Executive summary
The market for clinical decision support (CDS) and knowledge retrieval is undergoing its most significant transformation in a decade. In 2025, clinicians are demanding faster, provenance-first answers at the point of care, and a new guard of generative AI-powered assistants has arrived to meet this need. The latest major development is the launch of UpToDate® ExpertAI, a new chat interface grounded exclusively in UpToDate’s trusted content, with enterprise availability beginning in Q4 2025.
This move from a major incumbent signals a market-wide shift. It comes as EBSCO’s Dyna AI, Elsevier’s ClinicalKey AI, and fast-growing challengers like OpenEvidence and Glass Health are all shipping powerful new features. For UK clinicians and healthcare organisations, the key is to understand what each of these tools does best and how to adopt them safely, mapping any deployment to the governance frameworks of NICE and the NHS AI Knowledge Repository.
Market snapshot: what changed in 2024–25
The defining change has been the move from traditional keyword search to conversational, generative AI assistants. The underlying technology powering the safest of these tools is Retrieval-Augmented Generation (RAG), a technique that grounds AI answers in a curated library of trusted documents and provides visible citations. The major incumbents (Wolters Kluwer, EBSCO, Elsevier) have now all launched first-party GenAI assistants built on top of their proprietary content, while challengers like OpenEvidence and Glass Health are competing on speed, novel features, and different access models.
Buyer’s checklist
When evaluating any modern AI CDSS or reference tool, use this checklist:
- Provenance: Is the knowledge base a gated, curated library (like UpToDate or DynaMedex) or the open internet? Are all answers clearly and accurately cited?
- Retrieval quality: Does the tool use a modern RAG architecture to minimise hallucinations and provide accurate citations?
- Explainability: Can the tool show its reasoning or link back directly to the maintained monographs and guidelines it used?
- Licensing & access: Is it an individual or enterprise subscription? Does it offer integrations with your EHR or mobile apps?
- UK governance: Does the vendor have a clear plan for aligning with the NICE EVA pathway and contributing learnings to the NHS AI Knowledge Repository where appropriate?
Tool-by-tool: what’s distinct, where it fits
UpToDate® ExpertAI (new)
- What it is: A generative AI chat interface grounded exclusively in the comprehensive UpToDate content library. A key feature is its ability to surface the clinical reasoning of UpToDate’s expert contributors. Select enterprise availability is slated to begin in Q4 2025.
- Best for: Organisations that have standardised on UpToDate and want to leverage generative AI without exposing their queries to the open web.
EBSCO Dyna AI
- What it is: A RAG-based assistant that provides natural-language answers drawn from the DynaMed and DynaMedex knowledge bases. In a significant move, it is now available to individual clinicians, not just institutions.
- Best for: Clinicians and organisations who prefer the content and structure of DynaMed and want a fast, citation-first assistant with a clear "assistive, not autonomous" stance.
Elsevier ClinicalKey AI
- What it is: The generative AI layer for the ClinicalKey platform. Recent expansions include pathways for EHR integration and, crucially, the ability to earn CME/MOC credits directly from in-workflow clinical queries.
- Best for: Organisations within the Elsevier ecosystem who are looking for a tool that combines evidence retrieval with a seamless process for logging professional development.
OpenEvidence
- What it is: A free AI-powered medical reference tool for verified healthcare professionals. Its positioning is built on speed, direct-to-clinician access, and partnerships with major publishers. Recent feature releases include more advanced, "agent-style" capabilities.
- Best for: Cost-sensitive teams and individual clinicians who need a fast, citation-first general medical reference tool.
Glass Health (Glass AI)
- What it is: An AI clinical decision support tool designed specifically for helping clinicians build a differential diagnosis and draft a care plan.
- Best for: Use in differential diagnosis scaffolding and in teaching environments, where its structured reasoning can be a valuable learning aid. Local governance checks are essential before clinical use.
iatroX (UK-centric clinical reference)
- What it is: A UK-focused clinical reference platform. It uses algorithmic search and a RAG-based architecture over a carefully gated corpus of NICE and SIGN guidelines and peer-reviewed research. The Ask iatroX assistant provides citation-first answers, and the platform includes an adaptive Quiz engine and a CPD logging tool.
- Best for: UK clinicians who need rapid, provenance-first look-ups and learning tools that are grounded in national guidance. It is designed to complement global tools by providing the essential local context.
Comparison table
| Product | Corpus & Provenance | GenAI Method | Access Model | Stand-out Feature | Ideal Setting |
|---|---|---|---|---|---|
| UpToDate ExpertAI | Gated (UpToDate only) | Grounded Chat | Enterprise | Contributor Reasoning | UpToDate-standardised orgs |
| Dyna AI | Gated (DynaMed/-ex) | RAG | Enterprise/Individual | Citation-first answers | Users preferring DynaMed content |
| ClinicalKey AI | Gated (Elsevier) | RAG | Enterprise/Trial | Integrated CME credits | Elsevier ecosystem users |
| OpenEvidence | Broad medical lit. | RAG | Free (verified HCPs) | Agent-style features | Cost-sensitive individuals/teams |
| Glass Health | Broad medical lit. | RAG + CDS | Freemium/Paid | DDx & plan scaffolding | Training & education |
| iatroX | Gated (UK guidance/research) | RAG | Free | UK-guideline focus, CPD | UK clinicians & trainees |
Implementation playbook (UK/NHS)
- Start with one high-value clinical pathway where rapid, evidence-based answers are critical. Define time-to-answer and citation-follow-through as your primary metrics.
- Run a short, contained pilot under a clear governance framework. Align your evaluation with the principles of the NICE EVA pathway and plan to publish your learnings to the NHS AI Knowledge Repository.
- Provide clinicians with brief, targeted training on structured prompting and the importance of verifying all AI outputs against the primary sources linked within the tool.
- Make scaling decisions based on hard evidence of retrieval accuracy, citation quality, and measurable improvements in your workflow.
Risks & Mitigations
- Hallucinations / outdated content: Mitigate by choosing tools with gated, curated corpora and a RAG-based, citation-first architecture. Always check the "last-updated" stamps.
- Over-reliance: Mitigate by mandating an "assistive-use" policy where the human clinician is always in the loop and responsible for the final decision.
- Governance drift: Mitigate by using the NICE EVA and the NHS AI Knowledge Repository as the backbone for your documentation, ensuring your local use case stays aligned with national best practice.
FAQs
- What makes UpToDate ExpertAI different?
- It is a generative AI chat assistant that is grounded solely in UpToDate's own curated content, and it is designed to surface the clinical reasoning of its expert contributors. Enterprise availability begins in Q4 2025.
- Can individuals access Dyna AI?
- Yes. In a recent change, EBSCO has made Dyna AI available to individual clinician subscribers; historically, it was an enterprise-only product.
- Is there a free option for AI clinical reference?
- Yes, OpenEvidence offers free access for verified healthcare professionals, and its feature roadmap includes advanced agent-style capabilities. iatroX is also free.
- What’s the best UK-specific choice?
- For clinicians who need answers grounded specifically in UK national guidance from bodies like NICE and SIGN, a UK-centric tool like iatroX is the most direct fit, offering citation-first answers and built-in tools for CPD and learning.