Development and implementation of a mobile device-based pediatric electronic decision support tool as part of a national practice standardization project
Open accessAbstract
Objective: Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project. Materials and Methods: We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled “Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE).” The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics. Results: Overall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5]. Discussion: We observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects. Conclusions: ECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools’ impact on medical decision making, clinical practice, and health outcomes.
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ECDS tools are one way to disseminate CPGs on a large scale, as evidenced by the deployment of PedsGuide in a national standardization project.
“ECDS tools are one such way to disseminate CPGs on a large scale, as evidenced by the recent deployment of PedsGuide in a national standardization project.21”
From Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload (2019) · cites this paper as [21]
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Cites
User Acceptance of Information Technology: Toward A Unified View1
Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D. (2003) · MIS Quarterly · doi:10.2307/30036540 · Cited by 45,035 · see citing works
Kawamoto, K., Houlihan, C. A., Balas, E. A., & Lobach, D. F. (2005) · BMJ · doi:10.1136/bmj.38398.500764.8f · Cited by 2,703 · see citing works
The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview
Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., McKinstry, B., Procter, R., Majeed, A., & Sheikh, A. (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1000387 · Cited by 1,442 · see citing works
A roadmap for national action on clinical decision support
Osheroff, J. A., Teich, J. M., Middleton, B., Steen, E. B., Wright, A., & Detmer, D. E. (2007) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2334 · Cited by 707 · see citing works
Cresswell, K., & Sheikh, A. (2013) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2012.10.007 · Cited by 690 · see citing works
Grand challenges in clinical decision support
Sittig, D. F., Wright, A., Osheroff, J. A., Middleton, B., Teich, J. M., Ash, J. S., Campbell, E., & Bates, D. W. (2008) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2007.09.003 · Cited by 582 · see citing works
The usability engineering life cycle
Nielsen, J. (1992) · Computer · doi:10.1109/2.121503 · Cited by 581 · see citing works
Base-rate respect: From ecological rationality to dual processes
Barbey, A. K., & Sloman, S. A. (2007) · Behavioral and Brain Sciences · doi:10.1017/s0140525x07001653 · Cited by 409 · see citing works
Moja, L., Kwag, K. H., Lytras, T., Bertizzolo, L., Brandt, L., Pecoraro, V. L., Rigon, G., Vaona, A., Ruggiero, F. M., Mangia, M., et al. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.302164 · Cited by 341 · see citing works
Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments
Aronson, P. L., Thurm, C. W., Alpern, E. R., Alessandrini, E. A., Williams, D. J., Shah, S. S., Nigrovic, L. E., McCulloh, R. J., Schondelmeyer, A. C., Tieder, J. S., et al. (2014) · PEDIATRICS · doi:10.1542/peds.2014-1382 · Cited by 235 · see citing works
Self-citationPaul, M., Andreassen, S., Tacconelli, E., Nielsen, A. D., Almanasreh, N., Frank, U., Cauda, R., & Leibovici, L. (2006) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkl372 · Cited by 214 · see citing works
Association between an Internet-Based Measure of Area Racism and Black Mortality
Chae, D. H., Clouston, S., Hatzenbuehler, M. L., Kramer, M. R., Cooper, H. L. F., Wilson, S., Stephens-Davidowitz, S. I., Gold, R. S., & Link, B. G. (2015) · PLoS ONE · doi:10.1371/journal.pone.0122963 · Cited by 189 · see citing works
Lindquist, A., Johansson, P. E., Petersson, G., Saveman, B., & Nilsson, G. C. (2008) · Journal of Medical Internet Research · doi:10.2196/jmir.1038 · Cited by 174 · see citing works
Electronic Health Record–Based Decision Support to Improve Asthma Care: A Cluster-Randomized Trial
Bell, L. M., Grundmeier, R. W., Localio, R. A., Zorc, J. J., Fiks, A. G., Zhang, X., Stephens, T. B., Swietlik, M., & Guevara, J. P. (2010) · PEDIATRICS · doi:10.1542/peds.2009-1385 · Cited by 144 · see citing works
Blocks, Ovals, or People? Icon Type Affects Risk Perceptions and Recall of Pictographs
Zikmund‐Fisher, B. J., Witteman, H. O., Dickson, M., Fuhrel-Forbis, A., Kahn, V. C., Exe, N. L., Valerio, M. A., Holtzman, L. G., Scherer, L. D., & Fagerlin, A. (2013) · Medical Decision Making · doi:10.1177/0272989x13511706 · Cited by 143 · see citing works
A Multicenter Collaborative to Reduce Unnecessary Care in Inpatient Bronchiolitis
Ralston, S. L., Garber, M. D., Rice‐Conboy, E., Mussman, G. M., Shadman, K. A., Walley, S. C., & Nichols, E. L. (2015) · PEDIATRICS · doi:10.1542/peds.2015-0851 · Cited by 139 · see citing works
Sirajuddin, A. M., Osheroff, J. A., Sittig, D. F., Chuo, J., Velasco, F. T., & Collins, D. A. (2009) · PubMed · Cited by 131 · see citing works
Eliminating Health Care Disparities With Mandatory Clinical Decision Support
Lau, B. D., Haider, A. H., Streiff, M. B., Lehmann, C. U., Kraus, P. S., Hobson, D. B., Kraenzlin, F. S., Zeidan, A. M., Pronovost, P. J., & Haut, E. R. (2014) · Medical Care · doi:10.1097/mlr.0000000000000251 · Cited by 113 · see citing works
Ralston, S. L., Garber, M. D., Narang, S., et al. (2012) · Journal of Hospital Medicine · doi:10.1002/jhm.1982 · Cited by 100 · see citing works
Putzer, G. J., & Park, Y. (2012) · PubMed · Cited by 87 · see citing works
The effects of innovation factors on smartphone adoption among nurses in community hospitals.
Putzer, G. J., & Park, Y. (2010) · PubMed Central · Cited by 83 · see citing works
Diagnosis and management of febrile infants (0-3 months).
Hui, C. P., Neto, G. M., Tsertsvadze, A., Yazdi, F., Tricco, A. C., Tsouros, S., Skidmore, B., & Daniel, R. (2012) · PubMed Central · Cited by 79 · see citing works
Aronson, P. L., Thurm, C., Williams, D. J., Nigrovic, L. E., Alpern, E. R., Tieder, J. S., Shah, S. S., McCulloh, R. J., Balamuth, F., Schondelmeyer, A. C., et al. (2015) · Journal of Hospital Medicine · doi:10.1002/jhm.2329 · Cited by 75 · see citing works
Self-citationCharani, E., Gharbi, M., Moore, L. S. P., Castro‐Sánchez, E., Lawson, W., Gilchrist, M. J., & Holmes, A. H. (2017) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkx040 · Cited by 57 · see citing works
Dexheimer, J. W., Abramo, T. J., Arnold, D. H., Johnson, K. B., Shyr, Y., Ye, F., Fan, K.-H., Patel, N., & Aronsky, D. (2014) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2014.07.008 · Cited by 56 · see citing works
A Multicenter Collaborative to Improve Care of Community Acquired Pneumonia in Hospitalized Children
Parikh, K., Biondi, E., Nazif, J. M., et al. (2017) · PEDIATRICS · doi:10.1542/peds.2016-1411 · Cited by 51 · see citing works
Self-citationHeidenreich, P. A., Gholami, P., Sahay, A. P., Massie, B. M., & Goldstein, M. K. (2007) · Circulation · doi:10.1161/circulationaha.106.684753 · Cited by 49 · see citing works
Use of Smartphones in Hospitals
Thomairy, N. A., Mummaneni, M., Alsalamah, S., Moussa, N., & Coustasse, A. (2015) · The Health Care Manager · doi:10.1097/hcm.0000000000000080 · Cited by 49 · see citing works
Nuss, M. A., Hill, J. R., Cervero, R. M., Gaines, J. K., & Middendorf, B. F. (2014) · Journal of Community Hospital Internal Medicine Perspectives · doi:10.3402/jchimp.v4.25184 · Cited by 46 · see citing works
Facing the ongoing challenge of the febrile young infant
DePorre, A. G., Aronson, P. L., & McCulloh, R. J. (2017) · Critical Care · doi:10.1186/s13054-017-1646-9 · Cited by 44 · see citing works
Self-citationAsh, J. S., McCormack, J. L., Sittig, D. F., Wright, A., McMullen, C., & Bates, D. W. (2012) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000705 · Cited by 41 · see citing works
Attitudes and Behaviours to Antimicrobial Prescribing following Introduction of a Smartphone App
Panesar, P., Jones, A., Aldous, A., et al. (2016) · PLoS ONE · doi:10.1371/journal.pone.0154202 · Cited by 41 · see citing works
Does Clinical Presentation Explain Practice Variability in the Treatment of Febrile Infants?
Bergman, D. A., Mayer, M. L., Pantell, R. H., et al. (2006) · PEDIATRICS · doi:10.1542/peds.2005-0947 · Cited by 38 · see citing works
Lumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study
Scarfone, R. J., Murray, A. L., Gala, P. K., & Balamuth, F. (2017) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2017.04.003 · Cited by 38 · see citing works
Impact of Electronic Health Record Clinical Decision Support on the Management of Pediatric Obesity
Shaikh, U., Berrong, J., Nettiksimmons, J., & Byrd, R. S. (2014) · American Journal of Medical Quality · doi:10.1177/1062860613517926 · Cited by 35 · see citing works
Numeracy Among Trainees: Are We Preparing Physicians for Evidence-Based Medicine?
Johnson, T. V., Abbasi, A. A., Schoenberg, E. D., et al. (2014) · Journal of surgical education · doi:10.1016/j.jsurg.2013.07.013 · Cited by 32 · see citing works
Kreuzmair, C., Siegrist, M., & Keller, C. (2016) · Risk Analysis · doi:10.1111/risa.12623 · Cited by 32 · see citing works
Burgess, K. A., Atkinson, K. M., Westeinde, J., Crowcroft, N. S., Deeks, S. L., & Wilson, K. R. (2016) · Journal of Public Health · doi:10.1093/pubmed/fdw032 · Cited by 31 · see citing works
Khan, S., MacLean, C. D., & Littenberg, B. (2010) · Health Outcomes Research in Medicine · doi:10.1016/j.ehrm.2010.03.002 · Cited by 26 · see citing works
Gupta, R. K., & McEvoy, M. D. (2016) · Regional Anesthesia & Pain Medicine · doi:10.1097/aap.0000000000000391 · Cited by 19 · see citing works
Hendrickson, M. A., Wey, A. R., Gaillard, P. R., et al. (2017) · Pediatric Emergency Care · doi:10.1097/pec.0000000000001069 · Cited by 18 · see citing works
Palma, J. P., & Arain, Y. H. (2016) · Clinics in Perinatology · doi:10.1016/j.clp.2016.01.009 · Cited by 15 · see citing works
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Research works printed but not linked: 1
- [32]Herigon J, McCulloh R, Newland J. Development of a smartphone-based physician decision tool for common pediatric infectious conditions.Infectious Diseases Society of America Annual Conference; 2014; Philadelphia, PA.
Cited by
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Richardson, K. M., Fouquet, S. D., Kerns, E., & McCulloh, R. J. (2019) · Academic Pediatrics · doi:10.1016/j.acap.2019.03.001 · Cited by 32 · see citing works
Self-citation
- Authors
- McCulloh, R. J., Fouquet, S. D., Herigon, J., Biondi, E. A., Kennedy, B., Kerns, E., DePorre, A., Markham, J. L., Chan, Y. R., Nelson, K., & Newland, J. G.
- Affiliations
- Children's Mercy Hospital (US)
- Boston Children's Hospital (US)
- Johns Hopkins University (US)
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri, USA
- Corresponding author
- McCulloh, Russell J
- ORCID
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-06-07
- Volume
- 25
- Issue
- 9
- Pages
- 1175-1182
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC6118866
- OpenAlex
- W2806887867
- Cited by
- 36
- References
- 42
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 8 · 2020: 5 · 2019: 9
- FWCI
- 6.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of the American Medical Informatics Association (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, cc-by-nc)
- Funders
- Kansas City Area Life Sciences Institute
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- electronic clinical decision support, mobile health, mobile application, pediatric sepsis, standardization of practice, evidence-based practice adoption, length of hospital stay, diagnostic testing recommendations, usability, user engagement
- MeSH terms
- Smartphone, Humans, Infant, Pediatrics, United States, Practice Guidelines as Topic, Sepsis, Guideline Adherence, Decision Support Systems, Clinical, Information Dissemination, Evidence-Based Practice, Mobile Applications
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