As of today if I search for ‘anesthesia’ in the iOS app store I get 91 results for the iPad and 138 for the iPhone.  At first pass it would appear the market is covered.  There are a number of publishers coming out with e-versions of their established textbook/journal offerings.  Apps reviewing airway manipulation and drug calculations seem to come out daily.

However, if one digs a little deeper and begins to purchase and attempt to use individual apps it becomes immediately clear that app development for anesthesia is still in its infancy.  It never ceases to amaze me when application developers release a product that simply transitions static content from paper to electronic form.  Given the computing power and code dexterity available in smart phones and tablets don’t providers deserve more?  Given the lack luster build of most applications it doesn’t surprise me to find anesthesia providers are more apt to play Angry Birds than to utilize an app aimed at clinical decision support.

There are a number of factors that contribute… Level of experience, comfort with technology use, practice routine, availability of reference material, intellectual drive, device owned.  One of the biggest reasons may also be that nothing really great has been fielded yet.

My opinion is that in the next five years mobile application CDS use will establish itself and become as ubiquitous as the smart phone.  We simply need forward thinking, professional, and responsible clinicians to team up with equally savvy, professional developers to drive the evolution of clinically relevant CDS in anesthesia practice.

I found this lecture by Dr. Erhenfeld from Vanderbilt Medical informative in terms of how he envisions CDS evolving within their home grown Anesthesia Information Management System. 

http://www.mc.vanderbilt.edu/root/vumc.php?site=chtn%20western%20division&doc=38028

If you pick up the video discussion at the 20th minute Dr. Erhenfeld discusses what he terms “CDS 2.0″ which is an intriguing combination of real time analytics, evidence based protocols, and critical event alerts, all aimed at providing an appropriate, quality, cost effective, and population-based anesthetic specific to each patient.  The tech geek in me really looks forward to a time when this level of integration becomes a reality.

My questions… What about the other 99% of facilities that don’t have an AIMS, or plans to get one in the short-term, not to mention the level of tech integration that Vanderbilt is researching/building?  How do anesthesia groups prepare themselves for a tech rich future where healthcare reimbursement is driven by quality indicators in a way that is appropriate for their specific practice and patient population?  There are no easy answers, but I believe that leveraging mobile platforms for delivery of evidence based support and CDS to the point of care is one way to go about it.

Crazy to consider this given the fact that tablets didn’t exist three years ago. 

“The total amount of tablets shipped in 2011 was more than double what analysts predicted with 73 million tablets sold, which amounted to a 25.5 share of the mobile pc market. The growth is expected to continue with the amount of tablets predicted to ship in 2017 expected to be 383.3 million. It is expected that while much of this growth will be to new users, a significant portion of this increase will be at the expense of mobile PC’s.”

Fascinating numbers really.  Paired with analytics from flurry.com, discussing the use of mobile devices to access the internet is now outpacing both laptop and desktop computers combined, the writing is on the wall from the technology perspective.  The question in my mind is not IF tablet technology will have an impact on the practice of anesthesia but HOW do we RESPONSIBLY incorporate the use of such advanced technology into practice and to what end?  Even in the most technologically advanced anesthesia practices which have seen the light and currently utilize electronic anesthesia records (and there are tablet specific versions available) there is precious little clinical decision or literature support offered.  Another point to consider is that U.S. medical publishing companies are on notice and understand that a vast majority of their sales will be tied to electronic delivery within the next five years.  Considering these ideas together leaves me to believe that a solution needs to be created. 

Reference: http://www.opendoor.ca/2012/02/number-of-tablets-sold-worldwide-in-2011/ on 4.3.12 @ 2:27 pm.

… the hardware and software capability both exist.  Come on admit it, if your cell phone is not your first line communication at work you wish it could be.  The next logical step is integrating these highly sophisticated and totally portable computers (phone and tablet) into daily clinical practice.  SCARY, I know.  I had an epiphany some time ago.  I was providing an anesthetic for a patient undergoing coronary artery bypass grafting.  I had to calculate, pencil and paper,  and remember the formula for systemic vascular resistance.  I got it done but only after 5 minutes, a quick reference check to ensure the correct math equation was applied, and three adjustments to my pressor agents.  Why would a profession that touts its goal of making anesthesia as safe as airline travel fly so, well, blind.  The introduction of the pulse oxygen saturation monitor was an absolute revolution… now?

Don’t take my word for it though…

Mobile App Usage Further Dominates Web, Spurred by Facebook

If there was any doubt that mobile computing is eclipsing laptop/desktop use look no further than this very well written blog on Flurry Analytics…

If you happen to be a nurse anesthetist who needs a clinical-decision-support app for your iPhone, Chris Knapper and Matt Bell can help you.

The two men are nurse anesthetists themselves but are also building a fledgling company called E2 Medical Software, and on Thursday night they were at the Cherokee Mills office complex for a gathering aimed at entrepreneurs…. Read more…

Chris and I attended the kick-off of ETRAC yesterday evening (www.etrac.org.)  The reception was very well put together and delivered.  The message?  Their exists a robust network of support for entrepreneurial start-ups in East Tennessee and ETRAC is a formal process generated to foster that ecosystem.  It was great to meet fellow entrepreneurs and business leaders in the East Tennessee community.  We ran into a few old friends and made a great deal more new ones!  Thank you to Pershing, Yoakley and Associates for hosting a great event.  We are very excited to be in the position to apply for the ETRAC business accelerator program.

Welcome to the E2 Medical blog, a community of forward thinking anesthesia providers.  We hope you find our clinical decision support tools a great addition to your practice.  Please leave a comment…