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medicine as you visit patients. Nients. Now, he has his water in one hand, medication in the other and all of the r


the CDS app are on his mobile phone, tucked away in his pocket.


At Maputo Central Hospital in Mozambique, the staff uses a CDS app at the bedside to make clinical decisions. Even without networ connectivity, clinicians are stillare still able to access all clinical informa- tion, graded treatment recom- mendations and even graphics to support care-management decisions.


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Dr. Susannah Graves, who works at Maputo Central Hospital, explained in the forum: “We use clinical decision-support tools in the medicine department library, and on handheld devices on the ward. We look up information at the bedside when a clini- cal question comes up. T is has recently become much easier to do since


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installing the offl ine version of the app on the handheld devices since the Internet her slow (when it is working at all).”


sion of the app since the Internet here is extremely emely


In the United States, the Society for General Internal Medi- cine (SGIM) awards a one-year UpToDate subscription to up to 20 clinicians working in resource-limited settings around the country. To date, dozens of subscriptions have been donated to clinicians and organizations that provide medical care or related services to poor or underserved populations in the U.S. One such recipient, Dr. Robert Moon, board certifi ed in internal medicine and geriatrics, appreciates having remote access to clinical decision-support tools in his work caring for the homeless and uninsured across multiple community clinics in California, as well as in mission work overseas.


“Whether I’m practicing in my local community or in Ke-


nya or even Tijuana, the main benefi t of being able to access historical and current medical advice and information is mak- ing the most of what I’m given in any situation,” says Moon. “Not only can I refresh my memory on signs of advanced disease, but I can access details on regional medicine and what is available in the area I’m working in.” Dr. Moon values having “anytime access” to advice on conservative medicine and non-drug methods for treating


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At the Harvard Medical School AIDS Initiative in Vietnam (HAIVN), an international NGO with offi ces in Ho Chi Minh City and Hanoi, Vietnam, staff access to clinical decision-support tools was previously limited to times when they could access both desktop computers and a reliable Internet connection. Lately, however, they have begun turning to tools on their mobile devices. T is proves particularly useful on rounds and when providing clinical


used and receiving localized recom- mendations in real time, no matter where where I am.” t


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mentoring at HIV clinics in the remote provinces. In the GHDonline.org community, Dr. Donn Colby, medical offi cer and director of HAIVN, wrote that the avail- ability of clinical decision-support tools on mobile devices has greatly improved the accessibility for staff in Vietnam where 3G service is now available in most provinces except for very remote mountain areas and only costs a few dollars per month. Staff is able to access clinical decision-support tools while providing on-site clinical mentoring at provincial HIV clinics, making expert consultation immediately available to clinicians and patients. Healthcare costs represent an increasing percentage of


gross domestic product for many countries, and it’s growing. T is rising trend has created an urgent need to put in place innovative and cost-eff ective methods for delivering healthcare, especially in areas where funding is scarce. While presenting great opportunities for healthcare systems, mHealth or mobile healthcare still faces several hurdles before there can be full adoption. Access to evidence-based support tools on mobile devices, even in areas of limited or no connectivity, is one place to start.


HMT HEALTH MANAGEMENT TECHNOLOGY August 2013 21


anything from insomnia to muscular pain, details he says he learned in medical school but hasn’t had to put into prac- tice because of more modern methods. Still, the modern way isn’t always the practical way. “I work in a mobile medical unit and with community clin- ics, where the medicines we have access to are extremely limited,” he says. “I have a short list of medica- tions that are only $4, which only covers a fraction of the medical problems my patients present with. I like knolike k used


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wing what’s historically been


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