title: An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt.
abstract: OBJECTIVE
  Smartphone usage amongst clinicians is widespread. Yet smartphones are not widely used for the dissemination of policy or as clinical decision support systems. We report here on the development, adoption and implementation process of the Imperial Antimicrobial Prescribing Application across five teaching hospitals in London.
  
  
  METHODS
  Doctors and clinical pharmacists were recruited to this study, which employed a mixed methods in-depth case-study design with focus groups, structured pre- and post-intervention survey questionnaires and live data on application uptake. The primary outcome measure was uptake of the application by doctors and its acceptability. The development and implementation processes were also mapped.
  
  
  RESULTS
  The application was downloaded by 40% (376) of junior doctors with smartphones (primary target user group) within the first month and by 100% within 12 months. There was an average of 1900 individual access sessions per month, compared with 221 hits on the Intranet version of the policy. Clinicians (71%) reported that using the application improved their antibiotic knowledge.
  
  
  CONCLUSIONS
  Clinicians rapidly adopted the mobile application for antimicrobial prescribing at the point of care, enabling the policy to reach a much wider audience in comparison with paper- and desktop-based versions of the policy. Organizations seeking to optimize antimicrobial prescribing should consider utilizing mobile technology to deliver point-of-care decision support. The process revealed a series of barriers, which will need to be addressed at individual and organizational levels to ensure safe and high-quality delivery of local policy at the point of care.
authors.affiliation: National Centre for Infection Prevention and Management, Imperial College London, London, UK. e.charani@imperial.ac.uk
authors.forename: E
authors.initials: E
authors.lastname: Charani
authors.forename: Y
authors.initials: Y
authors.lastname: Kyratsis
authors.forename: W
authors.initials: W
authors.lastname: Lawson
authors.forename: H
authors.initials: H
authors.lastname: Wickens
authors.forename: E T
authors.initials: ET
authors.lastname: Brannigan
authors.forename: L S P
authors.initials: LS
authors.lastname: Moore
authors.forename: A H
authors.initials: AH
authors.lastname: Holmes
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D040421:Cell Phone / Q000706:statistics & numerical data*; D003141:Communicable Diseases / Q000188:drug therapy*; D020000:Decision Support Systems, Clinical / Q000458:organization & administration / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000592:standards*; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008131:London; D016134:Organizational Policy; D010342:Patient Acceptance of Health Care; D010595:Pharmacists; D010820:Physicians; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents