Shared Community-Hospital Care of Leg Ulcers Using an Electronic Record and Telemedicine

Abstract

The majority of leg ulcer care is provided by community nurses who should have access to specialist hospital assessment and treatment. A shared electronic care record (ECR) has been developed that includes color digital images and structured clinical information. Patients are referred electronically to a one-stop hospital clinic with direct access to duplex ultrasound where a definitive management plan is made and the patient attends hospital again only for further investigations (eg, biopsy) or definitive treatment (eg, angioplasty, bypass, venous surgery, or skin graft). Ulcer size is measured from the images and automatically plotted over time to show the response to treatment. The system is secure, is easy to install, and has minimal operating costs. The community nurses easily master the new skills required and are enthusiastic about the benefits of this powerful communication, training, audit, and research tool. Technical and practical feasibility has been demonstrated, and initial clinical results are impressive.

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