Digital Camera System

Complex acute wounds and chronic wounds are one of the most costly health care conditions in the United States. The U.S. wound care market is estimated to be $20 billion. One trend driving the wound care market is the aging population. As we age, we don't heal as well because our immune system doesn't respond as quickly. What's more, many elderly persons are malnourished and immobile - which makes them susceptible to pressure ulcers.

More than half of the patients admitted to the Visiting Nurse Service of New York are older than 65. Given that fact, it's not surprising that over 25% of our patients have wounds. This translates to more than 5,000 VNS patients with wounds at any one time. Many of these wounds are complex or chronic in nature.

To ensure the best possible care to patients with wounds, the Wound & Ostomy Center of Excellence has piloted and implemented an innovative use of a digital camera system in all regions. This new state-of-the-art method of reviewing wounds is enabling VNSNY to provide expert and timely assistance with difficult to heal wounds to our Coordinator of Care (COC) nurses as well as physicians. Better still, the digital photographs are far superior than the previously used Polaroid photos.

The Wound & Ostomy Center of Excellence has established four goals for the digital camera system. They are to:

• Increase the percentage of wounds that heal or that are nearly healed upon discharge
  
  
• Decrease the healing time of wounds in all classes of wounds
  
  
• Decrease the utilization - that is, the number of visits - used in healing wounds and costs
  
  
• Improve the nurse and physician collaboration so that patient outcomes will improve

Here is how the digital camera system works:

1. An Enterostomal Therapy (ET) nurse consult is requested by, say, a COC nurse for a wound patient needing a consultation.
   
   
2. The COC nurse signs out the digital camera from the tech room and takes a digital photograph of the patient's wound.
   
   
3. The digital disk from the camera is removed by the COC nurse and submitted to the (ET) nurse with a copy of the last patient progress note and wound consult form.
   
   
4. The ET nurse reviews the digital photograph of the patient's wound, plus the patient's progress note and wound consult form and other clinical information currently available in the VNSNY electronic record.
   
   
5. Corresponding with the COC nurse through our pen-based computer system, the ET nurse provides a written electronic wound consult and recommended changes to the Plan of Care. The ET and COC nurse review the wound consult without a costly joint visit.
   
   
6. The COC nurse contacts the patient's physician regarding the POC changes, explaining the rationale noted in the ET nurse consult. Printed pictures are sent to the physician, when appropriate.
   
   
7. A copy of the digital picture is printed in the patient’s hard-copy record.
   
   
8. The ET nurse saves and forwards the digital photo for electronic storage, if future reference is necessary.

The digital camera system has significantly increased the efficiency and effectiveness of our wound care management. In fact, ET nurses, using the digital camera system, have increased patient consults, coaching COC nurses to improve their care management. The digital camera system is a collaborative project involving the Centers of Excellence, Regional Operations, Information Systems and Clinical Systems Design.