Sydney Local Health District (LHD) plans to go live with a virtual wound care command centre at the rpavirtual hospital in July, offering services to residential aged care, burns, acute care and general practice patients.

The initiative will be discussed at the Nursing and Midwifery Digital Health Conference, a pre-conference event being staged with MedInfo23 in Sydney from July 8 to 12.

Sydney LHD has been trialling Tissue Analytics’ artificial intelligence-powered wound care app for use in hospital and remotely, working with local distributor Virtualcare to integrate it into Sydney LHD’s Oracle Health (Cerner) electronic medical record.

It is now being rolled out to rpavirtual’s virtual wound care centre after a successful trial, along with Concord, Canterbury and Balmain hospitals, community nursing and some hospital in the home programs.

It is also being used in various health services in South Australia and New Zealand with several projects at Melbourne hospitals also gearing up.

Sydney LHD clinical lead and nurse manager of skin integrity Michelle Barakat-Johnson and chief nursing and midwifery information officer Aaron Jones will discuss the project at the conference, including their experience in how to create a virtual wound care service.

The TA app is described as a software platform that turns a smartphone into an imaging system, enabling 3D wound imaging on phones or tablets.

Clinicians use it to measure, analyse, track and report wounds by taking photos of the wound at each consult, whether in a hospital, clinic, outpatient or nursing facility or the patient’s home.

There is also a patient-facing app which enables patients to take wound photos on their phone at home and securely send to their clinician along with a message to enable remote care by wound care experts.

Australia is one of the first countries to use the patient app and SLHD has worked with the vendor to ensure workability features, Adjunct Associate Professor Jones said.

Tissue Analytics says that wound clinicians can monitor patient progress from a secure web dashboard, react faster to changes and prescribe better treatments due to the connectivity the app provides and more precise wound measurement and analysis.

Tissue Analytics’ studies show that the app has less than a four per cent measurement error rate, compared to 44 per cent for hand or ruler measurements.

Digital wound management

The app was introduced after A/Prof Jones and Dr Barakat-Johnson saw it at overseas conferences when researching better wound management and digital solutions. It addressed issues they were having with wound assessment and offered continual format from acute to community setting, they said.

Images can also be integrated into the EMR in chronological date, and wound size, depth, circumference and progression are automatically measured and recorded.

“The AI does it all in one shot. Data also generates a report showing which wounds have healed, which haven’t, the types and so on,” A/Prof Jones said.

“We’re working closely with the US supplier, Tissue Analytics, and the local supplier, virtualcare, to have the system fully integrated into the Cerner electronic medical record at RPA (enabling images and data to be stored, reviewed and compared), with an expected completion date of June.

“It’s rolling out across Sydney LHD and will be used at the RPA, rpavirtual, Concord, Canterbury and Balmain hospitals as well as community nursing and some hospital in the home programs.”

rpavirtual wound care command centre

Dr Barakat-Johnson said simultaneously with the app, the virtual wound care command centre will be launched at rpavirtual in July and will provide services to residential aged care, burns, acute care and general practice patients.

“Once the system is up and running, it’s expected the centre will register 12 new patients a week,” Dr Barakat-Johnson said. “Patients can call for advice any time, no appointment is needed.”

The centre helps prevent admissions as nurse practitioners triage patients and work with wound clinic consultants and multiple services that provide to patients remotely. Dr Barakat-Johnson said work was underway on referral pathways and more nursing staff and specialists would be employed at the centre.

“Patients include those with complex or chronic wounds, people requiring hospital discharge who can’t get services in the community and those in the community who need care and don’t know where to go,” she said.

“GPs might need expert advice on patients with wounds so the centre enables shared care and provides expert clinical care to doctors in remote settings who call or refer patients.”

Patients can save time and money travelling to appointments, and hospitals save money due to reduced admissions, freeing up hospital beds.

Dr Barakat-Johnson said the app also improved patients’ understanding of and engagement in their wound care and empowered them to look after their wound.

“They also like the ongoing care with the command centre, secure messaging and ability to call at any time and get direction and care,” she said.

“The app has been used on almost 300 wound care patients so far in projects and studies conducted by Aaron and I over the past few years. Data indicate those treated (using the app and the centre) have improved wound healing and earlier discharge, and there are no disadvantages.

“We hope the success extends to more hospitals, community settings and GPs in remote areas.”

A/Prof Jones said patients seeing improvements in wounds on their phone was a game-changer because it was incentive to keep going and follow their wound care plan. All patients received a wound care plan and two to three photos were taken and uploaded a week.

“A built-in guide ensures the photo is taken the same way each time for comparison,” he said.

A research paper they published in the International Wound Journal showed that remote monitoring of wounds using the centre and app did not decrease quality of care or increase risk to the patient, and most patients found the app easy to use, suggesting its use was acceptable among an older generation prone to chronic wounds.

Rolling out across Australia and New Zealand

Ben Magid, CEO of Virtualcare, the Australian and New Zealand distributor for the platform, said the technology was commercially launched in Australia 12 months ago after the successful results at Sydney LHD.

He said users included two other Sydney LHDs, Te Whatu Ora – Health NZ MidCentral District and a South Australian community nursing service while several projects in major Melbourne hospitals were not yet live. Some were trialling the app while others had implemented it fully into systems.

“The plan for some is to introduce similar services like rpavirtual’s wound care command centre,” Mr Magid told Pulse+IT.

“The platform has SMART on FHIR integration with the EMR so when viewing a patients’ medical records, you can also view the entire TA online platform without leaving the medical record, which makes it easier.”

He said the app was used by some of the largest health services in the US such as Intermountain Healthcare in Utah and Northwell Health in New York.

July conference

The Nursing and Midwifery Digital Health Conference is being hosted by the Australasian Institute of Digital Health’s Nursing Midwifery Digital Health Network, having evolved from the annual Nursing Informatics Australia conference.

In line with the ‘future is accessible’ theme of MedInfo23, the nursing conference’s theme is ‘creating a digitally savvy workforce’. It aims to inspire nurses and midwives to become digitally empowered in the future delivery of care to achieve quality outcomes across all healthcare settings.

Early bird registration for MedInfo23 closes on April 14. Pulse+IT is a conference media partner for MedInfo23.

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