Abstract:BackgroundEach year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, p… Show more
“…When involved, they are the users that receive information at the back-end of the system, and may be: specialists asked to provide clinical advice on how to manage a difficult patient through image- and text-based systems; compiling or analysing data collected through a mHealth intervention; or teaching or evaluating a patient in real time through a telecommunication device. Usability of the front end of the app tends to be less relevant to this group, but workflow is very important, especially if they are working ‘on-call’ to provide clinical advice [33]. …”
While the field represents a wide spectrum of products and services, many aspects of mHealth have great promise within resource-poor settings: there is an extensive range of cheap, widely available tools which can be used at the point of care delivery. However, there are a number of conditions which need to be met if such solutions are to be adequately integrated into existing health systems; we consider these from regulatory, technological and user perspectives. We explore the need for an appropriate legislative and regulatory framework, to avoid ‘work around’ solutions, which threaten patient confidentiality (such as the extensive use of instant messaging services to deliver sensitive clinical information and seek diagnostic and management advice). In addition, we will look at other confidentiality issues such as the need for applications to remove identifiable information (such as photos) from users’ devices. Integration is dependent upon multiple technological factors, and we illustrate these using examples such as products made available specifically for adoption in low- and middle-income countries. Issues such as usability of the application, signal loss, data volume utilization, need to enter passwords, and the availability of automated or in-app context-relevant clinical advice will be discussed. From a user perspective, there are three groups to consider: experts, front-line clinicians, and patients. Each will accept, to different degrees, the use of technology in care – often with cultural or regional variation – and this is central to integration and uptake. For clinicians, ease of integration into daily work flow is critical, as are familiarity and acceptability of other technology in the workplace. Front-line staff tend to work in areas with more challenges around cell phone signal coverage and data availability than ‘back-end’ experts, and the effect of this is discussed.
“…When involved, they are the users that receive information at the back-end of the system, and may be: specialists asked to provide clinical advice on how to manage a difficult patient through image- and text-based systems; compiling or analysing data collected through a mHealth intervention; or teaching or evaluating a patient in real time through a telecommunication device. Usability of the front end of the app tends to be less relevant to this group, but workflow is very important, especially if they are working ‘on-call’ to provide clinical advice [33]. …”
While the field represents a wide spectrum of products and services, many aspects of mHealth have great promise within resource-poor settings: there is an extensive range of cheap, widely available tools which can be used at the point of care delivery. However, there are a number of conditions which need to be met if such solutions are to be adequately integrated into existing health systems; we consider these from regulatory, technological and user perspectives. We explore the need for an appropriate legislative and regulatory framework, to avoid ‘work around’ solutions, which threaten patient confidentiality (such as the extensive use of instant messaging services to deliver sensitive clinical information and seek diagnostic and management advice). In addition, we will look at other confidentiality issues such as the need for applications to remove identifiable information (such as photos) from users’ devices. Integration is dependent upon multiple technological factors, and we illustrate these using examples such as products made available specifically for adoption in low- and middle-income countries. Issues such as usability of the application, signal loss, data volume utilization, need to enter passwords, and the availability of automated or in-app context-relevant clinical advice will be discussed. From a user perspective, there are three groups to consider: experts, front-line clinicians, and patients. Each will accept, to different degrees, the use of technology in care – often with cultural or regional variation – and this is central to integration and uptake. For clinicians, ease of integration into daily work flow is critical, as are familiarity and acceptability of other technology in the workplace. Front-line staff tend to work in areas with more challenges around cell phone signal coverage and data availability than ‘back-end’ experts, and the effect of this is discussed.
“…The development of a smartphone-based consultation system for acute burns started in 2012 and from the beginning an app was installed on dedicated smartphones where structured patient data and photographs could be captured in a protocol-driven manner [14]. The project advanced in close collaboration with a panel of South African burns experts and emergency specialists and they soon requested that the app could be downloaded on their own smartphones.…”
Section: A Smartphone-based Consultation System For Acute Burnsmentioning
confidence: 99%
“…According to Leavitt’s Diamond model for organizational change, an organization has four components that are all interdependent and a change in one of them will also affect the other three (see Figure 1) [14]. For example, when introducing a new technology such as an app, people need to change their behaviour, they may need training to use the new technology and this may affect the health system.Figure 1.The organizational interaction diamond model, adapted from Leavitt’s Diamond model (1972) [15].…”
Section: Follow-up Design and Outcome Measuresmentioning
Background: A smartphone-based consultation system for acute burns is currently being implemented in the Western Cape, South Africa. Even though studies indicate that similar systems for burns tend to support valid diagnosis and influence patient management, the evidence is still sparse. There is a need for more in-depth evaluations, not least in resource-constrained settings where mHealth projects are increasing.
Objective: This article describes the consultation system and assessments in relation to its implementation with a special focus on methodological challenges.
Methods: A number of evaluations and assessments have been conducted, are ongoing or planned for in relation to the implementation of the teleconsultation system. Initial assessments showed that size and depth of burns could be assessed at least as well using photographs as at bedside and that the image quality of handheld devices can be used as well as computers. Studies on system usability are currently being done with a mixed-methods approach. A historical cohort design will be applied to assess the potential health impact of the system. Patients with burn injuries where the doctor at point of care has used the app to receive diagnostic support from a burns expert will be considered as exposed and patients with burn injuries where the app has not been used will be considered as non-exposed.
Conclusions: Smartphone-based consultation systems have the potential to strengthen the assessment of burn injury in many settings. However, ethically and methodologically sound evaluations are needed to find the best systems and solutions. This article identifies challenges and suggests potential assessments in relation to the implementation of such a system.
“…The data collection took place as part of a baseline study for an intervention [36]. Six hospitals and two CHCs were included, all with an emergency centre opened 24 h a day, seven days a week.…”
Section: Data Collection and Study Populationmentioning
Burns were far more common among children although gender differences arose only among adults. Men sustained more injuries of somewhat different aetiology and were referred to higher levels of care more often for comparable wound severity. The results suggest different disposition between men and women despite similar AIS scores. However, further studies with more comprehensive information on severity level and other care- and patient-related factors are needed to explore these results further.
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