Most clinical decision support tooling is designed cloud-first, with offline behaviour bolted on afterward, if at all. This paper argues that for a meaningful share of hospitals globally, that ordering should be reversed.
The argument
If a system requires connectivity to function, its utility is bounded by the least reliable link in a hospital's network, often a single mobile connection. Designing offline-first removes that ceiling entirely.
What we've observed building OncoTwin
Every core workflow in OncoTwin (twin creation, simulation, comparison, reporting) was built to run fully on-device first, with sync as an explicit, optional step. We outline the architectural implications of that choice, and where it adds genuine complexity worth the tradeoff.
This publication is in preparation and has not yet been submitted for peer review.