This article was downloaded by: [New York University] On: 19 May 2015, At: 04:20 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Medical Reference Services Quarterly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wmrs20
ClinicalAccess: A Clinical Decision Support Tool a
Karen Crowell & Emily Vardell
b
a
Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA b
School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Published online: 30 Apr 2015.
Click for updates To cite this article: Karen Crowell & Emily Vardell (2015) ClinicalAccess: A Clinical Decision Support Tool, Medical Reference Services Quarterly, 34:2, 215-223, DOI: 10.1080/02763869.2015.1019759 To link to this article: http://dx.doi.org/10.1080/02763869.2015.1019759
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Medical Reference Services Quarterly, 34(2):215–223, 2015 Published with license by Taylor & Francis ISSN: 0276-3869 print=1540-9597 online DOI: 10.1080/02763869.2015.1019759
ONLINE UPDATES: A COLUMN FOR SEARCH ANALYSTS Emily Vardell, Column Editor
Downloaded by [New York University] at 04:20 19 May 2015
ClinicalAccess: A Clinical Decision Support Tool KAREN CROWELL Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
EMILY VARDELL School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
ClinicalAccess is a new clinical decision support tool that uses a question-and-answer format to mirror clinical decision-making strategies. The unique format of ClinicalAccess delivers concise, authoritative answers to more than 120,000 clinical questions. This column presents a review of the product, a sample search, and a comparison with other point-of-care search engines. KEYWORDS ClinicalAccess, clinical decision support systems, point-of-care systems, product evaluation, search engines
# Karen Crowell and Emily Vardell Comments and suggestions should be sent to the Column Editor: Emily Vardell ([email protected]). Address correspondence to Emily Vardell, School of Information and Library Science, University of North Carolina at Chapel Hill, 100 Manning Hall, CB #3360, Chapel Hill, NC 27599. E-mail: [email protected] Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/wmrs. 215
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INTRODUCTION ClinicalAccessTM, a McGraw-Hill product, is designed to answer clinical questions at the point of care. ClinicalAccess provides answers to more than 120,000 questions with links to content from McGraw-Hill online sources. Answers to ClinicalAccess questions are precise and targeted, so users can quickly find what they need to know. When a more in-depth understanding is desired, users can link directly to any McGraw-Hill source to which they or their institutions subscribe. Clinicians are also encouraged to contribute more questions that come up routinely in caring for patients.
Downloaded by [New York University] at 04:20 19 May 2015
SCOPE ClinicalAccess aims to ‘‘provide specific answers to every question that could be encountered in the clinical setting.’’1 This is a tall order for any point-ofcare tool on the market, considering the vast amount of clinical information available, the rapid rate at which it continues to expand, and the frequency with which it needs to be updated. The extent to which ClinicalAccess meets this goal depends on the scope of the sources it uses to provide answers to the questions. Sources currently include familiar McGraw-Hill publications such as Harrison’s Principles of Internal Medicine, Schwartz’s Principles of Surgery, Tintinalli’s Emergency Medicine, CURRENT Medical Diagnosis & Treatment, and others. Links to relevant online content from McGraw-Hill’s AccessMedicine1, AccessPediatrics1, AccessEmergency Medicine1, and AccessSurgery1 are also included. Content within these sources is intended to cover a variety of specialties in the field of medicine. Users can consult a list online to identify the number of specialties included and the topics covered by each one. ClinicalAccess coverage is strongest for general medicine, internal medicine, cardiology, and oncology. Coverage gaps exist; surprisingly, pediatrics is not included on the list of specialties even though AccessPediatrics is one of the online sources from which ClinicalAccess content is derived. According to ClinicalAccess representatives, content for pediatrics, geriatrics, surgery, and specialties such as rheumatology is currently under development and continues to expand. ClinicalAccess is a subscription-based resource that requires those with institutional subscriptions to also subscribe to AccessMedicine. Users with subscriptions to other McGraw-Hill Access products can easily extend their search to the full content of these products if a topic is not covered by ClinicalAccess. However, users who subscribe only to ClinicalAccess and do not have separate subscriptions to the other resources are limited to viewing only linked content provided in the ClinicalAccess answers. Another option available to users is the Submit a Question feature. ClinicalAccess promises a speedy reply to user-submitted questions; content
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editors send responses within one business day either pointing users to available ClinicalAccess content or to newly created question-and-answer pairs for the submitted topic. These responses to user-submitted questions are added to the question bank and add to the richness of ClinicalAccess content.
Downloaded by [New York University] at 04:20 19 May 2015
METHOD New questions and topics are being added constantly. Topics are assigned to authors who use content from McGraw-Hill online resources to develop relevant questions and answers (Q&As) on every aspect of the topic. Physician editors review the Q&As for currency and accuracy, and the senior editor works with authors to make revisions as needed before the final versions of the Q&As are posted on the website. McGraw-Hill reviews all existing questions and answers in ClinicalAccess on at least a quarterly basis since sources themselves are updated. Librarians requested last reviewed date information to be included in the answer pages, and in response, ClinicalAccess is adding this feature in 2015. New guidelines and significant changes in practice are reviewed and incorporated by specialty editors on an ongoing basis. McGraw-Hill has taken the additional step of contracting with McMaster University’s Health Knowledge Refinery (HKR) to provide current content. HKR uses a Critical Appraisal Process (CAP) that identifies studies and systematics reviews in the current literature that meet their criteria, ranking them based on relevance and newsworthiness. They are entered in McMaster PLUS, a database made available by McMaster University to numerous content providers, including ACP Journal Club, Clinical Evidence, and DynaMed, allowing them to supplement their sources with current evidence-based information.
SEARCHING ClinicalAccess The most unusual feature of ClinicalAccess is that a search produces a list of questions rather than a list of citations or subject-specific topic pages. This is because ClinicalAccess matches users’ search terms with questions in its database, not the content of the answers. There are no designated subject headings or advanced search strategies that users can apply to retrieve the most relevant or comprehensive results. Users rely on ClinicalAccess programmers who develop the natural language algorithms that link searches to the appropriate questions, and the expertise of the subject specialists who create questions on each topic, identify the content that provides the answers, and assign classification codes for each page.
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SAMPLE SEARCH The home page of ClinicalAccess features a clean design focused on the search box at the center of the page (see Figure 1). A sample search of ‘‘treatment lithium toxicity’’ designed to explore treatment options for lithium toxicity was conducted. ClinicalAccess does not offer autosuggest features, so a user should type out the full query and then click Search or type Enter. The results page then features ClinicalAccess’ signature list of clinical questions responding to the query (see Figure 2). On the left side of the screen, users can narrow results by the following options: ‘‘Description,’’ ‘‘Diagnosis,’’ ‘‘Epidemiology,’’ ‘‘Etiology,’’ ‘‘Pregnancy,’’ ‘‘Prognosis,’’ and ‘‘Treatment.’’ These narrowing features are clearly designed to target responses to the clinician’s current need. Selecting one of the filtering options narrows the list of question pages in the results list. Since this question is targeted to treatment, the Treatment filter was selected. The list of questions in the results list shows the variety of questions related to treating lithium toxicity, including the role of particular medications and procedures, as well as mortality and signs and symptoms information. For this sample search, the question ‘‘What is the initial management of lithium toxicity?’’ was selected. The ClinicalAccess question pages are targeted and concise (see Figure 3). For this question page, a two-paragraph summary of lithium toxicity initial management is displayed. This summary, written by one of the ClinicalAccess content editors, includes citations for the recommendations from the McGraw Hill content outlined in the Scope and Methodology
FIGURE 1 ClinicalAccess home page. Images provided by McGraw-Hill Education.
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FIGURE 2 ClinicalAccess results page. Images provided by McGraw-Hill Education.
sections of this column. A user can either click on the reference number hyperlinked within the text or on the ‘‘Answer Source’’ link beneath each paragraph. Selecting ‘‘Answer Source’’ will display a pop-up box that lists
FIGURE 3 ClinicalAccess question page. Images provided by McGraw-Hill Education.
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the source title (in this case Goldfrank’s Toxicologic Emergencies, Chapter 70). Selecting the link within that pop-up box will link users directly to the targeted chapter relevant to that question. Drugs and other chemical compounds listed within the summaries are hyperlinked (as seen in Figure 3). Selecting one of the drugs will open a new tab in a user’s browser. This page features information on the selected drug from DrugPoints1 for Truven Health Analytics. This includes information on the generic and trade names, drug class, dosing information, contraindications=warnings, drug interactions, mechanism of action= pharmacokinetics, administration=monitoring, and images of the pills (located on the right-hand side of the screen). Beneath the two-paragraph overview and links to the answer’s source, is a link to Suggested Readings. Selecting this link will display a pop-up box of between one to two additional suggested articles on this topic. The suggested articles are not necessarily the latest evidence on the topic but rather reflect the subject editor’s suggestion for the best article on the topic. Under the link to Suggested Readings is a link to ‘‘View the current best evidence’’ from McMaster Plus. Selecting this link displays a pop-up box with the name of a featured, relevant article within McMaster Plus and a link to ‘‘View all results at McMaster Plus.’’ Selecting either of those two options opens a new tab that sends users directly to the McMaster Plus database and the targeted search results for the desired question. Finally, the bottom of each question page features ‘‘Related Questions.’’ In addition to several automatically displayed questions, users may once again narrow by the filters available from the main results page. Each of the question pages may also be e-mailed, printed, and shared (via Facebook, Twitter, Googleþ, Reddit, and Digg) from the top of the page.
ADVANCED SEARCH OPTIONS In addition to a general query as explored in the Sample Search section of this column, users have several search options available to them. For example, ClinicalAccess recognizes acronyms; a search for ‘‘ekg wpw’’ displays the question ‘‘What features on electrocardiogram are associated with Wolff-Parkinson-White Syndrome?’’ The system also recognizes common medical abbreviations such as ‘‘tx’’ for treatment. If a user searches on a specific medication, for example ‘‘Lasix for ascites,’’ the results page looks slightly different. The left side of the screen is identical to the format shown in Figure 2. However, the right side of the screen displays information taken from DrugPoints for Truven Health Analytics (see Figure 4). This includes ‘‘General,’’ ‘‘Dosing & Indications,’’ ‘‘Black Box Warning,’’ and ‘‘Contraindications=Warnings’’ information, as well as a link to ‘‘View Full Monograph.’’
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FIGURE 4 ClinicalAccess results page for drug-related queries. Images provided by McGraw-Hill Education.
ADDITIONAL RESOURCES ClinicalAccess provides seamless access from the Q&As to the McGraw-Hill sources cited in the answers but only for users who also subscribe to these sources. Institutional subscriptions to ClinicalAccess are bundled with AccessMedicine subscriptions, so affiliated users can move easily from ClinicalAccess to AccessMedicine and any other McGraw-Hill Access products to which their institutions subscribe. Even if users do not subscribe to other McGraw-Hill products, answers to the questions in ClinicalAccess are based on information in these products, giving them indirect access that is limited but still valuable. Also included are supplemental materials from the original sources, a total of more than 20,000 images, videos, algorithms, and tables integrated into answers to enhance the content. In addition to drug information made available through DrugPoints for Truven Health Analytics, answers to ClinicalAccess questions also include a link to relevant citations in the aforementioned McMaster Plus database. Users can view the citations in the database itself, and from there, modify or perform new searches, making full use of all of its features. Full text of the articles is not directly accessible, but McMaster Plus includes a PubMed ID number (PMID) link that takes users directly to the citation in PubMed. A link to the full text might or might not be available, but it will depend on the user’s affiliation and institutional access to journal content.
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SPECIAL FEATURES In addition to providing links to McGraw-Hill sources, ClinicalAccess also provides the appropriate way to cite them, including a choice of three styles: American Medical Association (AMA), American Psychological Association (APA), and Modern Language Association (MLA). Exporting citations is also made easy with links included for a variety of bibliographic management software programs such as EndNote, Zotero, or RefWorks. All of McGraw-Hill online Access sites, including ClinicalAccess, are built using responsive web design. Responsive web design allows the layout of each site to adapt to the device being used, providing easy reading and navigation with a minimum of resizing, panning, and scrolling. A ClinicalAccess application is currently under development, but no release date has been set. Also in development is a feature that allows users to create a personal account. According to ClinicalAccess representatives, they are in the process of exploring what users want most before implementing it.
COMPARISON WITH SIMILAR DATABASES ClinicalAccess is based on a model similar to the one Elsevier used to develop its point-of-care product, ClinicalKey. Both McGraw-Hill and Elsevier are well-established publishers who have learned to adapt to the online business world. They have each developed a point-of-care tool that serves as a point-ofentry to the extensive collections of medical books and journals they publish. While both publishers claim to have content comprehensive enough to answer most clinical questions, Elsevier is clearly ahead in terms of the number of books and journals it publishes, boasting a total of more than 1,000 books, 600 journals, and 17,000 videos. McGraw-Hill, on the other hand, is able to take advantage of its long-standing reputation as a supplier of medical textbooks, like Harrison’s and Emergency Medicine, which are heavily used in the classroom and in clinical settings. Both publishers have developed ways to make it possible to find information easily that provides a concise answer to users’ questions. While ClinicalAccess relies on subject experts to develop the Q&As on topics for each medical specialty covered in its sources, ClinicalKey indexes its content and utilizes a Smart Search tool that performs more like a traditional database search. ClinicalKey provides 1,400 Topic Pages with ‘‘quick clinical answer and summaries’’ from its best known clinical reference sources, including Conn’s Current Therapy, Cecil Medicine, Ferri’s Clinical Advisor, and First Consult. ClinicalAccess, on the other hand, mirrors medical instruction and reasoning, by employing Q&As that provide concise summaries of source content. Patient education materials are available (in up to ten languages) through other McGraw-Hill sources, such as AccessMedicine, but not directly
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through ClinicalAccess. ClinicalKey offers a collection of more than 15,000 customizable Patient Education Handouts with language and text size options available for printing. Both publishers supplement their content with outside information sources. ClinicalAccess provides links to drug information from Truven and citations ranked by level of evidence from McMaster Plus. ClinicalKey includes abstracts from MEDLINE and studies registered in ClinicalTrials.gov. Both publishers incorporate clinical guidelines that are either published in their own journals or come from government or professional medical association websites. When using either one of these products, it is important to keep in mind that you are only searching a subset of all the literature that is available on a given topic. Both McGraw-Hill and Elsevier have impressive collections, but there are many other significant sources of clinical information that may be overlooked if users rely exclusively on either one of these products. For those working at the point of care, though, a resource such as ClinicalAccess may be a convenient and authoritative way to make evidence-based decisions at the bedside. The fact that ClinicalAccess is constructed as a question–and-answer tool mirrors health care providers’ clinical reasoning skills and may be an effective complement to their workflow.
FOR MORE INFORMATION For more information on ClinicalAccess, please direct queries to Marsha S. Gelber, Senior Online Editor, Medical Professional Group of McGraw-Hill Education, 2 Penn Plaza, 9th floor, New York, NY 10121. E-mail: marsha. [email protected]
REFERENCE 1. ClinicalAccess. ‘‘About ClinicalAccess.’’ Accessed January 5, 2015. http:// clinicalaccess.mhmedical.com/public/about.aspx?specialtyID=30050.
ABOUT THE AUTHORS Karen Crowell, MLIS ([email protected]) is a Clinical Information Specialist, Health Sciences Library, University of North Carolina at Chapel Hill, 355 S. Columbia Street, CB #7585, Chapel Hill, NC 27599-7585. Emily Vardell, MLS ([email protected]) is a Doctoral Student, School of Information and Library Science, University of North Carolina at Chapel Hill, 100 Manning Hall, CB #3360, Chapel Hill, NC 27599.
Medical Reference Services Quarterly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wmrs20
ClinicalAccess: A Clinical Decision Support Tool a
Karen Crowell & Emily Vardell
b
a
Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA b
School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Published online: 30 Apr 2015.
Click for updates To cite this article: Karen Crowell & Emily Vardell (2015) ClinicalAccess: A Clinical Decision Support Tool, Medical Reference Services Quarterly, 34:2, 215-223, DOI: 10.1080/02763869.2015.1019759 To link to this article: http://dx.doi.org/10.1080/02763869.2015.1019759
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Medical Reference Services Quarterly, 34(2):215–223, 2015 Published with license by Taylor & Francis ISSN: 0276-3869 print=1540-9597 online DOI: 10.1080/02763869.2015.1019759
ONLINE UPDATES: A COLUMN FOR SEARCH ANALYSTS Emily Vardell, Column Editor
Downloaded by [New York University] at 04:20 19 May 2015
ClinicalAccess: A Clinical Decision Support Tool KAREN CROWELL Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
EMILY VARDELL School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
ClinicalAccess is a new clinical decision support tool that uses a question-and-answer format to mirror clinical decision-making strategies. The unique format of ClinicalAccess delivers concise, authoritative answers to more than 120,000 clinical questions. This column presents a review of the product, a sample search, and a comparison with other point-of-care search engines. KEYWORDS ClinicalAccess, clinical decision support systems, point-of-care systems, product evaluation, search engines
# Karen Crowell and Emily Vardell Comments and suggestions should be sent to the Column Editor: Emily Vardell ([email protected]). Address correspondence to Emily Vardell, School of Information and Library Science, University of North Carolina at Chapel Hill, 100 Manning Hall, CB #3360, Chapel Hill, NC 27599. E-mail: [email protected] Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/wmrs. 215
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INTRODUCTION ClinicalAccessTM, a McGraw-Hill product, is designed to answer clinical questions at the point of care. ClinicalAccess provides answers to more than 120,000 questions with links to content from McGraw-Hill online sources. Answers to ClinicalAccess questions are precise and targeted, so users can quickly find what they need to know. When a more in-depth understanding is desired, users can link directly to any McGraw-Hill source to which they or their institutions subscribe. Clinicians are also encouraged to contribute more questions that come up routinely in caring for patients.
Downloaded by [New York University] at 04:20 19 May 2015
SCOPE ClinicalAccess aims to ‘‘provide specific answers to every question that could be encountered in the clinical setting.’’1 This is a tall order for any point-ofcare tool on the market, considering the vast amount of clinical information available, the rapid rate at which it continues to expand, and the frequency with which it needs to be updated. The extent to which ClinicalAccess meets this goal depends on the scope of the sources it uses to provide answers to the questions. Sources currently include familiar McGraw-Hill publications such as Harrison’s Principles of Internal Medicine, Schwartz’s Principles of Surgery, Tintinalli’s Emergency Medicine, CURRENT Medical Diagnosis & Treatment, and others. Links to relevant online content from McGraw-Hill’s AccessMedicine1, AccessPediatrics1, AccessEmergency Medicine1, and AccessSurgery1 are also included. Content within these sources is intended to cover a variety of specialties in the field of medicine. Users can consult a list online to identify the number of specialties included and the topics covered by each one. ClinicalAccess coverage is strongest for general medicine, internal medicine, cardiology, and oncology. Coverage gaps exist; surprisingly, pediatrics is not included on the list of specialties even though AccessPediatrics is one of the online sources from which ClinicalAccess content is derived. According to ClinicalAccess representatives, content for pediatrics, geriatrics, surgery, and specialties such as rheumatology is currently under development and continues to expand. ClinicalAccess is a subscription-based resource that requires those with institutional subscriptions to also subscribe to AccessMedicine. Users with subscriptions to other McGraw-Hill Access products can easily extend their search to the full content of these products if a topic is not covered by ClinicalAccess. However, users who subscribe only to ClinicalAccess and do not have separate subscriptions to the other resources are limited to viewing only linked content provided in the ClinicalAccess answers. Another option available to users is the Submit a Question feature. ClinicalAccess promises a speedy reply to user-submitted questions; content
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editors send responses within one business day either pointing users to available ClinicalAccess content or to newly created question-and-answer pairs for the submitted topic. These responses to user-submitted questions are added to the question bank and add to the richness of ClinicalAccess content.
Downloaded by [New York University] at 04:20 19 May 2015
METHOD New questions and topics are being added constantly. Topics are assigned to authors who use content from McGraw-Hill online resources to develop relevant questions and answers (Q&As) on every aspect of the topic. Physician editors review the Q&As for currency and accuracy, and the senior editor works with authors to make revisions as needed before the final versions of the Q&As are posted on the website. McGraw-Hill reviews all existing questions and answers in ClinicalAccess on at least a quarterly basis since sources themselves are updated. Librarians requested last reviewed date information to be included in the answer pages, and in response, ClinicalAccess is adding this feature in 2015. New guidelines and significant changes in practice are reviewed and incorporated by specialty editors on an ongoing basis. McGraw-Hill has taken the additional step of contracting with McMaster University’s Health Knowledge Refinery (HKR) to provide current content. HKR uses a Critical Appraisal Process (CAP) that identifies studies and systematics reviews in the current literature that meet their criteria, ranking them based on relevance and newsworthiness. They are entered in McMaster PLUS, a database made available by McMaster University to numerous content providers, including ACP Journal Club, Clinical Evidence, and DynaMed, allowing them to supplement their sources with current evidence-based information.
SEARCHING ClinicalAccess The most unusual feature of ClinicalAccess is that a search produces a list of questions rather than a list of citations or subject-specific topic pages. This is because ClinicalAccess matches users’ search terms with questions in its database, not the content of the answers. There are no designated subject headings or advanced search strategies that users can apply to retrieve the most relevant or comprehensive results. Users rely on ClinicalAccess programmers who develop the natural language algorithms that link searches to the appropriate questions, and the expertise of the subject specialists who create questions on each topic, identify the content that provides the answers, and assign classification codes for each page.
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SAMPLE SEARCH The home page of ClinicalAccess features a clean design focused on the search box at the center of the page (see Figure 1). A sample search of ‘‘treatment lithium toxicity’’ designed to explore treatment options for lithium toxicity was conducted. ClinicalAccess does not offer autosuggest features, so a user should type out the full query and then click Search or type Enter. The results page then features ClinicalAccess’ signature list of clinical questions responding to the query (see Figure 2). On the left side of the screen, users can narrow results by the following options: ‘‘Description,’’ ‘‘Diagnosis,’’ ‘‘Epidemiology,’’ ‘‘Etiology,’’ ‘‘Pregnancy,’’ ‘‘Prognosis,’’ and ‘‘Treatment.’’ These narrowing features are clearly designed to target responses to the clinician’s current need. Selecting one of the filtering options narrows the list of question pages in the results list. Since this question is targeted to treatment, the Treatment filter was selected. The list of questions in the results list shows the variety of questions related to treating lithium toxicity, including the role of particular medications and procedures, as well as mortality and signs and symptoms information. For this sample search, the question ‘‘What is the initial management of lithium toxicity?’’ was selected. The ClinicalAccess question pages are targeted and concise (see Figure 3). For this question page, a two-paragraph summary of lithium toxicity initial management is displayed. This summary, written by one of the ClinicalAccess content editors, includes citations for the recommendations from the McGraw Hill content outlined in the Scope and Methodology
FIGURE 1 ClinicalAccess home page. Images provided by McGraw-Hill Education.
Downloaded by [New York University] at 04:20 19 May 2015
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FIGURE 2 ClinicalAccess results page. Images provided by McGraw-Hill Education.
sections of this column. A user can either click on the reference number hyperlinked within the text or on the ‘‘Answer Source’’ link beneath each paragraph. Selecting ‘‘Answer Source’’ will display a pop-up box that lists
FIGURE 3 ClinicalAccess question page. Images provided by McGraw-Hill Education.
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the source title (in this case Goldfrank’s Toxicologic Emergencies, Chapter 70). Selecting the link within that pop-up box will link users directly to the targeted chapter relevant to that question. Drugs and other chemical compounds listed within the summaries are hyperlinked (as seen in Figure 3). Selecting one of the drugs will open a new tab in a user’s browser. This page features information on the selected drug from DrugPoints1 for Truven Health Analytics. This includes information on the generic and trade names, drug class, dosing information, contraindications=warnings, drug interactions, mechanism of action= pharmacokinetics, administration=monitoring, and images of the pills (located on the right-hand side of the screen). Beneath the two-paragraph overview and links to the answer’s source, is a link to Suggested Readings. Selecting this link will display a pop-up box of between one to two additional suggested articles on this topic. The suggested articles are not necessarily the latest evidence on the topic but rather reflect the subject editor’s suggestion for the best article on the topic. Under the link to Suggested Readings is a link to ‘‘View the current best evidence’’ from McMaster Plus. Selecting this link displays a pop-up box with the name of a featured, relevant article within McMaster Plus and a link to ‘‘View all results at McMaster Plus.’’ Selecting either of those two options opens a new tab that sends users directly to the McMaster Plus database and the targeted search results for the desired question. Finally, the bottom of each question page features ‘‘Related Questions.’’ In addition to several automatically displayed questions, users may once again narrow by the filters available from the main results page. Each of the question pages may also be e-mailed, printed, and shared (via Facebook, Twitter, Googleþ, Reddit, and Digg) from the top of the page.
ADVANCED SEARCH OPTIONS In addition to a general query as explored in the Sample Search section of this column, users have several search options available to them. For example, ClinicalAccess recognizes acronyms; a search for ‘‘ekg wpw’’ displays the question ‘‘What features on electrocardiogram are associated with Wolff-Parkinson-White Syndrome?’’ The system also recognizes common medical abbreviations such as ‘‘tx’’ for treatment. If a user searches on a specific medication, for example ‘‘Lasix for ascites,’’ the results page looks slightly different. The left side of the screen is identical to the format shown in Figure 2. However, the right side of the screen displays information taken from DrugPoints for Truven Health Analytics (see Figure 4). This includes ‘‘General,’’ ‘‘Dosing & Indications,’’ ‘‘Black Box Warning,’’ and ‘‘Contraindications=Warnings’’ information, as well as a link to ‘‘View Full Monograph.’’
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FIGURE 4 ClinicalAccess results page for drug-related queries. Images provided by McGraw-Hill Education.
ADDITIONAL RESOURCES ClinicalAccess provides seamless access from the Q&As to the McGraw-Hill sources cited in the answers but only for users who also subscribe to these sources. Institutional subscriptions to ClinicalAccess are bundled with AccessMedicine subscriptions, so affiliated users can move easily from ClinicalAccess to AccessMedicine and any other McGraw-Hill Access products to which their institutions subscribe. Even if users do not subscribe to other McGraw-Hill products, answers to the questions in ClinicalAccess are based on information in these products, giving them indirect access that is limited but still valuable. Also included are supplemental materials from the original sources, a total of more than 20,000 images, videos, algorithms, and tables integrated into answers to enhance the content. In addition to drug information made available through DrugPoints for Truven Health Analytics, answers to ClinicalAccess questions also include a link to relevant citations in the aforementioned McMaster Plus database. Users can view the citations in the database itself, and from there, modify or perform new searches, making full use of all of its features. Full text of the articles is not directly accessible, but McMaster Plus includes a PubMed ID number (PMID) link that takes users directly to the citation in PubMed. A link to the full text might or might not be available, but it will depend on the user’s affiliation and institutional access to journal content.
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SPECIAL FEATURES In addition to providing links to McGraw-Hill sources, ClinicalAccess also provides the appropriate way to cite them, including a choice of three styles: American Medical Association (AMA), American Psychological Association (APA), and Modern Language Association (MLA). Exporting citations is also made easy with links included for a variety of bibliographic management software programs such as EndNote, Zotero, or RefWorks. All of McGraw-Hill online Access sites, including ClinicalAccess, are built using responsive web design. Responsive web design allows the layout of each site to adapt to the device being used, providing easy reading and navigation with a minimum of resizing, panning, and scrolling. A ClinicalAccess application is currently under development, but no release date has been set. Also in development is a feature that allows users to create a personal account. According to ClinicalAccess representatives, they are in the process of exploring what users want most before implementing it.
COMPARISON WITH SIMILAR DATABASES ClinicalAccess is based on a model similar to the one Elsevier used to develop its point-of-care product, ClinicalKey. Both McGraw-Hill and Elsevier are well-established publishers who have learned to adapt to the online business world. They have each developed a point-of-care tool that serves as a point-ofentry to the extensive collections of medical books and journals they publish. While both publishers claim to have content comprehensive enough to answer most clinical questions, Elsevier is clearly ahead in terms of the number of books and journals it publishes, boasting a total of more than 1,000 books, 600 journals, and 17,000 videos. McGraw-Hill, on the other hand, is able to take advantage of its long-standing reputation as a supplier of medical textbooks, like Harrison’s and Emergency Medicine, which are heavily used in the classroom and in clinical settings. Both publishers have developed ways to make it possible to find information easily that provides a concise answer to users’ questions. While ClinicalAccess relies on subject experts to develop the Q&As on topics for each medical specialty covered in its sources, ClinicalKey indexes its content and utilizes a Smart Search tool that performs more like a traditional database search. ClinicalKey provides 1,400 Topic Pages with ‘‘quick clinical answer and summaries’’ from its best known clinical reference sources, including Conn’s Current Therapy, Cecil Medicine, Ferri’s Clinical Advisor, and First Consult. ClinicalAccess, on the other hand, mirrors medical instruction and reasoning, by employing Q&As that provide concise summaries of source content. Patient education materials are available (in up to ten languages) through other McGraw-Hill sources, such as AccessMedicine, but not directly
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through ClinicalAccess. ClinicalKey offers a collection of more than 15,000 customizable Patient Education Handouts with language and text size options available for printing. Both publishers supplement their content with outside information sources. ClinicalAccess provides links to drug information from Truven and citations ranked by level of evidence from McMaster Plus. ClinicalKey includes abstracts from MEDLINE and studies registered in ClinicalTrials.gov. Both publishers incorporate clinical guidelines that are either published in their own journals or come from government or professional medical association websites. When using either one of these products, it is important to keep in mind that you are only searching a subset of all the literature that is available on a given topic. Both McGraw-Hill and Elsevier have impressive collections, but there are many other significant sources of clinical information that may be overlooked if users rely exclusively on either one of these products. For those working at the point of care, though, a resource such as ClinicalAccess may be a convenient and authoritative way to make evidence-based decisions at the bedside. The fact that ClinicalAccess is constructed as a question–and-answer tool mirrors health care providers’ clinical reasoning skills and may be an effective complement to their workflow.
FOR MORE INFORMATION For more information on ClinicalAccess, please direct queries to Marsha S. Gelber, Senior Online Editor, Medical Professional Group of McGraw-Hill Education, 2 Penn Plaza, 9th floor, New York, NY 10121. E-mail: marsha. [email protected]
REFERENCE 1. ClinicalAccess. ‘‘About ClinicalAccess.’’ Accessed January 5, 2015. http:// clinicalaccess.mhmedical.com/public/about.aspx?specialtyID=30050.
ABOUT THE AUTHORS Karen Crowell, MLIS ([email protected]) is a Clinical Information Specialist, Health Sciences Library, University of North Carolina at Chapel Hill, 355 S. Columbia Street, CB #7585, Chapel Hill, NC 27599-7585. Emily Vardell, MLS ([email protected]) is a Doctoral Student, School of Information and Library Science, University of North Carolina at Chapel Hill, 100 Manning Hall, CB #3360, Chapel Hill, NC 27599.
