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Reliable Wound Surveillance Mitigates Risk for Telehealth Providers Author: Dr. Mark Nixon

Mark Nixon, Chief Medical Officer, ARANZ Medical

February 23, 2016  |  Telehealth

As Iron Bow’s TED (Telehealth Education Delivered) makes its way across the United States visiting hundreds of VA medical clinics and offices, we are taking the opportunity to talk with all of our TED partners about the many aspects of telehealth and how technology is evolving to help care teams, practitioners and specialists improve care, anywhere, at any time.

In this piece, ARANZ Medical’s chief medical officer, Dr. Mark Nixon, discusses why accurate wound data helps telehealth providers avoid the risks associated with traditional wound assessment methods. He provides guidelines for measuring the effectiveness of telehealth wound assessment. Here is what he has to say:

When issuing the Titanic’s distress position, Fourth Officer Boxhall gave the correct latitude, but the longitude was 14 miles out. Ships arriving on the scene wasted precious hours doubling back and forth before stumbling upon the site of the shipwreck.

The Titanic example illustrates how costly and time-consuming lack of accuracy can be. Wound assessment accuracy is no exception. Wounds share the attribute of being deceptively difficult to navigate through the healing process. Like icebergs, there is a lot more to wounds than meets the eye. Precision does not necessarily ensure correct decisions will be made, but it reduces the chances of making the wrong ones.

Wound Assessment vs. Wound Surveillance

The wound assessment is a basic component of wound care. At discrete moments in time, a practitioner – often without specialized knowledge of wounds – inspects, measures, images, and documents each of the patient’s wounds. Despite all their time and efforts, the information produced is of dubious value, having used traditional and two-dimensional measurement techniques of questionable accuracy, capturing digital images of inconsistent quality, and not necessarily conforming to documentation standards.

Over time, many practitioners make many assessments under these conditions, thus accumulating a generally unreliable body of information.

Telehealth providers lacking reliable wound information are at risk of making misinformed wound management decisions leading to readmissions, litigation, and other negative consequences. The inadequacy of wound information becomes readily apparent if an adverse event prompts a scramble to make sense of piecemeal documentation. What’s more, providers are hampered from systemic improvement and innovation if inaccurate wound data prevents them from distilling meaningful insights or patterns.

A Systematic Approach

The emerging field of wound surveillance mitigates the risks associated with piecemeal wound assessment by providing accurate and comprehensive wound information free from cumulative error. It enables telehealth providers to systematically track the true progress of wound healing, and make more effective clinical decisions.

The concept of surveillance is, of course, not new to healthcare – for instance, population surveillance is a common epidemiological approach. This body of knowledge provides an understanding of the features that comprise effective and methodical wound surveillance.

What Does Effective Wound Surveillance Look Like?

The Field Epidemiology Manual lists six criteria to assess the quality of data and information, and the systems used to process and deliver those data and information. These six criteria have been adapted to demonstrate the conditions for a high-quality wound surveillance system:

  1. Accuracy – Is the wound information being gathered sufficiently free from error to be fit for purpose?
  2. Timeliness – Can all authorized wound stakeholders, such as practitioners, multi-disciplinary team members, clinical managers, and administrators access the wound information they need when it is needed?
  3. Completeness – Is the wound information sufficiently complete to be fit for purpose, to support complex decision-making, and for administrative and informatics purposes?
  4. Reliability – Is the wound information objective and credible? Can the results be replicated? Is a transparent method used to obtain the data?
  5. Relevance – Is the wound information contextually appropriate? Does it include the most important metrics?
  6. Delivery – How easy and user-friendly is the wound information-gathering process? Does the information gathered improve productivity across the facility?


Today’s Titanic uses precise digital tools such as e-navigation, which gather and organize accurate and reliable data that is critical to a safe and efficient passage. Similarly, modern wound surveillance uses 21st century technologies to create a systematic platform for wound monitoring, capturing accurate and consistent data, and obtaining reliable healing trends.

These technologies provide precise wound assessment data for “cockpit”-style wound surveillance. This allows the hazards of wound management to be more confidently and successfully navigated, mitigating wound-related risks to all stakeholders, and helping organizations to achieve sustainable system-wide improvements.

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