Data‐driven specialisation of wound care through artificial intelligence

1.

The evolution of wound care as a clinical speciality includes the development of similar but different service models. This evolution has been slow at best.1 Many factors influence this. Wound care service models are essentially based on a similar foundation but may differ subtly because of these regional processes and practices within health care in general.2

Data are a valuable asset in this evolutionary journey.3 Many wound carers collect data on a local or, at best, regional basis. As a collective, however, the community is not good at sharing or pooling these data as the process is complicated and cumbersome. While a multidisciplinary approach is preached by most, there is an over‐protection of local information that may benefit others.

Sharing is caring. Sometimes, this is a system issue rather than an individual issue. As many of the system approaches do not factor in wound care models, there is little or no ability for effective and consistent data capture. Modern technological approaches can, however, influence both the service delivery and the data capture and sharing.

The most obvious way of innovating care in practice is to focus exclusively on new technology that offers new treatment options to patients. However, new technological approaches that automate process and data capture can provide transparency of approach and lead to significant change. Digital health care is not new. It has been evolving for a couple of decades now, but as always, its adoption within wound care is much slower when compared with other clinical arenas.

In a previous editorial,4 we introduced the buzzwords Artificial Intelligence (AI) and Machine Learning (ML), but like most of the general population, many practitioners do not understand their meaning and, more importantly, their potential role in the management of wounds. Essentially, these concepts mean “data‐driven” or “experientially driven.”

AI will be a catalyst for the evolution of more informed wound care practice and will therefore help with the specialisation of the clinical area. Through the use of technology systems such as “apps,” clinicians can capture large volumes of data and then, through AI/ML techniques, have the transparency of approach to begin to truly understand the areas of focus and change required to standardise the practice.

Through the use of data and AI techniques, wound care can be standardised by understanding and training. AI married to human intelligence is allowing a more rapid standardisation and specialisation of wound care. This is delivered through two main areas: first, the actual ability to standardise practice across the care continuum and second, the ability, through the application of technology, to “up‐skill” its delivery even through less‐trained resources (eg, family or patient).5

In addition, the use of this approach can change the delivery of wound care but also enhance patient engagement. The possibilities of this type of approach within the standardisation of practice are many but include:

• Patient engagement in their care

• Workflow improvement for caregiver

• Care connectivity across the health continuum

• Education and awareness

• Symptom management (eg, pain)

Many patients with wounds have multiple comorbidities, and therefore, this technological solution has the opportunity to integrate with other solutions (eg, Electronic Medical Record (EMR)) in other clinical areas (eg, diabetes).

In this era of the emergence of sophisticated wound diagnostics, one of the simplest measures of wound progress or deterioration is the measurement of wound dimensions, wound area, or volume, which remains a significant challenge for many clinicians. The measurement of wound dimensions and area is challenging for a variety of reasons, but consistency and accuracy are the most significant. Within the past 10 years, we have seen the emergence of apps in a variety of health care arenas, and within the past 5 years, this includes the simple measurement of wound dimensions. Wound photography is not new but is not always performed, and a “picture paints a thousand words” (ie, provides much information).

Machine‐learning models can be trained with the use of tens of millions of patient charts stored in electronic health records, with billions of data points; this is impossible for a human as they may only see a few tens of thousands of patients in their entire career.

Through the use of effective assessment, documentation (including image capture), and AI/ML techniques, wound care can be standardised, made more objective, and augmented with the experience of millions of patients and billions of data points. AI married to human intelligence allowed more precise, patient‐centric care, resulting in better outcomes.

The ability to standardise practice through the many settings of care delivery and to “up‐skill” its delivery can help relieve the systemic burden of wounds.

To date, AI has revolutionised how we operate and will do for the foreseeable future. In wound care, AI will impact all areas, from prognosis, diagnosis, and treatment to workflow efficiency and broadening access to quality care. Engaging with technology will realise the promise of better outcomes for patients through the enhanced delivery of care by their care team.

Technology has already begun to change the delivery of wound care practice in many facilities, across the health care continuum. Through the use of data, AI techniques, and technology, with integration into larger EMR solutions, the transparency of approach is providing the catalyst for change. This is allowing patients to benefit from better care and providers to benefit from a more efficient care delivery, facilities, and systems to reduce cost.

Keep an open mind to the evolution of approach and/or technology. Sometimes, as clinicians, we do not easily identify the need that the technological solution may solve. It is an evolutionary journey between both consumer (ie, clinician) and solution (ie, technology or product).

Clinicians think clinically, not technologically. By designing these technologies to think clinically, solutions are provided that fit our “norm.” It is also important, however, that even in a more niche clinical arena, such as wound care, the technology has to integrate into practice and also with the other current technological solutions being used regularly in our care environment.

Today, care, for the most part, is being delivered by a more techno‐phobic generation, but that is changing rapidly, and within only a few years, the true technological generation (ie, millennials) will be delivering the majority of the care. This will truly change the delivery of care to the benefit of all, and wound care is an important part of that change. As a poorly understood but significant hidden and growing epidemic, the change is rapidly needed and should be embraced willingly.

Stand up and be counted. Seek technological change to make your practice more efficient today but, more importantly, lay the foundation for change tomorrow.