Mobile Technology for Improving Clinical Decision: A Comparative Assessment of its Usefulness for Clinical Nurses and Physicians

Health workers in the rural areas of South Africa have little access to clinical guidelines and public health information that are relevant for improving their practice. Treatment guidelines and other medical resources are provided to health facilities in hard copies. However, the number of copies provided are not sufficient for the number of health workers. Disseminating updates to remote health facilities requires an enormous effort and can take months; meanwhile health workers continue to use outdated guidelines until they receive updated materials. To overcome some of these challenges and provide better healthcare to their patients, 63 professional nurses and 62 physicians in the Eastern Cape are using the Mobile Health Information System (MHIS) that provides healthcare providers access to clinical and public health information at the point of care using commercially available smartphones and tablets. A study conducted in 2010 – 2013 to assess the outcomes of MHIS in improving clinical decision showed that all nurses and 80% of doctors reported making accurate diagnosis (p=.00014). All nurses and 79% of doctors reported improvements in managing the side effects of drugs (p=.00140). More nurses found the system useful for choosing correct laboratory tests than physicians (96% vs. 66%, p=.00354). More nurses reported making improved referral decisions than physicians (100% vs. 62%, p=.00004). Improvements in prescribing the correct treatment (100% nurses vs. 92% physicians, p=.07844) and prescribing the correct medication dosage (96% nurses vs. 82% physicians, p=.01871) did not differ significantly.