A Synergistic Approach to Creating A Wound Care Data Repository

Have you ever considered where data goes each time we document a patient’s record? Doesn’t it seem as if over the last decade our data has spiraled into an oblivion of binary code that is only appreciated by insurance billers and hospital administrators? Through technology, charting has become faster with the help of voice-recognition systems that allow healthcare providers to dictate at rates upward of 300 words per minute. This saves time and takes deciphering handwritten notes out of the equation. This system of electronic health records (EHRs) also allows clinicians to access more charts that are more accurate more quickly than we at one point could ever imagine. Additionally, the qualified clinical data registry (QCDR) reporting mechanism was introduced for the Physician Quality Reporting System (PQRS) in 2014. The QCDR completes the collection and submission of PQRS quality measures data on behalf of individual eligible professionals and PQRS group practices. PQRS is a quality-reporting program that applies a negative payment adjustment to those who do not satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (MPFS) services furnished to Medicare Part B Fee-for-Service beneficiaries. Those who reported satisfactorily for the 2016 program year (cutoff was June 30) will avoid the 2018 PQRS negative payment adjustment. Providers can “chose” not to report if they’re willing to take 4% reduction in Part B payment. 

Technology’s Presence in Wound Care 

The human brain is the only “computer” known to mankind with the ability to compute at a quantum level. Until we as clinicians can replace ourselves with quantum computers for medicine, we are in prime demand to interface with these binary devices with simplistic linear ways. To this end, computers are tools just as we use a scalpel for sharp debridement or an alginate for wounds. The only difference is that computers will continue to increasingly become tools that clinicians, like those in just about any profession, will rely on in today’s technologically advancing world. Particularly in the wound care industry, the last two years have seen a new technology emerge related to digital wound measuring (eg, digital apps for measuring wounds on a two-dimensional basis as well as a few manufacturers that are reaching towards 3-D measurement — eg, Silhouette,^® ARANZ Medical, New Zealand). Today, wound care clinicians can use mobile apps for documentation to more accurately measure the wound area as opposed to just on an X-Y axis. With a large majority of clinicians using computer-based EHR systems and encrypted apps that secure patient data, this presents a unique opportunity. But could there be an even more accurate method of documenting, measuring, and treating patients? For instance, over the last several years the genetics industry has used a more quantum approach to solving genetic code and specific markers by compiling data from research into a repository. One such repository, dbVar, is the National Center for Biotechnology Information’s database of genomic structural variation — it contains insertions, deletions, duplications, inversions, multi-nucleotide substitutions, mobile element insertions, translocations, and complex chromosomal rearrangements. This repository (www.ncbi.nlm.nih.gov/dbvar) is cloud-based and allows researchers to work simultaneously to analyze and correlate data more quickly. If this same research were conducted linearly, today’s knowledge and genetic tests would still be years off. More recently, this approach was applied to creating a rapid test for the Zika virus, and it will also reportedly be used for a vaccine or solution to Zika.¹ It could be possible to create a system for documenting, measuring, and treating patients through a similar manner used by geneticists. Additionally, the National Institute of Neurological Disorders and Stroke (NINDS) recently awarded a contract to establish the NINDS Human Genetics Repository — a genetic resource center for human gene discovery for neurological disorders.² The purpose of the repository is to develop genetic resources that can be shared by the research community and to encourage the research efforts of established scientists, junior investigators, and scientists with novel approaches.

Potential New Direction in Data Collection

Imagine a platform that clinicians could subscribe to as an opt-in for the purposes of submitting data. The logical organization for this repository would be an independent section of a nonprofit group offering a nonbiased approach and equal access while being regulated by a separate board of directors. The data would have to be compliant with the U.S. Department of Health & Human Services and be securely structured in order to comply with federal and state regulations. The data could be supplied via the EHR and various apps that contain nondescriptive patient information (eg, 54-year-old female presented with stage III diabetic foot ulcer). The data normally collected by the wound care clinician — the clinical details of each wound, vital signs, care planning — could easily be submitted to the repository while being compliant with the U.S. Department of Health and Human Services and Food and Drug Administration. Groups opting into the repository could have access to the data as well, potentially from sources on a global scale. This could make a dynamic, fluid, and ever-evolving source of data. By employing the technology today without new devices or drugs, wound care information and feedback would start to move at a quantum level instead of one that's linear. A clinician could see data from tens of thousands of patients living with the same types of wounds with similar onset over a specific period of time. That clinician could then query and extrapolate the best results along with the treatment plan used to achieve those results.  The eventual evolution of this data in a cloud-accessible system would be the ability to create algorithms and correlations via computer software to analyze a plethora of data points to achieve best practices on a near real-time basis. This data could be as simple as debriding a wound with a curette versus a 10-blade every “X amount” of days. Improvement in wound healing could be achieved incrementally by adjusting techniques and sharing of notes. Opportunities for research to be conducted more efficiently and more accurately would add monumental value. Perhaps phases III and IV of clinical trials could be conducted using each location and perhaps each patient as a “site”? Currently, ICRO Inc., Tampa, FL, is conducting Phase IV clinical trials on the efficacy of an over-the-counter (OTC) product to treat acne vulgaris while future plans to conduct new indications for both OTC and prescription products are said to be planned. Scalability of information would be easy due to Moore’s Law,³ a computing term that originated around 1970 that claims overall processing power for computers will double every two years. 

Many pharmaceutical companies and medical device companies within the wound care industry are employing this technique, yet this information is rarely shared with others outside the respective company. This data is typically acquired in clinical trials (with most data coming from Phase III). However, some companies conduct Phase IV clinical trials for efficacy of current approved or cleared products. This only provides a snapshot of a specific product and does not offer a continual evaluation or variations in technique of application. However, as clinicians with no loyalty to brands, specific devices, or pharmaceuticals, we have a great opportunity to share our data with one another and improve the practice of wound care in the process. In theory, this system would cost less each year and the value would increase. Wound techniques themselves would become fluid and ever-changing in this reality as well.

Impact on Education

Another dynamic this could create is a platform for teaching. Instructors could teach and illustrate the latest, most effective techniques anywhere in the world. In addition, the fluidity of the platform would allow practitioners as well as students to learn from others around the globe. Synergy would truly arrive in wound care if this were applied on a grand scale. Imagine a conference where practitioners knew each other by data and techniques they provided throughout the rest of the year. In conclusion, all of this data for wound care is really available now. We all enter (ie, “chart”) it every day, for every patient, for every wound. The healing rates, devices, pharmaceuticals, wound dressings, and techniques are all in the EHRs. The question now becomes how do we take this binary linear data and use it to serve our quantum brains? The challenge will be for wound care as a specialty to come together to create a platform for exchange. What we do with this data is up to us — could this be the answer for our patients? 

Leigh J. Mack is a lead research physician at American Biotech Labs LLC, American Fork, UT. He is currently pursuing his certified principal investigator and fellowship in clinical research.
 

References 

1. First Rapid Detection Zika Test Now Available Through Collaboration With Texas Children’s Hospital and Houston Methodist Hospital. Texas Children’s Hospital. 2016. Accessed online: www.texaschildrens.org/about-us/news/releases/first-rapid-detection-zika-test-now-available-through-collaboration-texas-children’s-hospital-and

2. NINDS Establishes Human Genetics Repository. National Institute of Neurological Disorders and Stroke. Accessed online: www.ninds.nih.gov/research/clinical_research/policies/hg_repository.htm

3. Moore’s Law or How Overall Processing Power for Computers Will Double Every Two Years. Accessed online: www.mooreslaw.org