Phones Enable Smart Wound Care in Rural Areas

by Candi Helseth

Smartphone Technology

Kristi McClellan, a Saint Francis University health sciences student, demonstrates how smartphone technology can be used for wound care.

Leslie Wilson spends a lot of time on her smartphone looking at what some people might term disgusting photos. Wilson, a registered nurse with advanced certification as a wound ostomy continence nurse (WOCN), uses cellular technology to monitor, assess, and develop treatment plans to heal nasty, persistent wounds. On the other end of that cellular connection is a home care nurse who applies Wilson’s advice and a homebound patient whose wound is getting proper care.

WOCNs like Wilson are in short supply nationwide. Meanwhile, the number of patients suffering from chronic wounds has risen to nearly six million throughout the United States, according to Brenda Guzic, St. Francis University (SFU) CERMUSA Assistant Director for Telehealth. SFU’s Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA) in Loretto, Penn., and Wilson’s employer, Home Nursing Agency (HNA) in Altoona, Penn., are collaborating in a project to assess the success of cellular technology wound home care throughout the HNA service area, in what they believe is the first and only rural program in the United States to use smartphone technology in this way. HNA has provided home health and other services in 13 west central Pennsylvania counties since 1968.

In her Altoona office, Wilson receives cellular images from HNA home care nurses who travel to patients’ homes. They give a verbal report of their findings while Wilson views the photographs. Then she consults with the nurse and patient while the nurse is still present in the home. In the past, Wilson said, she spent travel time going to a patient’s home for an initial assessment and often returning for follow-up visits. Now she sees more patients more frequently.

“My role is to provide wound assessment and topical treatment using the best product for that wound,” she explained. “This is definitely a collaborative effort. These images can easily be sent instantly to physicians or other providers involved in care. And patients still get that home visit from a nurse. There’s a good medical reason to keep that home visit because nurses can identify potential problems in the home that we wouldn’t know otherwise. The nurse also provides education so the family is involved in the care.”

Guzic said home care patients with wounds are the largest population nationwide for visiting nurses. Non-healing surgical wounds and pressure ulcers are the most common types of wounds in HNA patients, and the majority of those patients are diagnosed with a co-morbidity of diabetes and/or heart disease. Other patients who frequently need wound care treatment include those with diagnoses of strokes, multiple sclerosis and trauma injuries.

The majority of HNA patients are homebound and elderly, have trouble walking or moving, and/or are bedridden. Traveling to clinics for care is difficult due to the distance, patient’s condition, lack of transportation, weather conditions and other barriers.

“Use of smartphones effectively increases patients’ access to specialized wound care, increases the number of encounters for patients and allows agencies to better utilize hard-to-find specialty nurses more effectively,” Wilson said. “An average smartphone consult lasts 26 minutes compared to an in-home visit averaging 78 minutes. For in-home visits, there’s an additional 65 minutes in travel time, on average. The extra time required for one in-home visit equates to four visits that could occur with the use of smartphone technology.”

Guzic said patient satisfaction surveys indicate patients like the personal visits and are glad their wounds are being inspected more frequently. Hospital readmissions and emergency room visits have decreased.

When the project began seven years ago, nurses carried nearly 20 pounds of video conferencing equipment into the homes along with their clinical supplies. The smartphone can be tucked in a pocket and is more user friendly for nurses, Guzic said. With expansion of cell coverage in recent years, almost all HNA service areas have adequate coverage. Where it doesn’t exist, the nurses still use the video conferencing equipment.

The U.S. Army Medical Research and Material Command (USAMRMC) Telemedicine and Advanced Technology Research Center (TATRC) at Fort Detrick, Md., funds the project. In May, HNA and CERMUSA began compiling a study that will include assessment of wound healing rates, rehospitalization rates and quality of life scores resulting from the use of smartphone technology.

“We have a lot of young men and women who’ve been deployed in active duty and are returning to their rural communities for treatment and care,” Guzic said. “The military wants to be able to evaluate if they can get care equivalent to what they’d get in urban areas.” Results of the study should be published by fall.

For more information, contact Brenda Guzic at St. Francis University at 814-472-3273 or email her at

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