Kidney Week 2013: KDIGO App — Past, Present and Future

Nephrology has been at the forefront of clinical practice guidelines since the publication of Dialysis Outcomes Quality Initiative (DOQI) in 1997. These guidelines are largely credited in improving hematocrit, URR, and fistula rates as well as decreasing use of temporary and permanent catheters among dialysis patients. The success of DOQI in the first 5 years of its existence ultimately lead to the broader, international guidelines of KDIGO. But guidelines are useless if they are not distributed, digested, and used by active clinicians. The brains at KDIGO recognize this and they decided to develop a mobile app to distribute the guidelines.

As just announced at the KDIGO Kidney Week session, the KDIGO iPad app is now available. With this app, nephrology continues to show its leadership in clinical practice guidelines with the first clinical practice guidelines distributed by a mobile app.

Joel Topf, eAJKD Advisory Board member, was privileged to be a part of the app project and, ahead of Kidney Week, interviewed the team in a round table discussion of the app and its development.

eAJKD: Why a tablet app? What’s wrong the current distribution system?

Edgar Lerma: We now live in an era of tablets, apps, and social media. To be able to utilize these media as a means to access the KDIGO Guidelines in a very user-friendly manner is very timely. Its appeal is something that I think would be most appreciated by any healthcare provider with particular interest in diseases related to the kidney (including hypertension and kidney transplantation) in both the U.S. and international arena.

Think of the different roles that would benefit from this type of app: For clinician-educator, it should prove to be an invaluable addition to our teaching resources.

Joel Topf: Yeah, when you look at what is in the KDIGO It provides a frame work of evidence-based guidelines with comprehensive reviews of the evidence and literature. It really is a gold mine for educators.

Edgar Lerma: For clinicians, it would be a quick reference to evidence-based guidelines as well as recommendations from renowned experts and thinkers in the field. With the app, all of this is available at the point of care and with comprehensive search so you can quickly find what you are looking for and get back to the patient.

Michael Cheung: One of the powerful aspects of the iPad is that it is always connected to the cloud; this means that when new guidelines are published, KDIGO will be able to immediately push them out to all users. In medicine changes happen all the time, KDIGO is now going to have a better channel for communicating with its users and adapting to this velocity of knowledge. Also, we will be able to push ancillary content to the users. For example, Yusuke Tsukamoto is giving a KDIGO lecture at Kidney Week and the app has his lecture slides under the resource heading.

Tanya Green: The thing about the website and PDFs is that is really a desktop and PC solution, it is not a good fit for tablets where people look to apps to solve these kinds of problems. We needed a post-PC solution for the KDIGO guidelines.

eAJKD: Where did the idea come from? Can you provide some color to the history of this project?

Michelle Josephson: So the app concept really came out of the idea that the Implementation Work Force was struggling with what would really make implementation ideal.  And step 1 is getting the information/word out there.  But how to do that?  Meetings are helpful for those who attend but don’t really have the broad impact nor do they have the staying power or provide info when needed.  I felt like we needed something different and more effective.

And I brought this up with James Chon and to some degree challenged him to come up with a possible solution. He suggested making the guidelines into an app.  He started this process. And as this conversation was beginning Yusuke went to the KDIGO board who agreed that it was a wonderful plan.

John Cox (of Visible Health): We are  proud of our track record of collaborating with clinicians to produce mobile apps. Delivering clinical guidelines in a way that encourages adoption and implementation at the point of care is a challenging problem. In this particular case, the KDIGO team brought great vision to the table, but were very comfortable with the pragmatism of taking a measured approach to bringing the app to market.

eAJKD: What’s the future of the app look like?

Edgar Lerma: Having an app like this serves as a means to broaden the reach of the KDIGO guidelines (geographically) and perhaps will also allow a faster means of distribution whenever new guidelines are created or previously established guidelines are updated.

James Chon: The great thing about the app is that by freeing us from the limits of a static journal publication there are a number of different things we can do. We will be able to incorporate social media and collaboration. We will be able to allow readers to interact with the references in new ways.

Joel Topf: One of the things I want to do is abstract the text from the guideline in ways that lets a user say, just show me the 1A recommendations. Or show me all of the references that are written by the guideline authors. By going with a purely digital format we will have novel opportunities to make the guidelines both more useful and transparent.

eAJKD: Were there any surprises along the way?

Joel Topf: I was surprised by the pace of the project. We hired our programmers, the excellent crew at Visible Health in August and for the first four or six weeks we heard about progress but really couldn’t see much and then once they delivered the first beta copy further bug squashing and feature implementations went really fast. The whole process was surprisingly non-linear.

KDIGO iPad app is available for free at the iTunes app store.


Check out more eAJKD coverage of ASN’s Kidney Week 2013! Also, follow @eAJKD on Twitter for live updates!

4 Comments on Kidney Week 2013: KDIGO App — Past, Present and Future

  1. Sreejith Parameswaran // November 10, 2013 at 12:17 pm // Reply

    Very wise initiative. Is an android app on the anvil? A version for android will result in much wider dissemination and utilization than offering only iPad app, i believe.

  2. Thanks for your comment. I was part of the decision to go iPad only for version 1.0. Very early in the decision process we decided to make the app Tablet only. We thought that most people would not want to read long clinical practice guidelines on a phone. Once we decided on a tablet we looked at the usage patterns and found that it wasn’t even close. In medicine the iPad just crushes android. See the usage statistics from UpToDate:

    90% iOS and only 10% Android. This is why we made the decision for version 1.0.

  3. Joel, you are right about UpToDate stats, but, IMHO, UpToDate is somewhat different than what I hope the KDIGO app can be.
    For starters, UpToDate is not free, I personally have access to it from my institutional subscription. Few MDs from developing countries have a personal subscription to uptodate.
    Secondly, the Android penetration is very high in places like India and China….and as a free app, it would make a lot of sense to me to think about developing an android app.
    And I say this as a fellow Mac Fanboy!

  4. Your voice is not the only one clamoring for an Android version and we are considering doing that on the road map going forward, but keep in mind that the website offers all of the PDFs in multiple languages for free so that is available for Android users, so given that availability we felt comfortable choosing the dominant medical platform to see how we can push guideline distribution forward. Developing on two platforms would have diluted our efforts. I feel we made the right choice.

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