Over the past decade, the world of scientific journal publishing has been transformed by open access (OA) to information. In the strict sense, open access refers to the ability for others not only to view but also to build upon and distribute a work as long as attribution of the author(s) is provided
The huge increase in access to scientific knowledge has been chiefly of benefit to those researchers who have the time to search the literature. It is less helpful for working health care providers, since masses of literature do not lend themselves to reliably and promptly answering questions. A recent estimate that 85% of all medical research is wasted is based on waste in the research process and in publishing the research itself . This problem of waste is compounded when medical knowledge exists but health care providers have to make decisions without it, a phenomenon that has not been properly examined. One survey found that 80% of primary treatments given at a university hospital in the United Kingdom had some evidence to support their use . This study, however, did not look at whether better evidence existed or how well the evidence matched the treatment decision or patients’ values, nor does it likely represent typical practices. Others have claimed that the typical rate is closer to 10% to 20% .
Point-of-care (POC) medical summaries exist to help physicians make decisions in ways not well served by traditional publishing formats like journal articles and textbooks. POC summaries have been described as “web-based medical compendia specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information on a given topic to health care professionals” . Unlike PubMed, Cochrane, and other resources, POC tools are designed to be quick to search and navigate and aim to help health care providers solve emerging clinical questions. As such, they are collections of “review articles” browsable in real time to aid in patient care.
What Is Already Available?
A number of point-of-care medical summaries are available. Some are open access but not aimed at a professional audience, while those that are aimed at a professional audience are not open access. A few of the non–open access, web-based evidence summaries, while freely accessible, are funded by advertising revenue, making them vulnerable to distortion by financial interests . Others, such as National Health Service’s Clinical Knowledge Summaries, are only available in Great Britain. The most popular tools aimed at professionals are subscription-only, provided by several wealthy, for-profit publishers: UpToDate and DynaMed are the most successful and best known.
Health care providers and institutions are willing to pay to access high-quality point-of-care medical summaries. Personal subscriptions for DynaMed and UpToDate are several hundred dollars for a physician and substantially more for institutional subscriptions. UpToDate company data states that its entries are the result of over 6,000 authors, editors, and peer reviewers. It reports that it is used by over “1 million clinicians in 174 countries and [that] almost 90% of academic medical centers in the United States rely on UpToDate to provide the best care.” The word “rely” is a curious one, but usage statistics support the idea that health care providers find UpToDate helpful, with more than 23 million topic views logged each month . The company advertises research showing that its use is associated with “…reduced length of stay, lower risk-adjusted mortality rates, and better quality performance” . Based on visits, UpToDate was within the top 50 health sites on the Internet in March of 2015 .
While the value of these tools cannot be assessed by observation or anecdote alone, it is clear that clinicians seek out, use, and personally pay for them. The wider world is also interested in health care content. Google states that one in twenty searches is for health care information . Additionally, Wikipedia’s popularity among both physicians and the public is a further indication of global demand .