- Email: [email protected]
Patient confidentiality and new technologies in burn care
burns 41 (2015) 638–647
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor Patient confidentiality and new technologies in burn care We welcome the article by Morris et al. emphasising the value of Smartphone applications (apps) in burn care [1]. New technologies are becoming widespread, including digital imaging and Smartphone apps. More than 90% of surgical trainees own a Smartphone [2], and significant value from new technologies is derived from ease of information sharing. However, use of Smartphone cameras may be discouraged due to concerns with data protection, and increased use of telehealth is leading to changes in medical practice with new challenges in patient confidentiality. Data confidentiality requires password-protected devices and a secure network for transmission. Medical photography departments represent a safe method for wound monitoring, as images are stored on password-protected hospital computers and transmitted via a data encrypted and secure hospital network. A review of methods of imaging and new technologies recording clinical details in burns management, including cameras, video-conferencing and Smartphone apps, was performed. MEDLINE, PubMed and the Cochrane database were searched and all relevant results were reviewed. Ninety-seven articles were reviewed and data protection methods were poorly reported. Smartphone apps, videoconferencing, photography and internet-based communication were published in the literature. Consent for images was reported in most studies. Hand-held burns unit cameras and video equipment were infrequently reported as passwordprotected, and may be more prone to breaches in confidentiality than a password-protected Smartphone. However, personal storage of data may expose users to breaches in confidentiality and should always be deleted. Telehealth studies had poorly reported methods to ensure confidentiality, and Smartphone apps storing data have little warning of risks. Robust guidelines are necessary to uphold standards with evolving technologies, however recent clinical photography guidelines discussing data confidentiality do not address taking and sending images with Smartphones [3]. Many trusts will have policies in place for digital imaging, and secure hospital e-mails via an encrypted network ensure adherence with Data Protection Acts and the Computer Misuse Act [4]. New apps, such as PicSafe Medi, can provide secure transmission and storage of images on its cloud-server. It is approved by regulatory bodies in Australia, but whether it is approved overseas is unclear.
For transfer between trusts, controlled contracts should be in place as demonstrated in tele-radiology services [5]. The transfer of images between hospital sites can provide difficulty in determining responsibility for data protection [6], and contractual agreement is the best way to establish it. Use of Smartphone cameras is frequently not encouraged in the United Kingdom due to potential breaches of confidentiality. Patient treatment in burn care can be greatly enhanced through initial assessment and ongoing management via telehealth. The continued absence of formal guidance on Smartphones and their apps may limit implementation. Production of clear guidance by regulatory bodies is important to optimise the use of new technologies and enable improved availability of wound assessment and monitoring.
Conflicts of interest None.
Funding None.
references
[1] Javed M, Bodger O, Hemington Gorse S, Williams D. A comparison of two smartphone applications and the validation of smartphone applications as tools for fluid calculation for burns resuscitation. Burns 2014;40:826–34. [2] Rodrigues MA, Robertson AGN, Brady RRW. Smartphone and medical applications use by contemporary surgical trainees: a national questionnaire study. J Mobile Technol Med 2014;3:2–10. [3] Payne KFB, Tahim A, Goodson AM, Delaney M, Fan K. A review of current clinical photography guidelines in relation to smartphone publishing of medical images. J Vis Commun Med 2012;35:188–92. [4] Jones SM, Milroy C, Pickford MA. Telemedicine for acute plastic surgical trauma and burns. J Plast Reconstr Aesth Surg 2008;61:31–6. [5] Privacy and security in teleradiology. Eur J Radiol 2010;73:31–5. [6] The legal and ethical aspects of telemedicine. 2: data protection, security and European law. J Telemed Telecare 1998;4:18–24.
639
burns 41 (2015) 638–647
J.A. Dunne* ST4 Plastic Surgery, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK
Owen Bodger University of Swansea, Singleton Park, Swansea SA2 8PP, United Kingdom
J.M. Rawlins Plastic, Reconstructive and Burns Surgeon, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
Sarah Hemington Gorse David Williams Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
*Corresponding author. Tel.: +44 7870987503 E-mail address: [email protected] (J.A. Dunne)
*Corresponding author. Tel.: +44 07949450866 E-mail address: [email protected] (R. Morris)
http://dx.doi.org/10.1016/j.burns.2014.12.019 0305-4179/# 2015 Published by Elsevier Ltd and ISBI.
http://dx.doi.org/10.1016/j.burns.2015.01.019 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Response to Letter to the Editor
Letter to the Editor
Patient confidentiality and new technologies in burn care
Cost-effective outpatient burn-care for minor burns
We agree with the general concerns raised by Dunne and Rawlins [1] regarding data confidentiality and the use of smartphone cameras in the clinical environment. The apps which we evaluated [2] are simple calculators, requiring input data of age, body weight, burn surface area and time of injury. They do not use any patient identifiable data or take photographs of the patient, and the results of the calculations are not stored or transmitted in any form. We have no interests in promoting either app, but note that both apps studied present less of a threat to patient confidentiality than a handwritten Lund and Browder chart.
Dear Sir,
Funding Nil.
Conflict of interest Nil.
references
[1] Dunne JA, Rawlins JM. Patient confidentiality and new technologies in burn care. Burns 2015;41:638–9. [2] Morris R, Javed M, Bodger O, Hemington Gorse S, Williams D. A comparison of two smartphone applications and the validation of smartphone applications as tools for fluid calculation for burns resuscitation. Burns 2014;40: 826–34.
Rhys Morris* Muhammad Javed Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
Burn care is known to be expensive. Nowadays, research on burn-related costs is becoming a current subject of debate and a wide variety of methodological approaches and cost prices are found in the literature. The mean total healthcare cost per burn patient in high-income countries is calculated as $88,218 (range $704–$717,306; median $44,024) [1]. According to ‘American Burn Association, National Repository 2013 report’ the estimated number of burns receiving medical treatment is 450,000 and only 40,000 of these cases are hospitalized [2]. These data suggest that majority of burn cases are treated as outpatients and I think that cost-effective outpatient management should be a current issue in modern burn-care approach. This letter intends to discuss the factors which may influence the cost-effectiveness of outpatient burn-care. The goal of outpatient management in burn trauma is to provide the best environment for spontaneous healing in order to prevent scarring and allow normal functions. Infections must be avoided at all costs because it will change the depth of burn and increase scarring with functional losses [3]. In the light of these principles, I think that the primary factor which may influence the cost-effectiveness of outpatient burn-care is the appropriateness of initial treatment for minor burns. Superficial burn wounds result in less damage when compared to deeper ones, hence cautious attempts for protecting the burn wound from deepening should be started in the initial treatment. Immediate cooling of the burn wound with tap water, water-soaked gauze or hydrogel reduces the surface temperature as well as the state of dehydration of a burned zone. By cooling, pain and damage due to perilesional vasodilatation are reduced as well [4,5]. Analgesia with nonsteroid anti inflammatory agents, oral rehydration and appropriate elevation of the affected extremity are other initial therapies which may protect the wound from deepening [6]. Successful management in the acute phase lowers the number of future wound dressings and debridements,
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor Patient confidentiality and new technologies in burn care We welcome the article by Morris et al. emphasising the value of Smartphone applications (apps) in burn care [1]. New technologies are becoming widespread, including digital imaging and Smartphone apps. More than 90% of surgical trainees own a Smartphone [2], and significant value from new technologies is derived from ease of information sharing. However, use of Smartphone cameras may be discouraged due to concerns with data protection, and increased use of telehealth is leading to changes in medical practice with new challenges in patient confidentiality. Data confidentiality requires password-protected devices and a secure network for transmission. Medical photography departments represent a safe method for wound monitoring, as images are stored on password-protected hospital computers and transmitted via a data encrypted and secure hospital network. A review of methods of imaging and new technologies recording clinical details in burns management, including cameras, video-conferencing and Smartphone apps, was performed. MEDLINE, PubMed and the Cochrane database were searched and all relevant results were reviewed. Ninety-seven articles were reviewed and data protection methods were poorly reported. Smartphone apps, videoconferencing, photography and internet-based communication were published in the literature. Consent for images was reported in most studies. Hand-held burns unit cameras and video equipment were infrequently reported as passwordprotected, and may be more prone to breaches in confidentiality than a password-protected Smartphone. However, personal storage of data may expose users to breaches in confidentiality and should always be deleted. Telehealth studies had poorly reported methods to ensure confidentiality, and Smartphone apps storing data have little warning of risks. Robust guidelines are necessary to uphold standards with evolving technologies, however recent clinical photography guidelines discussing data confidentiality do not address taking and sending images with Smartphones [3]. Many trusts will have policies in place for digital imaging, and secure hospital e-mails via an encrypted network ensure adherence with Data Protection Acts and the Computer Misuse Act [4]. New apps, such as PicSafe Medi, can provide secure transmission and storage of images on its cloud-server. It is approved by regulatory bodies in Australia, but whether it is approved overseas is unclear.
For transfer between trusts, controlled contracts should be in place as demonstrated in tele-radiology services [5]. The transfer of images between hospital sites can provide difficulty in determining responsibility for data protection [6], and contractual agreement is the best way to establish it. Use of Smartphone cameras is frequently not encouraged in the United Kingdom due to potential breaches of confidentiality. Patient treatment in burn care can be greatly enhanced through initial assessment and ongoing management via telehealth. The continued absence of formal guidance on Smartphones and their apps may limit implementation. Production of clear guidance by regulatory bodies is important to optimise the use of new technologies and enable improved availability of wound assessment and monitoring.
Conflicts of interest None.
Funding None.
references
[1] Javed M, Bodger O, Hemington Gorse S, Williams D. A comparison of two smartphone applications and the validation of smartphone applications as tools for fluid calculation for burns resuscitation. Burns 2014;40:826–34. [2] Rodrigues MA, Robertson AGN, Brady RRW. Smartphone and medical applications use by contemporary surgical trainees: a national questionnaire study. J Mobile Technol Med 2014;3:2–10. [3] Payne KFB, Tahim A, Goodson AM, Delaney M, Fan K. A review of current clinical photography guidelines in relation to smartphone publishing of medical images. J Vis Commun Med 2012;35:188–92. [4] Jones SM, Milroy C, Pickford MA. Telemedicine for acute plastic surgical trauma and burns. J Plast Reconstr Aesth Surg 2008;61:31–6. [5] Privacy and security in teleradiology. Eur J Radiol 2010;73:31–5. [6] The legal and ethical aspects of telemedicine. 2: data protection, security and European law. J Telemed Telecare 1998;4:18–24.
639
burns 41 (2015) 638–647
J.A. Dunne* ST4 Plastic Surgery, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK
Owen Bodger University of Swansea, Singleton Park, Swansea SA2 8PP, United Kingdom
J.M. Rawlins Plastic, Reconstructive and Burns Surgeon, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
Sarah Hemington Gorse David Williams Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
*Corresponding author. Tel.: +44 7870987503 E-mail address: [email protected] (J.A. Dunne)
*Corresponding author. Tel.: +44 07949450866 E-mail address: [email protected] (R. Morris)
http://dx.doi.org/10.1016/j.burns.2014.12.019 0305-4179/# 2015 Published by Elsevier Ltd and ISBI.
http://dx.doi.org/10.1016/j.burns.2015.01.019 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Response to Letter to the Editor
Letter to the Editor
Patient confidentiality and new technologies in burn care
Cost-effective outpatient burn-care for minor burns
We agree with the general concerns raised by Dunne and Rawlins [1] regarding data confidentiality and the use of smartphone cameras in the clinical environment. The apps which we evaluated [2] are simple calculators, requiring input data of age, body weight, burn surface area and time of injury. They do not use any patient identifiable data or take photographs of the patient, and the results of the calculations are not stored or transmitted in any form. We have no interests in promoting either app, but note that both apps studied present less of a threat to patient confidentiality than a handwritten Lund and Browder chart.
Dear Sir,
Funding Nil.
Conflict of interest Nil.
references
[1] Dunne JA, Rawlins JM. Patient confidentiality and new technologies in burn care. Burns 2015;41:638–9. [2] Morris R, Javed M, Bodger O, Hemington Gorse S, Williams D. A comparison of two smartphone applications and the validation of smartphone applications as tools for fluid calculation for burns resuscitation. Burns 2014;40: 826–34.
Rhys Morris* Muhammad Javed Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
Burn care is known to be expensive. Nowadays, research on burn-related costs is becoming a current subject of debate and a wide variety of methodological approaches and cost prices are found in the literature. The mean total healthcare cost per burn patient in high-income countries is calculated as $88,218 (range $704–$717,306; median $44,024) [1]. According to ‘American Burn Association, National Repository 2013 report’ the estimated number of burns receiving medical treatment is 450,000 and only 40,000 of these cases are hospitalized [2]. These data suggest that majority of burn cases are treated as outpatients and I think that cost-effective outpatient management should be a current issue in modern burn-care approach. This letter intends to discuss the factors which may influence the cost-effectiveness of outpatient burn-care. The goal of outpatient management in burn trauma is to provide the best environment for spontaneous healing in order to prevent scarring and allow normal functions. Infections must be avoided at all costs because it will change the depth of burn and increase scarring with functional losses [3]. In the light of these principles, I think that the primary factor which may influence the cost-effectiveness of outpatient burn-care is the appropriateness of initial treatment for minor burns. Superficial burn wounds result in less damage when compared to deeper ones, hence cautious attempts for protecting the burn wound from deepening should be started in the initial treatment. Immediate cooling of the burn wound with tap water, water-soaked gauze or hydrogel reduces the surface temperature as well as the state of dehydration of a burned zone. By cooling, pain and damage due to perilesional vasodilatation are reduced as well [4,5]. Analgesia with nonsteroid anti inflammatory agents, oral rehydration and appropriate elevation of the affected extremity are other initial therapies which may protect the wound from deepening [6]. Successful management in the acute phase lowers the number of future wound dressings and debridements,