At Medical Database (MDB), a refined editorial process is critical to our ability to deliver and maintain MDB, our best-in-class clinical knowledge base and decision support system.
Our editorial process is driven via a top-down and bottom-up approach. The top-down path consists of daily review of our surveillance list of on-line sources (see list below) by the senior editorial team. This approach ensures our knowledge base will reflect the current state of the lab industry and respond within 30 days or less to any significant change in the laboratory industry or any relevant medical policy changes. The bottom-up approach is managed by our junior editors, who are responsible for reviewing 10% or 200 entries per month of the current knowledge base. [RB1] The review process is designed to refresh the published knowledge base information with relevant updates. This process ensures the entire knowledge base is reviewed and updated each year, and allows the team to process changes at a consistent and manageable pace. The list of resources used in the bottom up approach are listed below.
Our editorial process is managed by a hierarchical team, led by a hand-selected group of senior editors consisting of Board Certified Clinical Pathologists. The senior editorial team meets each month to review a list of suggested updates as determined by the dual approach described above, and include new entries, updates and discontinued labs tests. The editorial team is listed here.
Based on the collective view of the senior editors, a work list is distributed to our affiliated team of over 30 active clinical writers. The writers are segmented into areas of expertise within laboratory medicine, and are then matched to the most appropriate item in the worklist. The MDB clinical editors, reviewers and writers are medical professionals active in academic and clinical practice, board-certified in the appropriate clinical laboratory specialty and well known as an expert in their field.
Several policies are instituted to ensure the editorial sources are well balanced and are not biased by related medical device or pharmaceutical vendor interests. MDB follows a hierarchy of evidence consistent with most evidence-based resources. At the top of the hierarchy are meta-analyses of randomized trials of high methodological quality, followed by randomized trials with methodological limitations, observational studies and unsystematic clinical observations. Inferences are stronger when the evidence is summarized in systematic reviews of the literature that present all relevant data. Writers also consider relevant reference materials and published texts to provide well rounded context as per the reference list below. Our policies also require at least 4 relevant clinical sources are used for each laboratory entry.
Medical relevance scoring is based on clinical information synthesized by the writers and our proprietary ranking process. This process scores each test on several qualitative scales including medical necessity, clinical evidence of utility and value (clinical decision making, sensitivity, specificity, standard of care) as well as the most appropriate clinical indication. The output of this process is a quantitative score specific to the clinical test, the disease, and the clinical indication. The MDB score is considered one of the most critical data elements within the knowledge base. For this reason, our senior team must be in majority agreement of the interpreted score in order to publish the entry.
Once the MDB medical writers have submitted their drafts to the MDB automated editorial system, a team of seven junior reviewers review the content for accuracy and completeness. All bibliographical entries are reviewed and verified as relevant. Additional reference resources are also considered at this stage. Once approved the entry is passed to senior editors for review and feedback. Once approved by the senior editorial team, the final publication is published by the MDB founder and CEO, who personally reviews each entry as a final step.
It is notable that the MDB knowledge base constrains more than 2000 laboratory entries, each being subject to the above editorial process, and each entry has undergone a minimum of five review cycles prior to publication.