High-tech healing

Feeling the pressure of the federal mandates to reduce pressure injuries? You’re not alone—many nursing homes still struggle with inconsistent measuring, incomplete documentation and inadequate wound management strategies across all nursing shifts, notes a 2016 study in Nursing Open journal.

The big problem with wound documentation is the subjective interpretation of its characteristics, especially when trying to capture the organic shapes of wounds using a traditional nurse’s wound ruler. How has the shape of the wound’s perimeter changed since yesterday? What exact color is the tissue in each part of the wound? How has the wound bed changed over time? How can debridement actions be captured?

While some wound-documenting applications have been around for a few years, 2017 ushered in a massive surge of mature applications for wound care assessment that are designed for use outside of the hospital environment. The pervasiveness of “smart” hand-held devices and the evolution of cloud-based computing have brought imaging technology and complex measurement algorithms down to the point of care, eliminating many of the inconsistencies linked to hand-measuring with a traditional wound care ruler.

The main selling point is better wound-measurement accuracy—some products estimate up to 45 percent better accuracy compared to ruler hand-measuring. But equally key market drivers are streamlined data documentation and standardized reporting—all important for quality and compliance.

Yet, the best blossoming benefit of the technological revolution in wound documentation may be in being able to track at-risk patients before a wound infection takes hold. By moving wound documentation to a digital platform, wound information is easily available to all nurses regardless of shift and trends algorithms can alert caregivers to emerging problems if a wound begins to go south.

Most commercially available apps provide the ability to photograph a wound and run the image through a set of algorithms that will measure the perimeter and depth of the wound bed and assess the tissue colors. Many also have integrated electronic versions of traditional wound tools such as the Braden Scale and the PUSH tool.

Here are some of the wound assessment tools that are tackling the market’s challenges:

PointClickCare, a long-term care electronic health care record (EHR) developer with U.S. headquarters in Bloomington, Minnesota, launched its Skin and Wound app in late 2016. The solution aims to solve the problems of subjective measurements, using technology to standardize how wound areas are calculated and to track healing on a consistent basis using Braden and PUSH scores.

Using a smartphone device, the software can record photos and generate reports that can be integrated with its cloud-based EHR. Data analysis software provides wound trend charts at a glance, allowing caregivers to spot subtle shifts in wound healing before they become an infectious problem.

The system’s goal is to drive outcomes, says Genice Hornberger, senior product manager at PointClickCare. “We’ve started to do some analytics around things like, how long does it take for a wound to heal? What treatment is most effective or has the fastest closure rates for each specific type of wound?” she says. “We’re looking at the data and plan to release some new analytics later this year.”

The smartphone application and its metrics, developed through a partnership with Swift Medical, are currently available for Apple devices.

Baltimore startup Tissue Analytics is working with Intermountain Healthcare, Salt Lake City, to provide a simpler, more portable alternative to laser Doppler technology to measure a wound’s rate of healing. Caregivers capture wound images and tissue perfusion using a smartphone and upload the images to the cloud.

The solution, created by two Johns Hopkins bioengineering grad students, can send data directly to certain EHRs, based on partnerships. The solution piloted at several Intermountain sites in 2016, including its home care division, resulting in marked improvements in accuracy. After several months of testing, Intermountain is now rolling out Tissue Analytics’ application across its entire health system.

“Regardless of whether you’re in the clinic or home care, you’re using the same solution to measure, document, and size the wound,” says Todd Dunn, director of innovation at the Intermountain Healthcare Transformation Lab. “There’s now consistency in documentation between multiple different settings.”

Tissue Analytics also offers its app directly to patients, who can take images and track their own wounds—an interesting and home health-friendly twist to the wound care documentation market.

The Tissue Analytics application runs on Apple iOS and Android platforms.

New players

Plenty of interesting companies are jumping into the hot market of wound care.

Advanced Tissue, Little Rock, Arkansas, already a leader in wound care supplies, is now harnessing wound imaging using spectroscopy to give caregivers a new and more detailed view of the wound tissue and healing process. Through its partnership with the Nash UNC Health Care Center in Rocky Mountain, North Carolina, the company is working on new algorthims to measure and predict wound tissue progress.

Geko, developed by UK-based FirstKind, is using an adhesive electrical impulse device to improve the blood circulation needed for lower-limb wound recovery, tackling everything from edema to deep vein thrombosis. Recent trials showed improved outcomes for those using the peroneal nerve stimulation provided by the device compared to standard wound care.

Market differentiators to look for:

  • Integration with the electronic health record
  • Cloud-based access and image-sharing for wound care specialists and referral physicians
  • Standardized assessments and measurements across the nursing staff, regardless of wound training
  • Watch for the emerging availability of 3-D imaging
  • Ease of reporting for quality assurance
  • Watch for Android adoption

Kronikare, a new Singapore-based startup, is tapping into several health assessment markets, including wound care. Its mobile smartphone app, still under development, purports to being able to read a five-second video image of a wound and assess it within 30 minutes. The company is also making forays into cancer care and diabetes.

But overall, the biggest market chase right now is for the addition of much-craved 3-D imaging technology, which could greatly improve the way caregivers assess and treat the wound bed and perform debriding tasks.  Many companies seem close enough that 3-D imaging technology may be readily available in 2018.

“Incorporating the depth of the wound can really help nurses evaluate the wound bed and what treatment is best to come next,” Hornberger says.

Sore spots

While nurses in skilled nursing facilities may not always be experts in pressure injury prevention, “There is a gap between nursing practice and nursing documentation in nursing homes,” the above study concludes. “Nurses undertake more pressure ulcer prevention than they document in patient records.” While lack of consistent documentation methods is always a problem, the study authors add, “Implementing EHRs with decision support tools may be one way to address this issue and improve the quality and accuracy of documentation in nursing homes.”

Yet, technology-based wound care documentation tools are often an easier buy-in for nurses than the facility’s legal department, Hornberger says. “We have had to work to overcome some obstructions using photos. We so work through those with legal teams, but the nurses are usually on board first,” she says. “They may still have to measure the undermining and tunneling, but it’s been an easy sell for nurses.”

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