A person arrives at an emergency department with a painful burn. The examining physician needs to make a quick decision about the care to provide, but wants the advice of a burn expert – and the hospital doesn’t have one. Fortunately, there’s an app for that.
Providers now can get a remote consult with specialists at University of Colorado Hospital’s Burn Center with a downloadable app dubbed UCHealth Burn Consult. Developed by Allentown, Pa.-based CSymplicity Software, the free app allows providers to take photos of patients’ burns with their mobile phones and transmit them securely to burn specialists for evaluation. The app is HIPAA-compliant: All information sent and received is encrypted and erased from phones after the consult to ensure patient privacy.
UCH is the first provider in the Rocky Mountain region to offer the app, said Laura Madsen, RN, outreach coordinator for the Burn Center. The hospital worked with the app’s creator, Hamed Amani, MD, FACS, a burn specialist with the Lehigh Valley Health Network Regional Burn Center, to prepare it for launch. After a successful pilot with UCHealth Colorado Springs (Memorial Hospital) in December, Madsen began contacting hospitals outside the UCHealth system to let them know about UCHealth Burn Consult. She said she’s signed up providers at nine hospitals so far, including three late last month at Community Hospital in Grand Junction.
UCHealth Burn Consult works simply. The referring provider logs into the app from a mobile phone, enabling the camera to take photos. After selecting up to four, the provider fills out a form that includes his or her name; the patient’s name and birth date; and the type of burn sustained, such as grease, chemical, or electrical, and submits the information and the photos.
thThe app then displays a message advising the provider to call the number of the UCHealth DocLine for a consult. With that call, DocLine staff alert the burn specialist on call to log into the app and review the photos for an assessment and a consult with the referring provider about treatment for the patient.
The aim is to get the patient the appropriate level of care, Madsen said. For patients with very serious burns or frostbite, that could mean transport to UCH, but looking at the photos could also prevent a patient with more superficial injuries from being transported unnecessarily. In one recent case, a provider in Steamboat Springs submitted photos of a frostbitten patient. After review, the Burn Center decided the patient could safely receive treatment in the community.
“That’s a huge win because we were able to do what is best for the patient,” Madsen said.
“It has been very helpful to get the attached photos. We have been able to keep patients at their home hospitals and avoided unnecessary transfers,” added Anne Wagner, MD, of the Burn Center. “It has also made it very easy and efficient for providers to consult us. I feel strongly it improves patient care and is patient-centered.” Wagner said the number of requests for the app continues to increase.
In a phone interview, Amani said he developed the app to help providers make that type of difficult patient-transfer decision. He and his colleagues in Pennsylvania encounter it frequently. “We have had patients three to five hours away who didn’t need to come in to our burn center,” he said. “The app gives us a way to triage patients from afar.”
The burn app has been well received, he said, with 104 referral facilities using it within the Lehigh Valley network. These include emergency departments, urgent care centers, physician offices, and occupational health specialists working for companies, many of them in the gas industry. In addition to UCH, the app is also being used by one hospital in Louisiana and another in Nevada, Amani said.
“We’ve had nothing but enthusiasm thus far,” he said. “The aim of the app is to make providers’ lives easier, so there are no more just verbal descriptions of burns. They can now have an elucidated consult with referring providers.”
Madsen said she has also used UCHealth Burn Consult as another way to create positive contacts with community providers. “We try to maintain contact with far-reaching places, and this is a great way to do that. It’s a nice way to build strong relationships and help to answer questions.”
The burn app is just one of several CSimplicity has developed to assist providers in various specialties. Madsen found out about it at a day-long session of the American Burn Association devoted to the future of telemedicine. She spoke with Amani after he gave a demonstration of the burn app and brought the idea back to Burn Center Nurse Manager Mary Holden, RN, MS, and Medical Director Gordon Lindberg, MD. After they responded favorably, the Burn Center worked with Information Technology and the UCHealth TeleHealth team to test the app to ensure it worked properly and protected patient information.
Harder than it looks
The idea of using the now ubiquitous mobile phone to send burn photos just as one sends shots of the kids to relatives sounds intuitive, but it was far from a slam dunk, Amani said. In fact, he and his colleagues worked on it for more than five years.
“We have gone through the gamut of technologies, from video conferencing to web interfaces to mobile phones,” he said.
A major debate revolved around whether or not video was the best solution for remote burn consults. Amani said video is ideal for neurologists, particularly those looking for the facial droops and movement difficulties that are the tell-tale signs of stroke. Intensive care specialists have also used video effectively to examine patients and their ability to move while vital signs stream to them in real time.
But Amani said the success of video for these specialties didn’t translate to burn. “We found that the video camera can’t pick up the details we need, even at full zoom,” he said. Seeing those skin details is crucial for a specialist to determine whether a burn is second degree or third degree, or if a second-degree burn is deep or superficial, he explained.
“A still photo is acutely sensitive, has better resolution, and reveals the fine subtleties of the wound that we need,” Amani said. “Also, we’re not concerned with motion when we look at burns. We want to see the type of wound, the area on the skin, and its vastness.”
Taking photos is quicker than bringing in and positioning a video camera, Amani added. “On the sending side, we don’t need to get in front of a camera and give a report. On the receiving side, providers don’t want to be on video teleconferencing,” he said.
On the other hand, video could be a valuable tool for follow-up burn care, such as examining range of motion, scar contractures, and rehabilitation progress, Amani added.
Madsen said the Burn Center already considers the app a success and another example of changes in the way clinicians deliver health care.
“The app is part of the progression of technology,” she said. “Everybody has a smartphone. We’re counteracting the idea that referring providers don’t have to deal with little burns. We are telling them we are here to help you with a burn of any size.”