with more patient-centric content. Multi-language materials and video adapted from clinician content can reach more of the population with easy to digest and accessible information. 

The right decisions at the right time

One criticism that some may level at the growing use of CDS is that it risks creating a new generation of technology-reliant clinicians, replacing their own knowledge with the search results from an app. 

However, this is to misunderstand the true role of CDS, especially in the post-pandemic world. The key to the successful implementation of CDS is that it needs to be ‘smart’. Information needs to be delivered in a way that is seamlessly embedded into the physician’s workflow, supporting his or her reasoning process. When CDS technology can be embedded into an EMR then it moves from being an information resource to a personalised and dynamic tool. 

A guiding principle for the use of this powerful technology is that it needs to support the decision-making process rather than replace it. In this sense, CDS technology is about giving clinicians the tools that help them make the right decisions at the right time, and helping the patient receive better and safer care while delivering efficiencies and lowering the cost of care. 

Find out more about UpToDate at https://www.wolterskluwer.com/en/solutions/uptodate 

Article sponsored by Wolters Kluwer

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