By Neil B. Mehta, MD
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Physicians are expected to practice evidence-based medicine. When faced with a clinical question, we should search for evidence using focused queries of primary and secondary sources such as PubMed or the Cochrane Library. This is an important skill and is appropriate when we take time to look for an evidence-based answer to a specific question. In many cases, it is appropriate to continue with a current practice until newer information has been reviewed and validated.
Unfortunately, indexing and adding new recommendations to these information sources takes time. We may also be unaware that new information is available and may continue to practice as usual until faced with a situation like those outlined above or until we attend a continuing medical education activity, often quite by chance.
Today we can proactively update ourselves in a manner tailored to our own interests and focus and retrieve important information easily when we need it.
A strategy for information management
In general, we come across new information in one of three ways:
- Proactive scanning of personalized sources of information—as discussed above, a habit of regular scanning is critical to information management
- Reactive searching for information to answer clinical problems or when doing research
- Incidentally—an e-mail from a colleague, information shared on a social network or encountered while surfing the Internet.
In each case, we may find information that is potentially useful, something we may need to find again in the future. But unless we use this information often, we will not remember the details or may even forget we had seen it. Thus, we need a strategy to store this information so we can retrieve it easily at any time with any device; neuroscientists call this the “externalization” of memory.3 Ideally, even if we forget that we ever saw this information or where we stored it, a search would retrieve the location and details of this formerly viewed information.
In the following sections, we outline steps and tools of a strategy for managing clinical information relevant to your practice.
Step 1: setting up information feeds
The first step in this information management strategy is to become aware of relevant new information in your area of practice or research. To do this, you proactively set up feeds of information from reliable and authentic sources. These feeds can be browsed on any computer or smart mobile device.
There are several possibilities for creating these feeds. One option is to subscribe to the table of contents (TOC) of relevant journals via e-mail.
A more versatile and full-featured option is a research site summary (RSS) feed-reader. RSS is a standard for publishing summaries (feeds) of frequently updated content on the World Wide Web, such as journal TOCs and items from medical journal news sites (Table 1 shows what this looks like on screen), as well as aggregators like the American College of Physicians Journal Club. You can subscribe to these using feed-reader software from Feedly or Inoreader, which can be used with any browser on a desktop or laptop. They are also available as apps for mobile devices such as smartphones and tablets. The feed-reader periodically checks for new content and automatically downloads it to the device. Thus, you do not need to check multiple websites for updates or have e-mail inboxes fill with content; the content is delivered to your device for perusal at your convenience.
Step 2: Bookmarking evidence
When you find something useful or interesting, bookmarks help you find the information again quickly when you need it. Social bookmarking lets you create bookmarks you can share across other devices and with other people. Diigo and Delicious are two social bookmarking services that let you integrate with all popular browsers through a button or toolbar. They allow you to save displayed web pages with labels, descriptions and tags.
Diigo offers two additional features. It allows web pages to be annotated with highlights and notes. And during a Google search, relevant results from the Diigo library are simultaneously displayed.
If you forget you bookmarked something and saved it in your Diigo library, when you search for the information again on Google, Diigo will automatically display any results from your Diigo library next to the Google search results. This is very helpful as it is much easier to review information you have already read, marked up, and saved than it is to start over.
Bookmarks and annotations are stored in the cloud and can be accessed by any device.
Step 3: Storing your information
Cloud storage services meet the need for access to stored information at any time and with any device. Options include Dropbox, Google Drive and Evernote. Each provides different amounts of free storage and has apps available for most platforms and devices. They provide search tools and the ability to share articles or folders with other users. The information on these online drives is synced between all devices so that the most up-to-date version is always available to the user regardless of location and device.
The strategies and tools we describe here let you create a personalized and constantly updated medical news “magazine,” accessible from any of your web-enabled devices. They can transform the Internet into a searchable notebook of personally selected, annotated information, helping you to more easily stay up to date with advances in your field of practice, and to more easily manage the modern information overload.
This abridged article originally appeared in its full version in Cleveland Clinic Journal of Medicine. The full article includes step-by-step instructions and screenshots for clinicians interested in information management tools.
Dr. Mehta is Assistant Dean, Education Informatics and Technology, and Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine. He is also Director of the Center for Technology Enhanced Knowledge and Instruction, and staff in the Department of General Internal Medicine, Cleveland Clinic.