eKare inSight® 


As a clinician, it is important that you are aware of all the latest new products that have the potential to improve outcomes for you and your patients. Each month, Wound Care Today will highlight a product that is new, improved or innovative to keep you up to date with what is available. This month, we focus on eKare inSight®, a unique and easy to use Wound Management Digital System (WMDS) that transforms a smartphone into a medical device enabling standardised, accurate wound assessment at the point of care. eKare inSight® allows the sharing of real-time data and wound visuals, potentially leading to improved wound care efficiency by allowing workflow to be streamlined. Decisions about care can be made quickly and remotely, facilitating the expediated passage of patients through the care pathway and promoting the right treatment and interventions to be provided at the right time. Because of the simplicity of the system and the way it presents the wound healing information, patients can get fully involved in their care. 

Background 


Currently in the UK, the delivery of wound care has unwarranted variation, with the underuse of evidence-based practice and the overuse of ineffective interventions (Gray et al, 2018). In order to reduce unwarranted variation, there has been a call for clinicians to collect data to demonstrate the efficiency of their practice.  

Leading Change, Adding Value developed a framework (NHS England, 2016) to put an emphasis on the quantifying and measuring of outcomes in nursing practice in the UK, in alignment with Five Year Forward View (NHS England, 2014), so that clinicians can demonstrate where high standards of care are achieved, or can identify where improvements are needed, so that unwarranted variation in practice is reduced (NHS England, 2016). 

More recently, the National Wound Care Strategy Programme (NWCSP) (2018) has been developed to address the issue of sub-optimal wound care, building on the work of Leading Change, Adding Value and Five Year Forward View (NHS England, 2014; 2016). 

The NWCSP recognises the urgent need for valid and reliable metrics to measure wound care activity and outcomes. As a result, the three clinical workstreams are working with the data and information enabler workstream to identify how this might be achieved with minimal impact on the clinicians at the frontline of care (Adderley, 2018). 

The adoption of digital and artificial intelligence (AI) solutions is fundamental to transforming health and social care in line with The NHS Long Term Plan (NHS England, 2019). The NWCSP suggested the use of a WMDS to their lower limb first tranche implementation sites prior to recruitment (Adderley, 2022). Academic Health Sciences Network (AHSN) in the UK has broadened the reach of the NWCSP lower limb work with the launch of the Transforming Wound Care programme (AHSN, 2022a) and the appointment of the first six test and evaluation sites (TES). As part of both the NWCSP and the TES work organisations involved are largely implementing and evaluating the use of WMDS to aid with reporting but also to improve the quality of and accessibility to clinical documentation (AHSN, 2022b). 

eKare inSight® is already being used by several trusts in the UK to improve data collection and sharing to improve efficiency of working, to reduce costs and to improve patient outcomes.   

What is eKare inSight®? 


eKare inSight® simply combines an app and camera technology to transform a mobile phone into an indispensable wound management medical device that is intuitive and simple to use anywhere.   
 

Artificial intelligence assisted wound measuring 


Every image captured using eKare inSight® is accompanied by on-screen prompts to ensure users get the most consistent, best quality wound imaging and measurement mapping possible. The clinician simply needs to follow onscreen prompts, using their smartphone camera in the app, to capture a straightforward wound image. 

Following a couple of phone screen finger swipes, the wound perimeter is automatically detected and delineated for fast/precise measurement. The map of the wound obtained is analysed and resulting data presented as length, width, area, average depth, minimum depth and volume. 


Tissue composition analysis in seconds


As well as providing measurements of the wound border and depth, inSight® can determine the colour of tissues within wound bed. The percentage of red, black, and yellow tissue detected is quickly presented accurately and objectively, ready for the clinician to attribute to the relevant elements of the wound and anatomy.
 

Patient and wound assessment


Both wound and patient assessment data can be collected within inSight®. Historical assessments are also visible in the app, assisting caregivers with their decision making and holistic assessment, even when they have never seen the patient before.
 

Treatment Plan


A full treatment plan can be recorded, and previous plans viewed at the point of care.

How does eKare inSight® do this and is it reliable? 


The inSight® app combines latest vision systems using sensor technology (for visualising and recording the wound) with machine learning data analysis, to enable the system to learn from data it collects. It does this by identifying patterns and makes decisions with minimal human intervention.   
The apps algorithm then calculates the wound dimensions, including area and volume. Depth is presented as both maximum and average measurements. 
 

 
Extensive research and engineering have enabled the accuracy and reproducibility of inSight® to be validated. Bills et al (2016) showed that inSight® provided an accurate and reproducible method for determining wound healing changes in line with other available technologies but was faster and more consistent; critical factors when used in clinical practice. More recently, Swerdlow et al (2023) evaluated the inter- and intra-rater reliability of eKare inSight® in 42 wounds where a high level of reliability was observed for repeat wound area measurements by the same examiner and between examiners. The authors concluded that increased use of smartphones in clinical care, coupled with advances in smartphone imaging and machine learning, allows for a potential solution to the problem of fast and accurate wound measurements. eKare inSight® is widely used in clinical trials of all categories and is regularly accepted by the FDA.  

inSight® enables collection and sharing of real-time data to improve efficiency


The ability of inSight® to facilitate the collection and sharing of data, improving productivity across an organisation, is where benefits can really be seen.

Data collected by inSight® is General Data Protection Regulation (GDPR) compliant and the system is Cyber Essential Accredited (a UK certification scheme that shows an organisation has a minimum level of protection in cyber security) and has completed Digital Technology Assessment Criteria (DTAC) and other required security and governance assessments.

Data storage is cloud-based, eliminating the need to install software on IT equipment. Information can be viewed by logging in from any internet-enabled device, and organisations can set up as many user profiles as needed. This facilitates telehealth, virtual multi-disciplinary team meetings, a movement of routine wound assessment from acute to community and rapid escalation/de-escalation of patients as necessary, without the need for repeated specialist intervention or clinic visits, freeing up appointments. 


By using the eKare inSight® Patient Remote Monitoring app, clinicians can assign some responsibility for image and measurement taking to competent patients. They are reminded to take their wound images days/times set by their clinician. They take the image and that is automatically measured and fed into the overall record of that wound’s history. The patient can instantly review their healing progress and their clinicians can view this too, enabling them to decide if face to face intervention is necessary or if they can allocate that time to someone more in need. 
 
 

What about my electronic patient record system and duplication? 


eKare inSight® can be used to document all wound-related data. It has proven integration capabilities, winning the EMIS ‘Optimising Resources Partner of the Year 2022’. Currently eKare inSight® is integrated with various leading electronic patient record systems in the UK and other data sets such as CSDS via utilisation of SNOMED coding   

Data captured in eKare inSight® has been aligned to the various national requirements such as CQUIN and National Woundcare Metrics. Along with local requirements to replicate existing templates on EHR enabling true mobile data capture and removing duplication.

What are the benefits of eKare inSight® to my organisation and patients? 


eKare inSight® is a unique wound management platform. It has several advantages when used as part of clinical practice. 
 

Unlocked efficiencies, expediated healing, appropriate costs of healing, robust documentation, all through meaningful data 


eKare inSight® produces various types of data for the consumption of different types of people involved in the care of each wound and patient:  
  • Patient engagement – wound healing visuals available to patients may result in feelings of ownership and enhanced compliance (Box 1)   
  • More robust, timely clinical decisions – accurate, consistent, clear patient and wound-level visuals (images and graphs depicting healing progress) available to frontline healthcare professionals at the point of care and remotely in real time if a second opinion is required 
    ○ Optimise wound and patient management:   
    ○ Ongoing tracking of assessment criteria 
    ○ Holistic view of treatments can identify inappropriate use of product types (e.g. antimicrobials) by cross referencing reports with wound/patient symptoms 
  • Encourage system efficiencies (e.g. deterioration of wound may lead to proactive escalation of patients according to immediate need) 
  • Automated reporting and metric delivery – eKare inSight® is aligned to the national minimum data set for wound care (Coleman et al, 2017; Professional Record Standards Body, 2023). Its new reporting capabilities have been developed alongside NWCSP first implementation sites and mindful of the Commissioning for Quality and Innovation (CQUIN) (NHS England, 2023) and other similar metrics. The result is fast outputs in the format that is required, driving services and organisations towards a more efficient future using the power of data 
  • eKare inSight® is able to review adherence to formulary, appropriate product use or time to heal of specific patient or wound groups. 

Box 1
Patient story demonstrating patient engagement 

 
‘Mrs J.G. is an 89-year-old female with a leg ulcer to the lower gaiter area of the left leg. The ulcer had been present for around 12 months prior to her coming to lower limb service within the Wye Valley NHS Trust clinic. On presentation to us she was fully assessed, Doppler undertaken, and necessary compression applied. Mrs J.G. did struggle with concordance with compression treatment because she felt it was not achieving any benefits or results. She wasn’t confident that her wound was improving. We began to use eKare inSight® to digitally document wound assessments, image and measure her wound. eKare inSight® proved to be a great visual aid for both the health professional and patient. It allowed us to easily look back at photographs and treatment plans and adjust accordingly. We were able to share the relevant information with Mrs J.G. For the first time, Mrs J.G. was able to see a clear picture of the progress of her wound from the photos and the healing trajectory graphs. She was able to see that her ulcer was healing! This really improved her understanding, through pictures, of how compression helps to heal the ulcer. The patient became highly motivated to persevere with compression treatment. She involved her partner, who could now also see the healing and understood the treatment rationale, provided support and encouragement. The ulcer healed within six months of presentation to the lower limb team and Mrs J.G. is now able to self-care applying her own cream and daily wrap.’  

Alison Barker, Lower Limb Team Leader, Wye Valley NHS Trust 

Standardised and objective wound measurements 


It is well known that wound measurements taken using traditional methods are subject to practitioner variables, body morphology and patient positioning (Hampton and Kilroy-Findley, 2016). For comparison, it is important that patients are in the same position each time the wound is photographed, to ensure the measurements are taken from consistent points, but we know this is not always the case in practice (Hampton and Kilroy-Findley, 2016). 
 

Maintenance of asepsis  


Surgical site infection (SSI) is the third most commonly reported healthcare-associated infection (HCAI) and results in significant patient morbidity and mortality (Stryja et al, 2020). Data collected by NHS hospitals in England from April 2010 to March 2012 estimated the length of stay attributed to SSI increased by 7-13 days, with a total of 4694 bed days lost over the whole study period (Jenks et al, 2014). One of the primary principles of surgical/acute wound healing is the use of aseptic techniques at all times (Stryja et al, 2020) i.e. using sterile procedures and applying the principles of aseptic non-touch technique  (Lowbury et al, 2013). 

Wound infection continues to be challenging for patients, carers and clinicians, potentially leading to a delay in wound healing. Environmental risk factors associated with increased risk of wound infection include an unhygienic environment (e.g. unclean surfaces or instruments, such as a tape measure or wound measuring rulers) and inadequate hand hygiene or aseptic/clean technique (International Wound Infection Institute [IWII], 2022). When performing a sterile or clean wound dressing procedure, the IWII (2022) suggest equipment used, such as scissors or measuring rulers/tapes, should be sterile.     

eKare inSight® facilitates standardised wound photography, measurement, and tissue analysis without touching the wound itself, or the surrounding tissue (if using a smartphone with a sufficiently advanced specification such as iPhone 11 onwards). Because of this, using this non-touch technology may play a part in helping reduce the risk of SSI and wound infection.    

Clinical dashboard – real-time data  


Finally, through the data captured, various dashboards are automatically populated, from the top level view on caseload and wound dynamics and healing rates across the service or organisation, though to individual patient healing trajectories.  

These are intuitive to use and enable quick, informed decisions about progressing treatment that are not just based on the outcomes of the current, or most recent interventions, but on the whole episode of care.  

The reporting tools are flexible, allowing staff to customise and generate portable document format (PDF) reports or export comma separated values (CSV) files to meet clinical and compliance requirements. 

eKare has a pipeline of further digital developments within wound care. For more information on eKare inSight®, please visit www.ekare.ai 

References

Academic Health Sciences Network (2022a) Transforming Wound Care. Available online: https://www.ahsnnetwork.com/programmes/wound-care/transforming-wound-care/  

Academic Health Sciences Network (2022b) Transforming Wound Care: First test sites announced in new national programme. Available online: https://www.ahsnnetwork.com/news/transforming-wound-care-first-test-sites-announced-in-new-national-programme/ 

Adderley U (2018) Our vision for the National Wound Care Strategy Programme. Wounds UK 14(5): 13 

Adderley U (2022) National Wound Care Strategy Programme: past, present and future. J Vasc Soc G B Irel 2(1): 4-6  

Bills JD, Berriman SJ, Noble DL, Lavery LA, Davis KE (2016) Pilot study to evaluate a novel three-dimensional wound measurement device. Int Wound J 13(6): 1372-1377  

Coleman S, Nelson EA, Vowden P, et al (2017) Development of a generic wound care assessment minimum data set. J Tissue Viability 26(4): 226-240  

Gray TA, Rhodes S, Atkinson RA, et al (2018) Opportunities for better value wound care: a multiservice, cross-sectional survey of complex wounds and their care in a UK community population. BMJ Open 2018;8:e019440 

Hampton S, Kilroy-Findley A (2016) Taking photographs of wounds and data protection. Wounds UK 12(1): 40-44 

International Wound Infection Institute (2022) Wound Infection in Clinical Practice. Wounds International, London. Available online: www.woundsinternational.com  

Jenks P, Laurent M, McQuarry S, Watkins R (2014) Clinical and economic burden of surgical site infection (SSI) and predicting financial consequences of elimination of SSI from an English hospital. J Hosp Infect 86(1): 24-33  

Lowbury EJL, Ayliffe GAJ, Geddes A (2013) Control of hospital infection. Springer, Boston USA 

National Wound Care Strategy Programme (2018) About the programme. Available online: Wound Care Strategy | NWCSP (nationalwoundcarestrategy.net) 

NHS England (2014) Five Year Forward View. Available online: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf 

NHS England (2016) Leading Change, Adding Value. Available online: https://www.england.nhs.uk/wp-content/uploads/2016/05/nursing-framework.pdf  

NHS England (2019) The NHS Long Term Plan. Available online: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf 

NHS England (2023) Commissioning for Quality and Innovation (CQUIN): 2023/24. Available online: https://www.england.nhs.uk/wp-content/uploads/2022/12/CQUIN-2023-24-guidance-version-1.1.pdf 

Professional Record Standards Body (2023) Wound assessment and treatment. Available online: https://theprsb.org/standards/wound-care-standard/ 

Stryja J, Sandy-Hodgetts K, Collier M, et al (2020) Surgical site infection: preventing and managing surgical site infection across health care sectors. J Wound Care 29(2, Suppl 2b): S1–S69 

Swerdlow M, Lo J, Armstrong DG (2023) Reliability of an AI-powered application across different mobile devices for assessment of chronic wounds. Adv Wound Care Mar 28. doi: 10.1089/wound.2022.0095. Available online: https://pubmed.ncbi.nlm.nih.gov/36721378/   

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