The potentials of digital health in wound management.
Written by Bryan Zafra on 04.10.2022
Wound management requires multidisciplinary approach to be able to promote good healing of the patient’s wound. It encompasses nursing, surgical, and medical care together with wound managers. Long-term wounds such as venous/arterial ulcers, pressure ulcers, and diabetic foot ulcers, have a big effect on the quality of life of patients. Elderly and debilitated patients tend to suffer these long-term wounds. Pressure ulcer alone affects up to 2,300 patients per 10,000 population suffering in Ireland, Sweden, UK, and USA. Treatment-related cost is estimated to be in the range of 1.71 € to 470.49 € per day per patient. In Germany, there are about 1,300 people affected by pressure ulcer per year. Most of them are from nursing homes and in long-term hospital care.
Digital health can be used to deliver care at a distance. It can be done through video call sessions using a computer or other electronic devices such as mobile phones or smart glasses. Wound management greatly benefits from digital health in delivering care to patients at a distant place.
Use case #1
Spanning for 328 kilometres between Shanghai and Jinhua in China, a telemedicine consultation was done for wound management. A local surgeon in Jinhua wears a smart glass while he is consulting a patient with wound. The smart glass is connected to a wireless internet infrastructure that sends a live stream of the smart glass video feed to a wound specialist in Shanghai. The specialist can view the video feed using a hospital computer. The wound specialist can instruct the local surgeon on how to move the patient’s body part that has wound to be able to have a better inspection. The wound specialist give expert opinion on what management can be done. Of the 30 patients that was consulted using telemedicine, 14 underwent needed surgical intervention and 16 only needs wound dressing. The local surgeons have 100% and patients have 88% acceptance rate for the use of telemedicine in wound management. [6]
Images from Flaticon.com [8]
Use case #2
Measuring the wound dimension is important in wound management to be able to monitor the progress of wound healing. A group of researchers created an AI-based mobile application that measures wound size. In the core of this mobile app is a programming library called OpenCV which can detect different dimensions of a picture or video that is captured by camera of a device where it is installed. They feed this library with thousands different photos of wounds of different stages. The wound borders were identified, and the wound size was calculated by the app. Using this mobile app, the wound healing is monitored. Also, the mobile app can be used not only by wound managers, but also by other members of the healthcare team, as well as by the patients themselves. [2]
Images from Flaticon.com [8]
Digital health breaks the distance constraints for the access of specialised care. Patients are not required anymore to travel long distances to have a consultation with a specialist doctor (e.g. wound specialist), thereby saving money and time. Telemedicine also promotes better assessment since a local physician and a distant specialist can simultaneously do consultation with the patient.
Limitations of using telemedicine includes the data bandwidth that can be sent across long distances. In the first use case above, the telemedicine consultation experienced 4 second delay to transmit data in the span on 328 kilometres. Availability of devices can also be a limiting factor in telemedicine, since not all healthcare institutions have the financial capacity to purchase such devices. Nevertheless, telemedicine can help in providing care for patients with wounds. It can improve their overall health and it can minimise risks.
Reference:
[1] Cassoobhoy, A. 2021. How Does Telemedicine Work? WebMD. https://www.webmd.com/lung/how-does-telemedicine-work#1
[2] Ferreira, F., Pires, I. M., Ponciano, V., Costa, M., Villasana, M. V., Garcia, N. M., Zdravevski, E., Lameski, P., Chorbev, I., Mihajlov, M., & Trajkovik, V. (2021). Experimental Study on Wound Area Measurement with Mobile Devices. Sensors (Basel, Switzerland), 21(17), 5762. https://doi.org/10.3390/s21175762
[3] Hasselfeld, BW. 2022. Benefits of Telemedicine. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/healt/treatment-tests-and-therapies/benefits-of-telemedicine
[4] Lahmann, Nils & Halfens, Ruud & Dassen, Theo. (2005). Prevalence of pressure ulcers in Germany. Journal of clinical nursing. 14. 165-72. 10.1111/j.1365-2702.2004.01037.x.
[5] Shi C, Dumville JC, Cullum N, Rhodes S, McInnes E, Goh EL, Norman G. Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta‐analysis. Cochrane Database of Systematic Reviews 2021, Issue 8. Art. No.: CD013761. DOI: 10.1002/14651858.CD013761.pub2. Accessed 21 September 2022.
[6] Ye J, Zuo Y, Xie T, Wu M, Ni P, Kang Y, Yu X, Sun X, Huang Y, Lu S. A telemedicine wound care model using 4G with smart phones or smart glasses: A pilot study. Medicine (Baltimore). 2016 Aug;95(31):e4198. doi: 10.1097/MD.0000000000004198. PMID: 27495023; PMCID: PMC4979777.
[8] For icons in the illustrations: https://www.flaticon.com/free-icons/