1. Certified Trainers’ Programme Part Two Richard Crookes, Senior Training Specialist, MA, MCLIP (UK, Ireland & Nordic Countries - Biomedical), 22 nd June 2016

2. Objectives Overview of DynaMed Plus Live demo EMR/EHR/EPR integration DynaMed Plus mobile Support

3. …Not a textbook A TOOL Created by physicians who are EXPERTS in their respective fields who provide OBJECTIVE ANALYSIS of the evidence & recommendations in an easily digestible format with access anytime, anywhere from any device or system

4. DynaMed Plus EVIDENCE-BASED METHODOLOGY

5. The GRADE ( Grading of Recommendations Assessment, Development and Evaluation ) system was created in 2000 by a dedicated group of guideline developers. RECOMMENDATIONS are graded as Strong or Weak EVIDENCE is graded for the body of evidence as High, Moderate, Low or Very low quality (A, B, C, or D). QUALITY grading for evidence is based on the risk of bias introduced by study methodology, the precision the consistency of studies, the directness to the conclusion being made, and the likelihood of publication bias. What is GRADE?

7. GRADE is now the standard WHO The Endocrine Society ACCP ACP American Thoracic Society NKF/KDOQI KDIGO Norwegian Knowledge Center / Norwegian Directorate of Health Canadian Cardiovascular Society IDSA CDC AGA AASLD ICSI NICE SIGN NHS Kaiser Permanente Dutch College of GPs Multiple Red Cross groups GUIDELINE GROUPS More than 80 of the world’s leading organizations which produce guidelines formally use GRADE: SYSTEMATIC REVIEWS Independent systematic review organizations such as Cochrane have incorporated GRADE

8. DynaMed Plus: Content 4500 topics – Added Overviews and Recommendations 2,000 drug topics – Micromedex DrugPoints Images: 4600 graphics & images (including clinical photos, tables, radiological images) Links to British National Formulary (BNF) and eMedicines Compendium (eMC), which in turn provides Summary of Product Characteristics (SPCs) and Patient Information Leaflets (PILs). PubMed LinkOut

9. Search: Semantically-enriched search experience, facilitating easy and immediate discoverability Time-to-answer: Introducing features to streamline workflow: o Intelligent auto-suggest o Direct-to-section search results o Exact-match summary display o Quick access to relevant images and calculators DynaMed Plus: Search

10. DynaMed Plus

11. BNF Drug Links

12. Patient UK Information

13. NICE / SIGN / RCN Guidelines

14. Clinical Partnerships In 2010, McMaster University and EBSCO partnered to create a system to identify practice-changing DynaMed Plus updates. For most topic updates included in DynaMed the rating process is completed in partnership with McMaster University. In November 2011, EBSCO established a partnership with F1000. Similar to the process used with McMaster, the 2,000+ physicians in the F1000 network identify practice-changing updates which are then included in relevant DynaMed Plus topics.

15. Accessing DynaMed Plus via EPR DynaMed Plus supports all access options offered by the leading Electronic Patient Records Systems. The most commonly used methods include: Referential/Contextual Search Enables clinicians to search DynaMed Plus from within the patient record. HL7 Infobutton Enables quick access to relevant DynaMed Plus content for a specific disease, condition, medication, or lab results and ensures compliance with Meaningful Use Objectives.

16. Epic users can access DynaMed Plus content from the following locations using the HL7 Infobutton: “I find it very helpful that I can link to specific DynaMed articles from Epic. I really like to cut and paste from DynaMed into the patient’s notes. It makes my job easier.” Dr. Clyde Harris - New Hanover Regional Medical Center Accessing DynaMed Plus via EPR

18. Outcome: Users can access current evidence without leaving the clinical workflow 18 Clicking on Evidence link leads to evidence sources.

19. DynaMed Plus Mobile

22. DynaMed Plus Access Any Device Any Setting/System Anywhere Ambulatory EMR Acute/Inpatient EMR Physician Office EMR

23. Additional Features – Wikipedia Wikipedia’s top healthcare editors have complimentary access to DynaMed Plus to assist in content generation, research and verification of information on pages dedicated to medicine, pharmacology, public health, and other related topics. Currently, there are more than 155,000 medical articles posted to Wikipedia, which are supported by 950,000+ references. Healthcare content alone was viewed more than 4.88 billion times in 2013. “ Wikipedia is one of, if not the most viewed online medical resource for both patients and healthcare providers. This makes it crucial that its authorship be pristine and its content reliable…Access to DynaMed Plus not only strengthens the healthcare content being produced but also gives readers confidence knowing the information contained in Wikipedia healthcare entries is coming from a trusted source.” James Heilman, MD, Department of Emergency Medicine at the University of British Columbia

24. Topics Discoverable in Google Physicians, frequently use Google as a starting point to quickly look up information and kick off research. In an effort to allow faster access to DynaMed Plus content for current users, as well as increased exposure of DynaMed Plus content to new users, a new feature will allow some DynaMed Plus content to be discoverable by Google. Physicians searching for diseases/conditions and differential diagnosis information using Google will be provided immediate access to DynaMed Plus through IP authentication, if they are current institutional customers. Potential customers will be provided with a link allowing them to sign up for an individual subscription. This new feature is in conjunction with the N Clicks Free Release 16.1, where users receive access to 10 clicks worth of DynaMed Plus information before they are asked to subscribe.

25. Google Results

26. http://www.dynamed.com/home/