By Dr Mayank Priyadarshi, Dr Rajesh Mehta and Dr Ashok Deorari
Globally, of the estimated 5.9 million under-5 deaths in 2015, almost 1 million occurred on the first day and nearly 2 million during the first week, highlighting the need for coverage of good-quality care for newborns (1). There has been enormous pressure on the healthcare system to improve the quality of care being provided to ensure the best health outcomes while keeping a check on costs. Ongoing education of health care professionals and provision of evidence-based standard treatment protocols (STPs) are vital to improve quality of care and patient safety. There is also a need to train large number of healthcare providers spread over vast geographical areas without taking them away from their workplace for long durations. This necessitates exploration of cost-effective alternative forms of education and training. Digital technology such as smartphone-based solutions is a relatively low-cost way of providing reliable and technically sound healthcare information and knowledge that can help improve neonatal health outcomes. The ubiquity of smartphone access now offers a platform that can be leveraged for a variety of interventions, including enhancing knowledge of healthcare providers for best neonatal healthcare practices.
Why a smartphone app?
Five years ago, the need for readily available STPs was expressed by undergraduate medical students who were posted in community hospitals as part of compulsory training during internship. Often faced with the need to assess and manage sick neonates, medical graduates felt helpless without readily available case management tips or a senior professional to help them. In 2012/13, AIIMS-WHO CC, supported by WHO SEARO, through a process of peer review among neonatologists in the region, consolidated WHO guidelines in the format of STPs for the management of common newborn conditions in small hospitals (2). The objective was to provide the healthcare providers with a job aid to enable them to follow a step-by-step approach to assess neonates and treat them appropriately or refer. In order to make these STPs more usable, undergraduate students took the initiative to convert the STPs into a smartphone app, which was released in February 2014.
Features of AIIMS WHO CC STP app
The AIIMS-WHO CC STP app provides a stepwise, evidence-based approach to management of sick neonates in emergency room and the treatment of common conditions following initial stabilization. The app helps users in practicing rational and recommended newborn care, including calculation of IV fluid volumes and medication preparation. The app, in addition to being user-friendly, has the advantage of easy, immediate availability as a point-of-care tool, and gives an opportunity for users to learn and practice skills related to clinical procedures and use of essential equipment. It is also possible for users to do a self-assessment through multiple-choice questions that are also provided.
Need for revised version
The platform for apps has changed in the last five years, with technology upgrades in both Android and iOS software. Thus the app needed to be upgraded. Recently Reaching the Every Newborn National 2020 Milestones: WHO reported smartphone apps as an innovation for service delivery to disseminate best practices (3). Updating and adding value to previous versions should enhance coverage and utilization of this innovative tool.
What is new in this version?
The new version launched in September 2017 on both Android and iOS platforms with two key changes: first, the contents reflect new evidence, and second, small clips of videos and key steps for clinical case management have been added. The design has been made more user-friendly with a better display. Evaluation of sick newborns is made easier using the IMCI approach of ask-look-listen-feel to categorize problems and manage stepwise after initial stabilization. Entire algorithms are appended in the appendix as a PDF for reference or to make wall charts. An interesting section – the clinical Image challenge (a quiz) has been added. This is updated every two weeks and will keep app users engaged.
What advantage does the app have over e-books or textbooks?
The revision of a textbook is laborious and takes a long time before a successive is published. If mistakes crop in, one must wait for next edition to make corrections. On the other hand, app updates can be released in quick cycles and deployed very rapidly. Apps are cost effective, paperless, and can reach far and remote areas crossing country boundaries in a short time.
Evidence that apps enhance learning
Apps are useful tools for continuing education and as a supplement to preservice education. The training of physicians working in special newborn care units in district hospitals using the AIIMS-WHO CC STPs led to an improvement in knowledge and skills. Trainees expressed confidence that the app could be used as a job aid to improve clinical practices in managing common newborn conditions (4).The efficacy and acceptability of the app have been evaluated among nursing college students (5). In light of these studies, and increasing usage of mobile devices, this may serve as a simple, bedside tool for improving clinical practices, and as a refresher tool for continuing education of healthcare professionals.
Future of smartphone apps
With artificial intelligence transforming the way we work, there is scope for the app to be to updated to give feedback or debriefing to a health care provider during and after actual case management. Additional features which could be introduced include tracking cases, keeping logbook of trainees and healthcare providers, and linking with accountability and remuneration to healthcare providers.
Competing interests
The authors declare that they have no competing interests. The AIIMS-WHO CC STPs app was developed by the team at the AIIMS, and Dr. Ashok Deorari is listed as the author of the app. The app is freely downloadable from Google Play and iTune Apple stores.
Acknowledgments
We would like to express our thanks to Dr Neena Raina Coordinator, Health through the Life Course, and WHO SEARO for technical support and guidance.
References
- Levels and trends in child mortality 2015 . A report by WHO
- As assessed on 16 Sept 2017 from http://www.newbornwhocc.org/STPs/STANDARD-TREATMENT-PROTOCOL.pdf
- Reaching the Every Newborn National 2020 Milestones Country progress, plans and moving forward Geneva: World Health Organization. WHO, UNICEF report 2017.
- Prakash V, Thukral A, Sankar MJ, Agarwal R, Paul VK, Deorari AK. Efficacy and acceptability of an “App on sick newborn care” in physicians from newborn units. BMC Med Educ. 2016;16:84-92.
- Thukral A, Joshi M, Joshi P, Prakash V, Adkoli BV, Deorari AK. Apps for management of sick newborn: evaluation of impact on health care professionals. J Trop Pediatrics. 2014;60:370–376.