Smartphone photography by patients in telemedical wound assessment 157 5. Implementation On the basis of the results of this study, smartphone photography by patients was implemented as an addition to the existing telephonic post discharge care in our clinical practice. It is almost real time with immediate assessment after getting an email notification on our smartphone when receiving the pictures. Usually, a set of 1 lateral and 1 frontal pictures is sufficient for patients after device implantation. After catheter ablation, a set of 3 to 4 pictures is required with 1 or 2 frontal (depending whether both sides of the groin are visible), 1 lateral right-sided, and 1 left-sided views. Most patients, however, send more pictures, enabling us to select which picture will be uploaded to their electronic health record. Importantly, there is a formal backup as colleagues, and a medical supervisor can assist in the evaluation of submitted pictures. Regarding privacy issues, a workaround for keeping the email clear of personal information included clear instructions to patients by asking them to only include a code based on the time stamp of the telephonic consultation, for example, 11.20 hours. This implementation is a subject of future research. This use of mHealth may be a practical and useful instrument in following patients in rural areas or those who might not be able to reach the clinic or emergency department easily because of their medical condition. The described intervention is cost-effective, especially when sending through existing Wi-Fi networks. Our hospital is a tertiary referral center in an urban setting, but even then, patients may prefer remote follow-up as a feasible alternative to a clinical assessment, which is associated with travel time, travel and parking costs, waiting times, and so forth. The combination of clinical history and pictures proved helpful in deciding whether complications were clinically relevant. Moreover, patients indicated to be satisfied with the option to transmit pictures. When implementing it in a different healthcare and legal system, special attention should be given to the legal consequences on the use of multimedia and the privacy of patient-sensitive data. Limitations What’s New and Important Smartphones may be useful for telemedical wound assessment. Uploading pictures is feasible for most patients. Interobserver agreement of pictures is good. 9
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