Hi!!  The responses and advices and great comments I received on this are
really great!! Thank you all for participating!!


Here’s what I received...I hope helps someone else, as for me!!



Thank you all!!




We canceled UptoDate (for pricing reasons) and offer Dynamed instead.
Students complain, but several med school professors prefer Dynamed. The
profs say that Dynamed actually requires students to think; the main reason
the students love UtD is because it doesn't require any critical thinking on
their parts.

Our Reference and Outreach Department has also found that it takes less than
ten minutes to teach people how to use Dynamed, and once they're introduced
to it, they really like it.


Dean James, Ph.D., M.S.L.S.

Associate Director, Collection Development Houston Academy of Medicine-
Texas Medical Center Library

Email:  <mailto:[log in to unmask]>
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We used to have UTD and now offer Dynamed.  I find both resources have
utility and really we need to offer both (yeah, okay, no problem!).  Last
week while at Morning Report I got my usual earful regarding the loss of
UTD, but I really love this time to hear the residents opinions.  One
interesting aspect I hadn't heard before was complaints of Dynamed just "not
getting it." One physician was sitting in on my session and said that UTD
thought of and used terminology as it was really used by clinicians.  He
said that if you typed a question or keywords into UTD, it "knew" what
question you were asking.  Not so for Dynamed.  

I have found no love for the bullet-style information delivery of Dynamed. 

Complaints range from overwhelming, to laundry list of evidence that doesn't
make it helpful for a POC resource.  Seems they want that expert opinion. 


Again, I think there is a time and place for everything.

It's tough to really check the pulse of the user community since so many
people may love something only because it's what they know.  While we
librarians test out resources, talking with the residents reminded me that
we don't search like they do.  So is it possible to do a "good" evaluation
of a product designed to serve them?  How can the clinicians if they have
tasted the kool-aid?  Where's my magic 8 ball....


Brandi Dawn Tuttle

Information & Education Services Librarian 

Duke University Medical Center Library   

[log in to unmask]  



The last time I evaluated all of the resources the major item missing from
Dynamed was a drug interaction program.  

You might also want to look at Clin-eGuide. It has some excellent resources.
I actually wish we had it instead of UpToDate. It is more EBM, has several
great features. The only problem is Wolters bought UTD and pushes it instead
of Clin-eGuide.

Also, Clin-eGuide is available remotely with your subscription. 


I never really liked First Consult or PIER. Dynamed was great with updates
and EBM, but it lacked in the drug information area. 


Thank you, 

 Alisha Miles, MLIS, AHIP

Manager of Library Services

Simon Schwob Medical Library

Columbus Regional Healthcare System

 <mailto:[log in to unmask]> [log in to unmask] 



All staff and physicians can access UpToDate on the Extranet whether they
have their offices within hospital or elsewhere.  The formula UTD uses is to
determine Extranet cost   based on physicians who work fulltime with their
offices at the hospital but that doesn't mean its available just for them.
So the formula doesn't exclude any physicians or staff from using it via
Extranet.  We have several hospitalists so they were included in the

We have recently opened a new Regional Cancer Center so we have Oncologists,
etc.  who now only have offices at hospital (not in the community) and they
were counted in under the UTD formula. For large hospitals in urban centers
I would imagine there are many physicians who only have their offices onsite
at the hospital and the cost would most likely  be high.

Our UTD rep mentioned Extranet access was just introduced last year.  In the
course of our conversation I discovered the teaching hospital discount and
hadn't known about it for previous years renewals.


UpToDate now offers Extranet access so our users logon  to hospital network
'from anywhere'  using  their hospital ID/password and do not need to enter
any username/password to access  UTD.   Staff and physicians  are very
happy.   Also we discovered that as a teaching hospital we got a discount on
our renewal price this year.  

UpToDate has a formula they use to calculate cost for Extranet.  It was
based on the number of fulltime specialists who had their offices onsite at
the hospital.  The exclusion list Pathologists, Psychiatrists, Anesthetists,
etc.  So the cost wasn't out of site as we expected.  At the same time we
discovered we qualified for the teaching hospital discount which was also


Kathy Dedrick

Health Sciences Resource Centre 

Southlake Regional Health Centre




But they (UpToDate) also count all NPs and PAs in the specialty content
areas which really drives up the cost!


Regina M. Hartman

Library  Manager

The Christ Hospital

James N. Gamble Library

Cincinnati, OH  45219

Email:    <mailto:[log in to unmask]>
[log in to unmask] 



At my most recent location where we had access to both UpToDate and Dynamed
, the wits amongst us use to tell our clients the difference was that
UpToDate  was not uptodate as its not updated daily as is Dynamed.  

I personally preferred the latter and especially as others have indicated
its readily available off campus and available on mobile platforms e.g.
Iphone  as well.


Stephen Barnett

Library Coordinator

Endeavour College of Natural Health



I don't have Dynamed so I cannot comment on it. I do have both First Consult
and UpToDate. I go on patient rounds and can tell you that UpToDate is more
effective in answering those point of care clinical questions - especially
questions regarding diagnosis, what type of workup needs to be done, how a
disease may present, and caveats. Because they are written by physicians.

The flow of summaries match the way they think when they are working out how
to diagnose and treat a patient. I'm not thrilled about this fact because I
know they are expensive but I have to be honest. However, UpToDate doesn't
have everything and in those cases I am glad I have access to First Consult
as well as Clinical Pharmacology and EMBASE.



Susan Fowler, MLIS

Medical Librarian

Evidence at Becker:


Becker Medical Library, Washington University in St. Louis

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Just a clarification re: UpToDate the language carefully.

As I remember it, it doesn't say that every article is updated quarterly,
just that updates occur quarterly.  I think it also says somewhere what
percent of the database is updated on a certain frequency, but doesn't say
that the entire database is updated on a specific schedule.  The text also
leaves the impression that if the single author of an article does not
believe there is reason to update, the article may not be updated until
he/she feels it is necessary.  The authors are experts in their fields, and
their decisions certainly may be justified; however, I never saw any
requirement that every section be updated on a scheduled basis.  Only my
interpretation, but it bothered me.



Janis I. Silver, MAL, AHIP

Health Sciences Library

Southern NH Medical Center

Nashua, NH 03061-2014 



Once our doctors and nurses try Dynamed they love it - particularly since
they can access Dynamed off site using a username/password whereas UpToDate
is IP authenticated and can only be accessed on site.

Other staffs at our organization who also love Dynamed and find it
invaluable now are the Health Records/Billing staff because Dynamed
indicates the ICD-9/-10 codes at the beginning of each summary!   


Maureen Pakosh, BA., MISt

W. Keith Welsh Library

North York General Hospital

Toronto, Ontario   Email:  <mailto:[log in to unmask]>
[log in to unmask] 


You may want to check currency and where the info is coming from......


On Dynamed....look at the link on the left side for "recently updated"
notice the date and time. Dynamed inclusions are based on evidence based


Then go to Up to Date and check how often they update the data base...last
time I checked it was quarterly and based on expert opinion



Margaret Vugrin, MSLS, AHIP

Reference Librarian

Texas Tech University Health Sciences Library

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The physicians will tell you that UpToDate is the better of the two and that
may be true for them but I personally LOVE Dynamed. It has been a really
valuable tool for our nurses and Magnet journey.  Many of our physicians
(after trying it) love it and have their entire staff using it.


Our MHU nurses wanted to do a research smoking cessation for their patients
and were having a hard time with the research.  When they came to me I
showed them Dynamed and low and behold there is a WEALTH of info on it.

They are hooked now.


You might have a problem getting your patrons to try it but it is worth the

Miller, Lou [[log in to unmask] ] 



We provide both UpToDate (UTD) and DynaMed to our users, but MD Consult
instead of FirstConsult. Our users tend to prefer UpToDate, but they do
appreciate the functionality of MD Consult. 


As a librarian I prefer DynaMed over UpToDate, partially because it costs us
so much less, but also because: 

1. our users have complimentary offsite access to the product (UTD charges
us per doc, our nurses cannot get into it off-campus at all) 2. the
calculators and decision trees have become popular with residents and their
faculty 3. it helps to teach and explain EBM methodology and how to judge
evidence 4. it links users to the PubMed record for articles to which we do
not have full-text access, and it then allows all the functionality of
PubMed once there - UTD brings you to a Medline record, but then just stops
5. updates constantly throughout the day - always a fun teaching moment, we
can look at the clock and more often than not there will have been an update
within the last 10 - 15 minutes 6. written in easy to read bullet points


The benefits of UTD:

1. tables/charts/images can be downloaded directly into powerpoint slides 2.
divides into pediatric or adult priortization of topics (we are a pediatric
system) 3. it does seem that there is more overall coverage than DynaMed at
this time - but DynaMed is constantly adding 4. written as a searchable


I use UTD whenever I am doing a search on a topic that I know nothing about,
it provides easy to read and understandable background information with a
ton of references at the end. I use DynaMed whenever I need the latest
evidence on a condition - particularly for diagnostic and treatment options
- and I like that DynaMed puts the references/sources of evidence in the
text itself, not at the end where I have to go looking for them.


Good luck!


Kristina Flathers

Medical Librarian

Alfred I duPont Hospital for Children / Nemours Wilmington, DE 19803




We are currently making this decision as well.  We use Up To Date now, but
it's only on two computers in the library and one in an on-call room.  If
the doctors and residents want remote access or access anywhere in the
hospital, they have to purchase it on there own.  Our residents get money
every year to offset costs like these, and many take advantage of it.  

We are running a free trial of DynaMed this month.  I've set up a survey to
collect some feedback, and we've had some good results.  Most of the doctors
like DynaMed, but feel that Up To Date is better.  They would, however, use
DynaMed and prefer if that is what was offered remotely, hospital-wide, and
in an app form (our residents love apps!).  The surgeons and radiologists
aren't crazy about it, but then again, they don't use Up To Date much
either.  The medicine residents seem fine with it.  They all say it is easy
to use, provides reliable information, and they would recommend it to
others.  They are all aware that we are a non-profit institution and money
will always be an issue.  Up To Date doesn't seem to want to work with us on
price, but DynaMed does. I think the doctors will be glad to have a POC tool
that they can use all over the hospital no matter what it is.  

Elizabeth Laera
Medical Librarian
McMahon-Sibley Medical Library
Princeton Baptist Medical Center





Angélica Navarro Serment, MLIS
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