DynaMed - an evidence based medicine point of care tool

Submitted by JFahrni on Sat, 02/06/2010 - 11:25

Our facility is running a trial of DynaMed, “an evidence based medicine point-of-care” database. It reminds me of UpToDate.

From the DynaMed site:

• According to the National Academy Press (2001) 44-98,000 American deaths per year occur due to preventable medical errors; medical errors are estimated to cost the U.S. $17 to $29 billion annually
• Using the "best available evidence" for clinical decision-making improves health outcomes and reduces health care costs
• Busy clinicians use "fast and easy" resources expected to answer most of their questions instead of resources designed to provide the best current evidence
• Clinicians sometimes turn to textbooks and online resources with substantial breadth, but these resources do not use the best available evidence
• Physicians and other health care professionals need a resource where they can reliably answer most questions quickly and accurately (i.e., with the best available evidence)

The application is web-based and easy to use. I only played around with it for about 30 minutes, but was satisfied with what I saw. DynaMed has a nice list of clinical calculators and supports the use of handhelds, including the iPhone, iPod Touch and Android based devices.

I'll spend some more time evaluating DynaMed next week, but at this time I prefer UpToDate over DynaMed for the following reasons:

1) UpToDate appears to, on the surface at least, contain more in-depth information on any given condition

1) UpToDate use Lexi-Comp for their drug information

2) UpToDate has a nicer user interface

Here’s a link to a study in the November/December issue of Annals of Family Medicine that takes a look at the use of DynaMed by primary care clinicians.

Huge conflict of intest in Annals Study

Submitted by John Poikonen on Sat, 02/06/2010 - 19:06.

Shocking results of the Annals article that, DynaMed showed some value, given that the lead author has a bit of conflict of interest.

Conflicts of interest: Dr Alper is the founding principal of Dynamic Medical Information Systems, LLC, and the Editor-in-Chief of DynaMed.

Not sure UpToDate should be worried.

No head-to-head data

Submitted by Anonymous on Sun, 02/07/2010 - 00:17.

Yeah, I noticed that he was part of EBSCO Publishing. The one thing I found most interesting was that the article didn't compare DynaMed to anything.

I agree that UpToDate has nothing to worry about. Regardless, it's worth taking note of DynaMed.

Why there is something to worry about and COI revisited

Submitted by Kevin Clauson on Sun, 02/07/2010 - 17:57.

The reason I think UpToDate does have something to worry about is that hospitals, medical libraries, and universities are making serious budget cuts right now. UpToDate is *much* more expensive than DynaMed. We are just one of many institutions currently taking DynaMed for a test drive as a possible replacement for UpToDate. However, I think DynaMed will face the same type of uphill battle that Clinical Pharmacology did/does vs Micromedex. You have a generation of practitioners who learned/trained with one resource and they are not eager to learn a new one.

As far as the potential conflict of interest with the study, it was a National Science Foundation SBIR-funded project. The SBIR mechanism requires that the PI actually work for the business. So while it doesn't preclude bias, I don't think you can discount something considering the grant requirements mandate it.

The death of DI and open access

Submitted by Anonymous on Mon, 02/08/2010 - 11:38.

Good point Kevin. It's nice to know that the NSF requires the PI to work for the business; I was unaware.

I was just tossing this idea around over the weekend. With the amount of information available it's just not right for pharmacists to not have access to it via online resources like UpToDate, DynaMed, Lexi-Comp, etc. Years ago drug information centers were all the rage and provided very valuable information at no cost. Budget cuts and lack of funding have driven some to close and others to adopt a fee for service model.

It's a shame that resources like those mentioned above aren't openly accessible to everyone in the healthcare profession. Should a hospital that can afford it really have better drug information resources than one that can't? No. What's the solution? Should governing bodies aggressively require that hospitals have these resources? Should academia provide these resources? Should we begin rebuilding the dying drug information model?

I don't have the answers, but I know that I wouldn't do my job quite as well without having access to the most recent information. I don't use UpToDate, Lexi-Comp or journal articles to make every decision, but I would definitely be at a disadvantage if I needed the information and couldn't get to it.