Implementing team-based interprofessional telemedicine-based wound care management in post-acute settings leveraging a wound care-specific telemedicine software

Background:
PDPM/PDGM’s priority for value over fee-for-service interactions forces providers to work as a well-oiled team to rapidly provide care. Accurate diagnoses/plans of care result from timely evaluations with detailed documentation that reflect patient-centered needs. Barriers to optimal wound management faced by post-acute settings include lack of staff proficiency, delayed access to specialists, or overworked wound care professionals. To address these obstacles, we aimed to establish a roadmap for implementation of team-based interprofessional telemedicine-based wound management in post-acute settings, leveraging a wound care-specific telemedicine software that captures essential elements necessary for reimbursable services.
 

Methods:
Using the Design Thinking methodology(1), the software* was developed as a module within a clinical/reimbursement decision support web-application** for wound care/hyperbaric clinicians:
<ul>
<li>Clinician needs and CMS guidelines/requirements were mapped

<li>Module was developed with robust programming language‚ô•/library‚ô¶/framework‚ô£

<li>Use cases were prioritized; workflows were designed

<li>Documentation templates were created within the module

<li>Implementation playbook was created

 

Results:
The module is a cloud-based, mobile-responsive, HIPAA-compliant solution with documentation templates/features that allows synchronous/asynchronous telemedicine-based wound management.
Use cases include:
<ul>
<li>Medicare-billable interprofessional internet consultations between post-acute providers and in-house/external wound specialists (e.g. evaluation/management of a skilled nursing facility resident with chronic ulcer via synchronous/asynchronous communication between post-acute provider and external wound specialist)

<li>Medicare-billable televisits between external provider and post-acute patient (e.g. virtual check-ins to assess need for in-person office visit, remote evaluation of patient-submitted images/video, online digital evaluation/management)

<li>Other non-fee-for-service arrangements (e.g., remote wound nurse providing guidance to home health clinicians)

The implementation playbook provides wound management workflows and reimbursement guidelines for post-acute organizations/providers.  
 

Conclusions:
Roadmap for implementation of team-based interprofessional telemedicine-based wound care management in post-acute settings was developed, leveraging a wound care-specific telemedicine software. Anticipated benefits include better clinical outcomes (i.e, timely diagnosis/management) and cost/revenue optimization (i.e. reduced hospitalizations/accurate ICD-10 coding).

Trademarked Items (if applicable): Trademarked Items
* TeleVisit Tool, Wound Reference, Inc., San Francisco, CA
** WoundReference Clinical Decision Support Web-App, Wound Reference, Inc., San Francisco, CA
‚ô• Microsoft C#, Microsoft Corporation, Redmond, WA
‚ô¶ jQuery, open source JavaScript Library
‚ô£ .Net4.5, Microsoft Corporation, Redmond, WA

References (if applicable): References
1. Ferreira FK, Song EH, Gomes H, Garcia EB, Ferreira LM. New mindset in scientific method in the health field: Design Thinking. Clinics. 2015 Dec 10;70(12):770–2.