Transforming Care Anytime Anywhere – Pilot of Use of Clinical Apps for Tele-wound Consultation & Communication in Community Health Services: Two Years’ Experience in Hong Kong

Tong MH(1), Chim CK(1), Lai SY(1), Fung KY(1), Tsang TL(1), Leung HY(2), Choi SWC(3) Kwok MLA (1), Tam OFS(1), Hui ASE (1) 1)Community Outreach Services Team, North District , New Territories East Cluster, , Hong Kong 2)Department of , North District Hospital, New Territories East Cluster, Hospital Authority, Hong Kong 3)Information Technology Department, New Territories East Cluster, Hospital Authority, Hong Kong

Introduction Due to up surge demand for complicated wounds referrals, timely response from wound specialist to urgent consultations for wound deterioration in the community is not feasible in the real situation. Pilot of Use of Clinical Apps for Tele-wound Consultation & Communication in Community Health Services has been conducted in NTEC Community Outreach Services Team (COST) since March 2017

Methodology Phase 1 ( March - December 2017) A “wound care team” chat group was created in “HA Chat” apps among 20 community nurses(CN), wound specialists and geriatricians in COST. Real- time tele-wound consultations were started between CNs and wound specialists. Regular feedback to HA was provided for the enhancement of functions.

Phase 2 (September - October of 2018 ) Cross specialties collaboration was started involving Breast and Orthopedic Team. Group chat was created in mini iPad which was installed with the modified HA Chat and HA Clinical Management Operational Model of Using IT in Community Care System(CMS) apps. Wound image was taken and was uploaded to the Immediate consultation hospital CMS via clinical apps. All related staff are able to access for review. Advise provide timely

Nurse takes photo at home setting Doctor review clinical photo via I pad / CMS at hospital Result Telel-communication with the team timely Pilot use of apps for Tele-wound consultation (period) Table 1: Wound consultation via HA Chat/Clinical Cams apps Table 2: Type of wounds for Tele-wound consultation via HA Chat/Clinical Cam Apps Real time Real No. of No. of Real time bi- Respons Response Type of Stage 4 Non healed Surgical Others (sinus/ wound time patient complicated directional e time time wound for pressure leg ulcer with wound with peri-stomal consultation wound episodes wound communication <15 min 15-60 min advise involved between HA Chat tele ulcer with PVD or DM infection or complication APN/RN & wound necrotic foot ulcer gap community consultation wound base nurses record in HA Chat No. of 267 100 69 107 consultation 541 155 418 633 1861 92% 8% % 42% 30% 11% 17%

Wound Outcome: 78% of wounds were healed or Conclusion improved within the pilot period Tele-wound consultations via clinical apps in a community setting are effective to improve frontline High acceptability among nursing staff access to wound specialist and consultation provision. It could enhance quality, efficiency, and teamwork in community services regarding wound healing, patients benefit and staff engagement.