advancing availability of clinical insight to improve ...€¦ · advancing availability of...

AdvAncing AvAilAbility of clinicAl insight to improve pAtient cAre

The value of comprehensive, peer reviewed, evidence-based information in healthcare organisations is undisputed. In a recent multi-site study, 95% of clinicians surveyed suggested access to library services improved their clinical decision-making1. This paper discusses the role digitised clinical reference material, supported by advanced search technology, can play in supporting the Nordic healthcare systems – meeting not only the information needs of the clinician but helping to achieve objectives of improved patient care at an organisation and regional level.

A4 Norway positioning paper (Sept2014).indd 1 17/09/2014 12:31

2Elsevier Clinical Solutions

1.0 introduction - challenges in the nordic health systems

Throughout the developed world, life expectancy has been increasing. In Sweden, for instance, it has now reached 82 and in the other Nordic countries it is at 80 or more. Generally people not only live longer but also live healthy and active lives. nevertheless, a substantial and growing proportion of the nordic population now suffer from chronic conditions or follow unhealthy lifestyles which predispose them to future ill health.

Campaigns against daily smoking and excessive drinking have had considerable success throughout much of Europe, yet this is not the case when it comes to healthy eating and taking exercise. In Finland, Denmark, Norway, and Sweden adult obesity has reached 10% or higher and the Organisation for Economic Co-operation and Development (OECD) has estimated that although only 10% of Swedes aged 16-84 are obese, around 40% of the country’s population is already overweight.

This matters greatly because an unhealthy lifestyle tends to bring on chronic conditions such as type 2 diabetes and lead to cardiovascular diseases, organ problems, chronic obstructive pulmonary disease, a decline in cognitive functionality, and a general increase in long-term conditions. For the clinician, this can add to the complexity of treatment especially if dealing with a comorbid disease that lies outside an area of clinical specialty. This makes it more important than ever that healthcare professionals across the Nordics have ready access to a complete range of reliable, trusted, and evidence-based medical information sources to support their decision-making in clinically complex scenarios.

In addition to the impact on the individual, the increase in chronic conditions is having a direct impact on the use of clinical resources and associated costs on the healthcare system. In the Nordic countries healthcare is provided as a social service, but budgets are not limitless and ways have to be found to manage costs well, particularly as the focus on preventative medicine can increase costs in the short term. Furthermore, rising life expectancy means fewer are contributing to public finances, whilst more are consuming expensive healthcare services.

Generally speaking, there remains however, a high degree of public satisfaction with the Nordic healthcare systems and as an OECD report2 remarks, “Sweden’s generous health and long-term care systems are regarded across the OECD as models to be emulated”. The overarching aim of the national public health policy is to create social conditions that will ensure good health on equal terms for the entire population and to help achieve this access to good quality, trusted healthcare information is vital.

Advancing availability of clinical insight

An increase in chronic conditions can add to the complexity of treatment and have a direct impact on the use of clinical resources.



2.0 information as an enabler for change

Technology has repeatedly shown its value in healthcare, not only in terms of providing return on investment but more importantly, by being a valuable asset in improving patient care and outcomes. Technology is not just a matter of implementing sophisticated and expensive equipment or even of improving ways of managing and sharing data, but also going back to the fundamentals of having the most complete collection of current and trusted information available so that healthcare

professionals can provide the best treatment for their patients.

Given the volume of information sources available, getting to trusted information quickly can be a challenge. This is where a specialist clinical search engine, such as ClinicalKey, can help by giving access to a search that is as efficient, accurate, and complete, while at the same time returning only those results that are the most relevant.

2.1 norway – seeking high quality care supported by advanced technology Norway is one of the world’s wealthiest and most socially inclusive countries and understandably spends heavily on healthcare. However, as mentioned, an ageing population and reduction in the proportion paying taxes means that funding must be managed prudently. And while a recent Commonwealth Fund study3 highlighted that Norway’s healthcare system is efficient (ranking fourth out of 11 commonwealth countries) it also highlighted that Norway ranked the poorest in terms of providing good quality of care. This therefore demonstrates that although it is investing heavily in healthcare and delivering a relatively efficient healthcare system, norway continues to seek solutions that will ensure that healthcare professionals can provide the best diagnosis and most safe and effective treatment.

Six of Norway’s hospital trusts have already begun using Elsevier’s ClinicalKey solution, which suggests that Norway’s health professionals recognise the benefits that a clinical search engine can bring in supporting clinical decisions and improving the quality of care.

Norway has also established its Electronic Health Library, a publicly funded service for professionals and students, which

provides free access to point-of-care tools, guidelines, reviews, scientific journals, and a wide range of full-text resources. Here, ClinicalKey can provide a complementary solution by delivering the industry’s most complete collection of medical and surgical content - updated and indexed daily - including images and videos, as well as journals and full-text books.

The availability and use of IT is high in the Norwegian healthcare system and several national strategies exist to help increase its uptake. One of these include the Norwegian Health Network. The Network aims to provide efficient and secure electronic exchange of patient information between levels and across regional borders and now covers over 90% of the population.

However, one of the most pressing problems to be addressed is the increasing need for interoperability in the use of information services to support the provision of seamless and high-quality healthcare delivery. In this latter area ClinicalKey can be valuable, not just a matter of supporting clinical decision making at the point of care, but also allowing clinical support staff, ranging from librarians through to clinical information officers and many administrators, to search rapidly across multiple specialist sources, whether for training purposes or generally to reduce care cycles.


Technology is a valuable asset in improving patient care and outcomes.



3.0 Who needs it and why?


Although most healthcare systems are experiencing the same challenges irrespective of their location, when it comes to accessing reliable and comprehensive information quickly, different groups of healthcare professionals have different requirements.

3.1 for clinicians – at a patient’s bedside or on the go As mentioned, healthcare professionals across the Nordic countries are now seeing more complex conditions every day and this is only likely to increase with time. research shows that, on average, a clinician can ask around 9.5 clinical questions a day4 and their ability to find answers quickly will inevitably impact on their productivity and the quality of care provided.

It is therefore clear that clinicians need a search solution that delivers timely, evidence-based answers in a single place to help improve patient outcomes and release more time to care. In addition, they need accurate, current clinical information at the precise moment of making diagnostic and treatment decisions as well as specialised information for specific patient scenarios.

Answers must be integrated seamlessly into a clinicians workflow, be that when treating and diagnosing patients, staying current in their field, or sharing information with colleagues. Across the Nordics, particularly in Norway, where healthcare professionals regularly use technology in the healthcare setting, ClinicalKey’s mobile optimised interface is of particular value, helping to clarify anything from an inquiry to a complex problem urgently. The solution is adaptable enough to filter search results by clinically meaningful

subcategories or lead a clinician quickly from topic overview to in-depth specialty information.

3.2 for medical librarians – providing deep evidence and fast answers Librarians need to furnish clinicians with the best resources for finding information when they need it regardless of specialty. Clinicians need to have confidence in the information provided to them. A solution like ClinicalKey, with its huge range of searchable information, derived from evidence-based sources, provides both librarians and clinicians with the confidence that the correct results will be obtained.

Investment in advanced search technology can help librarians demonstrate time-saving and have a real impact at the point of care. ClinicalKey’s Smart Search capability understands medical terminology and specialist terms, initialisms, synonyms, surgical procedures, and drug names meaning ClinicalKey ‘thinks’ the way its users do. Providing clinicians with access to their search history and ability to save personalised searches, means ClinicalKey can increase consistency, improve workflow alignment and ensure the most relevant results are returned in the shortest possible time.

Research shows that, on average, a clinician can ask around 9.5 clinical questions a day3 and their ability to find answers quickly will inevitably impact on their productivity and the quality of care provided.

Many clinicians and medical students turn to general online sources such as Wikipedia for quick answers. Whilst there is no doubt that such sources can be useful they do need to be treated with caution; for example, a recent study5 revealed that the online encyclopedia contained errors in nine out of ten of its healthcare entries.




In addition to these focused search capabilities, the browse feature allows users to easily access specific books, journals, video series and more. By providing clincians with a fast, easy-to-use solution like ClinicalKey, librarians are able to spend more time on complex requests.

As a final point, librarians seeking to demonstrate return on investment, ClinicalKey’s usage reports make it easy to track and report on the volume and breadth of content searched, browsed, downloaded, printed, saved, or shared by users over time. And by viewing monthly reports based on content type and what peers are viewing, librarians can easily pinpoint the resources clinicians’ value the most.

3.3 directors of medical education and medical educators – the latest thinking anywhere Educators across the Nordics have the important role of imparting knowledge around new developments in areas of professional interest. For many tutors this will mean engaging in inter-disciplinary education, which can be challenging when attempting to ensure a firm grasp of the latest medical research and findings.

In a clinically complex environment enhancing patient safety and ensuring compliance through continuing education, rotations and professional development is critical. The entire healthcare organisation is dependent on education professionals to leverage tools, such as clinicalKey, that provide high-quality, evidence-based education. These tools will enable better clinical insight and foster an environment of learning and performance improvement based on innovation and personal development.

ClinicalKey also offers further practical benefits for medical educators. Not only does it provide access to hundreds of full-text journals and books, but also over 2.5 million images. The Presentation Maker tool allows users to automatically import images and citations into a presentation without interrupting the search. This can be extremely useful when preparing presentations, lectures, and course notes.

Investment in advanced search technology like ClinicalKey can demonstrate time-saving and have a real impact at the point of care.

The entire healthcare organisation is dependent on education professionals to leverage tools that provide high-quality, evidence-based education.




3.6 for chief executives – better answers for big decisionsFor chief executives organisational reputation is paramount which means they must maintain the trust of patients and their inspectors. In order for patients to be satisfied with a service, they expect those treating them to have all the very latest clinical and medical information instantly available to be assured that they are receiving quality care. ClinicalKey supports the decisions of care teams throughout a hospital by connecting them to the best of everything: concise, trusted answers when every second counts along with in-depth access to current evidence whenever, wherever they need it.

3.4 chief information officers and it professionals – smart decisions for ultimate supportThese roles are responsible for planning, developing and implementing clinical tools to enhance care and reduce risk. This means implementing IT systems that provide rapid online access to the most comprehensive clinical information available via user friendly solutions

Access to ClinicalKey’s simple and intuitive web-based resource means that clinicians can receive rapid answers to complex questions at the click of a button without the need for complicated search techniques or excessive training. ClinicalKey recognises HL7 terms and offers an interface to electronic health record (EHR) systems that can accept queries from HL7 standard Infobutton Managers. This provides easy access to relevant medical and surgical information when using a hospital ehr system.

3.5 chief medical officers, medical directors and heads of departments – maintaining quality and reducing costsChief medical officers, medical directors, and departmental heads work with CIOs and IT professionals in planning and implementing clinical tools and they understand that technology has an important and growing role in supporting clinical practice in the future. Their focus is on supporting their clinicians in ensuring patient outcomes continue to improve while at the same time maintaining quality and seeking to reduce costs. ClinicalKey can support this by streamlining administrative tasks and freeing up more time for clinicians to devote to patient care.



4.0 improved care quality, productivity and patient safety

The value of comprehensive, peer reviewed, evidence based information in healthcare organisations is undisputed. A 2013 large-scale, multi-site study6 on the value and impact of library and information services on patient care with 16,122 clinician respondents, showed that patient mortality was avoided in 6% of patient care incidents and misdiagnosis avoided in 13%. In addition, 95% of those surveyed said that having access to information resulted in better informed clinical decisions.

The majority of hospitals, regions and health authorities in Denmark, Finland, Norway, and Sweden are recognising that having an electronic means of providing this information is extremely beneficial. As a result, they have all deployed or are planning to deploy ClinicalKey to varying degrees.

In Denmark, where there has been a push to improve clinical productivity and responsiveness to patient needs, a recent contract award by the Danish procurement agency, DEFF (the Denmark Electronic Research Library), has seen the ClinicalKey solution deployed across the entire country. This means 19,000 clinicians, who have direct responsibility for health promotion and disease prevention, can now access this powerful tool to support them in their work.

“elsevier is a key provider in the field of knowledge-based information in digital format and therefore a natural partner for the denmark electronic research library (deff). the hospitals within the danish regions have had a licence to elsevier’s science direct and the database mdconsult since 2007. therefore, when clinicalKey became available it was an obvious decision to deploy it and bring together all of elsevier’s medical content into one easy-to use clinical search engine.”

Anders mejlbjerg business consultant for DEFF


“Ease of use and breadth of trusted content were important factors in choosing ClinicalKey. At a recent meeting our doctors were very enthusiastic about the product. It’s an excellent resource for both practising healthcare professionals and for trainees - our clinicians find it easy to use and it provides detailed search results incredibly quickly. It also offers huge breadth of content, and videos are especially popular with our clinicians. Ultimately it can inform clinical decision-making and streamline learning.”

conni sKrubbeltrAnghead of the Medical Library at Aalborg University, Denmark




“For me the most useful feature in ClinicalKey is that you can find several sources, including Medline, in one search. This makes it very easy for us to guide busy clients to information they’re searching for.”

AilA ruoKoKosKiInformation specialist at Keski-Suomen Central Hospital, Finland

“The books, journals and the Clinics of North America are very useful in ClinicalKey. Our clinicians also appreciate being able to use images in presentations and they like having access to the videos. It’s also really good being able to offer these materials to our clients, since the books available there include some of the most important information in medicine.”

birgittA eriKssonlibrarian at Medicinska Biblioteket in Orebro, Sweden

ClinicalKey works on many different levels but there are three key aspects of the solution that users most commonly mention. Firstly, it provides answers the most complete collection of trusted, evidence-based information sources. Secondly, it gives the ease of searching at both a simple level and at far greater depth, returning relevant information quickly. And thirdly it provides ready access to resources such as images, videos and full-text book and journal excerpts which can be used for teaching, for presentations, and for preparing patient education hand-outs.

Region Halland in Sweden, goes as far as suggesting access to ClinicalKey has had the direct impact on quality of patient care both at regional and national level:

“After subscribing to clinicalKey in 2013, region halland has seen a steep increase in usage, plus anecdotal feedback highlighting the role of clinicalKey in improved clinical decision making. mobile optimisation and continued advancements in search capabilities will only further these trends.

there are many interfaces available today but i always recommend clinicalKey as it offers time-poor clinicians the most complete search available. in addition, the systematic summaries and international guidelines available have enabled region halland to work with medical directors and regional administration to formulate local guidelines, meaning clinicalKey has informed clinical decision-making at an institution level as well as influencing practice across the region.”

ingA-lill jern-lArsson head of medicines information, Region Halland, Sweden



5.0 clinicalKey - leading with answers

ClinicalKey’s advanced search, level of content and usable interface ensure it meets needs across multiple clinical scenarios.

ClinicalKey’s design has been driven by an understanding of how users search for information. Multiple rounds of qualitative feedback from both clinicians and medical librarians have informed functional, aesthetic, and ease-of-use enhancements, to improve accessibility of ClinicalKey at the point of care. ClinicalKey is now optimised for smartphone, tablet, and desktop and rather than being device-specific, will adapt to any screen size. Optimisation for 3G mobile connectivity also means users are not reliant on WiFi availability, making it particularly valuable in the Nordic countries that are embracing mobile technology in healthcare and have some of the fastest and most reliable 3G networks in Europe.

The speed of medical change, the growing complexity of illnesses, the vast range of published information, and both the desire and the need for increased specialisation means up to two thirds of clinical questions can go answered7. Yet ClinicalKey’s advanced search, level of content and usable interface ensure it meets needs across multiple clinical scenarios – providing information, for example, on the correct treatment protocol, answers around diagnosis, guidance on how to formulate a treatment plan or perhaps information about complications or comorbidities.

Whilst clinicians frequently need answers tailored to a specific scenario, Elsevier research has found that up to half the time clinicians use one or two word search terms equivalent to a single concept, typically a disease. In this situation, the disease topic pages, a new feature within ClinicalKey, are extremely valuable. By searching for one of ClinicalKey’s 1,400+ disease topics, users can jump straight to a page where they will be able to view answers from preferred sources or click through to a list of search results to explore the topic further. These pages cover epidemiology, risk factors, clinical manifestations, treatments, and more and carry links to specialty specific answers and relevant drugs.





Elsevier is also actively working in partnership with institutions to better understand integration needs, with the shared objective of enabling contextually relevant, patient-specific knowledge resources to be integrated into clinical information systems.

6.0 one solution, countless opportunities

As this paper has frequently commented, ClinicalKey offers access to a wealth of the latest, clinically relevant evidence-based information through highly regarded journals, books, and videos complemented with other relevant materials. Elsevier is a major medical publisher and much of this material comes from its own resources, duly extended by material offered through PubMed and a fully indexed Medline.

ClinicalKey gives full-text access to over 1,000 reference books and over six hundred medical journals, including all the most highly regarded and trusted publications. The solution includes access to the ClinicalTrials.gov database, over 4,500 practice guidelines, some 850 First Consult monographs, and over a further 4,500 drug monographs. There are more than 1,400 specialist disease topic pages and some 50 clinics. Nor is it all text; ClinicalKey gives access to over two and a half million images, 3,000 videos and articles, and 17,000 medical and surgical videos.

The content is the foundation of the resource, but arguably even more important is that ClinicalKey has been designed to reflect user needs, providing answers with real impact in a clinically complex environment. In order to address the evolving challenges across the Nordics, Elsevier is also actively working in partnership with institutions to better understand integration needs, with the shared objective of enabling contextually relevant, patient-specific knowledge resources to be integrated into clinical information systems as healthcare systems evolve. Please contact us directly to discuss your integration requirements.




references cited in the text:

1. Marshall, J.. et al, January 2013, The value of library and information services in patient care: Results of a multi-site study. Journal of the Medical Library Association, 101(1):39-46.

2. OECD Reviews of Health Care Quality: Sweden - Executive summary, assessment and recommendations. Published 12 December 2013. Page 15

3. Davis, K. et al, June 2014, Mirror, mirror on the wall: How the performance of the US healthcare system compares internationally, 2014 update. The Commonwealth Fund.

4. “Watson and Healthcare” (quoting the British Medical Journal), April 2011

5. Hasty, R. et al, May 2014, Wikipedia vs Peer-Reviewed Medical Literature for Information. About the 10 Most Costly Medical Conditions, Journal of the American Osteopaths Association, May 1, 2014 vol. 114 no. 5 368-373

6. Marshall, J.. et al, January 2013, The value of library and information services in patient care: Results of a multi-site study. Journal of the Medical Library Association, 101(1):39-46.

7. “Watson and Healthcare” (quoting the British Medical Journal), April 2011


ClinicalKey is being used by some of the most forward-thinking healthcare organisations across Scandinavia to help improve clinical results, patient safety, and the ongoing development of clinical staff. This includes the Danish Regions, supported by DEFF, providing access to 19,000 clinicians across Denmark.

customers in scandinavia include:

Aarhus Universitet, Denmark Consortium Danish Regions, Denmark

Region Hovedstad

Region Midtjylland

Region Nordjylland

Region Sjaelland

Region Syddanmark

Keski-Suomen Sairaanhoitopiiri, Finland Lapin Sairaanhoitopiiri, Finland Mikkelin Keskussairaala, Finland Paijat-Hameen Sosiaali- ja Terveysyhtyma, Finland Satakunnan Sairaanhoitopiirin, Finland Vaasan Sairaanhoitopiiri, Finland

Styrelsen For Sundhed Og Forebyggelse, Greenland Diakonhjemmets Sykehus, Norway Helse Moere og Romsdal HF, Norway Helse Nord-Trøndelag HF, Norway Sørlandet sykehus HF, Norway Sykehuset I Vestfold, Norway Vestre Viken Helseforetak, Norway Landstinget Halland, Sweden Örebro läns landsting, Sweden Region Halland, Sweden

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