SilhouetteConnect wound assessment software screen

There is a sea-change required to help improve wound outcomes and reduce the health economic burden of patients suffering with wounds in the UK. The pivotal publication by Guest et al is a stark reminder of the gaps and the opportunities for improvement in wound management in the UK health system (1,2).

NHS England has been researching and consulting on this matter and there is a clear case made now to have a strong focus on wound assessment and wound outcomes delivered by providers, as apposed to activity-based commissioning and contracting for wound care services.

Please read on for a summary of the National CQUIN Indicators and specific details on the wound assessment CQUIN goal set for 2017-2019 for community providers.

Overview - Headlines from NHS England CQUIN scheme announced for 2017-2019 (3)

The CQUIN scheme (The Commissioning for Quality and Innovation) is a payments framework for providers to deliver clinical quality improvements and drive transformational change.

A two year scheme has been announced for 2017-2019, to give certainty and stability on the CQUIN goals and enable health communities to focus on implementing the initiatives. (4)

The CQUIN scheme aims to support delivery of the Five Year Forward View and directly link to the NHS Mandate.

Two areas of focus are outlined in the NHS England CQUIN Guidance , extracted here (4):

“1. Clinical quality and transformational indicators - 13 indicators have been defined which aim to improve quality and outcomes for patients.

2. Supporting local areas:

• Sustainability and Transformation Plans – reinforcing the critical role providers have in developing and implementing local STPs.
• Local financial sustainability – encouraging providers and commissioners to work together to achieve financial balance and to complement the introduction of system control totals at STP level. “

The National CQUIN Indicators for 2017-2019 (4)

Details of Wound Assessment CQUIN for Community Providers (5)

Indicator name: Improving the assessment of wounds

Indicator weighting (% of CQUIN scheme available)         0.25%

Description of indicator: The indicator aims to increase the number of wounds which have failed to heal after 4 weeks that receive a full wound assessment.

Rationale for Wound Assessment CQUIN Indicator

Extract from Page 130 of NHS England CQUIN Indicator Specification (5):

“1/ Failure to complete a full assessment can contribute to ineffective treatment which therefore   delays the rate of wound healing for patients. This has significant consequences for patients in respect of their quality of life as failure to treat wounds correctly can lead to delays in healing or failure to heal.

2/ For providers and commissioners the delay in wound healing   relates to the resources being consumed inappropriately. Managing patients with wounds and their associated co-morbidities is estimated to cost the NHS £5.3 billion; the average cost of unhealed wounds is more than double that of healed wounds.  There is also significant variation in current practice.

3/ A recent economic evaluation of a  wound care pathway for chronic wounds demonstrates that the current pathway experienced by many patients  delivers poorer outcomes at greater cost to the commissioner – the study estimates this cost to be approximately  10 times greater.  “

Achieving Transformational Change for Wound Care Pathways

Entec Health is working with NHS Providers to develop and deliver transformation of wound care pathways, enabled with the innovative Silhouette (ARANZ Medical) digital wound assessment and information management solution. (6,7,8,9,10)

Find out more here: Download Silhouette Health Innovation Prospectus

Silhouette is developed and manufactured by ARANZ Medical. Entec Health is an appointed distributor for ARANZ Medical in the UK.

References and Resources  

1/ Health economic burden that wounds impose on the National Health Service in the UK: Guest JF, et al BMJ Open 2015:5:e009283. Doi:10.1136/bmjopen-2015-009283, View BMJ Open Article

2/ The True Cost of Wound Care, Kate Pym, Entec Health Guest Blog: See Blog

3/ NHS England CQUIN 2017-2019 Resources: See NHS England CQUIN Resources 2017-2019

4/ CQUIN 2017/19 Guidance – Publications Gateway Reference 06023 See NHS England CQUIN Resources 2017-2019

5/ CQUIN Indicator Specification – Publications Gateway Reference 06023 See NHS England CQUIN Resources 2017-2019

6/The use of electronic data capture devices in wound care settings. J.Fletcher, Wounds UK 2012, Vol 8, No 4 Download Publication

7/ EMAHSN Diabetes Foot Digital Solution  Care Closer to Home demonstrator, enabled by Silhouette. Read more EMAHSN website

8/ Going Digital, case study of early adopter experience with Silhouette, Kings College Hospital NHS Foundation Trust, Diabetic Foot Clinic, London, UK. M.Bates, March 2013. Download Case Study via this page

9/ Use of novel 3D digital technology for assessment of diabetic foot ulceration. J Lucas et al, Diabetes Foot Clinic, King’s College Hospital, London, SAWC Poster Presentation April 2015 (Please request copy via author)

10/ Pressure Ulcer Management case study, Barlow Respiratory Hospital, Long Term Acute Care Facility, Los Angeles, US, October 2013, See Case Study (ARANZ Medical web page)

Medilink West Midlands has announced Entec Health as a shortlisted candidate for Partnership with NHS, in its Medical and Healthcare Business Awards 2015. The Awards event will take place at Malmaison Birmingham on 14 January 2016 and is set to start the year with a great flourish for the ventures which will be celebrated for their expertise, commitment and success.

"I am delighted that Entec Health's collaboration with the NHS to support best practice in wound care for the benefit of patients has been recognised by the panel", said Achala Patel, Founder and Managing Director of Entec Health.  

Over the past 4 years, Entec Health has developed strong engagement with a wide range of NHS Trusts to explore a new evidence-based approach in wound management practice, enabled by digital technology. 

Currently there is unacceptable variability in the standard of chronic wound care practice and outcomes achieved across the NHS nationally (1). Wound Care provision for patients with chronic wounds has a high cost to the NHS, estimated at £3billion per annum. (2,3).

Entec Health has an active NHS partnering programme which involves informing and engaging NHS stakeholders on the advantages of adopting digital wound assessment and wound informatics to address this “clinical excellence and cost-effectiveness gap” in wound management. The Silhouette system (ARANZ Medical) helps clinicians to capture, document and share digital wound images and objective, quantified wound healing data across a care pathway to support improved clinical practice, patient experience and service transformation. 

Entec Health is collaborating with innovator clinical champions and NHS Trusts to embed Silhouette as an enabler technology for evidence-based care and open up opportunities to improve the cost-effectiveness and efficiency of managing patients with chronic and acute wounds. 

The Partnership with NHS Award category is sponsored by West Midlands AHSN. You can find further details via the link.

http://www.medilinkwm.co.uk/events/medilinkwm-medical-and-healthcare-business-awards-2015

Book a Silhouette demonstration and discussion meeting with Entec Health:

Download the Silhouette Prospectus to learn more:

 Download Electronic Data Capture for Wound Care paper:

Download Silhouette King's Diabetes Foot Care Case Study:

References:

1. The need for EU standards in wound care: an Irish survey. Moore Z, Cowan S. (2005).
2. Wounds UK, 1(1): 20-8.The Smith and Nephew Foundation: Skin Breakdown – The Silent Epidemic. Posnett J, Franks P.J. (2007). The cost of skin breakdown and ulceration in the UK. Smith and Nephew Foundation, Hull.
3. The resource costs of wound care in Bradford and Airedale primary care trust in the UK. Vowden K, Vowden P, Posnett J. (2009). Journal of Wound Care; 18: 93- 102.
4. The use of electronic data capture devices in wound care settings. J.Fletcher, Wounds UK 2012, Vol 8, No 4
5. Going Digital, case study of early adopter experience with Silhouette, Kings College Hospital NHS Foundation Trust, Diabetic Foot Clinic, London, UK. M.Bates, March 2013, Online Case Study Publication, NHS High Impact Innovations Showcase.

1) DH will be looking for NHS Provider Trusts to invest in digital technology that improves clinical quality, productivity and efficiency.   

2) NHS Trusts will be required to seize opportunities to adopt technology that supports new models of care that respond to needs of patients, improve service access and optimise service cost-effectiveness.

Health Innovation - key to a sustainable future

Health Innovation is vital to every healthcare system in the world. Health Innovation can be defined as a pro-active, patient-centric response to delivering “fit for purpose” healthcare services in an ever changing landscape. In a “fit for purpose” healthcare service - patients, payers, commissioners and relevant stakeholders - are assured of excellence in patient outcomes and a health service which is equitable, value for money, appropriate to socio-economic demands and sustainable.

Health Innovation - enabled by technology

Health Innovation is a key strategic goal for the devolved UK nations. Health Innovation, enabled with  empowering digital technologies, is considered a critical catalyst to accelerating delivery of the NHS Five Year Forward View.

Entec Health is in the business of partnering with the NHS and Qualified Healthcare Providers to deliver Health Innovation, enabled by technology and transformation solutions. Our key areas of focus are health innovation in wound management, long term conditions, self-management and health informatics for better health outcomes. Learn more about us:

 Top 10 Attributes for Health Innovation - enabled by technology

Entec Health has built a body of field experience and knowledge in facilitating Health Innovation, involving engagement of over 400 stakeholders in 80+ NHS entities. This experience has been largely gained in introducing the Silhouette digital wound assessment and information system (ARANZ Medical) to the UK for transformation of Tissue Viability services and Diabetes Foot services in the NHS. We believe the insights and learning shared here may be of value across a range of healthcare services. Based on this experience, Entec Health has identified the 10 key attributes of successful transformation teams in driving forward Technology-enabled Health Innovation in the UK environment.

Health Innovation Index - facilitating success for transformation teams

The Health Innovation Index (HII) is Entec Health's home-grown qualitative tool, based on these 10 Key Attributes for Health Innovation. The HII is a simple, observational approach for checking if the right conditions for health innovation exist already or if there is some way to go before the transformation team can move forward. 

A score from 1 to 10 is assigned for each of the HII Key Attributes based on what is in evidence in the environment that the transformation team is operating in, with 1 = low, 10 = high.

Similar to a Human Resources appraisal, the attributes are assessed based on finding tangible examples of the attribute which can be observed as behaviours, actions and results.

A perfect HII score would mean a transformation team scoring 10 out of 10 for all 10 attributes = 100 points. Using the HII tool, we can support our clients to prepare for success by leveraging strengths and addressing gaps, to ensure that the conditions for Health Innovation enabled by technology, are very favourable for the transformation team. Collaboration for success. 

Health Innovation Index (HII) © Entec Health November 2015

Discover Silhouette - Wound Care ServiceTransformation 

Are you looking for innovative ways to improve clinical effectiveness, efficiency, service access and patient experience for your wound care service? Discover how the Silhouette digital wound assessment and information management system can help.

Get in touch - share your vision and goals for Health Innovation

We would be delighted to hear from you. Please contact us for an exploratory discussion.

Health Innovation Index (HII) © Entec Health November 2015

AHSNs and Alice in Wonderland

"Now here, you see, it takes all the running you can do to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that."
The Red Queen to Alice in Alice's Adventures in Wonderland by Lewis Carroll

I was literally out of air after 4 tough years as Managing Director of Entec Health, running incredibly hard to secure a sliver of success with introducing the Silhouette (ARANZ Medical) digital wound assessment solution to the NHS. Then along came AHSNs, the Academic Health Science Networks, like a breath of fresh air, offering much-needed advice and support to help Entec Health continue and run twice as fast. 

In our zeal to take an innovative, smart digital solution to the NHS, Entec Health has clocked up interactions with over 400+ NHS stakeholders, ranging from clinical leaders, service managers, front-line nurses, IT Directors to procurement specialists across some 80+ NHS entities. During the company's campaign to engage and recruit early adopters in the NHS, we have had some excellent support from a number of AHSNs. Though it should be noted that the quality of engagement and the rate of success has varied across the range of AHSNs. Often, a major factor is the effectiveness of the liaison partners appointed by AHSNs to manage the industry engagement.

Created in 2013, AHSNs have been getting into their stride with establishing relationships with partner stakeholders and developing joint programmes to deliver on agreed health & social care regional priorities. NHS England describes the role of AHSNs as:

"AHSNs have been established to deliver a step-change in the way the NHS identifies, develops and adopts new technologies and are predicated on partnership working and collaboration between the NHS, academia, the private sector and other external partners within a single AHSN context and across AHSNs."

It would be fair to say that Entec Health has had meaningful interactions with eight AHSNs to date and the company is now actively working with four of these AHSNs, together with partner NHS Trusts. My observation is that the effort to succeed with introducing innovative, enabling technology to the NHS is still a very tough mission but with AHSNs on the landscape, Entec Health now has allies who can give a steer on where we should put in the effort, find potential matches who connect to our value proposition and point us towards supporting resources we can leverage. 

As with any "transformation agency", the business of delivering the remit of AHSNs is challenging and there is still a lot of work to be done. A recent survey shows promising progress - the direction of travel of AHSNs is well supported by stakeholders.

"National survey finds 73% of stakeholders would recommend working with AHSNs." AHSN Stakeholder Survey 2015, YouGov

"The NHS needs to deliver a step-change in the way it identifies, adopts and spreads best practice, clinical innovations and new technologies more quickly and at scale in order to meet the enormous challenges set out in the Five Year Forward View." West Midlands AHSN website post 30.10.2015

See full AHSN Stakeholder Survey Report via this link:

http://wmahsn.org/storage/resources/documents/Stakeholder_survey_results__AHSN_Report_v0.6_(2)_.pdf

Looking ahead to the future and working towards effective adoption of relevant innovative technology by the NHS at scale and pace, Entec Health would propose that AHSNs could look to strengthen support in the following key areas:

1/ Closer links and relationships with strategic decision makers who have budgetary authority and have a remit to engage in strategic discussions and review of emerging technologies ready for NHS adoption. Strategic decision makers such as CEOs, Medical Directors, Finance Directors, Service Managers, Business Managers, Quality/Performance Improvement Managers, Innovation Leaders and Chief Clinical Information Officers in acute AND community NHS Provider Trusts.

2/ Better insights into how NHS Trusts will fund emerging technology investments and how they will prioritise these investments over next 5 years.

3/ Effective procurement strategies that NHS Trusts can use for purchase of innovative, emerging new technologies that come onto the market.

4/ Direct funding by AHSNs for specific demonstrator projects to validate and showcase benefits of embedding new technology to support development of best practice and healthcare service innovation. 

Entec Health is delighted to announce that Kate Pym will be supporting the organisation as a Health Service Improvement Champion & Coach. Kate Pym is an Accredited Healthcare Manager with the Institute of Healthcare Management, an Accredited Trainer with the Institute of Leadership and Management and a Registered and Certificated DiSC Trainer.

Before establishing herself as an independent consultant, Kate built a successful career over 20 years in the Pharmaceutical, Private Health and Social Care sectors. 

Kate brings strong experience and expertise in health service redesign, transformation projects, leadership, market access and strategic management. Kate has worked with senior NHS and Social Care commissioners and stakeholders across the UK, in a variety of services including dialysis, oncology and community care.

Kate will be working alongside Achala Patel, Managing Director, Entec Health to support the company's healthcare clients on realising clinical, patient and organisational benefits of the Silhouette digital wound assessment and information management system.

The Silhouette System (ARANZ Medical) is an innovative and enabling technology which supports improved clinical effectiveness and efficiency for wound management pathways in both primary care and secondary care settings. Entec Health is an appointed distributor to ARANZ Medical for Silhouette in the UK.

 “I am thrilled to be working with Entec Health, a  thought-leader and innovator in health technology.  Achala is an inspiration and demonstrates real vision in her mission to support transformation of wound management practice.  Entec Health has a patient-centred approach to health innovation which heralds great things for collaborative service improvement. It is always a great privilege to work in the development of health services with an overall objective of improving patient lives.”  commented Kate Pym,  an appointed Health Service Improvement Champion & Coach for Entec Health

Achala Patel, Managing Director, Entec Health added "I am really delighted and excited to have Kate Pym join our mission -  Entec Health's key goal is to collaborate with our clients to drive health innovation, enabled through technology solutions. Kate's passion and expertise in designing and delivering health service improvement strategies will be a major asset for us and our clients."  

As a company with a mission to support health innovation through technology-enabled transformation, we are really encouraged by the much stronger appetite and sense of urgency that is in the air around leading and driving meaningful, sustainable improvements in the NHS.

To support the direction of travel shared in the NHS England Five Year Forward View, Time to Deliver, June 2015 update, there are a number of rich resources that we want to shout about that NHS change leaders may wish to turn to in their quest for doing things in a better way for the good of patient outcomes, patient experience and a more sustainable, cost-effective NHS service.

See NHS England Five Year Forward View , Time to Deliver, June 2015, at https://www.england.nhs.uk/2015/06/04/time-to-deliver/

NHS Improving Quality have now launched the second edition of the NHS IQ Prospectus which signposts users to a wealth of tools, training and publications to support improvements in quality of care and transformational change. See more at http://www.nhsiq.nhs.uk/resource-search/publications/prospectus.aspx#sthash.tXRlqeh4.dpuf

 The Healthcare Quality Improvement Partnership, has also launched in July 2015, a comprehensive guide to quality improvement methods which provides concise summaries of the types of strategic transformation approaches which can deployed to support improvements in the NHS. You can view and download the HQIP Guide here http://hqip.org.uk/assets/Guidance/Guide-to-quality-improvement-methods-July-2015.pdf

If you are specifically involved in leading and managing wound management care pathways, you may find the Entec Health Silhouette Prospectus a valuable source of information and inspiration. The Silhouette Prospectus puts forward a case on how digital wound assessment and information management technology can help organisations to transform wound care practice and wound outcomes management for improved wound care pathways and evidenced-based care. You can download the Silhouette Prospectus here: http://info.entechealth.com/silhouette-prospectus-discover-digital-wound-assessment

West of England AHSN has launched an introductory video to inform and inspire clinicians on the benefits of Silhouette digital wound assessment and information management technology.

Together with the online video launch on the West of England AHSN Health Innovation Channel, there is a call for clinical innovators who are interested in collaborating on technology-enabled improvements in wound management pathways:

"A digital 3D wound assessment and management system for acute and community care. Seeking innovators involved in Tissue Viability and Podiatry services to collaborate with as early adopters for both clinical research and clinical practice. This can incorporate clinical leads and service leads who have a vision of transforming pathways of care for leg ulcer, pressure ulcer and diabetic foot ulcer management to deliver evidenced-based care, better patient experience and improved cost-effectiveness."

West of England AHSN Health Innovation Channel 

Find out more about the opportunities for wound practice innovation: http://info.entechealth.com/silhouette-prospectus-discover-digital-wound-assessment

See the Silhouette introductory video on WEAHSN Health Innovation Channel: https://www.weahsn.net/entec-health-silhouette/5860/#sthash.WfpQZXao.dpuf

Entec Health will be showcasing the Silhouette digital wound assessment and information management system this week at the 16th annual Scottish Conference of The Diabetic Foot Journal. Come and see us at Stand 19 in the Exhibition area.

The conference is being held at The Marriott Hotel, Glasgow on Thursday 18 June 2015.

Silhouette is receiving a very positive response from the podiatry community in the UK. The Silhouette system enables diabetic foot care health professionals to capture, share and report diabetes foot ulceration progress data in a digital format for improved patient management.

Silhouette supports clinicians to:

1. Generate objective wound progress data using novel 3D wound measurement
2. Monitor response to treatment with quantified ulcer size data and wound progress charts
3. Establish non-contact wound assessment that is fast and easy to perform
4. Share a central digital database of ulcer assessment information across MDT care team
5. Utilise PDF wound assessment report for better documentation of DFU outcomes 

SilhouetteConnect Patient Dashboard - Sample Screen Shot (Wound Model, Example only)

Visit the Entec Health stand at the Exhibition Area to see a demo of Silhouette and to test-drive the system. 

The conference theme is "Protecting the diabetic foot" and will include sessions on:

• common patient presentations
• providing evidence based and practical guidance to ensure effective assessment
• investigation, treatment strategy and management
• Scottish guidance and care pathways update from the Scottish Diabetes Group

The Programme Planning Committee:

• Paul Chadwick, Principal Podiatrist, Salford
• Graham Leese, Chair, Scottish Diabetes Group, Dundee
• Joanne McCardle, Advanced Acute Diabetes Podiatrist, Edinburgh
• Duncan Stang, Foot Coordinator for Scotland and Scottish FDUK Representative, Lanarkshire
• Matthew Young, Consultant Physician, Edinburgh

We look forward to seeing you at the conference.

Visit Wounds UK Event page for more details on the conference:

http://www.wounds-uk.com/events.php?eventid=90&tab=1#tabs

Home Care-Wound Care : Overview, Challenges and Perspectives

This is a milestone publication describing how wound care is continuing to develop in new directions across the health ecosystem in Europe. The document presents a critical assessment  of achieving effective wound care delivery in home care settings, from the perspective of organisation, health professional, patient and carer.

Against the backdrop of a growing shift towards care of patients with wounds from secondary to primary care across key regions in Europe, the report examines the prerequisite practitioner skills and knowledge needed to manage wounds in the patients’ home. In addition the authors make recommendations on achieving required standards of wound care in home care settings.

“The aim of this shift in care from secondary to primary service provision has been to promote community and home healthcare delivery, while simultaneously delivering better services, improving productivity, increasing patient safety and improving the quality of care (1).”

EWMA Home Care Wound Care (2014)

The report is produced by EWMA in collaboration with Journal of Wound Care, Initiative Chronische Wunden e.V. and the Tissue Viability Society.

The authors describe wound care service provision in UK, Germany and the Nordic Region as example models of care. There is insightful analysis on what each of the countries/regions would need to further address to deliver quality wound care successfully within home environments.

NHS England key areas for improvement

For NHS England, some of the key “improvers” for the future are outlined as follows:  

1. There are national guidelines for best practice but comprehensive implementation and ownership depends on local leadership; outcomes are not routinely identified
2. There is a need to develop integration between primary and secondary care
3. The collection of outcome data has generally been poor and cannot be robustly compared across regions.

The publication discusses best practice, clinical pathways, chronic care model, team working approach and health in the context of managing wounds in a home care setting: 

• Need for accurate and reliable patient assessment will become increasingly critical, especially where service delivery may require support of nurses without high level of wound care competency.
• Patient and carers need to be involved in the management process so that the goal of treatment and treatment progress is transparent and understood well to support good outcomes.
• Importance of wound care provision as a team effort, where a multi-disciplinary approach fosters professional collaboration to support effective, patient-centric care.

 “The provision of evidence-based clinical practice guidelines adapted to meet local needs can provide a solid base upon which to audit and evaluate practice. (1)”

EWMA Home Care Wound Care (2014)

The Chronic Care Model

The Chronic Care Model (Wagner, Austin) is proposed as a viable way forward to guide design of an effective clinical pathway for home care wound care.

 “Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes” (2,3,4).

EWMA Home Care Wound Care (2014)

Technological Advances

The role of technology and its promising potential is briefly covered, in relation to use of telecommunication (SMS, texting, phone support) for self-management, online consultancy, education and monitoring. A word of caution is given in reference to telephone-based nurse-to-nurse consultations without use of digital images as there is potential risk of inappropriate treatment of wounds without this critical visual information. (5)

Telecommunication  advances and other digital applications are acknowledged as tools that may play an increasing role in supporting home care and self-management, with a need for more research to establish further evidence in this field.  

Learn more:

Discover emerging new Silhouette digital technology for wound assessment and information management that can support future wound care service delivery strategies:

References

(1) Probst S., Seppänen S., Gethin G. et al., EWMA Document: Home Care-Wound Care,. J Wound Care 2014;23 (5 Suppl.): S1–S44.

(2) Wagner, E.H., Austin, B.T., Davis, C., et al. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001; 20: 6, 64–78.

(3) Wagner, E.H., Davis, C., Schaefer, J., et al. A survey of leading chronic disease management programs: are they consistent with the literature? Manag Care Q 1999; 7: 3, 56–66.

(4) Coleman, K., Austin, B.T., Brach, C., et al. Evidence on the Chronic Care Model in the new millennium. Health Aff (Millwood) 2009; 28: 1, 75-85.

(5) Buckley, K.M., Adelson, L.K.,Agazio, J.G., Reducing the risks of wound consultation: adding digital images to verbal reports. J Wound Ostomy Continence Nurs 2009; 36: 2, 163–170