A smartphone-based consultation system for acute burns – methodological challenges related to follow-up of the system

ABSTRACT

Background: A smartphone-based consultation system for acute burns is currently being implemented in the Western Cape, South Africa. Even though studies indicate that similar systems for burns tend to support valid diagnosis and influence patient management, the evidence is still sparse. There is a need for more in-depth evaluations, not least in resource-constrained settings where mHealth projects are increasing.

Objective: This article describes the consultation system and assessments in relation to its implementation with a special focus on methodological challenges.

Methods: A number of evaluations and assessments have been conducted, are ongoing or planned for in relation to the implementation of the teleconsultation system. Initial assessments showed that size and depth of burns could be assessed at least as well using photographs as at bedside and that the image quality of handheld devices can be used as well as computers. Studies on system usability are currently being done with a mixed-methods approach. A historical cohort design will be applied to assess the potential health impact of the system. Patients with burn injuries where the doctor at point of care has used the app to receive diagnostic support from a burns expert will be considered as exposed and patients with burn injuries where the app has not been used will be considered as non-exposed.

Conclusions: Smartphone-based consultation systems have the potential to strengthen the assessment of burn injury in many settings. However, ethically and methodologically sound evaluations are needed to find the best systems and solutions. This article identifies challenges and suggests potential assessments in relation to the implementation of such a system.

SPECIAL ISSUE:

• mHealth for Improved Access and Equity in Health Care

KEYWORDS:

• Acute burns
• mHealth
• burn outcome measures
• image-based diagnostic

Handling Editor Nawi Ng, Umeå University, Sweden

Handling Editor Nawi Ng, Umeå University, Sweden

Acknowledgments

The authors would like to acknowledge the Vula team for developing the app. We are also grateful to Professor Heinz Rodhe, Dr Nikki Allorto and Dr Wayne Kleintjes for their instrumental support and input on the project. The article was published thanks to financial support from the Wallenberg Foundation and Umeå University.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

None.

Paper context

Even though previous studies indicate that mobile phone-based applications for burns tend to support valid diagnosis and influence patient management, the evidence is still sparse. There is a need for more in-depth evaluations, not least in resource-constrained settings where mHealth projects are increasing. This article describes such a system for acute burns in the Western Cape, South Africa, assessments in relation to its implementation and the challenges of using image-based diagnostic support in the acute phase of burns.

Additional information

Funding

This study was supported by the Swedish Research Council, the Marianne and Marcus Wallenberg Foundation, and the Stellenbosch Institute for Advanced Studies (STIAS).

Notes on contributors

Marie Hasselberg

MH conceptualized the paper and prepared the first draft based on discussions with LL and LW. PB contributed with an extended description of the implementation of the project in the revised version of the manuscript. All authors contributed towards editing the manuscript, then read and approved the final manuscript.