Digital Monitoring and Documentation of Wounds: A Viewpoint from a Developing Country Protection Status

By Girisha Maheshwari, Pavan Mujawdiya, and Shivani Gupta
Affiliation: Inochi Care Private Limited, C-10, Malviya Nagar, New Delhi-110017, India.

Chronic wounds and their management pose a serious challenge to clinicians worldwide and are one of the major public health challenges faced by developing countries. Worldwide, over 40 million people develop chronic wounds, which adversely affects their quality of life.1 However, epidemiological studies concerning chronic wounds and their management are limited, especially in developing countries. According to the largest community-based epidemiological study on wounds in India by Gupta et al., the estimated prevalence of chronic and acute wounds is 4.48/1000 and 10.5/1000 in India.2 This study is more than a decade old, and there is no recent data available in the public domain. The lack of organized wound data makes it difficult to formulate new therapeutic strategies, create effective health care policies, or offer efficacious treatment options. Complex wounds take time to heal, and if they are not identified at the earliest stage, the treatment process may be complicated.

One of the most important wound management principles is periodic assessment and documentation of the wound healing process. Proper wound documentation and assessment facilitates better assessment of the wound type and helps in better diagnosis and treatment of the wound. A comprehensive wound measurement system helps to monitor both wound progression and predict wound healing.3 Moreover, proper documentation of the healing process helps clinicians and health care workers assess the effectiveness of medical care and take appropriate intervention strategies to maximize wound healing. An established wound assessment and documentation process certainly enhances the prevention and care of wounds in hospital settings. On the other hand, an improper assessment and documentation of a wound and its care results in ineffective treatment plans and may negatively impact patients' quality of life. The improper collection of wound data can also have serious legal repercussions.4

The studies from developing countries show that 70%-80% of patients with wounds are treated predominantly by nursing staff. The health care workers and nurses are considered the frontline heroes of wound care, and they are still dependent on traditional methods, which have not changed in decades.5 Numerous traditional methods used for measuring and documenting wounds are inaccurate, which may lead to inaccurate wound size measurements. For example, the most common method of wound measurement is the ruler method, which is crude and inaccurate. The inaccurate methods sometimes overestimate the wound area by up to 44%.6 Another major shortcoming of the traditional methods is that they lack a standardized approach. This leads to person-to-person variation, which significantly increases the work pressure on the nursing and caring staff. Such traditional methods also cause the loss of precious clinical data essentially to tracking wound healing.

The scarcity of trained human resources is another major issue in developing countries, such as India. As per the 2017 statistics, the ratio of doctors to patients in India stands at 1.34 to 1000 population.7 This scarcity of trained staffing in medical facilities has severely burdened the existing medical and nursing staff, leading to compromised documentation and poor treatment outcomes. According to some estimates, up to 40% of the nursing staff’s time goes into documentation activities, which significantly reduces the time for patient care. Therefore, a standardized approach for proper documentation and wound evaluation may help save clinicians/nurses time, improve the quality of life, increase the quality of care, promote quicker wound healing, and significantly reduce pain and suffering.

Digital methods of wound documentation can be a significant resource to address these challenges. With the adaption of newer and advanced methods of wound assessment and documentation, including digital technologies in developing countries, wound care practitioners will be able to assess all the aspects of wound care. Additionally, proper documentation and digital measuring tools can significantly save clinicians time, improve the quality of life among patients, and enhance the quality of treatment.8 Several mobile applications (apps) available on android and iOS platforms are beneficial in proper documentation and recording of wounds. Many of these apps offer a suitable platform for proper documentation and assessment of chronic wounds.9


Figure 1: The superiority of digital tools, such as mobile applications, for wound measurement and assessment vis-à-vis traditional approaches. Traditional methods suffer from several limitations, including but not limited to poor record-keeping, inadequate treatment, wastage of time for medical staff and nurses, and loss of precious medical data. These shortcomings drastically reduce overall treatment efficacy and lower patient outcomes. In contrast, digital tool use facilitates accurate wound assessment and offers timely and accurate treatment, leading to early discharge and better patient outcomes.

There are several of these digital wound documentation and assessment products available, but they are rarely used and implemented in the Indian health care system. Most of these products are imported products that are not specifically built with the geographical context and needs of developing countries in mind. India is dependent on imported products for the digital assessment tools, a strategy that does not fit well for the Indian health care system due to the higher cost of imported products, challenges involved in importing the tools, and issues involved in training and maintenance. There is an emerging need for an indigenous product that caters to the contextual needs in Indian geography, fits in the workflow of Indian medical professionals, affordable so that it can be used in all health care systems for mass screening and documentation of wounds.

Wound care in the Indian health care setting needs more research, and in the coming decades, technology may positively impact the wound monitoring and documentation system.

1. Las Heras K, Igartua M, Santos-Vizcaino E, Hernandez RM. Chronic wounds: current status, available strategies and emerging therapeutic solutions.J Control Release. 2020:535-550.doi:10.1016/j.jconrel.2020.09.03.
2. Gupta N, Gupta SK, et al. An Indian community-based epidemiological study ofwounds.J Wound Care.2004;13(8): 323-325.doi: 10.12968/jowc.2004.13.8.26657
3. Wang SC, Anderson JA,et al. Point-of-care wound visioning technology: reproducibility and accuracy of a wound measurement app. PloS one. 2017;12(8):e0183139. doi: 10.1371/journal.pone.0183139.
4. Russell L. The importance of wound documentation and classification.BJN. 2014;8(20):1342-54.
5. Shukla VK, Ansari MA, Gupta SK. Wound healing research: a perspective from India. 2005: 7-8.
6. Keast DH, Bowering CK, et al. Measure: A proposed assessment framework for developing best practice recommendations for wound assessment. Wound Repair and Regen. 2004; 12(3):S1–S17. 0123S1.x
7. Kumar R, Pal R. India achieves WHO recommended doctor population ratio: A call for paradigm shift in public health discourse! J Family Med Primary Care. 2018;7(5):84-844.doi: 10.4103/jfmpc.jfmpc_218_18.
8. Biagioni RB, Carvalho BV, et al. Smartphone application for wound area measurement in clinical practice. Journal of Vascular Surgery Cases and Innovative Techniques. 2021;7(2):258-261.
9. +WoundDesk.

About the Author
Shivani Gupta earned her doctorate degree in Biotechnology, during which time she completed the Biodesign Fellowship with an aim to solve unmet clinical needs and develop innovative technologies. She co-founded Inochi Care and is currently working on advanced wound healing technology. Inochi Care is a Spin off from the School of International Biodesign, All India Institute of Medical Bioscience, New Delhi. The company mission is “Healing the non-healing wounds”.

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