Mobile Clinical Decision Support Systems (CDSSs) represent an increasingly utilized technology to promote clinical guideline use. We sought to explore clinician guideline use and access preferences during implementation of a mobile guideline app at a free-standing children’s hospital integrating 23 guidelines. Surveys included demographic variables and access preferences among anonymous onboarded clinicians in January 2022. Response rate was 21.8% (57/261) among onboarded users, mostly attending (59.6%) and resident/fellow physicians (21.1%) in inpatient (42.1%) and emergency department (31.6%) settings. Onboarded users accessed guidelines on over half of shifts (68.4%) and quickly (80.7%, <1 minute). Overall, most users reported favorable patterns for adoption of mobile CDSSs as useful adjuncts to existing formats. Users reported more ease of access and frequent guideline usage, particularly for younger clinicians. Guidelines related to antibiotic decision-making or newer disease processes were most useful. Further study is needed on electronic health record incorporation, adherence, and patient outcomes.
WennbergJ.Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ. 2002;325:961-964.
2.
NeumanMIHallMHershAL, et al. Influence of hospital guidelines on management of children hospitalized with pneumonia. Pediatrics. 2012;130(5):e823-e830.
3.
McCullohRCommersTWilliamsD, et al. Effect of combined clinical practice guideline and electronic order set implementation on febrile infant evaluation and management. J Pediatr Emerg Med. 2021;37(1):25-31.
4.
SuttonRTPincockDBaumgartDCSadowskiDCFedorakRNKroekerKI.An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit Med. 2020;3:17.
5.
ByingtonCLReynoldsCCKorgenskiK, et al. Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics. 2012;130(1):e16-e24.
6.
HesterGZNickelAJWatsonDSwansonGLaineJCBergmannKR.Improving care and outcomes for pediatric musculoskeletal infections. Pediatrics. 2021;147(2):e20200118.
7.
AchillesJSCastaneda-LovatoJ.A quality improvement initiative to improve the care of infants born exposed to opioids by implementing the Eat, Sleep, Console Assessment tool. Hosp Pediatr. 2019;9(8):624-631.
8.
MenachemiNCollumTH.Benefits and drawbacks of electronic health record systems. Risk Manag Healthc Policy. 2011;4:47-55.
9.
HoweJAdamsKHettingerA, et al. Electronic health record usability issues and potential contribution to patient harm. J Am Med Assoc. 2018;319(12):1276-1278.
10.
QumseyaBGoddardAQumseyaA, et al. Barriers to clinical practice guideline implementation among physicians: a physician survey. Int J Gen Med. 2021;14:7591-7598.
11.
MojaLKwagKHLytrasT, et al. Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. Am J Public Health. 2014;104(12):e12-e22.
12.
HittiEHadidDMelkiJ, et al. Mobile device use among emergency department healthcare professionals: prevalence, utilization and attitudes. Sci Rep. 2021;11:1917.
13.
CastilloRMKimGYWyattKDLohseCMHellmichTR.Use of an EHR-integrated point-of-care mobile medical photography application in a pediatric emergency department. Appl Clin Inform. 2019;10(5):888-897.
14.
SapersteinYOngSAl-BermaniT, et al. COVID-19 guidelines changing faster than the virus: implications of a clinical decision support app. Int J Clin Res Trials. 2020;5(2):1-8.
15.
KernsEMcCullohRFouquetS, et al. Utilization and effects of mobile electronic clinical decision support on pediatric asthma care quality in the emergency department and inpatient setting. JAMIA Open. 2021;4(2):ooab019.
16.
KernsEStaggsVFouquetS, et al. Estimating the impact of deploying an electronic clinical decision support tool as part of a national practice improvement project. J Am Med Inform Assoc. 2019;26(7):630-636.
17.
McCullohRFouquetSHerigonJ, et al. Development and implementation of a mobile device-based pediatric electronic decision support tool as part of a national practice standardization project. J Am Med Inform Assoc. 2018;25(9):1175-1182.
18.
LeeMMahmoodALeeE, et al. Smartphone and mobile app use among physicians in clinical practice: scoping review. JMIR Mhealth Uhealth. 2023;11:e44765.
19.
SasakiNYamaguchiNOkumuraA, et al. Factors affecting the use of clinical practice guidelines by hospital physicians: the interplay of IT infrastructure and physician attitudes. Implement Sci. 2020;15:101.
20.
BirrenbachTKraehenmannSPerrigMBerendonkCHuwendiekS.Physicians’ attitudes toward, use of, and perceived barriers to clinical guidelines: a survey among Swiss physicians. Adv Med Educ Pract. 2016;7:673-680.
21.
BernsteinEBhardwajNPfohERYudelevichE.A nationwide survey of educational resource utilization and perception among internal medicine residents. J Gen Intern Med. 2021;36(6):1598-1604.
22.
ChawlaDThukralAKumarPDeorariA.Harnessing mobile technology to deliver evidence-based maternal-infant care. Semin Fetal Neonatal Med. 2021;26(1):101206.
23.
RichardsonKMFouquetSDKernsEMcCullohRJ.Impact of mobile device-based clinical decision support tool on guideline adherence and mental workload. Acad Pediatr. 2019;19(7):828-834.
24.
KhairatSMarcDCrosbyW, et al. Reason for physicians not adopting clinical decision support systems: critical analysis. JMIR Med Inform. 2018;6(2):1-10.
25.
LiberatiERuggieroFGaluppoL, et al. What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation. Implementation Science. 2017;12(1):113.
26.
ShahSYeheskelAHossainA, et al. The impact of guideline integration into electronic medical records on outcomes for patients with diabetes: a systematic review. Am J Med. 2021;134(8):952-962.
27.
FrostHMLouYKeithAByarsAJenkinsTC.Increasing guideline-concordant durations of antibiotic therapy for acute otitis media. J Pediatr. 2022;240:221-227.
28.
BiezenRRobertsCBuisingK, et al. How do general practitioners access guidelines and utilize electronic medical records to make clinical decisions on antibiotic use? Results from an Australian qualitative study. BMJ Open. 2019;9(8):e028329.
