Telehealth Wound Care: A New Option for Patients

Telehealth wound care was a priority so physicians could continue to provide comprehensive healthcare to chronic patients during the COVID-19 pandemic. Instead of being a short-term patch while there were restrictions in place, telehealth has become ubiquitous in health care and demanded by both patients and providers.

For rural patients, the expansion of telehealth has decreased wait times and access to specialists by 84%. Adherence to treatment plans has increased 67%. Chronic disease management has improved by 47%. The ability to access healthcare in a virtual format has greatly increased satisfaction—by 82% for patients and by 71% for providers.

While the infrastructure was in its infancy in 2020, great strides have been made to improve access, standardize telemedicine processes, and enable providers to serve patients remotely as they would in person. Because of the success and continued demand for telehealth services, the technology and number of participants will continue to expand. Specialists and those treating chronic wound patients in particular, will need to develop the skills to provide excellent care via telehealth.

What Wound Care Services Can Be Provided Virtually?

A wide variety of wound care services can be provided via telehealth. For patients who live in rural areas, have difficulty traveling, with mobility concerns that make navigating a clinic impossible, or have comorbidities that necessitate many medical appointments, telehealth is a solution that will enable them to attend more appointments and feel empowered to improve their health outcomes.

Consider offering any of these wound care services to patients through telehealth.

• Wound Assessment: Use video conferencing to examine the wound and evaluate changes or concerns.
• Triage: Determine the severity of a wound to decide the priority of treatment for the wound and how it is affecting the patient’s overall health.
• Referral: A visual assessment and evaluation of the patient’s overall health via telemedicine can result in a referral to a specialist, emergency department, or an in-office visit.
• Monitoring: Periodically monitoring the wound for discharge, changes in color or size, or signs of infection can prevent more serious problems with a wound.
• Treatment Planning: Developing or updating a treatment plan for wound care can be done remotely.
• Prescriptions: Evaluating the effectiveness of a treatment and ordering more or updated formularies will streamline the process of determining the correct treatment.
• Patient Education: Using telehealth for education allows caregivers to be involved in the appointment. Some telemedicine is provided asynchronously—providers write or record educational materials and patients can review them at their convenience and as many times as necessary.

How to Manage Wound Care in a Telemedicine Environment

Most healthcare processes do not change whether the interaction is in person or virtual. Providers will still ask about the general health of a patient, address concerns, evaluate wounds, and make treatment or prescription recommendations. Telemedicine can improve access and treatment for patients with chronic wounds, save time and costs, and continue to deliver high-quality care.

Patients may be asked to take and share pictures of their wounds regularly so providers can monitor the progress and make changes to treatment plans between scheduled visits. Telehealth enables patients to access immediate care when they have a concern and improves the ability of providers to track changes.

A chronic wound is one that has failed to heal in a standard four-to-eight-week cycle. These types of wound usually require multiple visits, travel to specialists, wait time for available appointments, and several changes to medication or dressings. This places a burden on the patient and their family for transportation and the cost of visits and treatment, and can delay appropriate measures. Telemedicine gives them the option to virtually communicate with providers, upload pictures, and receive immediate feedback without leaving their homes.

How Do Workflows Change with Telehealth Wound Care?

The focus for telehealth is collaborative care and individual treatment planning. Because of this, each session can be unique. The method of delivery, documentation, check-in, and follow-up can all change based on the needs of the patient. But in general, these factors need to be considered and addressed for telehealth wound care workflows:

• Staff need to be fully trained to deliver comprehensive and compassionate care via telemedicine
• The provider and the patient must have access to appropriate technology such as video conferencing technology, audio communication, secure text platforms, high-speed internet or broadband, and electronic health records that correctly code and document telehealth appointments
• Text or email reminders
• Accommodations for patients who are hard of hearing, visually impaired, non-English speakers, or who struggle with technology
• The ability for patients to complete any necessary paperwork electronically prior to the appointment
• Include in your documentation that this was a telehealth appointment
• Use appropriate billing code for telehealth delivery

For HIPPA compliance, you will need to verify the patient’s identity at the beginning of each visit and confirm who else can access the platform. Consider if a family member or caregiver is also participating and what they can access on behalf of the patient. 

Continue to ask patients regularly if telehealth is working for them. If they are struggling with technology, their internet connection, or understanding their suggested treatment, changing to in-person appointments may be more appropriate for the patient.

Improved Patient Outcomes via Telehealth for Wound Care

Historically, there’s been a lot of hesitance around adopting telehealth, especially for wound care, since the treatment relies so heavily on physical procedures like applying various bandages and even debridement. But there’s an abundance of evidence that it works for most patients and practices, sometimes even better than traditional appointment schedules. While there are barriers to effectively delivering healthcare via telemedicine, in most cases, it saves time and money and effectively treats chronic wounds.

In fact, studies have found that wound care delivered via telehealth has improved outcomes. Studies have found that:

1. It improves access to specialists, particularly for those living in rural areas.
2. Healing time is significantly shorter for patients who use telehealth for wound care. This can be attributed to more frequent monitoring thanks to remote monitoring programs and apps and the ability to quickly identify signs of infection or delayed healing with more frequent check ins.
3. Some studies have found that patients who use telehealth for wound care are admitted to the hospital less often, have fewer emergency department visits, and are less likely to experience amputations. These outcomes relieve a financial burden on the entire healthcare system.
4. There are more than six million chronic wounds in the United States each year, which cost our healthcare system $25 billion annually. Telehealth reduces overhead costs for physician offices, clinics, and hospitals by providing services to patients in their homes. It also relieves a burden on patients to travel to specialist’s offices or wait months for appointment availability. The majority of patients who use telemedicine report greater satisfaction with the experience than with in-person care.
5. For patients who are at high risk of infection, telemedicine removes the risk of physically being in an office or clinic. It also improves the experience for those who are anxious about appointments or travel.
6. Telemedicine patients reported feelings of empowerment to own their wound care and that they better understood how to access care that they needed. They are more likely to ask questions to their providers because they have open communication that can be sent at any time without the expectation of an immediate response. This type of care is convenient, not just during global pandemics when travel is restricted, but any time a patient struggles to attend the vast number of appointments required for adequate wound care.

Challenges of Telehealth for Wound Care

While there are obvious and immediate benefits to telehealth services for wound care, there can be limitations and challenges as well. Access to the appropriate technology can limit the ability of patients to participate in telehealth effectively. Patients living in rural areas where broadband is limited, older patients who are not familiar with technology, and low-income patients who do not have devices or high-speed internet in their homes will all struggle to reliably attend telemedicine appointments and receive information electronically. In wound care, this is especially troubling as these patients may delay contacting their physician or miss follow-up appointments.

Other barriers to the effective delivery of telehealth wound care include:

• Patients not understanding directions.
• Providers unable to personally monitor the progression of the wound healing.
• Losing the ability to smell or touch the wound.
• Lost time for changing treatment if bandages or medications need to be ordered and delivered.
• The patient has to take additional responsibility for changing the dressing and noting and reporting changes.
• Treatments will need to be scheduled for another time.

For patients who are comfortable with the necessary technology and providers who have invested in secure and user-friendly platforms, telehealth offers many benefits for those with chronic wounds. However, it is not the best choice for all patients at all points in their treatment plans.

Incorporating Telehealth into Wound Care

Treating chronic wounds requires interventions from multiple healthcare providers and frequently requires changing treatment plans as the wound progresses. For many patients, it is a burden to travel to multiple offices or clinics for follow-ups or to consult with specialists like wound care nurses. Telehealth offers an alternative that enables patients to attend more appointments in the comfort of their homes with the support of family or caregivers nearby. Offering telemedicine for wound care gives patients more access to their healthcare providers, encourages them to take greater ownership of their treatment plans, and allows for more frequent monitoring of the wound.

While it is not appropriate in every situation, physicians and patients report great satisfaction with telehealth and the frequency with which they can collaborate on the next step toward full healing.