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Building a physician reference for 2023
What would an "up-to-date" version of UpToDate look like?
(Just want to see the prototype? Click here.)
“So I went to the publisher of my major books, and the meeting was over immediately when he said ‘no one has made any money in computers yet.’”
— Dr. Burton Rose, founder of UpToDate, in 1991
The first revolution in physician references
The year is 1986, and Harvard Medical School professor Burton Rose just read a study he couldn’t believe.
Published in the Annals of Internal Medicine, this study of practicing physicians had a bold conclusion: “Only 30% of physicians' information needs were met during the patient visit, usually by another physician or other health professional.” In other words, 70% of the questions doctors had during their workday went unanswered—and doctors virtually never consulted a paper or textbook to find an answer.
This result shocked many—but it particularly bugged Dr. Rose, who had just written the canonical textbook on kidney disease. What was the point of publishing new textbooks if practicing doctors wouldn’t consult them?
Distraught, Dr. Rose was determined to find a way to supply doctors with the answers they needed to do their jobs. So he turned to the new hot new tech of the 80s: personal computers. Dr. Rose had played around with some early PCs and noticed two things: (1) they could store much more information than a textbook, and (2) they could be updated more frequently.
So he pitched his textbook publisher on the idea of a computer-based textbook. And…the publisher instantly shot him down. “Nobody is making money in computers,” they said.
So Dr. Rose took matters into his own hands and launched a computer-based textbook from his basement. The first version was a nephrology textbook, written by him, and distributed through the mail on floppy disks. Since he planned on sending out updated floppies every few months, he called his new company UpToDate.
More than thirty years later, UpToDate serves over 2 million clinicians and generates $800M in revenue for its parent company, Wolters Kluwer. It is far and away the most popular clinical decision support tool—the odds are very good that any doctor you meet in the street will have used it.
It’s a compelling story: a foresighted doctor glimpses the ways in which a new technology (personal computers) can revolutionize the practice of medicine; he seizes that opportunity; and he builds a software juggernaut that vastly improves the practice of medicine. My respect for Dr. Burt Rose runs deep.
But UpToDate’s revolution happened in the 90s. Thirty years later, Dr. Burt Rose would find today's web-based version of UpToDate eerily familiar. Sure, updating articles doesn’t involve FedExing floppy disks, but the “search and skim” workflow has barely changed at all. UpToDate is still just a textbook you can read in your browser.
And yet—technology has changed dramatically in the last 30 years! Shouldn’t there be faster, easier ways to get clinicians the information they need?
I’m so glad you asked.
Ways I would improve UpToDate
Improvement #1: Make it more up to date
When UpToDate launched in 1992, updated articles were shipped (via floppy disk) to users three times a year—and even today, most articles I’ve looked at were updated 1-2 months ago. This was blistering fast when UpToDate launched—back then, medical information doubled every 19 years. But today, medical information doubles every 73 days! Imagine searching for information about COVID in May 2020—would you trust results that were two months out of date?
A better version of UpToDate would integrate answers from new studies and guidelines as soon as they were published. This wasn’t even remotely possible in 1992—when most resources were still paper-based—but today this would be much easier to accomplish.
Improvement #2: Generate one-sentence answers
Most of the time, doctors are looking for specific answers, not full-length articles. A doctor who searches “amoxicillin dose for 6yo with otitis media” is not trying to read a 10-page article on ear infections—she’s looking for a one-line answer like “the recommended amoxicillin dose is 40-45 mg/kg every 12 hours.”
Again, this wasn’t possible in 1992—but improvements in search and natural language processing (NLP) have made it possible to give instant answers to specific questions (just try Googling “what is the molar mass of aluminum sulfate” for an example).
Improvement #3: Allow users to add their own references
Often, doctors are part of hospitals or medical groups that have their own guidelines. This means they have a two-step process for answering any question: (1) check the giant pile of PDFs in your hospital’s "guideline" Dropbox, and then (2) check UpToDate for general guidelines.
But it’d be way easier if doctors could just upload their guidelines to UpToDate, and then let UpToDate return answers from those guidelines. Putting all relevant references in one place makes it way less likely that a doctor will accidentally miss an important guideline.
It also opens up the possibility that institutions could share their guidelines with other institutions (shouldn’t medical guidelines be pretty universal, after all?).
The next phase of UpToDate: a prototype
Of course—and I think you saw this coming—I couldn’t resist trying to build the 2023 edition of UpToDate. So I teamed up with pediatric hospitalist Kevin Grassi to build a physician reference based on GlacierMD (a medical knowledge engine I've written about before), tailored specifically for pediatricians. And in burst of creativity I’ve decided to call it: GlacierMD - Pediatrics.
I'm happy to report that it has rudimentary versions of all the features mentioned above. Here’s Kevin walking through some of those features:
It's an early prototype—but at the very least, it shows that UpToDate (and its competitors) have plenty of room for improvement. Feedback so far has been positive, and we’re working quickly to add more features that UpToDate lacks.
If you’re a pediatrician and are interested in giving GlacierMD a spin (or know someone who might be), you can join the beta here:
Thanks for reading! If you’re interested in following the GlacierMD journey (or reading about the intersection of software/medical research/product development), you can subscribe to my Substack here: