Utilization of Telemedicine:
From Dirt Roads via the
Information Highway
Gina Addy McKelvey, RN, CWOCN
Utilization of Telemedicine

What is Telemedicine?
• An assortment of high-tech telecommunication systems
used to provide or support clinical care at a remote
setting (Ablaza, V. and Fisher, J., 1998).
• Involves use of telecommunications equipment and
communication networks for the purpose of transmitting
health care information among health care practitioners
at different sites (Visco, et. al, 2001).
Utilization of Telemedicine

What is Telemedicine?
• Also known as Teleassessment, Teleconsultation,
Telehealth
• Telemedicine is the use of telecommunications
technology for medical diagnostic, monitoring, and
therapeutic purposes where distance and/or time
separates the patient and health care provider (AHRQ,
2006).
Utilization of Telemedicine

My Synthesized Definition
• Telemedicine is the use of telecommunication equipment
and networks to transmit key clinical information to a
health care provider at a remote location. This
information is used to enhance the care of the patient in
one or more areas of health.
Utilization of Telemedicine

Store-and-Forward Telemedicine
• Clinical data is collected, stored, and then forwarded to
be interpreted later. A store-and-forward system
eliminates the need for the patient and the clinician to be
available at either the same time or place (AHRQ).
Utilization of Telemedicine

Home Based Telemedicine
• Enables physicians and other health care providers to
monitor physiologic measurements, test results, images,
and sounds, usually collected in a patient’s residence or
a care facility (AHRQ).
Utilization of Telemedicine

Office/Hospital Based Telemedicine
• Real-time clinician-patient interactions that substitute for
face-to-face encounters between a patient and a
physician or other health care provider.
Utilization of Telemedicine

Chronic Wounds
• Nearly 2.6 million people in the United States have
chronic wounds
• Chronic Wounds are responsible for 50-70% of
amputations
• Chronic wounds contribute to billions of dollars in health
care costs (Krasner, D., & Kane, D., 1997, as cited in
Visco, et al).
Utilization of Telemedicine

Wound consultations via telemedicine
• Store-and-forward telemedicine services collect medical
data, store them, and then forward them to be
interpreted later.
• Store-and-forward systems provide the ability to capture
and store digital images of patients.
• A store-and-forward system eliminates the need to have
the patient and the specialist available at the same time.
• Store-and-forward is therefore an asynchronous,
noninteractive form of telemedicine usually employed as
a clinical consultation (AHRQ).
Utilization of Telemedicine

Advantages of Telemedicine Wound
Care
• Often eliminates the need for patients in rural areas to
travel great distances to see wound specialists
• Facilitates a team approach to the care of the complex
wound patient
• Allows the specialist to enlarge the photographs to view
precise details of the wound tissue
• Provides access to a certified wound care clinician for
those agencies without a certified wound care clinician at
the agency level
Utilization of Telemedicine

Advantages of Telemedicine Wound
Care
• Because chronic wounds do not require acute
intervention, a Telemedicine Wound Care Specialist can
review data from multiple patients in one sitting at a
convenient time.
• In a 1992 study by Arnold, wounds treated by a WOC
nurse healed 80% of the time in a given period
compared to a 37% healing rate for wounds treated by a
non-WOC nurse (as cited in Ablaza & Fisher).
• Telemedicine allows the WOC nurse to collaborate in
the treatment of five times the patients she could see in
person.
Utilization of Telemedicine

Success story
Utilization of Telemedicine

Success Story
Utilization of Telemedicine

Another Success Story
• Telemedicine consult on patient April 2009.
• Patient had been on service since February 2007;
multiple wound care regimens without healing.
Compression had never been used.
• Recommendations for changes in plan of care including
compression, occupational therapy and physical therapy
consults.
Utilization of Telemedicine

Another Success Story
• By August, patient had made tremendous strides toward
healing and was overjoyed at her progress.
• Interdisciplinary team caring for the patient also excited
about the positive outcome.
Utilization of Telemedicine

Limitations of Telemedicine Wound
Care
• Inability to use all of your senses in assessment of the
wound
• Must rely on someone else’s assessment; analysis of
specialist only as good as the information captured by
the photo and the verbal report or review of electronic
record
• Staff must be trained in digital photography and wound
assessment including language particular to wound
assessment, like slough and eschar and maceration.
• The images are 2-dimensional; difficult to assess the
degree of tunneling and undermining
Utilization of Telemedicine

Example of limitations
• Clinician documented wound had slick pink tissue, scant
exudate, and periwound tissue was within normal limits.
Utilization of Telemedicine

The photo
Utilization of Telemedicine

Telemedicine Wound Care in the
Literature
• Seven studies, all Class II, demonstrated that some
characteristics of skin wounds and ulcerations could be
assessed effectively using store-and-forward
telemedicine (AHRQ).
Utilization of Telemedicine

Evidence Base for Store-and-forward
Telemedicine
• Studies on store-and-forward telemedicine only assess
diagnosis or management decisions and access to care,
but not clinical outcomes (AHRQ).
• Most of the published studies of telemedicine wound
care have small numbers of patients and very small
numbers of clinicians, which raises the question of
statistical power.
Utilization of Telemedicine

References
Ablaza, V. & Fisher, J. (1998). Telemedicine and wound care management. Home Care
Provider, 3 (4), 206-211.
Buckley, K., Adelson, L., & Agazio, J. (2009). Reducing the risks of wound consultation:
Adding digital images to verbal reports. JWOCN, 36 (2), 163-170.
Halstead, L., Dang, T., Elrod, M., Convit, R., Rosen, M., & Woods, S. (2003).
Teleassessment compared with live assessment of pressure ulcers in a wound clinic:
A pilot study. Advances in Skin and Wound Care, 16 (2), 91-96.
Hersh, W., Hickam, D., Severance, S., Dana, T., Krages, K., & Helfand, M. (2006).
Telemedicine for the Medicare population: Update, evidence report/Technology
assessment No. 131. AHRQ Publication No. 06-E007. Rockville, MD.
Visco, D., Shalley, T., Wren, S., Flynn, J., Brem, H., Kerstein, M., & Fitzpatrick, J. (2001).
Use of telehealth for chronic wound care: A case study. JWOCN, 28 (2), 89-95.
Wilbright, W., Birke, J., Patout, C., Varnado, M, & Horswell, R. (2004). The use of
telemedicine in the management of diabetes-related foot ulceration: A pilot study.
Advances in Skin and Wound Care, 17 (5), 232-238.
Wilkins, E., Lowery, J., & Goldfarb, S. (2007). Feasibility of virtual wound care: A pilot
study. Advances in Skin and Wound Care, 20 (5), 275-278.
Utilization of Telemedicine