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● Smartphones

No Internet?

No problem Ensuring access to clinical decision support even when Internet is spotty or nonexistent. By Denise Basow, M.D.


tudies have found that two out of three clinical encounters generate a question, yet only 40 percent of those questions are answered. If they were all addressed, it could change up to eight management

decisions each day – a clinically signifi cant impact. T is can prove challenging, however, for clinicians provid- ing medical care in resource-limited settings where medical staff frequently practices with inadequate access to colleagues who possess specialized training or resources. In these locales, a single clinician may act as internist, obstetrician, pediatrician and surgeon, and frequently do so with insuffi cient information resources to eff ectively address the broad range of health issues aff ecting patient care or the guidance needed from specialist colleagues. In addition to user-support challenges, access barriers are

prevalent in these areas. Internet connectivity is unreliable, and many hospitals do not have computer access on the wards. For clinicians in these settings, a mobile phone is often their only connection to clinical decision-support (CDS) resources. Indeed, smartphones have quickly become the primary

means by which individuals are accessing the Internet. Ac- cording to a 2011 Pew Internet Project report, 25 percent of smartphone owners go online primarily using their phone, approximately one-third of who have no high-speed home broadband connection. For clinicians, this problem extends beyond their homes and into the hospital setting, as well. With the explosion in the growth of mobile devices, health-

care practitioners are like any other consumers looking for new and improved ways to manage their lives and the lives of their patients online. As such, clinicians are increasingly reliant on a growing number of so-called mHealth applications to access critical clinical support at the bedside. When they lose the

20 August 2013

Denise Basow, M.D., is vice president, general manager and editor-in- chief, clinical decision support (UpToDate). For more on Wolters Kluwer: www.rsleads. com/308ht-209

wireless or network access their mobile apps require, however, there can be a direct impact on the quality of care they provide. For clinicians in the typical U.S. hospital, that loss of connectivity is an occasional frustration. For clinicians in resource-limited settings, it is a daily struggle. To mitigate this challenge, clinical decision-support apps that off er full access to locally stored clinical content are invaluable, and can even be lifesaving. To ensure users are accessing the most current information, the best apps will routinely verify and update requested content when connections are available. Research published in the Global Public Health Journal

supports this. T e study surveyed participants in the Global Health Initiative, a partnership between Wolters Kluwer Health and the Global Health Delivery (GHD) Project at Harvard University. T e descriptive research study suggests that providing evidence-based medical information resources via the Internet can improve healthcare provider knowledge and clinical practice.

Consider the experiences of Dr. Eda Kim, a physician with

Mercy Medical Center in Cambodia, who shared the following in a community forum for Global Health Initiative grant re- cipients on “We use (evidence-based support tools) so often for clinical care. Just this week I had to fi gure out when we could stop lamuvidine therapy for a patient with Hepatitis B who had been started on lamuvidine monotherapy. T e mobile application has been great for blackouts and for trips to the villages when I don’t have Internet access.” My favorite story comes from a physician in Ecuador. T e

doctor wrote us to share how using our CDS app on his mobile device was making a diff erence. He mentioned how it was dif- fi cult to think about carrying textbooks and other reference materials when you’re worried about carrying around water and


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