One important function of Dr. Harold Brem’s pioneering online wound electronic medical record (OWEMR) is that it allows us to see what works and what doesn’t. Over the past several years, we have accumulated all relevant information from individual patient records and collated this information in a central databank that can be used as a tool for basic medical research and clinical trials. Important elements of this databank include: data on the cellular characteristics of various types non-healing wounds; how these wounds respond to treatment with different growth factors and stem cells; data on the outcomes of surgical wound treatments; and healing rates for various categories of wounds.
The OWEMR and its associated databank have already been used to document healing outcomes for more than 2,000 patients. This database will allow us to determine new baseline clinical healing rates and develop new evidence-based protocols for chronic wound care. It also enables us to consistently determine when a wound isn’t healing—helping us to identify patients and wound types that can benefit from further molecular and cellular studies. Some of our specific accomplishments are described below.
Using our accumulated OWEMR data, we developed an objective system for scoring information on 137 unique medical variables in 10 categories for every patient. We then constructed a databank to correlate this information with patient demographics, medical history, baseline laboratory values, vascular testing results, X-ray results, wound healing rates, wound pathology and amputation data. In our first analysis, we found that osteomyelitis, found from examination of wound tissue, and antibiotic-resistant gram-negative bacteria, found from bacterial cultures, were associated with foot ulcer-related lower-limb amputations. This finding confirmed previous reports of risk factors for amputation, and also demonstrated the benefit of the OWEMR’s alert system in facilitating the early detection and treatment of osteomyelitis and infection.
Amputations result in part from deep infections that prevent wound healing. We drew on the OWEMR databank to review bacterial wound cultures over a 6-month period, in order to determine the prevalence of antibiotic-resistant disease-causing microorganisms in deep tissue of non-healing and infected wounds after surgical cleansing. We found that 9% of the patients had wounds that harbored potentially dangerous antibiotic-resistant microorganisms, and that some of these wounds contained more than one species or strains. Based on these findings, we altered our wound care protocol to include early treatment with broad-spectrum antibiotics after surgical debridement in order to prevent the growth of serious infections. In the future, similar OWEMR data could be used to plan personalized treatment based on the microorganisms found in each wound. Persistence of these organisms in the wound may also prove to be an important quantitative marker to predict healing success.
Finally, we are pleased to note that the OWEMR has been made available in the public domain, to be utilized in the future without charge by all interested members of the medical community.