1
|
Lee M, Lin X, Chai JZQ, Lee ES, Smith H, Tudor Car L. Smartphone apps for point-of-care information summaries: systematic assessment of the quality and content. BMJ Evid Based Med 2023; 28:320-327. [PMID: 36922021 DOI: 10.1136/bmjebm-2022-112146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Clinicians need easy access to evidence-based information to inform their clinical practice. Point-of-care information summaries are increasingly available in the form of smartphone apps. However, the quality of information from the apps is questionable as there is currently no regulation on the content of the medical apps. OBJECTIVES This study aimed to systematically assess the quality and content of the medical apps providing point-of-care information summaries that were available in two major app stores. We evaluated apps designed specifically for healthcare professionals and assessed their content development, editorial policy, coverage of medical conditions and trustworthiness. METHODS We conducted a systematic assessment of medical apps providing point-of-care information summaries available in Google Play and Apple app stores. Apps launched or updated since January 2020 were identified through a systematic search using 42matters. Apps meeting the inclusion criteria were downloaded and assessed. The data extraction and app assessment were done in parallel and independently by at least two reviewers. Apps were evaluated against the adapted criteria: (1) general characteristics, (2) content presentation of the summaries, (3) editorial quality, (4) evidence-based methodology, (5) coverage (volume) of the medical conditions, (6) usability of apps and (7) trustworthiness of the app based on HONcode principles. HONcode principles are guidelines used to inform users about the credibility and reliability of health information online. The results were reported as a narrative review. RESULTS Eight medical apps met the inclusion criteria and were systematically appraised. Based on our evaluation criteria, UpToDate supported 16 languages, and all other apps were English. Bullet points and brief paragraphs were used in all apps, and only DynaMed and Micromedex and Pathway-medical knowledge provided a formal grading system for the strength of recommendations for all the medical conditions in their apps. All the other apps either lacked a formal grading system altogether or offered one for some of the medical conditions. About 30% of the editorial quality assessment and 47.5% of the evidence-based methodology assessment were unclear or missing. UpToDate contained the most point-of-care evidence-based documents with >10 500 documents. All apps except 5-Minute Clinical Consult and DynaMed and Micromedex were available for offline access. Only Medscape complied with the HONcode principles. CONCLUSIONS Future apps should report a more detailed evidence-based methodology, be accessible for offline use and support search in more than one language. There should be clearer information provided in future apps regarding the declaration of authorship and conflict of interest.
Collapse
Affiliation(s)
- Mauricette Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiaowen Lin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Joanne Zhi Qi Chai
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Eng Sing Lee
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
2
|
Rui A, Garabedian PM, Marceau M, Syrowatka A, Volk LA, Edrees HH, Seger DL, Amato MG, Cambre J, Dulgarian S, Newmark LP, Nanji KC, Schultz P, Jackson GP, Rozenblum R, Bates DW. Performance of a Web-Based Reference Database With Natural Language Searching Capabilities: Usability Evaluation of DynaMed and Micromedex With Watson. JMIR Hum Factors 2023; 10:e43960. [PMID: 37067858 PMCID: PMC10152386 DOI: 10.2196/43960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Evidence-based point-of-care information (POCI) tools can facilitate patient safety and care by helping clinicians to answer disease state and drug information questions in less time and with less effort. However, these tools may also be visually challenging to navigate or lack the comprehensiveness needed to sufficiently address a medical issue. OBJECTIVE This study aimed to collect clinicians' feedback and directly observe their use of the combined POCI tool DynaMed and Micromedex with Watson, now known as DynaMedex. EBSCO partnered with IBM Watson Health, now known as Merative, to develop the combined tool as a resource for clinicians. We aimed to identify areas for refinement based on participant feedback and examine participant perceptions to inform further development. METHODS Participants (N=43) within varying clinical roles and specialties were recruited from Brigham and Women's Hospital and Massachusetts General Hospital in Boston, Massachusetts, United States, between August 10, 2021, and December 16, 2021, to take part in usability sessions aimed at evaluating the efficiency and effectiveness of, as well as satisfaction with, the DynaMed and Micromedex with Watson tool. Usability testing methods, including think aloud and observations of user behavior, were used to identify challenges regarding the combined tool. Data collection included measurements of time on task; task ease; satisfaction with the answer; posttest feedback on likes, dislikes, and perceived reliability of the tool; and interest in recommending the tool to a colleague. RESULTS On a 7-point Likert scale, pharmacists rated ease (mean 5.98, SD 1.38) and satisfaction (mean 6.31, SD 1.34) with the combined POCI tool higher than the physicians, nurse practitioner, and physician's assistants (ease: mean 5.57, SD 1.64, and satisfaction: mean 5.82, SD 1.60). Pharmacists spent longer (mean 2 minutes, 26 seconds, SD 1 minute, 41 seconds) on average finding an answer to their question than the physicians, nurse practitioner, and physician's assistants (mean 1 minute, 40 seconds, SD 1 minute, 23 seconds). CONCLUSIONS Overall, the tool performed well, but this usability evaluation identified multiple opportunities for improvement that would help inexperienced users.
Collapse
Affiliation(s)
- Angela Rui
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Pamela M Garabedian
- Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, United States
| | - Marlika Marceau
- Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, United States
| | - Ania Syrowatka
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Lynn A Volk
- Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, United States
| | - Heba H Edrees
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Massachusetts College of Pharmacy and Health Sciences (MCPHS), Boston, MA, United States
| | - Diane L Seger
- Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, United States
| | - Mary G Amato
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Massachusetts College of Pharmacy and Health Sciences (MCPHS), Boston, MA, United States
| | - Jacob Cambre
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Sevan Dulgarian
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Lisa P Newmark
- Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, United States
| | - Karen C Nanji
- Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, United States
- Harvard Medical School, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | | | - Gretchen Purcell Jackson
- Vanderbilt University Medical Center, Nashville, TN, United States
- Intuitive Surgical, Sunnyvale, CA, United States
| | - Ronen Rozenblum
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Clinical and Quality Analysis, Mass General Brigham, Somerville, MA, United States
- Harvard Medical School, Boston, MA, United States
- Harvard TH Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
3
|
Cerdeña JP, Asabor EN, Plaisime MV, Hardeman RR. Race-based medicine in the point-of-care clinical resource UpToDate: A systematic content analysis. EClinicalMedicine 2022; 52:101581. [PMID: 35923427 PMCID: PMC9340501 DOI: 10.1016/j.eclinm.2022.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Race-based practices in medical education and clinical care may exacerbate health inequities. Misguided use of race in popular point-of-care clinical decision-making tools like UpToDate® may promote harmful practices of race-based medicine. This article investigates the nature of mentions of Black/African American race in UpToDate®. METHODS We conducted a systematic content analysis of UpToDate® articles mentioning Black or African American race to assess for biological interpretations of racial categories. Following a simple text search for the terms "Black" and "African American" in UpToDate® on January 24 and March 19, 2020, respectively, removal of duplicates yielded an analytical sample of 208 documents. We adopted a deductive coding approach and systematically applied 16 a priori codes to all documents, refining the codebook to achieve a final inter-rater reliability of 0.91. We then developed these codes into two themes: (1) biologization of race and (2) racialized research and practice. FINDINGS Biologization of race occurred nearly universally across all documents (93.3%), with discussions of inherent physiological differences between racial groups and presentation of epidemiologic disparities without context emerging most frequently. Sixty-eight documents (32.7%) included codes related to racialized biomedical research and clinical practice, including references to racialized patterns of behavior and cultural practices, insufficient data on Black populations, research limiting study to a specific racial group, and race-based clinical practices guidelines. INTERPRETATION Our findings suggest that UpToDate® articles often inappropriately link Black race to genetics or clinical phenotype-without considering socio-structural variables or the health effects of structural racism-thus perpetuating a false narrative that race is inherently biological. UpToDate® articles may also promote unequal treatment by recommending race-based clinical practices. Such racial essentialism risks exacerbating racialized health inequities. FUNDING The study is supported by the Health Policy Research Scholars Program, Robert Wood Johnson Foundation, Medical Scientist Training Program, National Institutes of Health, the National Science Foundation, the JPB Foundation, the Minnesota Population, the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD), and the Center for Antiracism Research for Health Equity at the University of Minnesota.
Collapse
Affiliation(s)
- Jessica P. Cerdeña
- Yale School of Medicine, New Haven, CT, USA
- Department of Anthropology, University of Connecticut, Storrs, CT, USA
- Corresponding author at: Yale School of Medicine MD/PhD Program, 367 Cedar Street, New Haven, CT 06510.
| | - Emmanuella Ngozi Asabor
- Yale School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Marie V. Plaisime
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Affiliate Postdoctoral Research Fellow, Penn Program on Race, Science & Society Center for Africana Studies (PRSS), University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R. Hardeman
- Center for Antiracism Research for Health Equity, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
4
|
Gaus S, Schmidt J, Lüse P, Barthlen W, Hamelmann E, Vossschulte H. Decision-Making in the Pediatric Emergency Department-A Survey of Guidance Strategies among Residents. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1197. [PMID: 36010085 PMCID: PMC9406320 DOI: 10.3390/children9081197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/30/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
(1) Introduction: Working in an emergency department requires fast and straightforward decisions. Therefore, decision guidance represents an essential tool for successful patient-centered care. Beyond the residents' own knowledge and experience, printed books have been the primary source of information in the past. The aim of this study was to discover which strategies current residents use the most and to identify alternative quick reference strategies in the digital age. (2) Materials and Methods: This study analyzed the responses of a short questionnaire directed at 41 residents in a single pediatric emergency department (32 pediatric and 9 pediatric surgery residents) over a period of one month. (3) Results: Thirty-three (80.5%) residents answered the entire questionnaire. Strikingly, responses indicated that printed books are still pivotal in guiding decision-making. In addition, the acquisition of information via computers or smartphones plays an increasing role. However, the opinion and council of the attending physician is still of great value to the residents and is not to be underestimated. Overall, most of the residents would prefer to have access to a specially designed smartphone application. (4) Conclusions: Certainty and validity are essential in decision-making in a pediatric emergency department. Although printed books and attending physicians are still considered as reliable sources of information, internet-based information plays an increasing role. In order to provide the best up-to-date and most recent information, a validated and consistently updated smartphone application could be a useful option.
Collapse
Affiliation(s)
- Sebastian Gaus
- Pediatric Emergency Department, University Children Hospital Bielefeld (EvKB), 33617 Bielefeld, Germany
| | - Jeremy Schmidt
- Department of Pediatrics, University Children Hospital Bielefeld (EvKB), 33617 Bielefeld, Germany
| | - Paul Lüse
- Department of Pediatric Surgery, University Children Hospital Bielefeld (EvKB), 33617 Bielefeld, Germany
| | - Winfried Barthlen
- Department of Pediatric Surgery, University Children Hospital Bielefeld (EvKB), 33617 Bielefeld, Germany
| | - Eckard Hamelmann
- Department of Pediatrics, University Children Hospital Bielefeld (EvKB), 33617 Bielefeld, Germany
| | - Hendrik Vossschulte
- Department of Pediatric Surgery, University Children Hospital Bielefeld (EvKB), 33617 Bielefeld, Germany
| |
Collapse
|
5
|
VanDeMark SH, Woloszyn MR, Christman LA, Gatusky MH, Lam WS, Tilberry SS, Piper BJ. Examination of Potential Industry Conflicts of Interest and Disclosures by Contributors to Online Medical Resource Databases. JAMA Netw Open 2022; 5:e2220155. [PMID: 35788670 PMCID: PMC9257578 DOI: 10.1001/jamanetworkopen.2022.20155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Physicians contribute content to online databases, and other health care professionals use these websites to support their decision-making. Financial conflicts of interest (COI) have the potential to adversely impact evidence-based patient care. OBJECTIVES To quantify the potential COI among content contributors to 2 popular point-of-care medical resources, UpToDate and DynaMed, overall and by gender, and to compare self-reported and industry-mandated disclosures. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study compiled an initial list of contributors for each website using the Centers for Disease Control and Prevention's Leading Causes of Death. The top 50 causes were used to identify relevant articles from each database from November 30 to December 7, 2020. The authors and editors of those articles were investigated. Data were analyzed from January 2021 to March 2022. MAIN OUTCOMES AND MEASURES Self-reported contributor disclosure status was compared with financial remuneration as reported in the Centers for Medicare & Medicaid Services Open Payments (OP) database from 2013 to 2018. RESULTS A total of 179 point-of-care database authors and editors were assessed. Combined, they received $77.7 million, with a mean of $583 218 (95% CI, $0-$4 679 651) and median (range) of $29 073 ($10-$17 517 315) each. Most of the compensation ($68.1 million [87.6%]) went to UpToDate contributors. Of 128 UpToDate contributors, 76 (59.4%) reported nothing to disclose, and among these, 44 contributors (57.9%) had a record of receiving a financial payment on OP. Women UpToDate contributors received 2.5% of the total compensation paid from industry. The top 10 UpToDate contributors who received the most financial remuneration earned $56.1 million combined, were all men, and only 1 had a nothing-to-disclose status. Of 51 DynaMed contributors, 42 (82.4%) reported nothing to disclose, and among these, 35 contributors (83.3%) had an OP entry (mean, $79 820; 95% CI, $0-$400 774; median [range], $1403 [$26-$630 424]). Among the top 10 DynaMed contributors, 8 (80.0%) were men. Six of the top 10 DynaMed contributors reported nothing to disclose yet had an OP entry. CONCLUSIONS AND RELEVANCE This cross-sectional study found that contributors to point-of-care databases were the recipients of nearly $78 million from pharmaceutical companies and medical device manufacturers, and these payments were often not disclosed in association with contributed content. Although these findings do not necessarily suggest ethical lapses among the physicians studied, point-of-care resource websites, like UpToDate and DynaMed, should consider implementing more stringent COI policies and employ an unbiased team to verify self-reported disclosure statuses among content contributors against OP reports.
Collapse
Affiliation(s)
- SooYoung H. VanDeMark
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Mia R. Woloszyn
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Laura A. Christman
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Michael H. Gatusky
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Warren S. Lam
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Stephanie S. Tilberry
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Brian J. Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
- Center for Pharmacy Innovation and Outcomes, Geisinger Health, Forty Fort, Pennsylvania
| |
Collapse
|
6
|
Petersen D, Earl M, Wilson AQ. Looking at Library Resource Usage Trends in Medical Residents & Fellows: Survey Results from 2006-2021. Med Ref Serv Q 2022; 41:280-295. [PMID: 35980625 DOI: 10.1080/02763869.2022.2095817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Since 2006, the University of Tennessee's Preston Medical Library has collected survey feedback from exiting residents through targeted emails or at the required exit process in the library. Questions ask residents which types of articles or sources they use to find information and address the resident's use of the library's physical space. Survey results from 2006 to 2021 were examined for trends and changes in resident utilization of resources to better inform future library decisions on instruction and marketing. Resident resource usage varied over time and demonstrated an encouraging increase in attention to evidence-based tools. UpToDate's consistent popularity shows the durability of the product. A reported increase in use of reviews, randomized controlled trials, case reports, and practice guidelines reflects greater employment of more in-depth resources than merely expert opinion. At the same time, residents clearly valued the library's physical space. Survey results will inform future outreach focus.
Collapse
Affiliation(s)
- David Petersen
- Preston Medical Library, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Martha Earl
- Preston Medical Library, University of Tennessee Graduate School of Medicine, Knoxville, USA
| | - Alexandria Q Wilson
- Preston Medical Library, University of Tennessee Graduate School of Medicine, Knoxville, USA
| |
Collapse
|
7
|
Baxter SL, Lander L, Clay B, Bell J, Hansen K, Walker A, Tai-Seale M. Comparing the Use of DynaMed and UpToDate by Physician Trainees in Clinical Decision-Making: A Randomized Crossover Trial. Appl Clin Inform 2022; 13:139-147. [PMID: 35108739 PMCID: PMC8810269 DOI: 10.1055/s-0041-1742216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Costs vary substantially among electronic medical knowledge resources used for clinical decision support, warranting periodic assessment of institution-wide adoption. OBJECTIVES To compare two medical knowledge resources, UpToDate and DynaMed Plus, regarding accuracy and time required to answer standardized clinical questions and user experience. METHODS A crossover trial design was used, wherein physicians were randomized to first use one of the two medical knowledge resources to answer six standardized questions. Following use of each resource, they were surveyed regarding their user experience. The percentage of accurate answers and time required to answer each question were recorded. The surveys assessed ease of use, enjoyment using the resource, quality of information, and ability to assess level of evidence. Tests of carry-over effects were performed. Themes were identified within open-ended survey comments regarding overall user experience. RESULTS Among 26 participating physicians, accuracy of answers differed by 4 percentage points or less. For all but one question, there were no significant differences in the time required for completion. Most participants felt both resources were easy to use, contained high quality of information, and enabled assessment of the level of evidence. A greater proportion of participants endorsed enjoyment of use with UpToDate (23/26, 88%) compared with DynaMed Plus (16/26, 62%). Themes from open-ended comments included interface/information presentation, coverage of clinical topics, search functions, and utility for clinical decision-making. The majority (59%) of open-ended comments expressed an overall preference for UpToDate, compared with 19% preferring DynaMed Plus. CONCLUSION DynaMed Plus is noninferior to UpToDate with respect to ability to achieve accurate answers, time required for answering clinical questions, ease of use, quality of information, and ability to assess level of evidence. However, user experience was more positive with UpToDate. Future studies of electronic medical knowledge resources should continue to emphasize evaluation of usability and user experience.
Collapse
Affiliation(s)
- Sally L. Baxter
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States,Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, United States,Address for correspondence Sally L. Baxter, MD, MSc University of California San Diego9415 Campus Point Drive MC0946, La Jolla, CA 92093United States
| | - Lina Lander
- Department of Family Medicine, University of California San Diego, La Jolla, California, United States
| | - Brian Clay
- Department of Medicine, University of California San Diego, La Jolla, California, United States
| | - John Bell
- Department of Medicine, University of California San Diego, La Jolla, California, United States
| | - Kristen Hansen
- Department of Family Medicine, University of California San Diego, La Jolla, California, United States
| | - Amanda Walker
- Department of Family Medicine, University of California San Diego, La Jolla, California, United States
| | - Ming Tai-Seale
- Department of Family Medicine, University of California San Diego, La Jolla, California, United States
| |
Collapse
|