The digital age is upon us, like it or not, ready or not. For the past few years, payers have incentivized, encouraged, reimbursed, and adopted various digital, remote monitoring systems and devices as a way to encourage providers to adopt more digital, remote methods.

Although complete telehealth services were not reimbursed in all care settings in all Zip Codes by all payers throughout the United States at the beginning of 2020, many of the restrictions and barriers to provide nearly complete digital services were suddenly released in response to the needs of a nation in the throes of a pandemic. The significantly reduced restrictions give unprecedented access for patients to their health care providers during a time when going out could be deadly for those with underlying health conditions. Our patients need us now more than ever. However, navigating the wound care world by using digital platforms and technologies isn’t always as straightforward as it sounds.

What’s Your Point of Reference?

Let’s say a patient is utilizing one of the newly appointed codes that allow a patient to text or email a photo to their health care provider. Photos of wounds can be deceiving, and not all patients have a wound measurement guide to place in the photo.

Consider having the patient add a common household object near the wound (but not too near) so the wound size is clear. A dime and a quarter, for example, are common points of reference that are easy to place in a photo for a clear reference point. Consider instructing the patient to place the common household object at the bottom (or 6 o’clock) of the wound. This ensures that the wound alignment is understood and makes it easier to track wound progression from photo to photo with intervals deemed appropriate by the health care provider.

Lighting

Even face-to-face wound rounds can have lighting challenges. To flash or not to flash, THAT is the question! If a wound photo is too dark, it can obscure non-viable tissue. If the flash is too bright, it can “wash out” the periwound, obscuring visual symptoms of brewing infection or underlying tissue damage. If the lighting isn’t the same from assessment to assessment, it can look as though the wound changed when in fact no change may have occurred. Consider using indirect lighting.

A well-placed flashlight that is lighting just to the side of the wound is often enough to give the right amount of lighting without the “washout” effect. Perhaps a floor lamp can be placed close enough to provide adequate lighting without causing color distortion. Remind the patient to use the same lighting techniques from photo to photo to ensure consistency. Consistency is KEY! Consider asking for a photo of the dressing with each wound assessment as well so you can clearly see the amount and color of the drainage without having to rely on someone else’s perception of the amount and color of the wound drainage.

Connectivity

Live video chat is in the here and now. Many platforms allow us to live stream with our patients throughout the states while being HIPAA conscious and compliant. It is very exciting to perform tele wound care rounds with wound evaluations. It allows us to invite in responsible parties, family members with consent, nurses who need to be involved, and more.

We can consult with the patient, decide treatment options in real time, ensure that advanced wound modalities are applied correctly, educate about dressing applications, and so much more—that is, as long as you have an adequate Internet connection. Unfortunately, good Internet connection is not always an option. Before you agree to tele wound care consults, evaluate the options. Do they have access to Wi-Fi or hardwire connections? Perhaps a cellular signal is a better option for the area. Consider using platforms that can be operated on an app and various web browsers on a variety of operating systems (i.e., Apple, Android), including smart devices (i.e., tablets or cell phones) and/or computers. The more options we have at our disposal, the greater the chance the live streaming tele wound care rounds will be successful.

Conclusion

As daunting as these changes may seem, I have confidence in health care and our ability to rise and meet the challenges of today and the future while we continue to support our patients and heal the wounds of the world.