On Friday, July 8, 2016, I went on pediatric morning rounds with Dr. Alvarez and a group of 6 residents and interns at Hospital Nacional Dos de Mayo in Lima. Interns, in Peru, are medical students in their last year of medical school. As had become my norm, I arrived early in the morning, observed the chaotic routine of charting, then began rounds at 9:45 AM. We passed from patient to patient with brief discussions of ward cases with common diseases such as primary epilepsy. Then we stopped outside of a small isolation room that said “Do not enter.” The resident began the next presentation providing the history and explaining how the child had desquamation (peeling) of the hands.
Dr. Alvarez walked over to me and stated that this patient probably had Kawasaki disease. He asked me if I knew what Kawasaki disease was. I knew exactly what to do: I immediately used my tablet to open the PEMSoft mobile application to search “Kawasaki” in the A-Z Index search tool. I clicked on “General Information” and started reading up on the disease. The topic has 14 colorized images of children and different features of the disease. Dr. Alvarez, who up until this moment had taken little interest in PEMSoft, became increasingly intrigued and began looking over my shoulder. He asked what I was doing and I explained that I was using PEMSoft to look up Kawasaki disease and its current management. I proceeded to show him the different tabs and images available under the topic. He skimmed over the extensive information and made a nod of approval, then asked if he could use the tablet to see PEMSoft! He began reading the information more intently, then realized that the patient had “Incomplete Kawasaki” and asked me if there was additional information specifically for that form of the disease. After reading through the additional tabs of information on Kawasaki disease, he told me what they had started as treatment and he was able to confirm that they were treating the patient “correctly” according to the information provided under the app.
Meanwhile, as I was showing Dr. Alvarez PEMSoft, the interns began opening the PEMSoft app on their phones to see the images and read the treatment information about Kawasaki disease.
Consider that without PEMSoft, each intern would have needed to find a textbook, probably out-of-date, to look up the information. For the most current information, Dr. Alvarez would have needed to go to the library, search for recent summary articles on Kawasaki disease, then print it out and made a copy for each intern, which he would have handed out the next morning. Pictures would have been in black-and-white. If the patient had been transferred to another service or had been discharged, the interns would not have been able to look for the signs on the patient. By having PEMSoft at bedside, there was no delay between reading about the signs and symptoms of the disease and looking at the pictures, then examining the patient. Had they been treating the patient incorrectly, they would have been able to make changes immediately, instead of waiting a day or more to find a recent article with the latest treatment plan.
Hospital Nacional Cayetano Heredia
The following Monday, I was in the emergency department with a different group of interns at Hospital Nacional Cayetano Heredia in Lima, our second training site. They had been introduced to PEMSoft during our team trainings (we trained over 300 physicians in Lima to use PEMSoft) , so I asked them what they thought of it. Two of the interns who were interested in specializing in pediatrics were enthusiastic about PEMSoft and mentioned that they NOW use it “all the time! Everyday!” Daniella said she loved it because it was specific to pediatrics and it (the mobile application) didn’t use cellular data or require a wifi connection to the web. (Their phone could be on Airplane Mode and they still had access to all the information in PEMSoft.)
Maria, who wanted to specialize in cardiology but now on a pediatrics rotation, recounted that her group had been using PEMSoft often and even used the program the previous week to reach a diagnosis on a challenging patient. She said they had a patient come in with unusual symptoms and they could not figure out what was the illness. They opened up PEMSoft and went to the SEARCH window on the web version. There, they typed in the symptoms and PEMSoft produced a differential diagnosis list of possible causes. They could eliminate many of the diseases on the list, but there was one disease they had not considered, which turned out to be the cause of this child’s illness.
It was great to see PEMSoft being used regularly throughout the pediatric department in “real time”, making learning easier with many great color images and up-to-date treatment regimens. I was even MORE EXCITED to hear that it was being used when I WASN’T there, and that it was helping these young doctors to make more accurate diagnoses when they were stymied by a patient with unusual symptoms.
It was very rewarding to know that, thanks to PEMSoft, the people of Hospital Nacional Cayetano Heredia were getting better care. This culturally appropriate, technology driven, easily used APP was connecting young doctors with the most recent information at their fingertips.