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Why Telehealth Alone Won’t Solve the Burdens of Wound Management

Although telehealth has proven a novel solution to the isolation necessitated by the pandemic, there is often no replacement for the human touch in wound care. This author describes a hybrid approach of digitizing wound management to assist in wound healing.

Wound care has been late to the technology game, especially when it comes to tools for care management that enable fast and accurate measurement and documentation, tracking healing over time, and data sharing between team members. Telehealth can help keep patients with wounds safe by minimizing face-to-face interaction.

But telehealth alone will not solve the $50 billion annual wound care burden. To manage and treat wounds at scale, clinicians need digital tools to assess, track and collaborate on the healing of wounds. Digitizing wound management is the key to doing just that.

Treating chronic wounds is a slow and challenging process even in the best of times. More than eight million Americans—almost 15% of Medicare beneficiaries—have wounds that take months or years to heal.1 Those wounds need to be cleaned, treated and bandaged regularly. Caring for chronic wounds costs over $50 billion annually, and costs continue to rise.2

In the face of COVID-19, the challenges of wound care have become even greater. People with chronic wounds tend to be older, and often suffer from diabetes and other comorbidities, placing them at a high risk for coronavirus complications.

The many people already homebound because of their wounds have found themselves more isolated than ever before during the pandemic. Even for those with higher mobility, a simple visit for treatment at a wound clinic has become fraught with the risk of a COVID-19 infection. Half of American adults said that they or someone in their household have delayed or canceled medical treatment due to the pandemic, according to a recent Kaiser Family Foundation Health Tracking Poll.3 There is a real risk that patients may neglect treating their wounds, hindering healing and prolonging pain and discomfort. This may exacerbate the stress and depression that many people with chronic wounds cope with daily, because of their tendency to isolate.4

On the health care provider side, wound care clinicians have long been over-extended, with only one wound nurse for every 500 patients with chronic wounds.5 The disruptive effects of the pandemic coupled with an increasing demand for quality care have placed an ever-growing premium on clinicians’ time and resources. Many clinicians have shifted their roles, leading to irregularities in wound treatment, harming continuity, and leading to delayed care. A lack of coordination can also manifest itself in incomplete documentation, even though reimbursement policies and audits require increasingly comprehensive documentation.

Wound care has always benefited from the tireless work of nurses and other clinicians tending to wounds, but it has lagged behind in the utilization of technology. Innovative wound management solutions can help solve the challenges facing patients with chronic wounds and clinicians by providing tools to monitor, manage, and heal wounds more effectively.

Standardizing Wound Care

Because no two wounds are alike, best practices dictate that wound care be standardized to the greatest extent possible in order to better determine each wound’s unique characteristics and healing pattern. To optimize and expedite the healing process, wounds should be measured regularly and accurately over time, allowing for evidence-based decision making.6 Instead, wounds are typically measured using rudimentary paper rulers, reducing the consistency of measurement and limiting the ability of clinical staff to determine whether a particular wound is healing and which methods have been most useful in treating the wound.7 Even when wounds are photographed, variance in lighting, angle and camera type make such photographs less than optimal for tracking the wound over time.8

Using digital solutions to accurately measure, document and track wounds can save precious clinician time by streamlining care processes and keeping in-person interactions to a minimum. Once a wound is properly measured and assessed using a digital solution—with a smartphone app, for example—clinicians can receive automated feedback, beginning with an indication of whether or not the wound is healing, as well as a comprehensive analysis of the wound’s specific characteristics. Advanced image recognition can standardize wound imagery, allowing clinicians to visually track the course of a wound’s healing.

Digital wound management solutions can help counteract the negative effects of COVID-19 staffing irregularities, setting a consistently high standard of assessment even when a particular patient is cared for by a rotating staff of clinicians, some of whom may lack wound care expertise.

Streamlining Documentation

Reimbursement policies require complete and accurate documentation. Incomplete documentation can lead to denied claims and indefensible lawsuits. Beyond facilitating better healing, digital tools can ensure documentation is comprehensive and audit ready. Digital wound management solutions can integrate the most up-to-date documentation requirements to support billing and stand up to an audit.

When a wound is examined and measured using a wound management solution, the measurement and tissue composition readings can be automatically translated into the requisite clinical language for reimbursement documentation. The precise content should support the relevant billing code—for on-site exams, remote monitoring, a telemedicine appointment between patient and clinician, or a consultation between professionals.9

Monitoring Wounds Remotely

One factor driving the implementation of technology to better measure and monitor wounds is the rapid growth in telehealth over recent months. Forrester Research predicts more than 1 billion virtual care visits by the end of 2020, spurred by substantial regulatory changes.10

Telehealth solutions can serve an important role in guaranteeing continuity of care for patients with wounds, by allowing clinicians to monitor wounds remotely. Digital solutions allow for images of the wound to be uploaded to a centralized portal, where the wound can be tracked and assessed by experts on a regular basis, with decisions informed by the solution’s automated insights.

Patients might be monitored remotely from home most of the time, and even engage in self-care when possible—with instruction provided by clinicians via telehealth appointments. The ability to care for patients from afar can also help return case volume to clinics that have suffered from a reduction in patients during COVID.

A Hybrid Approach to Telehealth

Despite the innovations in wound care and telehealth, there is often no replacement for the human touch. Many chronic wounds require repeated cleaning and dressing by a professionally trained practitioner, and the distinguishing of factors—such as odor—that demand unmediated assessment. Thus, classic telehealth, with its virtual appointments over video conference, often cannot offer a full solution. Digitizing wound management—with a digital element accompanying and informing every step of the care process—is the key to easing the wound care burden.

Digitizing wound management allows for a hybrid approach, one combining hands-on care by a clinician, powered by technology, and complemented with remote care components. This hybrid approach can be especially useful during the pandemic, but will be an integral part of wound care going forward.
Digital wound management solutions have the added benefit of allowing specialists to examine wounds remotely, helping bridge the expertise gap between the clinician documenting the wound at a patient’s home, and the wound specialist analyzing documentation and data from geographically disparate patients using a dedicated portal.

A holistic example of the hybrid approach to wound care is the Wound Center Without Walls concept outlined by a group of physicians in the Wounds journal.11 Inspired by the concept of “hospitals without walls”—extending hospital care to low risk settings outside of the hospital—the authors propose untethering wound care from its traditional physical location.

After triaging each patient, a bespoke mix of care can be defined and delivered. Some patients may be monitored from home, with remote or in-person expert care provided when necessary. Many patients, however, will require the assistance of a visiting home health nurse, or physician if necessary. More complex cases might necessitate a visit to the physician’s office, a wound center, or hospital as a last resort. The care mix should be dynamic, based on the changing needs and condition of the individual patient.

As the Wound Center Without Walls authors note, “during the pandemic, the major goal of wound care will be management of the wound in order to prevent serious wound complications and hospitalization.”11 But the hybrid approach essential to mitigating the risk of COVID-19 today should continue to relieve the wound care burden from patients and clinicians alike long after the pandemic is gone.

Jonah Mink, MD, is the Medical Director of Healthy.io.

 

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References

1. Nussbaum SR, Carter MJ, Fife CE, DaVanzo J, Haught R, Nusgart M, Cartwright D. An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value Health. 2018;21(1):29.
2. Fife CE, Carter MJ. Wound care outcomes and associated cost among patients treated in US outpatient wound centers: data From the US Wound Registry. Wounds. 2012;24(1):10.
3. Hamel L, Kearney A, Kirzinger A, Lopes L, Muñana C, Brodie M. KFF Health Tracking Poll—May 2020—Health and Economic Impacts. Kaiser Family Foundation. https://www.kff.org/report-section/kff-health-tracking-poll-may-2020-health-and-economic-impacts/ . Published May 27, 2020. Accessed June 29, 2020.
4. Renner R, Erfurt-Berge C. Depression and quality of life in patients with chronic wounds: ways to measure their influence and their effect on daily life. Chronic Wound Care Management Research. 2017;4:143.
5. Cassata A. Digital wound care management is making its mark. HomeCare. https://www.homecaremag.com/september-2018/nurse-wound-care-expert . Published August 28, 2018. Accessed June 29, 2020.
6. Gethin G. The importance of continuous wound measuring. WOUNDS UK. 2006;2(2):60.
7. Langemo D, Spahn J, Spahn T, Pinnamaneni VC. Comparison of standardized clinical evaluation of wounds using ruler length by width and Scout length by width measure and Scout perimeter trace. Adv Skin Wound Care. 2015;28(3):116.
8. Queen D, Harding K. Is wound photography becoming sloppy? International Wound Journal. 2020 Feb;17(1):5.
9. Song EH. Reimbursement for telemedicine services in wound care. WoundReference. https://woundreference.com/blog?id=reimbursement-for-telemedicine-services-in-wound-care . Published May 12, 2020. Accessed June 29, 2020.
10. US Virtual Care Visits To Soar To More Than 1 Billion. Forrester. https://go.forrester.com/press-newsroom/us-virtual-care-visits-to-soar-to-more-than-1-billion/ . Published April 10, 2020. Accessed June 29, 2020.
11. Rogers LC, Armstrong DG, Capotorto J, et al. Wound center without walls: the new model of providing care during the COVID-19 Pandemic. Wounds. https://www.woundsresearch.com/article/wound-center-without-walls-new-model-providing-care-during-covid-19-pandemic . Published April 2020 . Accessed June 29, 2020.

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