Digital CDS Resource Gives Healthcare Providers On-Demand Support for Pediatric Care

PedsGuide, an mHealth app developed by Children's Mercy Kansas City, is an on-demand clinical decision support platform designed to assist rural and remote healthcare providers who are treating children.

One of the benefits of digital health is that it allows healthcare providers to collaborate and share their expertise with others who don't have that background. Children's Mercy Kansas City is following that path with a new mHealth app designed to give providers a clinical decision support tool for pediatric care.

"Many ERs see children because they have to," says Brandan Kennedy, MD, a pediatric hospitalist and clinical informaticist and associate director of inpatient health informatics at the Kansas City, Missouri-based hospital. "Less than 10% of their ER traffic is kids, so it's not their comfort zone … but that doesn't mean they can’t treat them."

To address that concern, Kennedy and his colleagues created PedsGuide, an app that gives users on-demand clinical decision support (CDS) resources for a wide range (and growing) of pediatric care concerns, from burn treatment to diabetic ketoacidosis. The free app can be accessed via desktop, laptop or mobile device, and even includes a quick-call feature to connect with emergency medicine physicians or the Children's Mercy medical transport team.

"We wanted to create something that can help physicians make decisions at the front line of care," he says.

Brandan Kennedy, MD, associate director of inpatient health informatics, Children's Mercy Kansas City. Photo courtesy Children's Mercy Kansas City.

CDS tools for frontline healthcare providers have evolved significantly during the past few decades, thanks in large part to the advent of online resources and mobile devices. What once had to be looked up in a reference book, dictionary or magazine can now be accessed via computer or smartphone.

The challenge, as always, is in finding the right resource, an effort made all the more difficult by the growing numbers of CDS providers.

At Children's Mercy Kansas City, the belief is that healthcare providers treating children should be getting their guidance from pediatric specialists.

Sallie Guezuraga, who manages the Innovations Center at Children's Mercy's Center for Pediatric Innovation, says ER physicians first came up with the idea to develop a resource that would help frontline care works in emergency situations. They soon realized the information they wanted to include was changing often, thanks to new research and innovations. The onset of the pandemic added to the volumes of information—and the urgency to get that information out there.

"We couldn't update it quickly enough," she says. "We had to digitize it."

Armed with a research grant, the Innovations Center team created a simple mHealth app designed to help clinicians in treating children under 3 years old who presented with a fever. From there, they created new modules for infant care, then asthma treatment, then resuscitation workflows. The topics and ideas just kept coming in.

"The build became very ambitious," says Kennedy, who joined Children's Mercy several months into the program.

The current app platform has seen roughly 70,000 uploads, and Kennedy and Guezuraga say they're nowhere close to being done mapping out the infrastructure.

Sallie Guezuraga, Innovations Center manager, Children's Mercy Kansas City Center for Pediatric Innovation. Photo courtesy Children's Mercy Kansas City.

As part of the process, he says, the research team studied human factors engineering, including concepts like usability testing and think-aloud feedback, to understand how people interact in these situations with others and with technology. They wanted to know how clinicians might need and access information in different situations, such as an emergency or operating room or clinic. They also travelled with EMS responders in ambulance to see how an app might be used in an emergency situation in a rural location.

"In our current state in medicine, we have information overload," says Kennedy, noting there are more than 33 million articles of clinical literature in PubMed alone. "We have to make sure that we are translating that research into practice … in such a way that it can be used" by healthcare providers needing quick and accurate answers to their questions.

"We want to understand how and when people are using [PedsGuide] and what they are using it for," he adds.

To get a module ready for use could take as little as 18 months, says Guezuraga, or it could take a few years. And the infrastructure has to be in place so that Children's Mercy can research and update that information often.

To keep that information relevant, Children's Mercy Kansas City allows the research team the time they need to update the platform. And Guezuraga says the team is working with other organizations, such as the American Academy of Pediatrics, to make sure the information is reliable and valid.

They also want to keep the app free of charge. The idea is that healthcare providers need a resource that they can trust.

"This is an app developed by those who are in the field," Guezuraga says. "We have the experience, and we can say, 'Yes, this is what the protocol might say, but this is what actually happens.' We've been there and we know."

Kennedy points out that the app platform isn't seen as a marketable product or competitive advantage, but a tool that healthcare providers should be able to access freely and on demand. It affects all downhill care, he says, because children treated in a rural ambulance, doctor's office, clinic, ER or OR will be treated better and more effectively if the provider has access to the right information, and that in turn helps organizations like Children's Mercy Kansas City to focus on patients who need specialized care.

"We are leveraging the entire health system" to help frontline and primary care physicians improve their actions, Guezuraga says. "This ultimately helps the kids, which is our goal."