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EmailInformatics Research Overview
Our research is driven exclusively by patient need. From working directly in inpatient units, intensive care units, outpatient clinics and nursing homes, our clinical research team is fully committed to translating patient need at the bedside into a research question. Our ultimate goals are discoveries that can benefit patients with chronic wounds.
We have established a biomedical informatics program funded by the National Institutes of Health, (National Library of Medicine, R01LM008443-04). This program is devoted to determining if use of the Online Wound Electronic Medical Record (OWEMR) as a routine intervention in clinical care can decrease amputations in those with diabetic foot ulcers (DFUs) and prevents the progression of pressure ulcers (PUs) to stage IV. The OWEMR databank is a web-based informatics clinical intervention tool that synthesizes up to 137 data points about chronic wounds from multiple data sources, identifies for the clinician the information needed to make treatment decisions, and uses intelligent search and report features to provide clinical alerts that identify patients who require emergency interventions or changes in treatment strategy. It includes the patients’ medications, past medical history, relevant laboratory parameters i.e., photograph and real-time healing graph of the wound’s progress, and a single-screen summary of relevant clinical information can be retrieved at the push of a button for the clinician at the point of care. The clinical decision support system alerts providers to facilitate appropriate and timely intervention. Through recording each patient visit in the OWEMR, we have the capability to identify when treatment needs to be altered for a non-healing wound, and when a change is the protocol is necessary.
Summary of Accomplishments to Date:
We have implemented the OWEMR throughout NYU Medical Center and demonstrated its value as a standard of care along with evidence-based wound protocols as: 1) a clinical tool that facilitates patient care by providing a single easy-to-use display of all information relevant to wound care, implements standardized protocols and identifies wound emergencies [Ostomy Wound Manag, 2009]; 2) an intervention that reduces the number of limb amputations [Wound Repair Regen, 2009] and prevents progression in severity of PUs; and 3) a research tool that characterizes chronic wound histopathology [J Am Coll Surg, 2009] and microbiology [Int Wound J, 2008] and identifies variables such as osteomyelitis, ischemia and malnutrition that contribute to healing vs. non-healing.
Exploratory studies to date have used the OWEMR to:
- measure the baseline healing rate of PUs among hospitalized patients
- reduce the incidence of stage IV PUs in the Intensive Care Unit by 97 percent
- establish a database of wound and pertinent medical information for PUs and DFUs which has resulted in innovations in the molecular, cellular and pathological basis of healing
- reduce the DFU-related lower-limb amputation rate
- reduce the rate of PU progression among patients in intensive care units (ICUs) from early stages to Stage IV.
Our initial results suggest that providing a single-screen or single-page summary of all the data needed to make clinical decisions about individual patient wound care in real time at the point of care can dramatically reduce PUs and DFU-related limb amputations.
