Executive summary
In 2025, the market for clinical decision support and point-of-care reference tools is more dynamic than ever. The major incumbents have all launched powerful generative AI assistants, signalling a fundamental shift from keyword search to conversational, provenance-first answers. EBSCO's DynaMed, now enhanced with Dyna AI and Micromedex drug content, has been recognised as a leader in point-of-care disease reference. This comes as its primary rival, UpToDate, has launched its own UpToDate Expert AI, grounding generative AI answers in its deep editorial content.
Alongside these global giants, Elsevier's ClinicalKey AI is expanding its EHR integrations, while BMJ Best Practice remains a UK favourite, particularly for managing multimorbidity. For UK clinicians, the free national primary care summaries from NICE CKS provide an essential baseline. In this complex landscape, UK-centric AI assistants like iatroX are finding their place, offering a free, citation-first "front door" to UK-accepted guidance with tools like Ask iatroX and the iatroX Brainstorm feature, designed to complement the deep content of the major paid reference platforms.
What matters in 2025: selection criteria
When evaluating a modern clinical reference tool, consider these key criteria:
- Content model & depth: Is it a concise, bullet-point summary or a deep, narrative review?
- Evidence handling: Does it use formal evidence grading and maintain transparency?
- AI assistance: Does it offer a generative AI layer? Is that AI grounded in a curated corpus and does it provide citations?
- Drugs & interactions: Is drug information native to the platform or integrated via a partner?
- UK fit: Does it align with NICE guidance and the practical, primary-care focus of CKS?
- UX & integration: How good is the mobile app? Does it offer EHR integration and offline access?
- Cost & licensing: Is it an individual or enterprise subscription? Is there a free or nationally-funded access route?
Snapshot profiles (what each platform is optimised for)
- DynaMed / DynaMedex: Known for its concise, "bullet-first" topics with explicit Levels of Evidence. The DynaMedex bundle merges this with Micromedex drug content and adds the Dyna AI generative assistant for conversational answers.
- UpToDate: The global standard for comprehensive, narrative reviews with graded recommendations, written by a huge network of clinical experts. Its UpToDate Expert AI was launched in 2025.
- BMJ Best Practice: A workflow-oriented tool with step-by-step guidance. Its standout feature is the Comorbidities Manager, which helps tailor treatment plans for patients with multimorbidity.
- ClinicalKey AI: The conversational AI layer over Elsevier’s vast library of textbooks and journals, with a growing focus on EHR integration and capturing CME/MOC credits from clinical queries.
- NICE CKS: The free-to-access UK resource providing over 370 primary-care-focused summaries, which are continually reviewed and updated.
- iatroX: A free, UK-centric clinical co-pilot. Ask iatroX provides fast, cited answers to help you navigate to UK-accepted guidance, while iatroX Brainstorm is an educational tool for structuring differential diagnoses.
Evidence and accuracy: who grades what (and how)
- DynaMed: Provides explicit Levels of Evidence and Grades of Recommendation for its content.
- UpToDate: Uses a well-established system of graded recommendations, with transparent authorship and peer review for all its topics.
- BMJ Best Practice: Emphasises its daily update cycle and has a publicly available portfolio of studies on its effectiveness.
- Comparative studies: It's important to note that independent academic work has found DynaMed to be non-inferior to UpToDate for both accuracy and speed in answering simulated clinical questions, suggesting both are high-quality choices (PMC).
The 2025 AI layer (what “gen-AI” really adds)
- Dyna AI (EBSCO): Now available across the DynaMedex suite, with enterprise rollouts beginning in 2024–25.
- UpToDate Expert AI (Wolters Kluwer): Launched in late 2025, offering evidence-grounded responses from its proprietary editorial corpus.
- ClinicalKey AI (Elsevier): Launched in 2024 and expanded its integrations throughout 2025.
- iatroX: Uses a retrieval-augmented generation (RAG) architecture over a library of UK-accepted guidance and peer-reviewed research to return citation-first answers. Its Brainstorm feature is designed to widen differentials with a UK context.
UK-specific fit
For UK clinicians, NICE CKS provides the essential, free primary care baseline. BMJ Best Practice is often preferred for managing complex patients due to its unique Comorbidities Manager. A UK-centric tool like iatroX can act as a bridge, helping you to quickly find relevant UK guidance from national bodies like NICE and SIGN, which can then inform your deeper reading in one of the major paid databases.
Head-to-head: quick comparison table
| Dimension | DynaMed/DynaMedex | UpToDate | BMJ Best Practice | ClinicalKey AI | NICE CKS | iatroX (Ask / Brainstorm) |
|---|---|---|---|---|---|---|
| Content Style | Concise, bullet-first | Narrative, encyclopaedic | Stepwise, care pathways | Conversational | UK primary care summaries | Q&A + differentials |
| Evidence Grading | Levels + Grades | Graded recs | Methodology + studies | Varies by source | Summary guidance | Citations to UK sources |
| AI Layer | Dyna AI | Expert AI | — | ClinicalKey AI | — | Retrieval-grounded Q&A |
| Drugs Database | Micromedex | Lexidrug/links | Connectable DB | Elsevier drug refs | Links to BNF | Complements BNF workflows |
| UK Fit | Neutral/Global | Neutral/Global | Strong (multimorbidity) | Neutral/Global | UK-specific | UK-specific |
Which to choose? Scenario-based recommendations
- “I need a quick, graded answer and deep drug information.” Start with DynaMedex. You can sense-check this with a quick query in iatroX for any UK-specific guideline snippets.
- “I want the full narrative and pathophysiology of a condition.” Go to an UpToDate article. You can use its Expert AI for a fast summary, then check for any specific UK policy nuances via iatroX or the NICE website.
- “My patient has multiple long-term conditions.” The BMJ Best Practice Comorbidities Manager is purpose-built for this task.
- “I need textbook depth or a specific visual.” ClinicalKey AI is best for searching across Elsevier’s book and journal content.
- “I need a free, UK-centric lookup or a differential safety net.” Start with Ask iatroX or iatroX Brainstorm. You can then escalate to a paid database if a deeper appraisal is required.
FAQs
- Is DynaMed “better” than UpToDate?
- The evidence from independent studies suggests they are comparable in terms of accuracy and speed. The best choice often comes down to user preference for content style (concise vs. narrative), the depth of the drug database, and your preference for their new AI assistants.
- What’s unique about BMJ Best Practice?
- Its Comorbidities Manager, which is designed to help clinicians create tailored treatment plans for patients with multiple long-term conditions.
- Do these tools have AI now?
- Yes. Dyna AI, UpToDate Expert AI, and ClinicalKey AI all launched or expanded significantly during 2024–25.
- Where does iatroX fit in this landscape?
- It acts as a free, UK-centric layer that provides fast, cited answers and a "brainstorming" tool for differentials. It is designed to be used alongside your main reference database to provide specific UK context.