gms | German Medical Science

Introduction: The diagnosis and therapy of chronic wounds are multiprofessional, multistep, and exceedingly complex issues [1]. Establishing the correct diagnosis is a crucial step in avoiding mistakes in the wound treatment [2]. In the BMBF project Posithera it is the primary challenge, to combine requirements of information continuity and decision support in one system. The development and successful implementation of a hands-on decision support system with real benefit for the users is highly depending on well-defined use cases.

Methods: The research of the study identified key characteristics of use cases for the deployment of decision support functions in the medical supply chain of chronic wound treatment. To achieve that, several workshops at varying locations in Lower Saxony were conducted from June to August 2017 by the University Medical Center Göttingen Department of Medical Informatics and the University of Applied Sciences Osnabrück with nationally wound experts. Based on the workshop results, use cases for the implementation of decision support functions in the treatment of chronic wounds were formulated. The use cases were discussed by the project consortium and examined for their feasibility. For this purpose, the criteria: access to medical evidence and contact to medical experts, but also technically- and temporal feasibility, were taken into account.

Results: The decision support use cases of „diagnostic process“ and „monitoring of the wound“ were chosen to be implemented in the second project year. In addition two use cases were formulated and chosen to collect data about the patient and the wound in a structured manner to build up a fact base, which is the prerequisite for the decision support functions.

The fact base consists of data clusters in the context of chronic wound treatment, which are in detail: master data, general status and medical history, wound anamnesis, wound status, diagnostic, therapy, patient reported end points, nutrition, and education [3], [4].

The goal in the „diagnostic process“ is to formulate a suspected diagnosis by the physician and to confirm it through diagnostic methods. To assist the physician in this process, the decision support system needs interdisciplinary knowledge about the different pathogenesis of the chronic wounds, which needs to be formalized grounded on evidence-based medical knowlegde like S3 guidelines. The use case „monitoring of the wound“ supports the physician, wound manager or nurse to estimate the tendency of the wound healing process. Parameters, like the wound size, can be analyzed in dependency of the factor time over weeks, month, and years. So a course can be calculated, that indicates, in reference of the mentioned example, the wound size getting smaller or not. This can be a good indicator for a healing or non-healing wound. The required knowledge needs to be formalized based on current consensus of wound experts.

Discussion: Taking the Medical Devices Act into account, a future hands-on solution, based on the use cases of our project PosiThera will become a medical device. The results of our study are crucial steps towards the classification of such a medical device.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.