Point of care decision-making tools - Overview

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Contents

Introduction

See also Filters (ie. hedges), How to appraise POC tools, Point of care evaluation criteria

Health professionals working at the frontlines of care have precious little time to search for answers to their questions in the primary literature via medical databases. Being short of time, they typically browse Google scholar, PubMed and other search tools. Moreover, several appraised sources of information are also available to free health professionals from having to locate the evidence on their own.

Many health providers are accustomed to reading digested, summaries of evidence to guide them in their clinical thinking and decision-making. Point-of-care tools help in that regard. The point-of-care sources below aim to synthesize all available evidence for major clinical topics (especially the top layers of the evidence-based pyramid). By summarizing medical knowledge, it is easier to apply the best evidence within the context of providing patient care.

Features of POC tools

  • syntheses of current evidence for diagnosis, tests and interventions (e.g. treatments, drugs)
  • designed for rapid consultation at the point of patient care
  • evidence-based and frequently updated, with links to relevant literature
  • include drug information, ICD coding, information for patients, PDA application, and provision for links to electronic health records

Access and navigation issues

Point-of-care decision-making tools make health professionals' synthesis of evidence easier. However, many of these tools are accessed by keyword or textword searches (ie. no MeSH) relying on point-and-click findability, browsing and scanning of web pages to find what is needed. That said, some POC tools are easier to navigate than others due to the use of structured abstracts and well-designed interfaces. Keep in mind that POC tools tend to answer very broad clinical questions and are not as helpful for specific foreground questions. Point-of-care tools are small in size compared to the many million citations in MEDLINE and EMBASE; and tiny compared to the mammoth Web or Google scholar. In addition, as proprietary tools, they are owned by commercial vendors and are generally marketed as tools that synthesize medical evidence from the major medical databases.

Background vs. foreground clinical questions

Some health librarians view point-of-care tools as tertiary synthesized sources of information ie. syntheses of primary and secondary research articles, and evidence, from major biomedical journals. An example of a primary research article is a recently published clinical trial of a drug indexed in MEDLINE; an example of secondary research is a review of recent clinical trials in a specific area of medicine. See systematic review, for examples. Finding answers to clinical questions may require searches for general, background information about the who, what, where, when or why about a disease, or its processes. Examples of background questions include What is Down's syndrome? and What is trisomy 21? Background questions are simple questions about the facts of a disease, and some point-of-care tools provide excellent context (or background) for these questions. Two tools strong in providing background are UpToDate and BMJ's Clinical Evidence. Guyatt et al suggest that background questions are most often asked by medical students. As medical training continues through residency and practice, clinical questions get more and more specific - the foreground of medical evidence. Many research studies indexed in MEDLINE answer specific foreground questions whereas textbooks answer background questions.

ACP Journal Club - OvidSP

ACP Journal Club - http://www.acpjc.org/ comprises an archive (from 2000 to the present) of the cumulative electronic contents of ACP Journal Club, with recurrent weeding of out-of-date articles. The content is carefully selected from over 100 clinical journals through reliable application of explicit criteria for scientific merit, followed by assessment of relevance to medical practice by clinical specialists. Its general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts. ACP Journal Club is available via OVID EBM Reviews.

ACP Journal Club has now developed a PLUS version that primarily provides online access to all articles that pass the ACP Journal Club criteria in full text.

ACP PIER® (Physicians' Information and Education Resource) - Stat!Ref

ACP PIER is an evidence-based point-of-care decision tool, available through Stat!Ref. ACP Pier provides a collection of over 400 evidence summaries published by the American College of Physicians. Each module provides authoritative guidance to improve the quality of care. In keeping with PIER's motto, "Clinical Guidance from ACP", each entry contains practice guidelines developed from evidence found in peer-reviewed journal articles and traditional textbooks.

Topics are selected by ACP based upon prevalence in clinical settings. Evidence is then gathered by literature review and evaluated based on formal criteria. The level of evidence for each recommendation is displayed clearly within the application. This resource also contains information concerning complementary and alternative medicine, ethical and legal issues, and procedures. More...

BMJ Clinical Evidence

BMJ Clinical Evidence uses the evidence from systematic reviews to address clinical questions such as what is effective in treating common cold? It is an international source of the best available evidence for effective health care. Using a large team of experienced information specialists, editors, peer reviewers, and expert authors, Clinical Evidence selects around 3000 treatments that have been evaluated in research for analysis and divides their effectiveness for specific indications into categories. CE is based on questions that clinicians and patients want answered. This may be the right starting place for a search for relevant evidence on major topics. For more information, see BMJ Clinical Evidence

BMJ 'Point-of-Care' (includes "Best Practice")

BMJ Point of Care is developed by the BMJ Evidence Centre and Epocrates -- a U.S.-based leader in technology and high-quality drug information.It was created to meet the challenging information demands of the clinical care setting and offers:

  • Disease monographs that include diagnoses, treatment options, tests to order, guidelines etc.
  • patient-centered approach to information with treatment organized by patient group
  • Embedded links to drug dosing and best available evidence from Clinical Evidence (with paid subscription)
  • Information on 3,300 drugs and 400 alternative medicines; comprehensive drug interaction checking tool
  • Up-to-date, detailed formulary for top national and regional healthcare insurance plans
  • Embedded links to ePocrates; referenced with links to Pubmed abstracts
  • A useful pill identifier tool plus hundreds of helpful medical tables and calculators.
  • Includes BMJ Best Practice

For more information see: http://group.bmj.com/products/evidence-centre/bmj-point-of-care-1 or demo http://group.bmj.com/media/movies/poc/

High quality POC tools such as BMJ Clinical Evidence support evidence-based decision and BMJ Point of Care is similar overall. It blends clear, concise expert opinion with medical evidence and provides authoritative concise answers to clinical questions through its hierarchical browsing structure. Monographs with embedded links to references and BMJ Clinical Evidence cover 29 specialties and include diagnoses, symptom evaluation, drug dosing, tests to order, relevant images (MRI, angiograms) and patient handouts. BMJ POC is a direct competitor to DynaMed and UpToDate.

Clin-eguide - Wolters-Kluwer-Ovid

Clin-eguide (Wolters-Kluwer Ovid) is a Wolters-Kluwer-OVID product that presents a synthesis of the best available evidence on diagnosis, management, and treatment of high-cost problems occuring in inpatient, outpatient and emergency department settings. For more information, see Clin-eguide (Wolters-Kluwer Ovid)

Clinical Evidence (see BMJ Clinical Evidence)

Clinical pharmacology - Elsevier

Clinical pharmacology is used by more than 1,500 hospitals and over 35,000 retail pharmacies in the U.S., as well as government and managed care agencies, PBMs, pharmaceutical manufacturers and academic institutions. Provides up-to-date, peer-reviewed, clinically-relevant point-of-care drug information for all U.S. prescription drugs, as well as off-label uses and dosage, herbal supplements, nutritional and over-the-counter products and new or investigational drugs.

CliniPearls - UBC eHealth Strategy

CliniPEARLS is a PDA software to provide up-to-date Clinical Practice Guidelines (CPG). The streamlined user interface allows practitioners to easily find the information they need at the Point-of-Care. At present there are more than 5000 registered physicians and other health professionals using CliniPearls. The software currently provides access to 38 guidelines.

Cochrane Library - Wiley

See The Cochrane Library

Cochrane Database of Systematic Reviews (Cochrane Reviews)

Database of Abstracts of Reviews of Effects (DARE)

Cochrane Central Register of Controlled Trials (Clinical Trials)

The Cochrane Methodology Register (Methods Studies)

Health Technology Assessment Database (Technology Assessments)

NHS Economic Evaluation Database (Economic Evaluations)

Cochrane Database of Systematic Reviews

Since 1996, systematic reviews prepared and maintained by the Cochrane Collaboration have been published in The Cochrane Database of Systematic Reviews. CDSRs are regularly updated as more information becomes available and in response to comments from physicians. Systematic reviews are now widely regarded as being of better quality, on average, than their counterparts in print journals.

Cochrane Database of Systematic Reviews is one of the most important databases in evidence-based medicine. It is on par with MEDLINE in the view of many and provides quick access to the systematic reviews of randomized controlled trials (RCTs) undertaken by the international Cochrane Collaboration. Its strength is providing easy access to RCTs that deal with drugs, interventions and therapies. For more information, see Cochrane Library.

Database of Abstracts of Reviews of Effects (DARE) - OvidSP or Wiley

DARE is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary of the review together with a critical commentary about the overall quality. The database is a key resource for busy decision makers and can be used for answering questions about the effects of specific interventions, whether such questions arise from practice or when making policy. DARE covers a broad range of health related interventions and includes over 3000 abstracts of reviews in fields as diverse as diagnostic tests, public health, health promotion, pharmacology, surgery, psychology and the organization and delivery of healthcare. DARE complements the Cochrane Database of Systematic Reviews by quality-assessing and summarizing reviews that have not yet been completed by the Cochrane Collaboration. DARE is produced by the Centre for Reviews and Dissemination (CRD), University of York, UK and undertakes weekly extensive searches and assesses thousands of citations to identify potential systematic reviews.

DynaMed - EBSCO

DynaMed (EBSCO) is a just-in-time reference tool integrating evidence-based and practical information for clinical practice. As a point-­of-­care tool, it is easy to use and offers clinically organized summaries to more than 3200 topics and covers more than 500 journals. Content is updated daily. DynaMed does not offer all evidence on topics but rather the best evidence. Summaries are listed alphabetically and by category and are searchable. DynaMed also offers handy calculators, decision trees, clinical criteria, and unit and dose converters. Lexi-Comp can be integrated as a separate service. An article by Banzi et al in the British Medical Journal has found Dynamed to be the most up-to-date point of care tool available. For more information, see DynaMed_(EBSCO)...

Evidence-Based Medicine Guidelines (EBMG) - Wiley

Evidence-Based Medicine Guidelines (EBMG) by Wiley publishers provides physicians with access to 1,000 concise, evidence-based summaries of symptoms and diseases, over 3,000 high quality evidence summaries and a library of 1,000 photographs and images. Developed by ~300 general practitioners and specialists, it includes diagnostic and therapeutic guidelines and recommendations on diagnostic tests and drug dosage. Information is presented in a user-friendly format with clear explanations of all available evidence. Evidence is graded from A to D and assumes no prior statistical knowledge. Protocols are transformed into images and decision support tools.

eMedicine - WebMD

eMedicine comprises the largest and most current Clinical Knowledge Base available freely to physicians and other healthcare professionals. eMedicine's subscription site for point-of-care use for institutions is iMedicine. Nearly 10,000 physician authors and editors contribute to the eMedicine multimedia Clinical Knowledge Base, which contains articles on 7,000 diseases and disorders. The evidence-based content, updated regularly, provides the latest practice guidelines in 59 medical specialties. eMedicine's professional content undergoes 4 levels of physician peer review plus an additional review by a PharmD prior to publication.

Essential Evidence Plus - formerly 'InfoPOEMs/InfoRetriever'

Essential Evidence Plus, formerly 'InfoPOEMs/InfoRetriever', is the only database system of filtered, synopsized, evidence-based information. InfoRetriever searches a full spectrum of evidence-based content, tools and POEMs - or, Patient-Oriented Evidence that Matters™. POEMs meet three criteria: 1) they address a question that we face as clinicians 2) they measure outcomes that we and our patients care about: symptoms, morbidity, quality of life, and mortality; 3) they have the potential to change the way we practice. As POEMs are valid, they improve important patient outcomes and change what physicians do.

Evidence-Based Medicine Reviews (EBMR) - OvidSP

See The Cochrane Library

  1. Cochrane Database of Systematic Reviews (Cochrane Reviews)
  2. Database of Abstracts of Reviews of Effects (DARE)
  3. Cochrane Central Register of Controlled Trials (Clinical Trials)
  4. The Cochrane Methodology Register (Methods Studies)
  5. Health Technology Assessment Database (Technology Assessments)
  6. NHS Economic Evaluation Database (Economic Evaluations)

Evidence Matters

Evidence Matters (EM) is a user-friendly clinical knowledge management system to help support the use of research in decision-making. It answers questions on the effectiveness, safety, and costs of therapy options for a particular patient, in an evidence-based manner. Designed by clinicians, users of EM include clinicians, decision-makers, managers, medical librarians, and those who create guidelines, careplans, and formularies. EM creates patient-customized answers via summarized, instant meta-analyses (more accurately a "meta-graph") of all current research and best practices from thousands of peer-reviewed journals. More...

FirstConsult - Elsevier

FIRSTConsult - used in conjunction with Elsevier's MDConsult - is a relatively new, evidence-based primary care clinical information system that provides continuously updated thinking on the latest in evaluation, diagnosis, therapeutics, patient management and outcomes. Designed to give you rapid access to concise point-of-care information, FIRSTConsult provides both practical information and diagnostic tools. It is both Web, and mobile-based, including the iPhone. FIRSTConsult provides information to ~20,000 disease-specific topics, presented in a concise, accessible format.

  • Differential Diagnoses provides rapid evaluation of a patient's chief complaint with access to lists of ~1,800 diagnoses sorted by age and prevalence
  • Medical Topics is FIRSTConsult's comprehensive database of weekly updated information on patient evaluation, diagnosis, treatment, tests and prevention
  • Patient Education provides handouts for patients in English and Spanish
  • Procedures provide clear guidance, including videos of procedures integral to medical practice

FIRSTConsult is edited by practicing physicians who ensure that content is accurate and relevant. They work to ensure that content is updated with the latest recommendations supported by evidence-based medicine. Access to FIRSTConsult through a computer or handheld is via the web, local area network or intranet on an annual basis. FIRSTConsult can be embedded in other applications and programs such as patient health records via iCONSULT. More...

Harrison's Practice: Answers on Demand

Harrison's Practice: Answers on Demand delivers essential point-of-care information on the diagnosis and management of over 800 medical conditions. Continuously updated and available for desktop and mobile devices. The tool is also a fully integrated drug database that includes dosing information, adverse reactions, indications and contraindications. Hyperlinks to PubMed provide instant access to primary literature; personalization features that include saving content to "My Archive" and your mobile device.

JBI COnNECT - Joanna Briggs Institute

JBI COnNECT (Clinical Online Network of Evidence for Care and Therapeutics) is an evidence-informed qualitative source of information for nurses, midwives, dieticians, physiotherapists, radiography technicians that contains the JBI Systematic Review Database, Best Practice Information Sheets, Protocols & Work in Progress, Healthcare Reports, and JBI COnNECT, a collection of evidence-based resources and tools, and RAPid, the Rapid Appraisal Protocol Internet Database. JBIC develops pre-appraised evidence summaries and clinical pathways to assist patients/residents/clients, their families and those involved in their care, to use evidence-based information in clinical decision-making. JBIC assigns a level of evidence to systematic reviews in the database. (See press release).

NHS Clinical Knowledge Summaries

NHS Clinical Knowledge Summaries (formerly Prodigy): U.K. National Health Service product designed to provide "a reliable source of evidence-based information and practical ‘knowhow’ about the common conditions managed in primary care. CKS provides quick answers to real-life questions that arise in the consultation, linking to detailed answers that clearly outline the evidence on which they are based”. Searchable by topic or alphabetically or by clinical topic, includes patient information, drug data, links to Cochrane and Dynamed. ‘My CKS’ allows storage of CKS content and web links. Simple, easy-to-use interface.

NOTE: CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). It is still possible to browse information within the tool but please note that from March 2011 the content of CKS is no longer being maintained.

Nursing Reference Centre - EBSCO

Nursing Reference Centre is a comprehensive reference tool designed to provide relevant clinical resources to nurses and other health care professionals. NRC covers conditions and diseases, drug information, patient education , diagnostic details, best practice guidelines, point-of-care reference books and evidence-based care sheets (as in CINAHL).

OvidMD™, the fastest path to trusted clinical answers in your specialty

Stay tuned November 17th, 2011 (DMG)

  • With OvidMD™ get the right clinical answer quickly; uncover treatment options, evidence-based guidelines, and drug therapies, download images and patient handouts, link instantly to full text, and more – all in one search.

ProQuest Nursing & Allied Health Source

The ProQuest Nursing & Allied Health Source provides users with reliable health information in nursing, allied health, alternative and complementary medicine and more. It is designed to meet the needs of researchers in health as well as nursing and allied programs at academic institutions. ProQuest Nursing & Allied Health Source provides abstracting and indexing for more than 1,015 titles, with over 860 titles in full-text, plus more than 12,300 fulltext dissertations representing the most rigorous scholarship in nursing and related fields.

Rehabilitation Reference Centre - EBSCO

Rehabilitation Reference Center™ (RRC) is an evidence-based clinical reference tool for use by rehabilitation clinicians at the point-of-care. RRC provides therapists and students with the best available evidence for their information needs in the areas of physical therapy, occupational therapy, speech therapy, etc. Content in RRC includes more than 450 Clinical Reviews, more than 150 research instruments, information from AHFS on over 11,700 drugs and their manufacturers, more than 9,800 exercise images, key reference handbooks, guidelines from the National Guideline Clearinghouse, more than 1,500 relevant patient education topics.

Thomson Clinical Xpert

Thomson Clinical Xpert powers your handheld device with a wealth of clinical knowledge from Thomson Healthcare, the industry’s leading provider of evidence-based decision support. It is available for download to the including the iPhone, iPod touch, and iPad, as well as Windows Mobile, Palm and BlackBerry smartphones. It is updated instantly at each sync with the latest information and your downloads give you access to: disease and laboratory test information.

Plus free access to information about:

  • drugs
  • interactions
  • alternative medicine
  • toxicology
  • news & alerts
  • convenient calculators

Within this suite the following products are available:

Thomson Reuters Infection Xpert

An all-inclusive clinical intelligence dashboard designed specifically to help Infection Preventionists manage and reduce HAIs, capture and submit mandated infection reporting metrics and analyze hospital infection data to improve patient safety.

Thomson Reuters Pharmacy Xpert

A one-of-a-kind clinical intelligence dashboard that combines real-time surveillance with Micromedex® evidence to help pharmacists improve outcomes, reduce costs, and manage risk.

Clinical Xpert Billing

Powered by Ingenious Med™ — helps physicians and hospitals more accurately record procedure and diagnosis codes, and automatically transmits billing data to the physician practice for increased billing efficiency and revenue capture.

Clinical Xpert™ CareFocus

Provides clinical surveillance by applying hospital-defined clinical profiles against real-time patient data to identify high-risk patient populations and prompt clinicians for immediate intervention.

Clinical Xpert™ Navigator

Delivers comprehensive, easy to use patient information to the clinician directly at the point-of-care via smartphone and Web-enabled devices

Handoff

Improves communication and collaboration among care team members with a highly visible and centralized exchange of patient information and tasks.

UpToDate - WoltersKluwer

UpToDate (see UTD mobile) is one of the most popular POC tools in medicine. It offers comprehensive "evidence-based clinical information" via the web, desktop and mobile device, for a variety of health professionals though targeted to internal medicine and related specialists. UTD is designed to provide concise, practical answers to clinicians (almost recommendations with its listing of evidence grades) when they need them most and viewed as an essential point-of-care tool by some. Topics (~8,500) are written exclusively for clinicians in 17 different medical specialties, and more than 4,400 clinicians serve as authors. UTD has an extensive peer review process to ensure that the information and recommendations are accurate and reliable. While considered an electronic text by some health librarians, UTD is described as a "practical clinical reference tool designed to provide quick access to synthesized medical information in an easy-to-use format". It is comprised of topic reviews written by recognized experts who address specific topics, synthesize research and make recommendations for treatment. In total, UTD includes more than 97,000 pages of text, plus graphics, links to Medline abstracts, more than 385,000 references and a drug database. To write entries, 460 medical journals are searched regularly along with the biomedical databases and hand-searching of the literature. More...

References
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