title: Cost Effective Use of Free-to-Use Apps in Neurosurgery (FAN) in Developing Countries: From Clinical Decision Making to Educational Courses, Strengthening Health Care Delivery.
abstract: OBJECTIVE
  Financial limitations and the scarcity of technological knowledge are a major hurdle to good communication platforms, data storage, and dissemination of medical knowledge in developing countries. Out of necessity we used free-to-use apps in our practice. We studied the applicability and cost effective aspect of a systematic use of these apps in neurosurgery.
  
  
  METHODS
  We designed the Free-to-use apps in neurosurgery (FAN) module in 4 phases at Kathmandu Medical College Teaching Hospital over the last 3 years. We used free apps like Viber, Dropbox, Skype, and VLC media player on 3G and Wi-Fi network. Users were trained in ethics and measures to ensure confidentiality and privacy of patient-related data. Endpoints studied were feasibility, reliability, cost effectiveness, and overall satisfaction of the users.
  
  
  RESULTS
  In the FAN module, the Viber app was used to send pictures of digital images via smartphones within 30 minutes, enabling quick decisions by the consultants. Dropbox not only helped store images but also helped quick verification of discharge summaries as early as 15 minutes increasing overall efficiency. With Skype, consultants could be contacted even when they were abroad, and with the use of FAN they remain updated of their patients. By the use of Skype and VLC media player, 2 operative live workshops from abroad were transmitted live with good visual and audio reception, allowing question-and-answer sessions with the faculties. User satisfaction was more than 90%.
  
  
  CONCLUSIONS
  The FAN module helped in quick reliable decision making, allowing for instantaneous communication and storing data and exchange of knowledge across countries.
authors.affiliation: Department of Neurological Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal. Electronic address: dramitthapa@yahoo.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Thapa
authors.affiliation: Department of Neurological Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal.
authors.forename: Bidur
authors.initials: B
authors.lastname: Kc
authors.affiliation: Department of Neurological Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal.
authors.forename: Bikram
authors.initials: B
authors.lastname: Shakya
mesh_terms: D040421:Cell Phone / Q000191:economics* / Q000706:statistics & numerical data; D000066491:Clinical Decision-Making / Q000379:methods; D003219:Confidentiality; D003362:Cost-Benefit Analysis / Q000379:methods; D003695:Delivery of Health Care / Q000191:economics* / Q000379:methods; D003906:Developing Countries / Q000191:economics*; D006801:Humans; D063731:Mobile Applications / Q000191:economics* / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000191:economics* / Q000193:education*
keywords: Communication; Free-to-use apps; Neurosurgery; Smart phones; Telemedicine