How a medical student partnered with a hospital to create an evidence based guideline app

Although pediatric community-acquired pneumonia (CAP) is an admittedly narrow topic, we take a look at the CAP Guideline App today because of how it was developed — by a medical student in conjunction with a teaching hospital.

While many of the apps we review are created by established developers and/or groups of physicians, this app is interesting in that a medical student took the initiative to create it and enlisted the help of a hospital in its development, perhaps revealing a model for enthusiastic medical students to contribute to the growing medical app landscape.

Josh Herigon, a second-year medical student at the University of Kansas School of Medicine, with a degree from the Boston University School of Public Health, and a background of health services research, created the free CAP Guideline App.

Josh saw that a team of pediatric health care providers led by Dr. Jason Newland at Children’s Mercy Hospital in Kansas City, MO, had established guidelines for the management of pediatric CAP in 2007 and placed them on the hospital website. What Josh sought to do was make these guidelines more accessible to users by creating an interactive app for mobile devices that included these guidelines. Josh worked with Dr. Newland throughout the development process, earning the endorsement of Children’s Mercy for the app, which was released March 2011.

As for the app itself, it opens with a disclaimer from Children’s Mercy before launching into the home screen. The home screen offers two options– going directly to the guidelines, or a “quickguide” on antibiotic therapy options.

A disclaimer listing patients who the guideline should NOT be used for (children <2 months old, hospital-acquired PNA, immunocompromise, significant co-morbidities) is displayed before the guidelines are reached.

The guidelines begin when the clinical exam suggests possible community acquired pneumonia. Throughout the guidelines, the blue shapes may be clicked on for more in-depth information. Clicking on the initial blue box displays a page detailing etiology, epidemiology, and then the history and physical assessment for pediatric CAP.

Further blue boxes explain the diagnostics associated with CAP, particularly radiology and laboratory tests.

The next major decision point lies with whether the child should be hospitalized– and the app provides a local expert consensus for criteria for hospital admission.

From this point forward, users can follow the flow chart for inpatient management, focusing on whether the patient has an effusion (complicated inpatient management) and eventually leading to discharge planning criteria with clinical improvement.

Alternatively, users can display information related to ambulatory management of CAP for those children who do NOT meet criteria for hospitalization. This information includes different antibiotics for outpatient treatment of CAP, including the dosing and estimated cost for a course of the selected antibiotic therapy.

The “quickguide” for antibiotic options offers options for ambulatory management, uncomplicated inpatient management, and complicated inpatient management (complicated when patients have focal consolidations on CXR with significant pleural effusions).

As you can see here, these options include information related to the dosing and estimated cost of a course of antibiotic therapy.

Although the references are not cited within the app, the original webpage includes a bibligraphy

As reviewed here, the CAP Guideline app, while well-designed, does have an undoubtedly narrow scope of content. It is probably best used by medical students on their pediatric clerkships, family medicine doctors, or emergency physicians, as most pediatricians are probably very well-versed and comfortable with the management of pediatric CAP.

However, we are impressed by how this app was developed– a medical student saw an opportunity to make a set of hospital-developed, evidence-based guidelines more accessible to users, and worked with a teaching hospital to develop an app to meet these goals.

Likes:

- Free, evidence-based, and supported by a teaching hospital
- User interface in the form of flow chart algorithms is easy to use and follow
- Development– the concept of a medical student working with a hospital lays the groundwork for another avenue of future app development

Dislikes:

- Narrow scope limited to pediatric CAP
- Basic level of information may not be useful to most practicing pediatricians (If they app updates guidelines as they change, it could offer extended utility).

Summary:

This app provides solid evidence-based clinical practice guidelines for the management of community-acquired pneumonia for children in an easy-to-follow user interface via interactive algorithms. Although its scope is limited to pediatric CAP, we applaud Josh, Dr. Newland, and Children’s Mercy Hospital for this model of app development– medical students working with a teaching hospitals to develop free medical apps have the potential to significantly increase the breadth and diversity of medical applications available for mobile devices, as medical students are often among the most tech-savvy, evidence-obsessed, and enthusiastic health care providers in our system.

In this manner, we encourage medical students who have ideas for medical apps to work with their local teaching hospitals to develop free programs to enhance the delivery of health care.

iTunes Link to CAP Guideline