While this study was conducted in Finland using Finnish classification systems, it is extremely relevant to wound care clinicians in any setting using or moving toward electronic medical records. Wound care nurses must work closely with information technology experts to design a system that incorporates all critical elements of wound assessment and wound management and that provides appropriate prompts to the nonspecialist clinician. As the authors note, the transition to electronic record systems will generate tremendous amounts of data, which can be used to help answer clinical questions, but this will be possible only if we all utilize consistent terminology related to wound assessment and wound management. In addition, we need to be sure that our descriptors and interventions are comprehensive.

Specific challenges facing wound clinicians at present include accurate classification in terms of wound etiology and incomplete "menus" from which to select the most accurate descriptors of wound status. In terms of wound etiology, the electronic record "menu" should include the various types of moisture-associated skin damage (such as incontinence-associated dermatitis and intertriginous dermatitis) as well as dehisced incisions, burns, traumatic wounds, pressure ulcers, venous ulcers, arterial ulcers, neuropathic ulcers, mixed etiology ulcers, and "other." We also need to be sure that our descriptors of wound status include all types of tissue that may be found in the wound bed and status of wound edges in addition to dimensions, depth, undermining or tunneling, type and volume of exudate, periwound status, and signs/symptoms of infection. Currently, many documentation systems limit wound bed descriptors to "necrotic tissue," "granulation tissue," and "epithelial tissue" and fail to include the category of "viable but not granulating." The omission of this category forces the clinician to choose between 2 incorrect descriptors: necrotic or granulating. This is significant since selection of the category "granulation tissue" indicates that the wound is actively healing, when in fact wounds that are viable but not granulating are frequently nonhealing wounds that require aggressive management. Similarly, many documentation systems include indicators of invasive infection (erythema, induration, increased exudate, increased odor) but fail to include indicators for surface infection/critical colonization (diminished quantity or quality of granulation tissue, increased friability of granulation tissue, increased exudate, increased pain). Since treatments for invasive infection and surface infection are different, it is important to accurately capture both types.

The authors have done an excellent job of presenting the many reasons for ensuring accurate and comprehensive electronic documentation systems for wound care. Wound care clinicians need to work closely with the information technology experts in their own setting to design a system that incorporates all elements of wound assessment and wound management and that provides appropriate prompts to the nonspecialist clinician. We also need to continue to work to clarify terms used for wound classification and wound description.