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Initial Experience of the American Society of Regional Anesthesia and Pain Medicine Coags Regional Smartphone Application: A Novel Report of Global Distribution and Clinical Usage of an Electronic Decision Support Tool to Enhance Guideline Use
  1. Rajnish K. Gupta, MD and
  2. Matthew D. McEvoy, MD
  1. From the Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN
  1. Address correspondence to: Rajnish K. Gupta, MD, Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Dr, 4648 The Vanderbilt Clinic, Nashville, TN 37232-5614 (e-mail: raj.gupta{at}


Background and Objectives Decision support tools have been demonstrated to improve adherence to medical guidelines; however, smartphone applications (apps) have not been studied in this regard. In a collaboration between Vanderbilt University and the American Society of Regional Anesthesia and Pain Medicine (ASRA), the ASRA Coags Regional app was created to be a decision support tool for the 2010 published guideline on regional anesthesia for patients receiving anticoagulation. This is a review of the distribution and usage of this app.

Methods The app was created to be a user-friendly version of the guideline. Download statistics were collected from April 2014 to October 2015, and app usage data were collected from October 2014 to October 2015. Usage data were analyzed for number of devices, number of search sessions, medications searched, and types of procedures.

Results There were 8381 downloads, with 83% from North America. Of users who allowed data tracking, 4504 unique devices were identified with 30,003 separate search events. The most searched-for medications were rivaroxaban (n = 4427; 11%), clopidogrel (n = 4042; 10%), and enoxaparin, prophylactic twice daily dosing (n = 3249; 8%). Neuraxial procedures (n = 22,477; 78%) were the most commonly searched-for procedures and over half (n = 22,773; 52%) the users were interested in how long to hold a medication before performing a procedure.

Conclusions This is the first publication of download and usage data concerning medical smartphone apps. It provides a template for future app uptake and use in clinical practice. The app platform provides a new mechanism of rapidly disseminating guidelines and facilitating distribution of frequent updates.

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  • Financial reimbursement from sales of the app partially goes to reimbursing initial app development costs. Future royalties from app sales are distributed to ASRA and Vanderbilt University but not to the authors.

    A grant from the Foundation for Anesthesia Education and Research (FAER) (3-04-300-0025) supported the initial prototype development of the ASRA Coags Regional App. ASRA supported the remainder of app development costs. All development costs were directed to Mustard Seed Software alone.

    Presented in part as a poster (“Initial clinical utilization experience of the ASRA Coags app”) during the Spring Meeting of the American Society of Regional Anesthesia and Pain Medicine in Las Vegas, NV, May 2015.