Although telehealth cannot replace every aspect of in-person wound care, telehealth’s patient-centric model can engage patients in their own care and streamline care for physicians. This author discusses the digital transformation of the wound clinic, including a hybrid approach to wound care.
The COVID-19 pandemic has been an inflection point for telehealth. Over the course of 2020, clinicians, patients and entire health care systems rapidly adopted remote care solutions, accelerating a trend that might have otherwise taken years to achieve.
It is safe to say that such sweeping changes have been largely absent from the field of wound care. Chronic wounds typically require regular cleaning, dressing, and treatment by a trained clinician—highly tactile processes that cannot be carried out via videoconference. But the spectrum of possibilities offered by digitization and remote care has much to offer wound care, without displacing the physical interaction between clinician and patient that is at its heart. In fact, digital solutions offer the opportunity for more patient-centric wound care, facilitating increased patient engagement and motivation to close the gap in care that maintains a consistently high national burden of chronic wounds.
Digitizing wound care means using technology to help solve one of the field’s greatest challenges: the lack of standardization in wound measurement and assessment. For wounds to heal faster they must be monitored regularly over time; even the smallest of changes can provide valuable insights that can inform and optimize care plans. But the rudimentary methods commonly used to measure wounds, such as paper rulers, lack accuracy and fail to provide the basis for consistent, standardized measurements. Data for a single patient is often fragmented across multiple sources, further thwarting attempts to track healing. The implications for non-healing wounds—a particularly costly source of immense suffering—are significant.
The best digital wound care solutions use normalized data—quantitative, qualitative, and visual—to provide an accurate picture of how a wound is faring and progressing over time. Automated alerts can draw attention to stagnating or deteriorating wounds, and even provide suggestions for care plan changes that have shown positive results for similar wounds in the past, in support of data-driven clinical decision making.
The digital transformation of wound care only begins at the individual level. The advent of coherent and up-to-date wound records allows for the transformation of workflows and processes at every level, incorporating a hybrid approach to wound care—one that combines hands-on treatment augmented by technology, with elements of remote care.
Providing wound care clinicians with digital tools can affect clinicians in powerful ways. On the most immediate level, streamlining and shortening an otherwise laborious assessment process frees up valuable time that can be dedicated to what matters most: treating and communicating with the patient.
Standardized and easily accessible wound records, available to all relevant staff members online, also allow for far greater flexibility when deploying and managing staff. The realities of contemporary care are such that a single patient is often seen by a rotating group of clinicians, resulting in discontinuous care. A standardized visual point of reference, augmented with automated insights, can go a long way in solving this challenge and provide for seamless care across staff.
Rich digital records also facilitate better case supervision. When a simple scan results in comprehensive and easily accessible data, supervisors can comfortably enable junior staff to treat wound patients. More experienced clinicians can then use the digital records to keep close tabs on patients without the need to meet with them regularly. Such asynchronous care flows allow for increased upskilling of junior staff and skill mixing that can ease the burden on specialists.
In the event that interprofessional consultations are required, digital solutions can act as the basis for telehealth appointments. That can enable efficient access to quality care when a WOCN or wound doctor isn’t immediately physically accessible, whether due to reasons related to the pandemic or because of long wait times. The use of telehealth for appointments between clinicians—rather than between a clinician and patient—is achieving increased recognition, with new Medicare reimbursement codes reflecting this.
The patient-centric approach to wound care recognizes the outsized role that patients with wounds must play in the long road towards healing. It is not only a patient’s right to be actively engaged in caring for her own wound—it has been shown to produce tangible healing outcomes. Engaging patients entails understanding their needs and soliciting their preferences throughout the care process in a manner that shapes care plans and optimizes the care experience.
Digital solutions can have a significant contribution to patient engagement. By providing highly detailed information to the clinician regarding each wound’s history and trends, such solutions eliminate speculation and allow them to share an evidence-based assessment with their patient that can increase confidence and motivation.
Another important element of patient engagement made possible by technology is the ability to share imagery showing the progress of a wound over time. This “time-lapse” view offers patients an unmediated look at their own wound that would otherwise be anecdotal and speculative (in the event that a patient is able to catch a glimpse of their wound at all, which is not always the case). In our own experience, we’ve seen firsthand what a powerful motivator this can be for patients. While the images may be sobering, the opportunity to see firsthand whether or not the current course of action is working can be a powerful stimulus for a patient to buy in to her care, resulting in increased adherence to treatment plans.
The increased openness to technology in the face of the pandemic on the part of both caregivers and their patients has opened a unique window of opportunity with the potential to transform wound care. But digitization is a process, and solutions are not one-size-fits-all. Clinicians and organizations would do well to tailor their chosen solution to their individual characteristics. When done well—by empowering clinicians to provide better treatment and engaging patients to assume an important role in the process—the benefits to healing will soon follow.
Jonah Mink, MD, is the Medical Director of Healthy.io.