Health care professionals routinely use point-of-care (POC) clinical reference tools like DynaMedex on their computers or hand-held devices to make real-world evidence-based decisions in the clinical setting. With current and reliable drug and disease-related information in a single resource, clinicians around the world use DynaMedex to support clinical decisions and stay current on the ever-changing landscape of medical evidence. Pharmacists access DynaMedex, including Micromedex Assistant, for current information on drug indications, interactions, and dosages. DynaMedex also serves as a valuable resource for medical students and residents as they hone their clinical skills.
A recent study published in the Journal of the Medical Library Association (JMLA) evaluated DynaMedex to find answers to 265 real-world clinical questions. Assembled from medical board review resources, interviews with clinical specialists, and anonymized questions from pharmacists on the research team, these questions spanned five clinical categories (epidemiology, diagnosis and clinical presentation, treatment, complications and prognosis, and prevention) and six medical specialties (cardiology, endocrinology, hematology-oncology, infectious disease, internal medicine, and neurology). The dataset represented an array of clinical questions to assess the usefulness, relevance, currency, validity, and accessibility of DynaMedex for clinicians at the POC.
Some examples include:
- “What is the most validated test to screen and monitor for severity of cognitive impairment in patients with dementia?”
- “When should a Coronary Artery Calcium (CAC) assessment in an intermediate risk individual be repeated if the initial score is zero?"
- “Which of the following is the most common cardiac complication in children born to mothers with Systemic Lupus Erythematosus?”
The 265 questions were divided randomly among three research pharmacists. Each question was then evaluated by two out of the three.
Here’s the breakdown: researchers found an answer in DynaMedex for 259 of the 265 clinical questions (98%). Answers to 241 questions (91%) were found by both reviewers; answers to 18 questions (7%) were found by one reviewer but not the other; and answers to six questions (2%) were not found by either reviewer.
"Overall, the reviewers were able to answer real-world disease-related queries using keyword searches in the application with ease, and much of the time it provided the best evidence available, included detailed answers, and offered access to clinical guidelines. Such resources are likely to become increasingly important in care delivery going forward.”
Among the 259 answers found in DynaMedex, 97% were rated to be relevant to patient care. Of these, 68% were assessed as easy to find, 97% as citing the best available evidence, 72% as inclusive of clinical guidelines, and 95% as sufficiently detailed to answer the clinical question. For the answers that were not relevant, easy to find, or otherwise received a lower rating, the authors offered examples to explain their evaluations, such as differences “due to reviewer's search terms.”
DynaMedex scored well in this study, however, there are some limitations.
First, the study did not directly compare point-of-care resources. Using DynaMed’s own critical appraisal criteria, a single-arm study design such as this would be considered a low level of evidence. Second and potentially limiting the generalizability of the results, the study was conducted at a single academic medical center, had a small sample size, and assessed clinical questions that may not be representative of diverse medical specialties and settings. Third, the most appropriate study population for an evaluation of DynaMedex for real-time patient care interactions would be clinicians rather than pharmacists, though pharmacists represent a subset of DynaMedex users. Finally, the study was supported by IBM Watson Health (now known as Merative). In the interest of transparency, DynaMedex combines the clinical expertise and extensive, curated disease content of DynaMed with the depth and breadth of drug information of Merative’s Micromedex in a single tool. The authors state that Merative had no role in developing the manuscript and there are no indications of conflicts of interest.
Despite their increasing relevance in a variety of clinical settings, there have been few studies evaluating the utility of commercial point-of-care resources (e.g. Lee, Kwag, Baxter).
Overall, these are good results. This study had a high level of interrater agreement, covered a respectable breadth of clinical categories and specialties, and speaks to its audience of medical librarians and healthcare professionals who want to make informed decisions with POC resources. The editorial team at DynaMedex can use the findings from this study to further improve the product. The feedback button in DynaMedex can also be used to send suggestions directly to the team, and all users are encouraged to utilize this feature.
Find the study at Journal of the Medical Library Association Vol. 112 No. 1 (2024)
