by Jay Luxenberg, MD

I’ve been writing about apps for more than a year, yet I haven’t written about the medical app I use the most often now. I will attempt to explain why the app I use is expensive, leagues away from the mostly free apps I have been writing about. It is UpToDate.  You are likely familiar with them as a web-based resource, and in my case I have been using them for years through an institutional subscription. I have found their frequently updated reviews of clinical topics very useful, but I have not had access to their app until recently, as their institutional subscriptions do not offer access via smartphones or tablets except through the web browser while using a VPN – way too cumbersome for me to find useful under most clinical circumstances. Recently, however, I have purchased an individual subscription, which allows access via my iPhone and iPad. That is what I will discuss today.

UpToDate is a clinical decision support system, and you may have read a recent paper in the Journal of Hospital Medicine entitled “Use of UpToDate and outcomes in US hospitals”  (DOI: 10.1002/jhm.944) that indicated that hospitals that offer access to UpToDate to their clinical staff experience shorter lengths of stay, lower risk-adjusted mortality rate, and better quality performance for every condition on the Hospital Quality Alliance metrics. The apps remember your log-in info and so with minimal effort you are able to access a search function that offers very useful summaries of the most recent clinical studies and guidelines for just about every clinical situation I manage to look up. It also offers calculators, a “what’s new” feature by clinical arenas including geriatrics, and a “Practice Changing Updates” for those of us that are time challenged. Now hold on to your hat’s, kids – it keeps track of the time you spend looking stuff up, and offers AMA PRA Category 1 CME credit. It also offers AAPF CME, and credit for PAs and NPs as well. I’ve been very happy with the quality of the information presented, and haven’t noticed any nefarious influences. The iPhone is always with me, but the iPad application is just beautiful – well formatted and easy to read. You can also print off information including very useful patient information on a truly impressive range of topics. The apps utilize links, linking you to detailed drug information and references. Click on a reference and you will get detailed abstracts and a PMID that allows you to quickly find the whole article. 

Although prices vary with type and length of subscription, baseline is $499 a year, or $45 for a recurring 30-day subscription. Trainees get a discount.

I have been very happy that they offer group discounts for group practices that order 11 or more individual subscriptions together with one form of payment – that is what I am availing myself of, as I offered access to every physician and NP in our practice.  I really do find that it is worthwhile paying for access even though I get on-line access free through my university teaching affiliation.  Now you can see why I was hesitant about writing about this – after all those wonderful free apps I am confessing my affection to an expensive service. Oh well, some things in life are apparently worth a bit of hard earned money!