Second, when a physician decides that a particular drug is appropriate for treatment, he or she needs to find out quickly
if the drug is on the formulary. The up-to-date information must also be available with a minimal investment of the practitioner's
To be timely in this second sense, the information must appear in the right format and be consistent with the way doctors think. When doctors think about medications, they go through a set of steps in a certain
order (e.g., indications, then efficacy, then side effects, then interactions), so it is important to provide information
in that order. Once a good format is established, information providers should stick with it. Doctors tell us they value consistency.
For time-critical information, or even Part D formulary data, doctors want the information presented the same way, in the
same place, so they know where to look for it. If information providers do not follow this formatting rule, doctors can miss
critical information, waste valuable time looking for it, or both.
Very often, physicians want to be provided with information only in the depth and detail that is required for them to take the next right action. In the Part D example, physicians don't want to know why a particular
drug was included on the formulary or whether it has been recently added. They want to find out, quickly and easily, whether
a particular drug will be covered by this patient's plan or not.
UpToDate, a popular information service available in both computer and PDA versions, provides exactly enough disease information
to determine what signs and symptoms to look for, what tests to run, and what treatment to provide. In-depth information about
the reasons for these actions is not provided, on the assumption that physicians will seek out this information from other
sources, such as textbooks, medical journals, etc., when time permits.
The form factor—the choice of media—also plays an important role. For example, information that a physician might use to treat the patient
he or she is currently seeing should be presented in a form that the physician can access at the hospital bedside, in the
treatment room, or while on the cell phone. For this type of information, the PDA has gained widespread popularity. In fact,
several directors of information technology at major medical schools have told us that each medical student is provided with
a PDA, which comes pre-loaded with the software that the student needs to support such point-of-care decisions. When a doctor
wants to do a thorough literature search on a treatment area, he or she typically will sit down at the desktop computer. Interestingly,
hard copy (e.g., medical journals) still plays a significant role; physicians report that they often carry journals to make
good use of down time between patients.
Not surprisingly, doctors give source credibility significant weight when determining what information sources to consult for particular purposes. Much of the credibility
they assign to a particular source derives from what they see other physicians in their community employing. In certain medical
settings, for example, it is considered virtually mandatory to have read the latest issue of The New England Journal of Medicine. To be of value to the practitioner, a point-of-care information source must be unbiased. Company-funded sources that advertise
their own products or, worse, exclude products of other pharmaceutical manufacturers, tend to be rejected by physicians, due
to the bias in information selection.
Unlike point-of-care information, clinical updates need to be pushed by the provider instead of "pulled" by the physicians who need the information. Doctors have no way of knowing when new developments
occur, and thus no reason to go searching for them. In fact, important updates must stand out against the backdrop of other
kinds of information, including promotions, which physicians receive on a daily basis.
Since the update does not refer to a specific patient under treatment at the moment, timeliness is less significant than for
point-of-care information. Even so, some updates are more urgent than others. A doctor wants to know immediately when a drug
is being recalled due to lethal side effects, for example. Such updates should reach a doctor within a day, so that he can
begin to cull his or her files for patients taking the medication.