A smartphone-based consultation system for acute burns – methodological challenges related to follow-up of the system

Abstract

Background: A smartphone-based consultation system for acute burns is currently being implemented in the Western Cape, South Africa. Even though studies indicate that similar systems for burns tend to support valid diagnosis and influence patient management, the evidence is still sparse. There is a need for more in-depth evaluations, not least in resource-constrained settings where mHealth projects are increasing. Objective: This article describes the consultation system and assessments in relation to its implementation with a special focus on methodological challenges. Methods: A number of evaluations and assessments have been conducted, are ongoing or planned for in relation to the implementation of the teleconsultation system. Initial assessments showed that size and depth of burns could be assessed at least as well using photographs as at bedside and that the image quality of handheld devices can be used as well as computers. Studies on system usability are currently being done with a mixed-methods approach. A historical cohort design will be applied to assess the potential health impact of the system. Patients with burn injuries where the doctor at point of care has used the app to receive diagnostic support from a burns expert will be considered as exposed and patients with burn injuries where the app has not been used will be considered as non-exposed. Conclusions: Smartphone-based consultation systems have the potential to strengthen the assessment of burn injury in many settings. However, ethically and methodologically sound evaluations are needed to find the best systems and solutions. This article identifies challenges and suggests potential assessments in relation to the implementation of such a system.

Orthopaedic referrals using a smartphone app: Uptake, response times and outcome

“…For instance, although there are numerous examples of teleconsultation in other medical specialties, [24] there appeared to be little existing literature on mHealth in orthopaedics referrals. Previous studies relating to the Vula app have focused on considerations around its use for burn referrals [15,17] and did not report outcomes such as referral distribution and referral outcome as in the current study. It is noted, however, that qualitative research on expectations around the app identified a possible role for education through Vula [15] -a suggestion supported through evidence of upskilling in some of the current referrals.…”

“…Further details of the app and considerations around its use for burn referrals have been published elsewhere. [15,17] In August 2016, the Division of Orthopaedic Surgery at Tygerberg Hospital was the first orthopaedic department to introduce referrals via the app, and awareness of this new referral option was specifically promoted through visits to key health facilities in the hospital's referral network. In theory, Vula had several advantages over traditional phone-based referrals.…”

WhatsApp Mobile Health Platform to Support Fracture Management by Non-Specialists in South Africa

“…Password-protected phones and restricted communication about patient management could be used to protect confidentiality. 25,31 Other mHealth applications, such as Vula Mobile, censor identifying information except to the referring clinician 32 and should be considered for future use by ORG. Limitations in data collection did not allow for further stratification of fracture cases.…”

Problems and Costs That Could Be Addressed by Improved Burn and Wound Care Training in Health Professions Education

“…Costs of burn care could potentially be reduced even further by using pre-existing smartphones, as they don't require significant investment in new technology and might increase the utility of telemedicine even further. 18 Moreover, improved utilization of technology has the potential to reduce overtriage and improve pre-arrival care. While telemedicine would mitigate some of the inequities of burn care delivery, it fails to address the underlying problem-lack of burn education.…”