Today's Wound Clinic - Spring 2008 - (Page 31)

inphotography tion, particularly at the deposition and/or testimonial phase, when photos put in front of a jury are out of focus, not done according to facility policy and procedure or worse … show a visual decline in the wound status, supporting the plaintiff ’s claim that appropriate care was not rendered. “One colorful wound picture will increase the amount of the settlement in a pressure ulcer case,” says Mary Bruno, Bruno Medical-Legal Consultants, Inc., Hernando, Fla. However, the question remains, which is the most effective method of taking pictures for the court room? ON THE PATH TO EXTINCTION To further complicate the issue, Polaroid stopped manufacturing instant cameras 18 to 24 months ago and will halt production of film this year. Per recent Associated Press reports, Polaroid is seeking a partner to acquire licensing rights for its instant film. If this does not happen, Polaroid customers will have to seek an alternative to instant photography. Other technologies have been developed and more are on the horizon that may not only offer a legally sound alternative to instant photography but one that can better measure and map the wound. These include; Silhouette (ARANZ Medical Ltd, Christchurch, New Zealand) and VERG (Vista Medical Ltd,Winnipeg, Manitoba, Canada). Products like these are typically used in the outpatient wound clinic but the need for advanced wound assessment and documentation is evident in both the inpatient and outpatient settings given our litigious society and reimbursement issues. The InfoV.A.C (K.C.I. USA, Inc., San Antonio, Tex), which is used across the continuum from inpatient facilities to home healthcare, offers the capability to download wound images into the V.A.C. system, enabling the clinician to track the progress through photo and stored measurements. recurring. Electronic documentation systems allow wound centers to store these photos to augment clinician and physician narrative documentation. Electronic photo documentation also permits wound analysis and will track the wounds chronologically, often with measurements and percentage of improvement—again, supporting the care rendered as well as justification for further treatment if needed by third party payors. CMS CHANGES Inpatient facilities are now faced with purchasing and learning a new technology or eliminating wound photography all together. In response to CMS changes regarding Hospital Acquired Conditions (HAC) and the Present on Admission Indicator (POA), most facilities have to revisit policy and procedure, protocols, staff and physician education, and most importantly the documentation used on admission as well as throughout the patient’s hospital stay. Photographing pressure ulcers is one way to document care and appropriate treatment in addition to being a good liability strategy for the facility that practices evidence-based healthcare. In preparation for the CMS changes and the possible loss of reimbursement, it is imperative that wound care professionals do all they possibly can to improve identification of ulcers and document in a timely manner. Though coding for billing is not done from hospital photos, it may be possible with concurrent review by those that are coding, that the physician may be able to be questioned on the existence of the ulcer seen in the photo, prior to discharge. This may serve as a checks and balance system for physician documentation that is so critical to this particular indicator. It is still crucial that the bedside clinician perform a full assessment and give an appropriate and concise written description of the ulcer. This is particularly the case when a patient is Today’s Wound Clinic Spring 2008 “Digital photography can be altered once downloaded onto a computer, so it is often inadmissible in a court of law.” INSTANT VS. DIGITAL VS. 35 MM Hospitals all over the country have been using instant cameras for years not simply because of ease of use and relative inexpensive cost, but because the instant photos produced cannot be altered. Digital photography can be altered once downloaded onto a computer, so it is often inadmissible in a court of law. It seems that 35 mm cameras tend to be more costly when including the routine cost of photo development as well as having the inconvenience of completing the roll of film prior to development.This is a frank inconvenience on the inpatient unit. Good photo quality with a 35 mm camera tends to require more skill and training on the part of the person taking the photo. Instant photography has been the standard for these very reasons. THE ROLE OF DIGITAL IN DOCUMENTATION According to Bruno, wound clinics have been utilizing digital photography to track the progress of wounds for years. Clinics seem relatively unscathed by litigation because the photos tend to substantiate the care given proving that “the clinic is providing good care supported by evidenced based medicine,” Bruno says. Wound clinics utilize digital technology, enabling them to photograph on a routine basis and store the photos for long periods of time, tracking the wound not only throughout the healing phase, but often the entire process as many are often recalcitrant and 31

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Today's Wound Clinic - Spring 2008 Contents InTroduction InBusiness Documentation: The 30,000-Foot View Documentation: Clearing Up the Role of Compliance InTech InPhotography InFluence InStruction InNews InCentive Ad Index

Today's Wound Clinic - Spring 2008

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