Advice for Medical Illustration Departments Considering 3D Wound Imaging.

Initial Eykona installations have been closely linked to working with key clinical staff in the following areas in order of priority:

● Podiatry & Diabetes Consultants with a specialist interest in diabetic feet
● Vascular Surgery (with a special interest in Lower Limbs & Feet)
● Tissue Viability Nursing (Wound Care)
● Burns & Plastic Surgery
● Dermatology

There are key NHS Agendas that these different departments work towards (including targets and consensus documents). These are as important to the Hospital senior management and board of directors as they are to the clinicians. With such a range of possible uses, there is an opportunity for Medical Photography to take ownership of the implementations, providing a central resource for training, support, and system admin.

Having a consultant on board really supports cases as they often have ways of requesting budgets from charities as well as university funds etc. The more departments and consultants on board the better the chance of it happening. If the system is useful to multiple departments there is much less resistance at a financial level.

In addition there are features of the system that appeal to different specialities these are listed below. Eykona are constantly working on updates to support requests from these clinical groups. Because the software is free, updates providing these new features are available free too, as they become available.

One thing that links all of the specialities is that a lot of the work they do is hugely subjective and has no hard data behind it. An expressed need for accurate and objective measurement and data is present in the UK health service.


Podiatry & Diabetes Consultants With A Specialist Interest In Diabetic Feet:

The key agenda topics for these customers are currently the focus on the diabetic lower limb amputation rates. It has recently got national profile (BBC and all national papers). There is a huge disparity between regional areas and the rate of diabetic amputations. If you have diabetes depending on where you live and how easily you can access specialist Multi-Disciplinary Foot Health Teams (Vascular Surgeon, Diabetic Consultant, Podiatrist, Diabetic Nurse, Wound Care specialist) affects if you keep your foot/leg or not and with a decent proportion of those having an amputation not surviving beyond the next 2 to 5 years it is hugely important and there is now pressure from government, Department of Health, NHS Diabetes, Diabetes UK (national charity) and the media and public. Aside from the cost to individuals the cost to the nation is estimated at £650 Million pounds per year (£1 in every £150 pounds the NHS spends).


Where Medical Photography and Eykona come in:

NHS Diabetes is calling on the NHS to set up specialist diabetes foot care teams as a matter of urgency. Foot care multi-disciplinary teams (MDTs) can generate savings for the NHS that substantially outweighs the cost of the team. One example shows how a local hospital team costing around £33,000 a year generated savings of almost £¼ million a year for the local NHS. Most importantly MDTs have been shown to reduce amputations by up to two thirds.

● All of the members of the MDT team need to understand the patient and their foot wound/ulcer issues but not all will get to see the patient. Eykona gives the MDT team an opportunity to all discuss patients using the 3D wound model software and check if the correct treatment options are applied.

● Patients are often transferred into the community from hospital when it is considered their wounds are stable and progressing but this is often hard to check. Eykona gives accurate and objective evidence that a wound is healing and if this is to the required level. Treatments can be changed if not successful by understanding this information.

● There is not a great deal of information as to how many foot wounds or diabetic foot ulcers there are in a particular area or how many new patients are presenting with foot ulcers or how long on average they take to heal. Eykona can support in the collection of all this information and present it in potential report format at the end of a 6 or 12 month period.
Interaction with patients to prove to them they are getting better is really important in this field as well (Patient Compliance with treatments etc.). Keeping them motivated to get better and do the right things to heal

● Plastics, Rheumatology, Burns, Vascular, Haematology, Sports Injuries & Liver departments are all recognising the potential of utilising thermography and are asking for research trials to be carried out. These are ideal candidates for Medical Photography to offer their services to, extending their importance to the trust by improving patient care. Anova Technology are specialist suppliers of thermography systems to Medical Photography departments, offering packages complete with training and support

Medical Photography with their photographic and image management experience, can support the MDT's by implementing and administering the Eykona software in a networked environment, with centralised data storage allowing the MDT's to access the data they need across a number of workstations. They can act as a centralised resource for training, with first line support to end users, as well as being administrators for the Eykona image/data management system.


Vascular Surgery (with a special interest in lower limbs & feet):

As the wound care professionals in hospitals and might seem to be the first place that you would consider contacting to discuss the concept from a clinical perspective. However they often don't have a high level clinical champion They also vary in how innovative they are., this means that they might not be the key clinicians that would promote the use of the system. This is often more likely be a clinician in any of the other 4 specialities listed.

Although the TVNs are responsible for most of the Wounds that occur in a Hospital Trust the core focus is currently Pressure Ulcers. This again has a national agenda driven by Department of Health the Strategic Health Authorities (SHAs) the senior management in hospitals, the media and general public.

Eykona have been working with SHA level contacts to drive this agenda of collecting information on pressure ulcers (numbers) and how they heal (speed) this is embraced by a number of clinicians but not all (some see it as extra work). Eykona can collect this information. The Trusts are rewarded and incentivised to deal with pressure ulcers under the QIPP CQUINs payments for pressure ulcers.

More information about QIPP and CQUINs pressure ulcer payments can be found online.

TVNs are often responsible for the selection of dressings and products used for wound healing. Historically products have been chosen not only on the basis of evidence and quality but marketing and good salesmanship. More recently with the aim to save money many trusts have introduced woundcare formularies where they have tendered all of their dressings business to one company or a combination of 2 companies in an effort to save money and get better training and education for staff in return. A problem is they often never see the company representatives once the contract is signed. What it is proposed they would like to do is carry our 3 monthly audits of company performance through collecting data on a selection of wounds. These are then the focus of quarterly reports generated by the dressing companies (reflecting the quality of their dressings and the training they provide to the hospital staff). As these tender contracts are often worth in excess of £100,000 + per year it is envisaged that it may be possible to get the companies to pay for the Eykona System and that they would work with the Medical Photography departments to collect the data.

Under the NHS agenda of Any Qualified Provider Tissue Viability services are up for tender by Trusts who can select to have a private company provide Tissue Viability services for a hospital or community area. Not many hospitals and PCTs have decided to do this in 2012 but in 2013 it is expected to go up. The key to the current Tissue Viability services retaining their contracts is that they can provide evidence that they give a good service that is efficient, evidence based, value for money and provides good patient outcomes. Eykona can support all of these. If they can't do it they may be out of a job.


Burns & Plastic Surgery:

Burns and plastic surgeons deal with wounds in the Trust and often need to get accurate measurement to make sure their interventions are having an effect.

Burns Surgeons: Not on all burns (some are too extensive for the Eykona system to image) are a particular issue in recording healing rates. These burns are often covered with skin grafts and the % take rate of these grafts are measured over a 3 week to 6 week period to see what % has taken to the body and what % the body has rejected. This will be a national target from 2013. Currently they do this by subjectively looking at the burn and guessing by eye what % has taken. They are aiming for 95% take for successful coverage.

Plastic Surgeons: There are a number of areas that are currently being explored in plastics. The Eykona System is being used to look at scar maturation and to take positive Volume and colour measurements to determine the healing phase of the scar. Interaction with patients to prove to them they are getting better is also important in this field. (Patient Compliance with treatments etc.).

As above the Vascular Surgeons often take the lead on the MDTs and drive this agenda of integrated services forward within the Trust.


Dermatology:

This is currently a new area for Eykona they are currently working with clinicians to use the Eykona System for Mole mapping and the changes in different skin conditions linked to area and colour. The inbuilt polarised flash system coupled with polarised lenses and the fact that the system effectively takes 8 simultaneous images lit from 4 separate directions allows extremely repeatable colour measurements to be taken.


In Summary:

Medical Photography can benefit from the deployment of the Eykona system, otherwise various clinicians in the hospital are likely to go it alone. Some of the benefits to Medical Photography include:

● The ability to offer an additional service with value to senior members of Hospital board, in a way that supports meeting some of their strategic aims. (QIPP, CQUINS)
● A way to build closer working relationships with clinical staff by offering a service that is more than just images but objective, accurate patient data.
● The ability to offer service effectiveness data to the Trust for specific wound, foot health or scar clinics etc.
● Acting as a clinician sponsored data collection department that can provide information on the effectiveness of specific products at wound or scar healing. This can even potentially be done through cameras purchased by the suppliers of wound care products, as a tool to objectively validate the products.


Contact us for more information.