How Wound Care with Telemedicine Works
- Christopher Leonard, DO, MHI
- April 16, 2020
Over 1000 of Vohra’s skilled nursing facility partners are now utilizing telemedicine for wound rounds during the COVID-19 pandemic. This remote access to the patient has allowed physicians to maintain continuity of care and heal wounds while reducing the risk of exposure for this vulnerable population.
Telemedicine, while more common today, is not new. Many of the Vohra physicians have used telemedicine as a part of their practice for years to help treat patients in rural locations. In the following interview, Dr. Alejandra Moscoso, MD of Frisco, TX, explains how the Vohra telemedicine program has successfully worked for her practice over the years.
How many skilled nursing facilities do you service with telemedicine?
“For the last four years, I’ve seen about 30% of my patients via telemedicine, primarily for patients in rural facilities. During the COVID-19 crisis, The Centers for Medicare and Medicaid Services (CMS) waived many of their restrictions around who qualifies for telemedicine, so now all my facilities are using telemedicine for wound rounds.”
How does Vohra’s telemedicine program help these residents and facilities?
“These facilities originally were qualified for telemedicine due to CMS guidelines qualifying facilities in certain rural locations. Typically, these sites did not have a wound care doctor or a wound care clinic nearby. Additionally, many of the local primary care physicians were not trained in wound care, or they did not have the time for it. The facilities and patients really needed help. Through telemedicine, patients were able to have a wound care specialist physician look after their wounds.”
“It is important to me that we are there for the nurses. These facilities had no wound care doctor before me. The nurses were basically left to make all the decisions regarding wound care. So, it’s a good thing for the nurse that they have a physician they can rely upon.”
What do typical telemedicine wound rounds look like?
“I always tell the nurses ‘if you can FaceTime, you can do this. It’s as easy as that.’ And now, due to changes surrounding COVID-19, CMS is allowing nearly all video streaming software options. The nurse shows me the wound and describes the progress since my last visit. I’ll ask the nurse to tilt the camera up or down, left or right. I’m charting as I make my treatment recommendations. We then move on to the next patient. Typically, telemedicine rounds are quick and efficient.”
You also have the opportunity to speak with the patients and family members through this program?
“In the beginning, it’s a little different for the residents because the doctor shows up through the computer. But once the process is explained to the residents, they actually like it. They’re happy with the service and the fact that I am there every week. I speak with family members, explain the care, and discuss the family member’s wounds when appropriate to do so.”
“Being at the patient’s bedside is ideal. But when I cannot be there, whether it’s because we are in a pandemic or because the location is so remote, telemedicine is the next best thing. The outcomes are great. Few patients are ever sent to the hospital for further treatment.”
Can you describe how the Vohra wound documentation works for telemedicine consults?
“Every time I round, the facility receives my physician notes on all patients, just like in-person consults. It’s the same Vohra electronic medical record. It’s the same type of note with my wound descriptions, treatments, and recommendations. I’m charting as I go. So, the wound notes are ready almost immediately after I complete the call.”
Are there other advantages for a facility using Vohra telemedicine?
“Because I don’t drive to the facility, nurses can consult me nearly any time. I tell my buildings the moment you have a new consult, let me know. I can take a few moments to consult on that one patient. It will generate a physician note. The facility will have my orders in place, and they can begin treatment right away.”
“With any existing patients, I tell the nurses the moment you think something is not working, let me know. I will take a few minutes and see them. Maybe we need to change the treatment. I can see the same patient as often as is medically indicated.”
Do you have a success story of healing a complicated wound?
“The nurses and I have healed a lot of tough wounds. One that comes to mind more recently is a woman with a wound on a Charcot deformity (Editor’s Note: Charcot deformity is a change in the bones of the foot that occur in diabetics with neuropathy. The foot weakens and changes shape and if left untreated can result in amputation). Those are difficult to heal. We healed it, and it has been healed for more than three months.”
What’s the clinical satisfaction you feel when you see results like that example?
“I love it. It’s one of the reasons why I chose to work with Vohra. I can see the results of wounds actually healing, whether in person or through telemedicine, no matter the circumstances.”
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