Chapter 9 156 4. Discussion This is the first (pilot) study in the field of cardiology to demonstrate the feasibility of using smartphone mobile photography as a practical instrument in post discharge telecare. Where many studies focus on providing a device, we let patients use their own device.(8-10) Importantly, most patients were able to make post discharge photos of sufficient quality for evaluation and sent them to a secure email address. Our findings are in agreement with Wiseman et al (11) who performed a survey in 2014 among older patients after vascular surgery who were able and willing to use smartphone photography for remote wound management. In addition, patients after an electrophysiological intervention proved to be successful in uploading pictures of their intervention-related wound for clinical assessment. In addition to an increasing ownership of smartphones during recent years (e.g., in the Netherlands from 58% in 2012 to 82% in 2015), even among older patients (12,13), the quality of smartphone cameras has improved considerably. As shown in this study, the quality of most photos was considered good and enabled the investigators to evaluate the wound remotely in addition to the existing care, with good interobserver agreement. Previous studies in dermatology have indicated that telemedicine using pictures from mobile phones was feasible and accurate (2,8). In addition, patients may not be prone to low sustained use of mHealth, as described by Bhavnani et al (14), because this is a 1-time use of the integrated technology in a smartphone. Consequently, the proposed intervention with emailing photographs to a secure email server could be a feasible alternative until secure uploading of pictures by patients themselves in their electronic health record is implemented. It might be a good alternative in reassuring patients when suspecting a complication instead of an extra follow-up visit. This might further bridge the gap between discharge and the first outpatient clinic visit. Our study clearly indicates that smartphone users experienced fewer problems when uploading pictures in comparison with patients with a feature phone. This suggests that telemedical wound care is better suited for those with a smartphone. This is also reflected by most smartphone users who preferred a telemedical contact with clinical pictures taken with the mobile phone than a clinical visit. In contrast, most feature phone users preferred a clinical visit. Importantly, both groups evaluated teleconsultation with mobile photography as appropriate.
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