Telemedicine is a new, rapidly evolving area and can be of great value in the provision of healthcare to remote and rural populations. Wound healing and wound management are prime candidates for telemedicine. By reducing the need to travel long distances to the hospital or to consult with a physician, telemedicine decreases the costs and improves the quality of life for patients with chronic wounds, while still maintaining high standards of wound care. The intent of telemedicine is to reduce, in a clinically equivalent way, the number of visits to a specialized clinic, but not necessarily to eliminate all visits. Wound care telemedicine allows the general practitioner to communicate with the specialist via telecommunications in co-managing the patients' wounds, effectively reducing the wait for specialists, allowing patients to get treated faster.
The spread of COVID-19 rapidly progressed to become a pandemic event, causing major disruption in healthcare services, including the care of patients with wounds. Out of necessity, the delivery of wound care, which should be regarded as an essential medical service, shifted. The major goals of wound care during the pandemic have been shifted to prevent serious wound complications to minimize hospitalization and surgery, when possible, rather than necessarily to complete wound healing.
Risk for COVID-19 in patients with chronic wounds, a non-healing wound is often a culmination of multiple underlying medical problems. Most patients with chronic wounds have multiple comorbidities, such as diabetes, hypertension, and chronic kidney disease. These same risk factors place many patients with chronic wounds in a high-risk category for developing severe consequences if they become ill with COVID-19.
Diabetes mellitus, hypertension, cardiovascular diseases, smoking, chronic obstructive pulmonary disease (COPD), malignancy, and chronic kidney disease were among the most common comorbid conditions. Because of this increased risk, efforts to decrease exposure to the virus are of the utmost importance in patients with chronic wounds. In addition to using the standard practices for preventing person-to-person transmission, reducing the number of wound care visits, reducing the time interval, and selecting the optimal environment for wound care may help reduce exposure to COVID-19.
The main requirement for initiating telehealth is patient accessibility via smartphone or computer. Any of several online computer/smartphone applications and services, as well as hospital-based telehealth platforms, can be used. Most nurses have access to a telehealth communication platform to help keep track of medical information, such as the vitals, physical examination, wound measurements, and the progress of the wound. Verbal consent of the patient or legal guardian is required for telehealth or telephonic communication.
Any of these allow a virtual appointment with the patient, during which the patient can discuss their history and concerns. The patient can be scheduled for a weekly telehealth visit with a nurse, and patients with deterioration of wound progress can be directed back to the office for further evaluation.
There are many technical barriers to telehealth services. Adequate internet capability, whether wired (ethernet) or wireless, of the provider and patient is essential and determines the speed and image quality in demonstrating wounds to the provider. Some patients are unable to download the appropriate applications owing to the age of their devices. Older devices have less memory capacity for the newer apps needed for telehealth. Increasing the broadband capability allows faster transmission of video images and less ‘freezing.’ Poor image quality makes it difficult to provide a proper diagnosis.
Patients who lack resources for data transmission and photos via a smartphone may resort to correspondence via the hospital or patient portal system, if available. The patient can email photos or discuss their concerns directly with their provider over the phone (i.e., telephonic). With email, there may be delays in the transmission of patient health information due to its encryption. It is also important to note that coding and billing reimbursement for provider services over the phone differs from telehealth face-to-face visits.
Multiple studies during the pandemic have pointed to the effectiveness of telehealth for improving wound care outcomes as well as high patient satisfaction rates with these services. Telehealth has been used to care for patients with diabetes for over two decades with good results. In a meta-analysis that included two trials, 213 patients treated using telehealth were compared with 301 patients treated with usual care. The telehealth system comprised a trained nurse who collected data and took digital images of the wound. Collected data included questions about the quality of life, such as nutrition, movement, and pain levels, as well as patient satisfaction with the treatment.
The information was then sent to the physician for decision-making. Complete ulcer healing, healing time, and amputation rate were similar between the groups. The telehealth group had a significantly higher mortality rate (4.1 percent versus 1.2) without clear underlying reasons. No adverse events were attributed to using telehealth. The studies in the systematic review also reported that supplementing outpatient clinic visits with telehealth consultations increased the frequency of complete healing and the healing rate of diabetic foot ulcers, as well as reduced the frequency of limb amputation. Several studies also reported good patient satisfaction with their telehealth experience.
Telemedicine can be used as a valuable add-on service to enhance patient care in the specialty of wound care. In-person, face-to-face interaction between a physician and patient allows physicians to handle many complex social and psychological issues pertaining to the patient and their family members that cannot be achieved by telemedicine. Telemedicine lacks the ‘touch,’ which has the power of healing. Telemedicine presents new opportunities for physicians in their wound care practice. In the future, the wound care center can become a hub for telemedicine services connecting home health, skilled nursing facilities, acute long-term care, and rural facilities.
Wound care telemedicine may provide needed continuity of care for our complex wound care patients in all settings. Telehealth technology is going to disrupt how we practice in the future and it promises to provide the triple aim of low cost, better quality, and access to our patients. At the same time, many state and federal legal considerations should be looked at before starting wound care telemedicine services.
We shared the article on ‘feasibility of wound care telemedicine in 2023’ for reference purposes, you can visit reference links for a detailed understanding. Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. As a leading medical billing company, we are aware of telemedicine billing guidelines for Medicaid, Medicare, and all private insurance payers. We can assist you in receiving accurate insurance reimbursement for wound care telemedicine services. To know more about our wound care billing and coding services, email us at: info@medicalbillersandcoders.com or call us at: 888-357-3226.
References:
COVID-19: Issues related to wound care and telehealth management
How Telemedicine Is Influencing Wound Care
