Abstract
Chronic wounds, including pressure ulcers, compromise the health of 6.5 million Americans and pose an annual estimated burden of $25 billion to the U.S. health care system. When treating chronic wounds, clinicians must use meticulous documentation to determine wound severity and to monitor healing progress over time. Yet, current wound documentation practices using digital photography are often cumbersome and labor intensive. The process of transferring photos into Electronic Medical Records (EMRs) requires many steps and can take several days. Newer smartphone and tablet-based solutions, such as Epic Haiku, have reduced EMR upload time. However, issues still exist involving patient positioning, image-capture technique, and patient identification. In this paper, we present the development and assessment of the SnapCap System for chronic wound photography. Through leveraging the sensor capabilities of Google Glass, SnapCap enables hands-free digital image capture, and the tagging and transfer of images to a patient’s EMR. In a pilot study with wound care nurses at Stanford Hospital (n=16), we (i) examined feature preferences for hands-free digital image capture and documentation, and (ii) compared SnapCap to the state of the art in digital wound care photography, the Epic Haiku application. We used the Wilcoxon Signed-ranks test to evaluate differences in mean ranks between preference options. Preferred hands-free navigation features include barcode scanning for patient identification, Z(15) = -3.873, p < 0.001, r = 0.71, and double-blinking to take photographs, Z(13) = -3.606, p < 0.001, r = 0.71. In the comparison between SnapCap and Epic Haiku, the SnapCap System was preferred for sterile image-capture technique, Z(16) = -3.873, p < 0.001, r = 0.68. Responses were divided with respect to image quality and overall ease of use. The study’s results have contributed to the future implementation of new features aimed at enhancing mobile hands-free digital photography for chronic wound care.
Highlights
Chronic wounds affect 6.5 million Americans and pose a $25 billion annual financial burden to the U.S health care system [1]
We evaluated nurse preferences for features and interactions aimed at enhancing digital image capture and documentation
The data illustrate that nurses strongly favored SnapCap’s ability to rapidly identify patients through barcode scanning. They favored the use of voice-based commands to launch applications and to document wounds, as well as the double-blinking action to take photographs
Summary
Chronic wounds affect 6.5 million Americans and pose a $25 billion annual financial burden to the U.S health care system [1]. Of particular importance to hospitals are pressure ulcers (bedsores), which along with venous and diabetic ulcers, comprise the vast majority of chronic wounds. Studies have reported that a pressure ulcer extends the length of stay for an acute hospital admission by seven to fifty days [3]. In 2007, the Centers for Medicare and Medicaid Services (CMS) made a policy decision not to pay for the most severe HAPUs [5]. To reduce the incidence of HAPUs, hospitals are mandating thorough and accurate documentation, which is necessary to determine the degree of wound severity, evaluate the effectiveness of therapies, and modify treatment plans as appropriate
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