Clinical note-making and patient outcome measures using TELER®
01/09/11 | Service development and delivery
This paper describes the advances in the TELER® system of clinical note-making and patient outcome measurements, including the new digital pen and paper format. The digital pen records clinical data by reading handwriting, while Bluetooth technology transfers data from the pen as encrypted digital files and converts them to machine readable text. The text can be used to populate many computer applications. Overall these advances provide a sophisticated, yet simple tool for delivering evidence-informed wound care and patient outcomes in routine treatment and care.
TELER is a generic system for making clinical notes and measuring patient-centred outcomes of treatment and care. It can be applied to any condition or sphere of activity, clinical or non-clinical, where the outcomes of interventions need to be measured over time. The application in this paper is for clinical wound care for epidermolysis bullosa (EB).
TELER was first applied to wound care by Grocott [2-7] in a malignant wound study. The application of TELER to other patient groups was undertaken by the WRAP (Woundcare Research for Appropriate Products) collaboration, funded by the Engineering and Physical Sciences Research Council[8-12]. TELER has been subsequently incorporated into routine clinical practice by the Department of Vascular Surgery at the Bradford Teaching Hospitals NHS Foundation Trust in the UK.
The TELER System is currently being developed and validated in its new digital pen and paper (DPP) format in a collaborative study that includes patients with epidermolysis bullosa (EB), their carers and clinicians as well as researchers from King's College London and Longhand Data Ltd. The study is being funded by the Guys and St Thomas' Charitable Foundation in the UK.
The DPP technology captures and records ordinary handwriting using a digital pen, which functions and looks just like a normal pen but contains a digital camera, processor and memory. The pen transfers writing as encrypted digital files via Bluetooth. The handwriting is converted to machine-readable text, which can be used in computer applications such as databases and spreadsheets in a number of customised formats. (See Longhand Data Ltd)
THE TELER SYSTEM
The system has two main elements: clinical note-making and clinical measurement. These assess information regarding the pattern of change, or lack of, in a patient's condition. This may be coded at the individual patient level (evaluation). Patients can participate in evaluating their own outcomes, if they are able to do so. Based on measurement theory, data are recorded to measure whether patient outcomes are attributable to the care received. This involves assessing whether a pattern of outcome scores has not occurred by chance and is, therefore, attributable to the care received.
The clinical note-making element comprises data that are routinely collected including patient identification numbers, demographic details, clinical history, diagnostic tests, diagnoses and medical and surgical interventions, including drugs and topical dressing products.
The clinical measurement element collects observational data through the TELER Indicator, a numerically formatted ordinal scale of patient outcomes at the point of treatment and care. It records the relationship between the treatment and care given, how it was perceived by the patient and the outcomes in terms of clinically significant change. Outcome measures include patient experiences, symptom management, wound healing, palliation (when wound healing is not an achievable goal) and dressing use and performance.
The TELER System can discriminate between treatment effects, dressing performance failure, gaps in clinical knowledge and wound care skills, including product use. It is designed to be the legal clinical record that is used at the point of care, and not as an additional data collection activity. It therefore functions as a clinical audit and governance tool, and is a mechanism for routine data capture, patient monitoring and service delivery. The system can also be used for research when incorporated into an appropriate research design, and used with ethics and research governance permissions and authorisations.
- Using agreed upon TELER Indicators aids patients to understand their treatment and clinicians to assess the patient’s outcome
- WEB aims to develop a TELER clinical note-making system, in DPP format, specifically for the evaluation of dressings and costs of wound care for EB
- DPP pens are equipped with the technology needed to record, save and transmit handwritten evaluations
- DPP makes it easy to send TELER System data to other establishments and clinicians. It also collects data for future research