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Wound histories The wound care software automatically generates wound histories. In initial focus groups, clinicians indicated that this feature is a significant benefit, since the history of the wound is often difficult to discern from a paper-based patient file. Wound histories are generated in graphical,as well as text-based format, to address individual preferences in overviewing information. Where the smartphone or Tablet includes a high-resolution camera, wound images can accompany the wound histories.
Alerts The wound care software provides alerts for multiple
conditions. These conditions can be programmed by the user, and include rapid wound deterioration (in excess of a programmed threshold for time and/or score), wound that are due for reassessment (relative to a programmed frequency), wounds that have been present for longer than a programmed duration, and other user-generated alert conditions. The alerts are shown to the user immediately upon logging in and accessing a given patient file on the device.
Ongoing learning The software supports ongoing learning via help screens, on-demand contextual information and built-in tutorials. This extends its applicability as a learning tool in nursing education programmes at colleges and universities. As wound care is a specialty area in nursing, this feature is useful in supporting those clinicians in general practice who provide wound care.
System design Each smartphone or tablet device running wound care software is associated with an individual healthcare worker and their multiple patients (rather than the device being associated with a unique patient at the bedside and his/her multiple healthcare providers). The general objectives were to design an interface that would maximise user compliance and the value of the data for primary users. This included ensuring the simplicity of the user interface, minimising visual elements on any given screen to reduce clutter, using colour cues to focus information, and converging on critical information. The design minimises the number of steps required to complete common tasks (wound entry, wound assessment), and intuitive guidance leads the user only to the areas of the form applicable for the given patient. Simple widgets (checkboxes and spinners) are used
whenever possible for data entry. Additional functionality considerations include the potential discomfort or inconvenience of carrying the device on one’s person, maintaining its battery capacity, considerations in infection control. Privacy of personal health information and medical records
is a significant priority. Each individual is assigned a user ID and password for a secure login. Via a 3G/4G or Wi-Fi connection to a server, access rights are confirmed and the server will hold all patients’ wound data and users’ information. All user IDs and passwords will only be granted from an administrative
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standpoint, run by a separate server-side application. For added security, all messages sent from either client or server will be encrypted. If remote server infrastructure is not available or not desirable, the software application can be used with the smartphone or tablet’s internal memory card to keep a patient’s record private to the device itself. Having one centralised server (whether on site, off site, and/or shared between multiple facilities) allows for privileged, server- side applications to mine the data for anomalies within and between data sets. Overall, being internet protocol (IP) centric, all public internet security protocols would be integrated. The framework was designed to facilitate extensions to
other platforms (iPhone, BlackBerry, tablets, and device- agnostic HTML5 framework) and to other wounds (eg, surgical wounds). Additional extensions can include the reporting of other prevalent community health issues, including monitoring of blood pressure, body weight, blood sugar, depression screening, and dementia screening.
Conclusion The wound care software detailed here serves as a proof-of- concept of the viability of the technology for one particular patient care application and lays a framework for a range of potential follow-on applications. Documentation compliance is expected to improve through this work with follow-on benefits for patient and caregiver experiences, and ultimately, in patient outcomes. The work also advances e-health in nursing care.
Marcia Friesen is Assistant Professor, Design Engineering, University of Manitoba, Winnipeg, Canada; Jesse Vivanco and Jason Haydaman are Research Assistants, Electrical & Computer Engineering, University of Manitoba; Carole Hamel is Clinical Nurse Specialist, Riverview Health Centre, Winnipeg; Robert McLeod is Professor, Electrical & Computer Engineering, University of Manitoba.
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