Tuesday, February 23, 2016

The quest for open access point of care resources: can we have a free Up to Date?

Should physicians have to pay for information resources? Many physicians, among the most vocal being the pharmascolds, have maintained that they should. Recently, though, there has been a large and growing push for open access to clinical look up resources at the point of care. This was the subject of an essay and a related editorial from a recent issue of PLOS Medicine.

As the open access movement has grown increasing numbers of research articles are available free of charge on line. In addition, not only these but all Medline indexed articles can be searched for free via Pubmed, with free access to the abstracts of those journals that are not open. This, then, makes it possible for everyone to do free searching and retrieval according to the original standards of evidence based medicine. But optimal use of Pubmed requires special skills and, as I have said before, is too time consuming for most clinicians. That is one of the main barriers to the practice of evidence based medicine. The founders of EBM realized early on that the solution was to develop secondary sources, which are pre-processed summaries of clinical topics that doctors could access at the point of care. The problem is that those that have been developed, at least those widely regarded to be good, are expensive. Therein, according to the articles, lies the problem: the open access movement, for all its accomplishments, has yet to deliver pre-processed content of the type doctors need at the point of care.

It's not that it hasn't been tried. The essay cites some attempts that have failed. I can think of others not mentioned, or only given passing mention. Scientific American Medicine, for example, originated as the first continually updating paper textbook of medicine, was offered on line for free to physicians who registered with WebMD. Free access went away after a couple of years. Merck Medicus once offered free access portals to Access Medicine, MD Consult and more but they didn't last.

We still have eMedicine though it has gone through a few iterations. It remains free access and, though I have not found it as helpful as Up to Date in the past, it has improved over time.

Conspicuously absent from both papers was any mention of the open access initiatives in social media such as FOAM and BLITTER.

Conclusions and reflections:

The availability of free on line secondary source point of care information is limited.

High quality POC reference sources are largely subscription based.

Efforts on the part of the open community to build free resources have been of limited success.

Free high quality resources have mainly been available through industry support but they have not been sustainable.

There appears to be a sharp divide between pharmascolds and the open access community over whether clinicians should have to pay for access to information. Over the past decade and a half the pharmascolds have largely won the battle against industry support.

Efforts by the social media community show promise but are early in development.


Joel Topf said...

How could you not mention wikipedia?

robert donnell said...

I should have mentioned Wikipedia as well as the medical wikis out there. That was an oversight though I don't think Wikipedia has the imprimatur of the other resources under discussion. Unfortunate as it may seem perception is of some importance if you have to cite some authority to defend what you do. It is also unsettling that a Wikipedia article can be written or changed by "anyone" at any time. That said I think its quality has improved of late and it has its limited place as a go to source for doctors. It's probably good for simple and undisputed matters of fact and as a general introduction to a topic (as one professor said Wikipedia is an OK place to start your research but not the place to finish your research).

Another reason I should have mentioned Wikipedia is that research data indicate doctors actually do use it as I blogged here:

As for the medical Wikis there are many that showed promise but are largely incomplete. From what I've seen most seem to have fizzled out. And speaking of fizzling out there's good old Google Knol. R.I.P.

Joel Topf said...

I want one of the major medical organizations to announce that they are going to start systematically improving wikipedia. Can you imagine what a game changer it would be if the American Society of Nephrology started a program to fund a dozen a fellows a year to write, edit, and organize the kidney regions of wikipedia. Have fellows and/or junior faculty compete for positions that provide protected time. Some applicants may come from library science and want to do big picture organization, others could come from a disease orientation, like monoclonal antibodies in nephrology or glomerulonephritis. In two or three years I'm sure the Kidney Wikipedia could be as good as the renal sections of up to date.

robert donnell said...

That would have an interesting symmetry to it, because as I recall Up to Date started as a nephrology resource. Imagine a world where we could all access a resource with the power of Up to Date, for free. It reminds me vaguely of what the Linux community has done in response to Microsoft and Apple.