1. Smarter Decisions, Better Care

2. 1 Industry Challenges Across the World 1 - http://www.pwc.com/gx/en/healthcare/emerging-trends-pwc-healthcare.jhtml Although healthcare challenges can vary from region to region, health systems of every type around the world have the same objective: to deliver the highest possible quality of care to the maximum number of people. 1 “ ”

3. 2 What Clinicians Say For me it's simply the most convenient and trustworthy source of evidence and information to support clinical decision-making. Ray Armstrong, MD - Romsey, UK “ “ "UpToDate is not a commercial product for me. UpToDate is a new way of practicing medicine." R.M. Valentijn, MD - HAGA Hospital The Hague, The Netherlands “ “

4. 10 500+ Clinical topics 1500+ Patient topics 28 000+ Graphics 160+ Medical calculators 400 000+ Evidence links What’s New/ Practice Changing UpDates 22 Specialties CME/CPD 5 400+ Drug entries 3 A New Way to Practice Medicine 5 700+ Physician authors

5. 4 A Trusted Resource 21+ years For 21+ years, the most trusted evidence based, peer reviewed editorial content, proven to improve patient care quality 5 700+ authors Expert evidence-based recommendations made by over 5 700+ physician authors from 51 countries 850 000 clinicians 29 000 hospitals worldwide rely on UpToDate, including:  95% of medical teaching institutions in Benelux and Germany  90% of medical teaching institutions in Japan  90% of medical teaching institutions in the United States 279 000 000+ searches Clinicians view more than 279 million topics annually in UpToDate, changing 80 million clinical decisions

6. 5 What Clinicians Say Source: 2012 UpToDate individual subscriber survey indicated they trust UpToDate as a point of care clinical information resource In an 17 000 individual subscribers survey of over 95 % I trust UpToDate as an authoritative point-of-care clinical information resource. “ ”

7. 6 National Adoption UpToDate has national contracts with the governments of Iran, Norway, Saudi Arabia, Jordan, and Spain, Oman. These countries have standardized the use of UpToDate in public healthcare. In countries such as Luxembourg, the Netherlands and Switzerland use of UpToDate is a de facto standard

8. 7 Doctors Have Clinical Questions Covell, DG. Ann Intern Med 1985; 103:596; Green, ML. AM J Med 2002; 109:218; Osheroff, JA. Ann Intern Med 1991:575; Ely, JW. J Am Med Inform Assoc 2005; 12:217; Gorman, PN. Med Decis Making 1995; 15:113. Unanswered clinical questions impact patient management decisions Approximately 2 out of 3 clinical encounters generate a question Physicians have approximately 11 clinical questions a day 60 % of questions go unanswered Answering all clinical questions could change 5 to 8 patient management decisions each day

9. 8 Clinicians Save Time with UpToDate Percentage of users who report that UpToDate saves them time in answering clinical questions Source: 2012 UpToDate individual subscriber survey

10. 9 Research Demonstrates UpToDate Impacts Outcomes We invite you to review the study data yourself: http://www.uptodate.com/home/research Over 60 research studies UpToDate is the most widely studied point of care clinical decision support tool. To date there have been over 60 studies that have looked at UpToDate as a tool to:  Allow more questions to be answered faster  Change decisions  Improve outcomes

11. 10 Clinicians Need Help Making Better Decisions 1 Lucas, BP. The impact of evidence on Physicians’ inpatient treatment decisions J Gen Intern Med 2004; 19:402. Cook County Hospital Cook County Hospital, Chicago, IL Test: Critical decisions assessed before and after providing clinical knowledge support on a random sample of 146 inpatients Result: Attending physicians changed treatment decisions for 18% of patients Insight: UpToDate drove most decision changes 1

12. 11 UpToDate Changes Clinical Decisions Phua J, See KC, Khalizah HJ, et al. Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds. Singapore Med J 2012; 53:116. Researchers at Singapore’s National University Hospital report that bedside use of UpToDate led to changes in patient care decisions… 37% of the time

13. What Effect Did the Information from UpToDate Have on My Plan… Data from CME responses (n = 2,575,145) (n = 1,187,150) (n = 388,305)

14. UpToDate Impact by Clinician Query Type (n= 4.1 Million CME Responses)

15. 14 Enstinet Usage Feb 2012 – May 2015

16. 15 Enstinet Usage Feb 2012 – May 2015

17. Enstinet Usage Analysis 16 This reinforced my plan: 136,400 /year, 11,366/Month, 2,841/Week This modified my plan: 66,000/year, 5,500/Month, 1,375/Week I need more information:17,600/year, 1,466/Month, 366/Week 2014 – 2015 Usage = 220,000

18. 17 Top Specialty Facility Name - ENSTINET Date Range From 05/01/2014 To 05/01/2015 Rank Topic Specialty Total Topic Hits 1Drug Information29,595 2 Obstetrics, Gynecology and Women's Health 21,039 3Pediatrics18,837 4 Infectious Diseases 17,862 5Gastroenterology and Hepatology15,985 6 Nephrology and Hypertension 13,356 7Endocrinology and Diabetes11,967 8 Cardiovascular Medicine 11,642 9Hematology11,155 10 Oncology 11,154 11Pulmonary and Critical Care Medicine9,491 12 Neurology 7,829 13Rheumatology6,266 14 Adult Primary Care and Internal Medicine 5,107 15Adult and Pediatric Emergency Medicine4,962 16 Allergy and Immunology 4,932 17General Surgery4,171 18 Patient Information 3,054 19Dermatology2,340 20 Psychiatry 1,801

19. 18 Use of UpToDate Associated with Improved Outcomes 1.Solucient maintains the nation's largest healthcare database, comprised of more than 26 million discharges per year from 2,900 hospitals. 2.Bonis PA. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the US. Int J Med Inform 2008; 77:745. Significantly shortens lengths of stay Significantly lowers complication rates Significantly lowers adverse outcome rates Solucient 1 studied the impact of UpToDate on length of stay, patient complications and patient safety 2

20. 19 Quality Indicators Improve with Increased Use of UpToDate Bonis PA. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Int J Med Inform 2008; 77:745. Complications UpToDate Usage Levels and Impact on Patient Complications, Patient Safety and Mortality Improvement in Risk Percent Patient SafetyLength of Stay UpToDate Topic Reviews Per Week 14840310962980 0% 20% 40% 60% 80%

21. 20 Researchers at Harvard University Find UpToDate Associated with Improved Outcomes Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med 2012; 7:85. Use of UpToDate Associated with... Improved Quality  Every condition on Hospital Quality Alliance Metrics Shorter Lengths of Stay  372 000 days over 1 year Lower Mortality Rates  11 500 lives over 3 years

22. Using UpToDate Increases Medical Knowledge 20 Minutes a day McDonald, F, Zeger, SC, Kolars, JC. Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency J Gen Intern Med 2007. 21 Equals an Entire Year of Residency

23. UpToDate is recognized and accredited for CPD  American Academy of Family Physicians  American Academy of Nurse Practitioners  American Academy of Pediatrics  American College of Emergency Physicians  American College of Obstetricians and Gynecologists  American Osteopathic Association  Australasian College for Emergency Medicine  Austrian Academy of Physicians  Federación Mexicana de Colegios de Obstetricia y Ginecología  Colegio de Medicina Interna de México  College of Family Physicians of Canada  Dubai Health Authority  Health Professions Council of South Africa  Oman Medical Specialty Board  Postgraduate Medical Training Bodies in Ireland  Royal College of Physicians and Surgeons of Canada  Royal Australian Australasian College of Physicians  Royal Australasian College of General Practitioners  Royal Australian and New Zealand College of Obstetricians and Gynecologists  Royal New Zealand College of General Practitioners  Singapore Medical Council 22 Accreditation Council for Continuing Medical Education AMA PRA Category 1 Credit(s) TM Accreditation with Commendation

24. 23 Economic Impact of UpToDate at Salford Royal NHF Foundation Source: November 2011, Forrester Research: The Total Economic Impact Of UpToDate’s Clinical Decision Support System For Healthcare Institutions: A Case Study Of Salford Royal NHS Foundation Trust in the UK Benefits Included:  Staff productivity  Diagnostic test efficiencies  Improvements in the quality of care Forrester Research found Salford Royal NHS Foundation Trust (SRFT) recovered the costs of UpToDate in 90 days 90 = ROI days

25. 24 For More Information [Presenter to customize for particular audience] Phone: Institutions outside of the US/Canada +31 172 641440 Email: international@uptodate.cominternational@uptodate.com www.linkedin.com/company/uptodate ?trk=hb_tab_compy_id_21924 www.twitter.com/UpToDate www.facebook.com/UpToDateEBM www.youtube.com/uptodateebm