CliniPEARLS: A Technical Framework for Disseminating Clinical Practice Guidelines from Different Providers on PDA and Smartphone Devices

  • Noreen KamalEmail author
  • Tracy Thain
  • Kendall Ho
Part of the Healthcare Delivery in the Information Age book series (Healthcare Delivery Inform. Age)


Clinical practice guidelines (CPG) are becoming more readily available as aids to health professionals in clinical care decisions. CliniPEARLS is a technology framework that allows for the publication of CPGs from multiple providers on various PDA (personal digital assistant) and smartphone devices. The technical contributions for CliniPEARLS include (1) allowing for multiple organizations to publish guidelines on a single platform; (2) providing a flexible security and administration structure that allow users to subscribe to guidelines from multiple organizations; (3) allowing for a central place to enter the guideline content by either internal editors or external contributors with the appropriate permissions; (4) four client handheld applications that connect to the central framework for Palm, Windows Mobile, Blackberry, and iPhone; and (5) providing a mechanism to ensure the users obtain the latest guidelines and update their existing ones. The project revealed insights and lessons learned in developing a technical framework for an electronic dissemination mechanism for guideline updates and connection of multiple device types. One of the key findings from this study shows the importance for developers of CPG applications to be on the cutting edge of technological advancements in hardware and software.


Mobile Device British Columbia Personal Health Record Client Application Multiple Provider 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


List of Key Terms

Client software

This is the application that accesses a remote service on another computer system (server) through a network such as the Internet


Clinical practice guidelines are systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances (Field and Lohr 1992)


An operating system is the software that manages the connection between the hardware and a computer’s applications (e.g., OS on computers include Windows 7 or Mac (Snow Leopard))


Personal digital assistants are mobile devices that function as personal information managers; they typically are stand-alone devices that historically are not connected to the Internet


An organization that has an interest in creating and disseminating clinical practice guidelines


A physical computer dedicated to running one or more such services (such as data access) to serve the needs of programs running on other computers (clients)

Server–client architecture

A distributed application structure that partitions tasks or workloads between providers, server computer, and requestors, client computer, or device


A mobile phone that is capable of running advanced functions such as e-mail, Internet browsing, calendar, and other applications


  1. Android. (2011). Accessed 24 March 2011 from
  2. Bates, D. W., Kuperman, G. J., Wang, S., Gandhi, T., Kittler, A., Volk, L., Spurr, C., Khorasani, R., Tanasijevic, M., & Middleton, B. (2003). Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. Journal of the American Medical Informatics Association, 10, 3523–3530.Google Scholar
  3. Blackberry. (2011). Accessed 24 March 2011 from
  4. Braunwald’s Practice Guidelines. (2011). Accessed 24 March 2011 from
  5. Bullard, M. J., Meurer, D. P., Coleman, I., Holroyd, B. R., & Rowe, B. H. (2004). Supporting clinical practice at the bedside using wireless technology. Academic Emergency Medicine, 11(11), 1186–1192.PubMedCrossRefGoogle Scholar
  6. Burdette, S. D., Herchline, T. E., & Oehler, R. (2008). Practicing medicine in a technological age: Using smartphones in clinical practice. Clinical Infectious Diseases, 47, 117–122.PubMedCrossRefGoogle Scholar
  7. Cabana, M. D., Rand, C. S., Powe, N. P., Wu, A. W., Wilson, M. H., Abboud, P.-A. C., & Rubin, H. R. (1999). Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA: The Journal of the American Medical Association, 282(15), 1458–1465.CrossRefGoogle Scholar
  8. Carroll, A. E., Saluja, S., Tarczy-Hornoch, P. (2002). The implementation of a Personal Digital Assistant (PDA) based patient record and charting system: Lessons learned. Proceedings of AMIA Symposium 2002, 111–115.Google Scholar
  9. Carroll, A. E., Tarczy-Hornoch, P., O’Reilly, E., & Christakis, D. A. (2004). The effect of point-of-care personal digital assistant use on resident documentation discrepancies. Pediatrics, 113(3), 450–454.PubMedCrossRefGoogle Scholar
  10. Clinical Care Options. (2011). Accessed 24 March 2011 from
  11. Davis, D. A., & Taylor-Vaisey, A. (1997). Translating guidelines into practice: A systemic review of theoretical concepts, practice experience and research evidence in the adoption of clinical practice guidelines. Canadian Medical Association Journal, 157(4), 408–416.PubMedGoogle Scholar
  12. Edmonson, S. R., Smith-Akin, K. A., & Bernstam, E. V. (2007). Context, automated decision support, and clinical practice guidelines: Does the literature apply to the United States practice environment? International Journal of Medical Informatics, 76(1), 34–41.PubMedCrossRefGoogle Scholar
  13. Epocrates. (2011). Accessed 24 March 2011 from
  14. Field, M. J., & Lohr, K. N. (1992). Guidelines for clinical practice. Institute of Medicine Washington. Washington, DC: National Academy Press.Google Scholar
  15. Gadd, C. S., Baskaran, P., Lobach, D. F. (1998). Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care. Proceedings of AMIA Symposium 1998, 91–95. Orlando, FL.Google Scholar
  16. Garg, A. X., Adhikari, N. K. J., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., & Haynes, R. B. (2005). Effects of computerized clinical decision support systems on practitioner performance and patient outcomes. JAMA: The Journal of the American Medical Association, 293(10), 1223–1238.CrossRefGoogle Scholar
  17. Holopainen, A., Galbiati, F., Voutilainen, K. (2007). Use of smart phone technologies to offer easy-to-use and cost-effective telemedicine services. First International Conference on the Digital Society (ICDS’07) 2007 (p. 4), Washington, DC: IEEE Computer Society.Google Scholar
  18. iPhone. (2011). Accessed 24 March 2011 from
  19. Johnson, P. D., Tu, S. W., Musen, M. A., Purves, I. (2001). A virtual medical record for guideline-based decision support. Proceedings of AMIA Symposium 2001 (pp. 294–298). Wasihnton, DC.Google Scholar
  20. Kawamoto, K., Houlihan, C. A., Balas, E. A., & Lobach, D. F. (2005). Improving clinical practice using clinical decision support systems: A systematic review of trials to identify features critical to success. BMJ: British Medical Journal, 330, 765–768.PubMedCrossRefGoogle Scholar
  21. Lobach, D. F., & Hammond, W. E. (1997). Computerized decision support based on a clinical practice guideline improves compliance with care standards. The American Journal of Medicine, 102(1), 89–98.PubMedCrossRefGoogle Scholar
  22. Lomas, J., Anderson, G. M., Dominick-Pierre, K., et al. (1989). Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. The New England Journal of Medicine, 321, 1306–1311.PubMedCrossRefGoogle Scholar
  23. Lu, Y.-C., Xiao, Y., Sears, A., & Jacko, J. A. (2005). A review and a framework of handheld computer adoption in healthcare. International Journal of Medical Informatics, 74(5), 409–422.PubMedCrossRefGoogle Scholar
  24. Palm (PDA). (2011). Accessed 24 March 2011 from
  25. Pocket, P.C. (2011). Accessed 24 March 2011 from
  26. Reponen, J., Niinimaki, J., Kumpulainen, T., Ilkko, E., Karttunen, A., & Jartti, P. (2005). Mobile teleradiology with smartphone terminals as a part of a multimedia electronic patient record. International Congress Series, 1281, 916–921.CrossRefGoogle Scholar
  27. Sim, I., Gorman, P., Greenes, R. A., Haynes, R. B., Kaplan, B., Lehmann, H., & Tang, P. C. (2001). Clinical decision support systems for the practice of evidence-based medicine. Journal of the American Medical Informatics Association: JAMIA, 8, 527–534.PubMedCrossRefGoogle Scholar
  28. Tan, K. B. (2006). Clinical practice guidelines: A critical review. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services, 19(2–3), 195–220.PubMedGoogle Scholar
  29. UpToDate Inc. (2011). Accessed 24 March 2011 from
  30. Wilcox, R. A., & La Tella, R. R. (2001). The personal digital assistant: A new medical instrument for the exchange of clinical information at the point of care. Medical Journal of Australia, 174(11–12), 659–662.Google Scholar
  31. Windows Phone. (2011). Accessed 24 March 2011 from

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.UBC Media and Graphics Interdisciplinary Centre (MAGIC)VancouverCanada
  2. 2.eHealth Strategy OfficeUniversity of British ColumbiaVancouverCanada

Personalised recommendations