A new, updated deployment of technology for Wound Care Teleassistance (WCT) service is now under way at the Centre de Coordination de la Télésanté (CCT) of the Centre intégré universitaire de santé et de services sociaux de l’Estrie-CHUS (CIUSSS de l’Estrie-CHUS), located in the Eastern Townships, in Quebec.
The aim of the WCT program is to improve access and care for patients needing complex wound care. Built on standardized methods and grounded in a clinical network of specially trained nurses, the WCT service model is unique in Canada. In 2014, about a hundred nurses, covering around 65 health facilities, were using it.
By 2014, 5 years after the initial deployment, it became obvious that the technology in place needed to be upgraded. In fact, most of the hardware used to provide the service was not supported anymore, which posed a threat to the continuity of the WCT service.
The CCT took this situation as an opportunity to reassess the needs of the nurses in regard to WCT and also re-evaluate the care organization to make sure that the service was still relevant and operating according to the actual needs. The results of these consultations was formalized and put up in a weighted requirement grid following the importance of each of the points suggested by the nurses.
The main concerns in the redesign were to find a software solution oriented towards the needs of the clinical teams and then to find an independent hardware platform to support this solution.
The rationale behind this choice was to avoid a vendor lock-in if ever the hardware or the software provider was to close, or otherwise cease to offer his services, and to be more future-proof. This way we made sure that we offered a reliable solution to our end users.
Six software solutions were reviewed and tested according to each of the features identified in the need analysis. Each was also rated according to their perceived ease of use and the future possibilities.
One of the main upcoming enhancements which had to be considered was the possibility to do WCT clinics where there is no accessible wireless connection, be it at the patient’s home, nursing homes or other health facilities. The chosen solution was REACTS from IIT, an innovative Quebec-based company. REACTS is a cloud-based software solution tailored directly to the needs of clinical staff needing to do virtual clinics and other telehealth activities.
On the hardware side, we opted for a tablet computer that was chosen mainly because of its ability to use an external camera that can be placed near the patient.
Also, the possibility to use a SIM card was another requirement, as one of our goal is to use the tablet in the health facilities without WiFi or at a patient’s home. The use of an LTE portable hotspot was considered, but was deemed more complex to manage and would have meant having one more device to manage, take around and recharge. The Dell Venue Pro 11 tablet was found to meet all our requirements. It is the tablet that was bought as the new technology for the service.
Since its launch, the new technology was used by many nurses and most of them are satisfied with the results. Among the positive comments that we received are the larger image, the flexibility of the tablet, the ergonomics of the software deployed. The old system only had one video stream from the patient to the expert nurse; now, the patient can simultaneously see the expert.
This was seen as a major upgrade for the virtual WCT clinics and it also offered a better setup for expert nurses when they do teaching sessions on wound care techniques with local nurses.
However, no system is perfect. One of the drawbacks of the new one is the image quality. The Logitech C615 camera deployed is capable of HD resolutions, but it lacks the optical zoom and the glass optics of the previous camera, which provided a superior image quality.
According to the nurses, the new camera still delivers images of sufficient quality to safely do WCT clinics. Also, the use of two video streams, as opposed to one in the previous system, takes more bandwidth which can be an issue in more remote sites, especially during peak hours.
Overall, most consider the transition to the new system a success as it provides a flexible solution that can be installed on different hardware platforms, and makes it possible to extend our reach toward patients that are located in places where there is no connectivity – such as patient rooms in nursing homes, and ultimately, at the patient’s own house.
Jonathan Lapointe is telehealth technology advisor at the CCT du CIUSSS de l’Estrie – CHUS.