The importance of evidence-based data in supporting services for wound care and the potential for Innovation.

The DigitalHealth.London Accelerator and Health Innovation Network South London held a roundtable discussion on the current challenges facing wound care services. Our Senior Project Manager for Innovation Karla Richards shares her thoughts and reflections from this roundtable and how data and innovation can lead the way in transforming wound care services.

In December 2023 a group of professionals including tissue viability nurses and clinical nurse specialists, consultants in vascular surgery and plastic surgery, podiatrists, representatives from the health tech industry, and other professionals came together to discuss the challenges they face in providing wound care.

Participants highlighted multiple significant factors in the growing burden of wound management including unnecessary and unwarranted variation in the delivery of services, poor documentation, inconsistent information, lack of clear diagnosis, differences in evidence-based clinical practice and lack of continuity of care. People working within systems worry that the current ways of working are disjointed, and there is often a lack of communication across pathways, meaning clinicians may miss valuable information about their patients. In addition to the challenges and potential improvement opportunities in wound care, several key points were discussed, including using data to demonstrate demand and improve business cases for services and dressing budgets, improving communications about patient needs across services, and opportunities for new technology. A common thread across all these areas was data, or a lack thereof, and the ability to effectively demonstrate need.

The need for data sharing across systems is vital to transforming wound care. Data provides clinicians with information about the patient’s journey. This can be previous medical history, referrals, types of wounds and treatments, clinical concerns, and patient progress. Decisions driven by this data can be used as a guide for clinicians to provide accurate, solution-based care focussed on the needs of each patient. However, with clinicians operating on separate systems it can be challenging to collect and share information as a patient moves across care settings.

One key point made in the discussion is that there are no metrics for counting the actual number of patients receiving wound care in a particular geographical area or ICS. Anecdotally, there is huge unmet need for high quality wound care, but without standardised reporting, it is difficult to gather data for business cases or to justify increased spending on care.  One clinician explained that when looking at amputations, it is impossible to identify how many patients were also diabetic as this information is not captured on admission as standard. Coding is erratic and does not always translate from primary to community and secondary care. There is also no standardised way of capturing physical information about a wound. Some teams still use a tape measure to document wound size, with others taking photographs and often it is impossible to track the full history of a wound from first origins to current status, even in cases leading to amputation.

Clinicians are missing crucial data on dressings too. There is a wide range of dressing types available, with a wide range of costs, from simple bandages to specialist materials which are indicated for particular types of wounds. Some teams are reluctant to use the most expensive dressings, whilst others may use them more frequently than is clinically required. Without a standard way to track dressing selection and use in relation to healing progress, there is no evidence to justify spending on these consumables and to support business cases.  Currently some providers of dressings can provide platforms that show quantity and type of dressing at a team level, but this data is rarely recorded and linked to outcomes for individual patients. The gold standard would include tracking patient progress from first engagement with health care services thorough treatments, dressings used, and outcomes all with standard coding in order to demonstrate how many people are getting evidence-based care.

One participant in the discussion, from an independent social enterprise running a wound care clinic, shared how they collect data on their own system. As a social enterprise, they are a smaller organisation and able to control their own record keeping very closely, and they are also held to a very high standard by their commissioners. They take pride in their systems creating a “story” about each patient which ultimately shapes the care they receive, and whilst being cared for by them this works well. However, this data remains in their system if the patient changes to another provider, as the digital record doesn’t follow patients from independent providers to the NHS. Conversely, the clinic doesn’t have access to the full NHS record on their patients and may not be able to see their full referral history. This highlights the need for patients to own their own data, whatever provider they use.

The Roundtable participants also expressed concerns around relationships and staffing. Changes to immigration rules have seen a drop in the number of EU professionals working in the NHS, and one team mentioned that they have listed jobs and had no one apply. Covid-19 has also affected staffing and it has affected patients, who seem to be presenting much later than previously or calling about their concerns rather than going for face-to-face appointments. The specialist teams report that when they are finally seeing patients in clinic, many of them have a much higher level of wound acuity than would have been seen in initial appointments in the past.

So what are the solutions to these issues? The overarching priority for the professionals was improved data sharing and consistency in recording care and outcomes. New technology was also discussed – but as a tool to facilitate the gold standard of care and not just a “shiny new thing” to distract.

Two health tech innovators were in the room - Healthy.io with their wound care product Minuteful for Wound and a consultant in plastic surgery from Plexaa. These two innovations address wound care from opposite ends of the problem; Plexaa is a smart wearable which preconditions the skin pre-operatively to improve blood supply to the skin. This has been shown to prevent wound healing complications following surgery in clinical trials. Minuteful for Wound allows for better, more accurate decision making and wound care management with consistent documentation through 3D scanning and colour imaging. This medical device uses a smartphone to track wounds over time, identify tissue types, and to provide recommendations on dressings and treatment. The data for each patient can sit within the app and be transferred across providers and along the patient care pathway.

The use of technology across multiple settings would mean that professionals have access to the full history of a wound, can see previous treatment plans, and get AI-generated decision support for care. Supporting the use of these types of technology to become part of the existing pathways of care would not only help clinicians, but patients could also see their own progress and begin to understand their own journey better. By empowering patients to participate in their own care, compliance to medication and treatments is improved. Engaged patients may also be interested in participating in peer support, which some of the clinicians agreed could be a valuable tool for patients on similar treatment journeys.

The key conclusions from this event were around the importance of the whole story of the patient’s wound moving with them across different care settings, and finding a clear, unified method to share data, coding and decision making. Technology does have a place in supporting care for patients in both the preparation of skin for surgery and with digital measurement standardising the tracking of wounds and their improvement, or the flagging of decline.  More work is needed to address the perception of innovation and how it can reinforce the sharing of good data-driven decision making and support the workforce to understand existing care pathways. However, effective change also requires personal connections, strong networks, standardisation, and enthusiasm for meaningful transformation.

Thank you to all those who took part in this roundtable, for your honest thoughts and experiences and to Sara Nelson, Programme Director, DigitalHealth.London, for chairing this discussion.