Winning New Zealand's War Against Wounds with AI and Dedicated Specialty Nurse-Led Services

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Winning New Zealand's War Against Wounds with AI and Dedicated Specialty Nurse-Led Services

Wednesday, 5 April 2023

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FEATURE - Industry Innovation Article - Virtualcare - Tissue Analytics

When it comes to wounds like diabetic ulcers, pressure injuries and burns, New Zealand is at war. These conditions impact thousands of people, often leading to needless pain and suffering, costing the healthcare system millions. It doesn't have to be that way.

Making a difference
The leadership of Te Whatu Ora MidCentral – Health New Zealand, dedicated nurses and private enterprise are collaborating to make a difference in wound care. One example is how Lesley Batten, RN, MA, PhD, Associate Director of Nursing and her colleagues have launched an innovative approach to improving the documentation of the care of wounds at MidCentral District.

It all started a few years ago when Batten and a district nurse made a house call to a patient with a significant and long-standing wound. Her colleague had a large stack of paper files, making it hard to see if there was any improvement. Lesley asked the patient about the history of his wound and he showed her three photos on his phone to show the progress.

"I realised then and there that the images told a story that all that paperwork just couldn't," said Batten.

That experience became the genesis for Lesley's interest in using digital imaging to track, monitor and report on the progress of the wounds that most impact the 180,000 people in her District, which covers Manawatu, Horowhenua and Tararua regions. While wounds can affect anyone, they especially strike the elderly, socioeconomically disadvantaged and those of Māori, Pacific, and South-Asian ethnicities.

A People and Technology-Focused Solution
Batten and her colleagues recognised they needed a better way to document and evaluate care. This was even more evident over the ongoing battle against COVID-19, which sometimes made it difficult to visit patients at home, in residential facilities, or for them to attend the clinic for appointments.

While the team had long recognised the value of photos for wound care, taking and getting the images into the patient chart was time-consuming. Plus, it didn't give nurses the ability to measure and track the wound's progress (map) in a way that was consistent and made sense.

Batten had been looking for options for years when she learned about Net Health® Tissue Analytics in 2022. The U.S.-based company, which is expanding globally, is headquartered in Pittsburgh, Pennsylvania and pioneered the use of artificial intelligence (AI) and machine learning for digital wound care imaging.

Powered by artificial Intelligence (AI) and machine learning and backed by the world's largest database of wounds, Tissue Analytics provides a powerful and sophisticated, yet easy-to-use app, on smartphones or other digital devices. Its capabilities enable providers and patients to securely send and share images and track the progress of wounds using 2D and 3D images.

Mapping and colour-coding enable providers to see how wounds are healing or if they are at risk for worsening so that care plans can be adjusted for optimal care. It's an approach that ensures better, faster and more consistent care to all patients.

"We were really excited to learn about the capabilities and opportunities offered by Tissue Analytics," said Batten. "Plus, about 85% of our care is delivered in homes, so we needed something simple to use, reliable and that would provide accurate measurements at each visit and with all our nurses. We thought the opportunities were brilliant!"

Started with a Trial
MidCentral began its experience with a clinical trial. Clear objectives were set, and the team developed a list of questions they wanted answered to ensure the value of the technology for their service. Questions asked included how easy it was:

To take a wound image and store it in a sequential manner in a clinical file
To map and graph the measurements over time
To audit care against wound type, healing progress and products used
For a patient to provide a photo

Batten reports that one of the most surprising findings was how well the technology engaged patients. "Some patients had never seen their wounds as they were on areas hard to see," she recalls. "Patients were especially fascinated with the mapping process that let them see the wound's progress over time. The degree of engagement has been brilliant, and that helps patients feel empowered and heal faster," said Batten.

Bringing Value to Clinicians and Patients
Batten notes that the Tissue Analytics technology has provided clinicians, patients, and the MidCentral District several other benefits. Some of the things she believes are most notable include its ability to help nurses:

Identify non-healing wounds quickly. They can tell if wounds are not healing and rapidly make appropriate interventions.
Support new staff. Because many patients are remote, new staff often must work by themselves. With digital imaging, they can share images with experienced colleagues and quickly obtain the input needed to develop an effective treatment plan.
Ensures access for patients who are in remote areas. Many District Nursing patients have trouble getting to appointments because of their age or travel limitations or, as we recently experienced, natural disasters such as the recent cyclone. Batten and her colleagues believe anything that helps them stay connected with patients is beneficial.

Moving Toward the Future
The MidCentral team fully believes in the value of digital images. Research has been clear for years that even small wound size and shape changes can indicate deterioration or progression. The sooner clinicians pick up on these changes, the sooner they can develop optimal care plans.

Because of their positive experience and promising outcomes, the District recently committed to extending its trial agreement with Tissue Analytics and plans to expand its use to the entire district nursing service. Batten notes that several other Districts in New Zealand are interested in their experiences and expect broader adoption of the technology in the near future.

Batten admits there are still steps to take. One of her biggest concerns has always been her staff, ensuring they are comfortable with the technology. "We need to make sure the clinical team is happy and that any technology we use is seamless whether used in the home or clinic," said Batten. "We must ensure new technologies don't take away from our goal to provide personalised, hands-on care."

For example, one early concern of some staff was that AI would replace the decision-making by experienced clinicians. She stresses that’s not the case. "As we extend and expand this trial, it's our job as program leaders to reinforce the message that AI doesn't diagnose – and it can never take the place of a caring and skilled nurse. That is the essential job of clinicians, nurses included" she says. "We believe in AI for wound care documentation but we also promise to never forget there is a person behind the image and making the clinical decisions."

In fact, Batten and the supporters of digital technology believe that the clinician role is now more vital than ever. The technology provides more information and insights that skilled nurses and other health professionals need to review, advise and effectively use.

The goal of any technology must be to provide options and the ability to provide care in new ways that emphasise and promote evidence-based and patient-centered care. Batten believes that digital imaging and MidCentral's new emphasis on wound care technology will enable their team to reach that goal while ensuring they provide better and more consistent care to all patients, no matter their need, wound or location.

About the Author
Ben Magid is the CEO of Virtualcare, a solution provider for the healthcare industry headquartered in Sydney, Australia. The company is the South Pacific partner for Net Health Tissue Analytics. More Information is at Virtual-Care.NZ and Net Health.