Review of the much anticipated UpToDate iPhone app, arguably the most read medical reference tool

UpToDate is the go-to reference for physicians at all stages, covering over 8,500 medical topics that are authored, edited, and reviewed by over 4,400 expert clinicians.

To be honest, I don’t know how I could have gotten through my intern year without turning to UpToDate almost daily for assistance with diagnostics and management, as well as to learn more about my patient’s illnesses.

In my last night float shift at the VA alone, I used UpToDate to learn about the intraductal papillary mucinous neoplasm (IPMN) seen on CT in my patient with pancreatitis symptoms, how to approach my post-CABG patient with hypertriglyceridemia, how to interpret the EKG in my patient with a dual-chamber pacemaker, and how to decide whether I should consult pulmonary for a bronchoscopy in my patient with possible tuberculosis.

In short, UpToDate is a comprehensive, physician-developed, evidence-based (over 385,000 references), widely-used (almost a half-million subscribers), continuously-updated, pharmaceutical-free, and illustrated resource. Until now, it was only available for mobile devices via an unwieldy webapp. Now, UpToDate finally hit the iPhone as a native iOS app , and here we review this much-anticipated mobile application for the iPhone.

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The home screen of the UpToDate App opens with options for Search, Calculators, Settings, Bookmarks, History, and “What’s New.” The bread and butter of UpToDate, of course, is utilizing the search function to learn more about a specific topic, whether it be an illness, procedure, or medication.

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Here we search for GERD, or gastroesophageal reflux disease. Note the dynamic search – similar to what we are used to on the traditional online application — that offers suggested topics as we type what we are searching for into the search pane. Upon clicking on “GERD,” the app offers a list of applicable topics.

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Note different tabs along the top for All, Adult, Pediatric, and Patient topics. Pediatrics topics are, obviously, quite useful for pediatricians or family physicians concerned with children, while patient topics offer UpToDate information in a manner suitable for patient learning, another terrific feature of UpToDate. I often rely on UpToDate to help patients better understand their illnesses.

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Clicking on a representative topic – here, the medical management of GERD in adults — displays links to contributors, when the topic was last updated, and a quick link to “Summary and Recommendations” before an outline of the topic’s contents.

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Of course, the contributors for UpToDate are experts in their respective fields, and this topic on GERD is no exception. Including an opening link to the topic summary is a nice touch of the app, and includes UpToDate’s well-known strength or grade of its recommendations.

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The outline allows for quick navigation to a particular section of the topic by clicking on the section of interest. Like the traditional online version, the app includes embedded references that can be clicked on to view abstracts, one of the features I love most about UpToDate—its basis on and easy navigation to the primary literature.

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Another strength of UpToDate lies in its inclusion of figures, tables, algorithms, and pictures that are incorporated into its topics, and the app version is no exception. Here is an algorithm incorporated into the aforementioned topic on GERD. Note how it can be zoomed and panned within the app.

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Yet another navigation tool within the app are the windows accessible from the bottom right corner within a topic. Clicking here brings up links for topic graphics, related topics, topic calculators, and topic references, facilitating even faster navigation. Moreover, in addition to the quick links for the home screen (in the bottom left corner) and the search function (in the top right corner), the outline/text toggle in the center of the bottom bar allows for quickly returning to the topic outline. Clearly, the developers have put a great deal of effort into making the UpToDate app easy to navigate, and appear to have succeeded.

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The Calculators function is not a feature I frequently use in the traditional online application, but is highlighted here in the app version. The many calculators can be browsed either alphabetically by calculator name, or sorted by specialty. However, there is no dedicated search function.

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A quick look here at the MELD (Model for End-Stage Liver Disease) calculator shows that it is easy to use, reliable, includes notes which describe the calculator, and features the particular formula used in the calculator. Upon a quick review, it appears that this calculator function in UpToDate may very well hold its own against our previously reviewed top free calculators for the iPhone .

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The UpToDate App also includes bookmarks and a history function for quick recall.

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Finally, the UpToDate App highlights a “What’s New” feature from the home screen, which discusses new developments in particular fields, complete with references and topic links.

Pricing:

  • An individual subscription for UpToDate (which includes the ability to install the UpToDate App onto the iPhone) runs $195/year ($0.53/day) at the trainee rate, or $495/year ($1.36/day) otherwise, with discounts for longer-term subscriptions.

Likes:

  • Nothing matches UpToDate when it comes to updated medical references
  • Comprehensive, peer-reviewed, reference-oriented, illustrated, and pharm-free
  • Smooth user interface with easy dynamic searching and impressive navigation

Dislikes:

  • Pricing: UpToDate will cost you, as noted above, for its considerable resources
  • While eagerly awaited by many residents and medical students, institutional subscribers do NOT yet have access to the iPhone App version
  • While the offline version of the UpToDate App is set to debut later this year, this current version can sometimes take several moments to load topics

Conclusion:

  • You can bet that this UpToDate App will make the next edition of our Top 10 Apps for Internal Medicine Physicians.
  • Simply put, it might be well-worth an individual subscription while waiting for institutional subscriptions to include mobile devices (no date has been set yet).

Author:

Amit Patel, MD

View Comments

15 Responses to Review of the much anticipated UpToDate iPhone app, arguably the most read medical reference tool

  1. Mark August 22, 2011 at 11:16 am #

    My understanding is that UpToDate is not as up-to-date as its competitors. Point-of-care resources like Dynamed are updated daily, while UpToDate is only updated a few times per year. So I’m not sure I’d agree that nothing matches it.

    • Brian August 22, 2011 at 4:06 pm #

      UpToDate can and does update continuously. I’m sorry to say that you are incorrect. Although you should look into who authors the Dynamed topics. Their website states residents can be authors. Nice huh? Notice they do not list them on their topics. Wonder why?

  2. aristotelis August 22, 2011 at 12:59 pm #

    I dissagree! updating medical knowledge 3 times per year is the best man can have. You just not need any more update to work as a doctor, you do your best even with 1 update/year also, if you are able to remember half o them ;)
    The most common diseases and treatments are the most common. we are not HouseMD we are just human (doctors).
    Thanks for this GREAT (and the best) database imho of medical knowlwdge in our iphone, at last…

  3. House August 22, 2011 at 1:17 pm #

    It is toooooo expencive!!!!! Not buying it!!!!

  4. Jeff August 22, 2011 at 1:44 pm #

    How can a product be “evidence-based” if they do not disclose the process through which they review the evidence. Any “expert” can write a topic, it can, be peer-reviewed, but unless you know why an article in included as a reference you cannot make a claim UpToDate is evidence-based.

    • Brian August 23, 2011 at 11:29 am #

      So, because you do not understand UpToDate’s process, it cannot be evidence based? Do you not think it is still a human who interprets that evidence at Dynamed? Who’s advise is it you are taking and are they qualified to give that recommendation? Who interprets the evidence does matter. UpToDate lists who reviews the evidence simply for that reason. They are qualified to answer the question, “How should this evidence be applied to a specific patient?”
      UpToDate’s policies are readily available on their website. Even their policy and tutorial on EBM are included.

  5. daniel dawson md August 23, 2011 at 7:34 am #

    While a good resource, UTD often has info that while peer reviewed, is not in the mainstream of care. Often times I find residents following care plans of questionable value after reading UTD rather than following established evidence based guidelines. A little knowledge is a dangerous thing!

  6. Dale August 24, 2011 at 9:48 pm #

    @Brian
    A major part of being evidence-based is explicitly describing your methodology, so the clinician can decide whether the information is valid. The UpToDate website now provides a decent amount of information about its evidence collection and grading process, but it didn’t used to. Also, they do update daily now when something practice-changing has occurred, but the bulk-updating still only happens three times a year. I think that is also a recent change, but not sure.

    About DynaMed’s authoring, yeah, it is a little weird that they don’t have stated authors for summaries. Maybe they’re want to focus on evidence-based over expert-based. But their list of contributors is available here:
    http://www.ebscohost.com/dynamed/list.php
    I didn’t read anything about residents being contributors, but I think that’s a common practice with many evidence-summarizing services.

    Overall, they’re both good tools. Everyone has their favourites. Probably a good idea to check your answers in both if possible.

    • Brian August 26, 2011 at 1:10 pm #

      When we looked at their author list a year ago approx 15-20% were residents. Now they are not listed, but this link still states both students and trainees can be reviewers: http://www.ebscohost.com/dynamed/becoming.php

      Guyatt has said many times that evidence alone cannot be used to make sound clinical decisions, you need to weigh risks/rewards, patient values, cost of treatment, etc in making the decisions for patient care. Who do you want doing that? IMO this is what sets UTD clearly apart from other resources. Would an oncologist call a family practice physician (let alone resident) to ask how to treat his patient just because they read a study on the topic? Are they actually qualified to answer that question? Dynamed doesn’t even tell you that could be or what is happening. If that is common in EBM then that it is easy to see why UTD is the trusted source that it is as they would never allow that to happen and are very clear about who their authors/reviewers are (stated on each topic). Make no mistake, all authors and reviews are human and are giving THEIR OWN opinion about the evidence and how to apply it to medicine. By not clearly stating who that is and what their experience is, Dynamed is misleading their users in my humble opionion.

  7. pradeep August 25, 2011 at 12:21 am #

    I Feel UpToDate is one of the best evidence based,peer reviewed synthesized information by renowed authors for the clinicians.And compared to MD consult or Dynamed ,it has got a very high visibility & presence across the globe,because of the quality of its content and added features like more than 23000 graphics to download,700 patient education topics,calculators,drug interaction through lexicomp and much more. And that’s the reason it is used in almost 91% of hospitals in the US ,and almost 80% of the hospitals in Europe.
    Whosoever has got any doubt ,can always go to website http://www.uptodate.com and request for a 30 days free guest pass and can themselves experience this wonderful tool.

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