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Abstract
Background The rapid global adoption of mobile health (mHealth) smartphone apps by healthcare providers presents challenges and opportunities in medicine. Challenges include ensuring the delivery of high-quality, up-to-date and optimised information. Opportunities include the ability to study global practice patterns, access to medical and surgical care and continuing medical education needs.
Methods We studied users of a free anaesthesia calculator app used worldwide. We combined traditional app analytics with in-app surveys to collect user demographics and feedback.
Results 31 173 subjects participated. Users were from 206 countries and represented a spectrum of healthcare provider roles. Low-income country users had greater rates of app use (p<0.001) and ascribed greater importance of the app to their practice (p<0.001). Physicians from low-income countries were more likely to adopt the app (p<0.001). The app was used primarily for paediatric patients. The app was used around the clock, peaking during times typical for first start cases.
Conclusions This mHealth app is a valuable decision support tool for global healthcare providers, particularly those in more resource-limited settings and with less training. App adoption and use may provide a mechanism for measuring longitudinal changes in access to surgical care and engaging providers in resource-limited settings. In-app surveys and app analytics provide a window into healthcare provider behaviour at a breadth and level of detail previously impossible to achieve. Given the potentially immense value of crowdsourced information, healthcare providers should be encouraged to participate in these types of studies.
- mHealth
- analytics
- global health
- anesthesiology
- practice patterns
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Footnotes
Contributors VO-S designed data collection tools, monitored data collection for the whole trial, wrote the statistical analysis plan, cleaned and analysed the data and drafted and revised the paper. He is guarantor. GE analysed the data, contributed to the statistical analysis plan and revised the paper. SG contributed to the statistical analysis plan, analysed the data and revised the paper.
Competing interests All authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. The app was initially released in 2011 by VO-S with advertising in the free version and a paid companion app to remove the ads. The app intellectual property was transferred to Emory University in 2015, and advertisements were subsequently removed, and the companion app to remove ads made freely available for legacy users not updating to the ad-free version. Following review by the Emory University Research Conflict of Interest Committee, VO-S has been released from any conflict of interest management plan or oversight.
Ethics approval The study was reviewed and approved as a minimal risk study by the Emory University Institutional Review Board (IRB# 00082571). This review included a finding by the FDA that the app falls into the category of 'enforcement discretion' as a medical device, meaning that at present the FDA does not intend to enforce requirements under the FD&C Act.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The full dataset, technical appendix and statistical code are available from the corresponding author upon reasonable request. Signed written consent was not obtained from participants, but participants were made aware of the study, were provided with IRB-approved informed consent information and provided the opportunity to opt out of the study at any time. Documentation of electronic consent was recorded. The presented data are anonymised, and both the risk of identification and the risks from identification are low.