Background

Currently in the UK, the delivery of wound care has unwarranted variation, with the underuse of evidence-based practice and the overuse of ineffective interventions (Gray et al, 2018). In order to reduce unwarranted variation, there has been a call for clinicians to collect data to demonstrate the efficiency of their practice. 

Leading Change, Adding Value developed a framework (NHS England, 2018) to put an emphasis on the quantifying and measuring of outcomes in nursing practice in the UK, in alignment with Five Year Forward View (NHS England, 2014), so that clinicians can demonstrate where high standards of care are achieved, or can identify where improvements are needed, so that unwarranted variation in practice is reduced (NHS England, 2018).

More recently, the National Wound Care Strategy Programme (NWCSP) (2018) has been developed to address the issue of sub-optimal wound care, building on the work of Leading Change, Adding Value and Five Year Forward View (NHS England, 2014; 2018).

The NWCSP recognises the urgent need for valid and reliable metrics to measure wound care activity and outcomes. As a result, the three clinical workstreams are working with the data and information enabler workstream to identify how this might be achieved with minimal impact on the clinicians at the frontline of care (Adderley, 2018).

The adoption of digital and AI solutions is fundamental to transforming health and social care in line with the NHS’ Long Term Plan (2019). The East Midlands Academic Health Science Network (EMAHSN), is one of five AHSN’s that run Digital Accelerator Programmes, and is the innovation arm of the NHS in the East Midlands. The EMAHSN aims to increase the speed at which digital health products are taken up in the NHS, and help to develop collaboration across all sectors involved in healthcare to identify, test and spread ways to drive NHS transformation. 

eKare inSight^® was selected by EMAHSN for the 2019/20 Digital Accelerator cohort as a solution for the challenge of variation in wound care. They will now give eKare specialist advice, training, one-to-one support and opportunity to show inSight^® to NHS decision makers and influencers.

eKare inSight^® is already being used by several trusts in the UK to improve data collection and sharing to improve efficiency of working, to reduce costs and to improve patient outcomes. 

What is ekare inSight^®?

eKare inSight^® simply combines an app and camera technology to transform a mobile device, such as an iPad or iPhone, into an indispensable wound management platform that is simple and easy to use in any care setting. The use of Apple Technology means the app is available for download on the app store and the user display is familiar and intuitive to use.

 

What are the benefits of eKare inSight^® to my organisation and patients?

eKare inSight^® is a unique wound management platform. It has a number of advantages when used as part of clinical practice.

inSight^® facilitates standardised wound photography, measurement and tissue analysis in seconds, without the need for wound contact

It is well known that wound measurements taken using traditional methods are subject to practitioner variables, body morphology and patient positioning (Hampton and Kilroy-Findley, 2016). Usually, measurements are carried out using a disposable tape measure to determine the greatest length by greatest width (Shah et al, 2013). However, this is quite subjective and different practitioners may view these points on the same wound slightly differently. For the purpose of comparison, it is important that the patient is in the same position each time the wound is photographed, which is not always the case in practice (Hampton and Kilroy-Findley, 2016). It has also been reported that some clinicians working in community settings do not have access to cameras to use as part of wound assessment (Gray et al, 2019).

inSight^® can be used to photograph and automatically measure wounds removing the need for traditional measurement techniques using tape measures and wound contact. 

On the first use of inSight^®, an image is taken and the camera and app automatically adjust for attributes such as brightness and shot angle, to accurately capture wound dimensions and the colour of tissues present in the wound bed. The camera will present an alert if the picture is taken too close or too far away. The wound perimeter is automatically detected and delineated for fast/precise measurement. 

The app’s algorithm then calculates the wound dimensions, in either 2D (wound width x length) if using an iPhone, or 2D or 3D (wound width x length x depth) when using an iPad.

On subsequent photography of the wound, the previous assessment image is ghosted on the screen to help the user capture the wound from the same perspective to improve consistency of use. 
 

Tissue composition analysis in seconds 

Usually, tissue types present in the wound are recorded on wound assessment as a measure of wound progress or deterioration. However, this is a subjective measurement, with differing clinicians potentially recording the percentage of tissue types differently. 

inSight^® has the ability to determine the colour of tissues within wound bed with healing (red), devitalised and dead tissue (yellow or black) being analysed in seconds with minimal clinician input. 

The app can be used to document and collect essential data, in addition to the automatic wound measurements, meaning documentation for an episode of care can be kept in one place, removing the need for paper records and manual recording of subjective measurements.

How does inSight^® do this and is it reliable?

The inSight^® camera and app combine the latest¬ in 2D and 3D vision systems with sensor technology (for visualising and recording the wound) with machine learning — a branch of Artificial Intelligence (AI) — that uses data analysis to enable the system to learn from the data it collects; it identifies patterns and makes decisions with minimal human intervention. 

Extensive research and engineering has enabled the accuracy and reproducibility of inSight® to be validated. Bills et al (2016) showed that inSight^® provided an accurate and reproducible method for determining wound healing changes in line with other available technologies, but was faster and more consistent; critical factors when used in clinical practice. 

Peter Witney, Commissioning Manager, NHS Great Yarmouth and Waveney Clinical Commissioning Group commented: ‘We have been using eKare inSight^® since February 2019, and have found it useful in enabling professionals to view accurately recorded and measured images. Previously the person with the wound would either have to attend multiple meetings for their wound to be visually assessed, or the health professional would need to interpret the description from another person. Now they are able to view the image of the wound and the automatic measurements of the system. This improves communication and assessment between individuals and we have found it to be a valuable tool’. 

inSight^® enables collection and sharing of real-time data to improve efficiency

The ability of inSight^® to facilitate the collection and sharing of data, improving efficiency across an organisation, is where benefits can really be seen.

Data collected by inSight^® is GDPR compliant and the PIA/IG process has been successfully completed with several NHS organisations. 

Data storage is cloud-based, eliminating the need to install software on IT equipment. Information can be viewed by logging in from any internet-enabled device, and organisations can set up as many user profiles as needed. This facilitates telehealth, virtual MDT meetings, a movement of routine wound assessment from acute to community and rapid escalation/de-escalation of patients as necessary, without the need for repeated specialist intervention or clinic visits, freeing up appointments for those who really need them.

Libby Gray, Tissue Viability Lead Nurse, Norfolk Community Health and Care (NCHC) has used inSight^® successfully in this way: 

‘I have already seen community staff beginning to embrace the new technology. We have been able to view and share much better quality images with the patients themselves and the relevant clinical specialists such as GPs and hospital consultants. This has led to us gaining specialist advice in a much more timely and effective way improving patient confidence and motivation. Very exciting!’

Dr Nick Morrish, Consultant Diabetologist Bedford Hospital and Clinical Lead for East of England Diabetes Clinical Network, has also found the use of inSight^® to be valuable in clinical practice:  

‘We are six months through a two-year project utilising eKare inSight® for NHS Diabetic Foot Services in two areas within our network and are encouraged by the positive feedback around improving clinical decision making, better use of resources and patient satisfaction. We are now keen to get more objective data about its impact on patient outcomes. We are happy to be collaborating with eKare in this project.’

 

Clinical dashboard – real-time data

Finally, through the data captured, various dashboards are automatically populated, from the top level view on caseload and wound dynamics and healing rates across the service or organisation, though to individual patient healing trajectories. 

These are intuitive to use and enable quick, informed decisions about progressing treatment that are not just based on the outcomes of the current, or most recent interventions, but on the whole episode of care. 

The reporting tools are flexible, allowing staff to customize and generate PDF reports or export CSV files to meet clinical and compliance requirements. 

If any changes are made to the software, these can be downloaded for free in the same way as app updates are downloaded on a personal phone. Flexibility at an account level offers the ability to alter fields to suit the organization’s needs.  There is also the option to enable digital consent within the system which has proved very popular with clinicians and patients.

Nicholas Brown, Commercial Manager, East Midlands Academic Health Science Network, stated: ‘We’re delighted to welcome eKare alongside other innovators and like-minded businesses across the UK to the digital health ecosystem we’re building. Wound care presents a significant challenge for the NHS and eKare is able to demonstrate a proven digital solution with a strong pipeline of future developments we feel has huge potential to help improve how wound care is delivered.’

eKare has a pipeline of further digitial developments within wound care. For more information on eKare inSight^®, please visit www.ekare.eu