The goal of this project is to build on the Winthrop wound-healing team's previous work with the Online Wound Electronic Medical Record (OWEMR) and databank, in order to evaluate its effectiveness as a clinical decision support tool (CDST) that can enhance the healing of chronic wounds. A similar clinical trial, also using the OWEMR developed by Winthrop team members, is already underway at multiple centers outside Winthrop to evaluate the OWMER as a clinical support tool for reducing limb amputations resulting from diabetic foot ulcers (DFUs) in a variety of healthcare settings. The clinical trial now getting underway at Winthrop-University Hospital utilizes a more advanced form of OWEMR-based CDST, reflecting ongoing work at the Winthrop Wound Healing Center to extend and refine the evidence-based parameters and treatment protocols employed by the CDST to monitor wound-healing progress in patients, notify physicians and other care providers when a given parameter indicates the need for immediate medical attention, and offer appropriate treatment recommendations.
Winthrop's updated version of the OWEMR-based CDST collates hundreds of different parameters for each patient, ranging from various blood-test values to assessment of wound characteristics and general physical condition (for example, whether a patient is mobile or not). As part of this updating process, we have also carefully reviewed and evaluated the existing literature on medical protocols related to various physiological parameters in order to program the CDST with the best evidence-based treatment recommendations for each set of medical parameters.
Winthrop's OWEMR-based CDST is a HIPAA-compliant web-based informatics tool that tracks hundreds of different variables for each chronic wound patient, providing real-time e-mail alerts to the patient's physician and other caregivers whenever there is an abnormal clinical finding, and recommending interventions based on evidence-based protocols. It can be used to monitor both inpatient and outpatient care, with data updated on a regular basis by a nurse or physician as it becomes available. The parameters tracked by the CDST are divided into five areas, each of which is considered critical to the quality of care for wound patients:
Our clinical investigation of our clinical decision support tool will employ a randomized controlled trial to evaulate how use of the CDST influences the healing rates—defined as the percentage of patients with completely healed wounds after 20 weeks—of patients with pressure ulcers and diabetic foot ulcers. Our hope is to see a significant improvement in the healing rates of PU and DFU patients treated with the CDST.