Hospitals look to improve wound care with software

By Eric Wicklund

Healthcare organizations are embracing new technologies to improve wound care, which can lead to serious complications, including death, if not managed properly.

Digital health tools such as smart bandages and sensors and reporting tools within the EHR that include images can help care teams keep close tabs on wounds and avoid hospital-acquired pressure injuries (HAPIs), which are listed by the Centers for Medicare & Medicaid Services as "never events." The agency has estimated that HAPIs can add more than $43,000 in costs to a hospital stay, with severe cases running into the hundreds of thousands of dollars.

One such health system facing that challenge is New York's Northwell Health system

“We were taking ruler measurements, and it was extremely inaccurate because I might be off by a millimeter or two,” Alisha Oropallo, MD, FACS, FSVS, FAPWCA, FABWMS, director of the Department of Vascular and Endovascular Surgery's Comprehensive Wound Care Center in Lake Success, said in a recent e-mail. “Then the nurse might measure the next week and have a slightly different measurement; sometimes, the depth would not be taken; and rulers don’t provide an accurate square surface area, so if you wanted it, you had to manually calculate it.”

Northwell Health has partnered with Pittsburgh-based digital health company Net Health to deploy its Tissue Analytics (TA) software for wound care management. The technology is integrated into the health system's EHR platform to give clinicians more accurate wound data and allow for real-time monitoring.

HealthLeaders recently spoke, virtually, with Roxanne Elling, RN, BA, BSN, CWOCN, a wound care specialist at Good Samaritan Hospital Medical Center in West Islip on New York's Long Island, part of the Catholic Health system, about how the technology improves the wound care process at her hospital.

Q. What impact does wound care have on your organization?

Elling: Wound care has a great impact on all healthcare organizations. With the implementation of the EMR, the demands for all clinical documentation have increased, which of course includes a complete wound assessment. With time constraints, staffing challenges, competing priorities, and thorough documentation needs, these can be difficult to complete during one’s shift.

Q. What challenges are you facing with wound care? (e.g., number of patients with wounds increasing, impact of COVID, HAPI penalties, compliance, MIPS, etc.)

Elling: Health disparities within our population have given rise to untreated chronic conditions and loss of optimal health. Pressure injuries are caused by poor nutrition, limited mobility, and chronic conditions. When these conditions are left untreated or poorly managed, a sicker, more vulnerable patient is admitted. This is especially a concern among the elderly, and was also more common during COVID. Like most hospitals, GSH is challenged by pressure injuries, and their impact on our reimbursement and overall ratings. 

Q. How was wound care handled prior to the adoption of technology?

Elling: Prior to the use of Tissue Analytics (TA) technology, the clinician spent a large amount of their time carefully measuring and documenting each of the patient’s skin related challenges, including but not limited to Incontinence Associated Dermatitis, pressure injuries, skin fold challenges, and traumatic wounds. This documentation was often significantly subjective. Despite the overwhelming amount of education given to both physicians and nurses, there was a consistent challenge with documentation accuracy among various clinical groups.

Q. How has new technology improved wound care?

Elling: With the use of TA technology we have the ability to see what the clinician saw at the time of admission through pictures. This allows the Certified Wound Ostomy and Continence Nurse (CWOCN) to review and expertly evaluate without actually being at the patient’s bedside at the time of admission.

This is especially helpful for challenging documentation. With the adoption of the technology, accurate and/or progressing wounds that are in question can be better monitored.

We were fortunate to have adopted TA in our facility over two years ago. While change is generally a challenge, TA has now become part of the culture and part of our practice as clinicians. As EHRs and technology evolve, such as documenting on smartphones, the need for a HIPAA-protected environment is a necessity for sharing information for evaluation. TA gives all clinicians involved in patient care the ability to see what is going on “below the blankets.”  It is essential that all team members are able to visualize, acknowledge and update the plan of care regularly. Tissue analytics allows our physicians to review pictures at their fingertips in real time and within a protected environment.    

For our facility, and throughout our hospital system, TA is being used as an inpatient tool. It allows the CWOCN to see what challenges each patient has, and it enables us to structure our days, prioritize our patient load and maximize time management strategies. For our physicians, TA has greatly improved the ability to collaborate by allowing the patient’s photos to be included in their assessment and ongoing evaluation. Keeping physicians continuously updated with photographs of skin conditions has become an essential communication tool used in patients’ ongoing treatment plans. 

As a society we expect immediate results. With the capability of virtual visits and remote chats online with physicians, the need for more real time evaluation in acute care is required. With TA, staff at the bedside has the ability to enter a photo into the chart that can be viewed by physicians elsewhere in real time. Ongoing and progressive photographs within the EMR can demonstrate effective improvement in wound condition and character and assist us in driving successful management.

Q. What are the challenges or barriers to using these new techniques?  

Elling: Similarly with any technology, the challenges are generally related to user education and usability as well as the reliability of hardware and connectivity.   

Q. How do patients feel about these services? 

Elling: Prior to taking any pictures, patients and family members are educated and understand the need for us to photograph their skin to validate treatment and monitor healing over time.

Hospitalizations are always stressful. In using TA technology, the care team has been able to demonstrate wound healing to family members while participating in the patient’s plan of care.  This allows open communication of challenges with the patients’ clinical status, in an ongoing effort to help everyone collaborate for better goals of care for each patient. 

Q. How do you measure success with this technology? 

Elling: We have data to suggest that between 6% and 10% of pressure injuries were incorrectly staged on arrival to our facility. We believe that without the use of TA, the appropriate prevention and treatment interventions could be overlooked as well as the risk of potential financial penalties as a result of incorrect documentation.

Eric Wicklund is the Innovation and Technology Editor for HealthLeaders. This story first appeared on HealthLeaders Media.