Chapter 9 158 This study has certain limitations that should be taken into account when interpreting the results, starting with the low number of participants in this pilot study investigating the use of mobile phones in augmenting telemedical wound care. Importantly, nonparticipants and feature phone users were more often older adults. Despite the expectation that the number of patients who are not able or willing to use their smartphone for mHealth will diminish, a minority of patients will still require the traditional clinical assessment of their complications. Importantly, we did not evaluate patients clinically on the same day as the photos were taken and uploaded. Thus, we could only report on telemedical assessment and evaluation of the intervention by patients. Furthermore, assessment of the clinical pictures was reduced to 2 options: whether the patient had a clinically relevant complication, which is rather subjective. In daily clinical practice, the evaluation of wounds incorporates many different factors. We realize that it would be useful to have an objective measurement, especially for groups other than nurse practitioners or physicians who lack specialized training or experience. This may imply a certain multipoint score to evaluate hematomas and infections, which may be the focus of future research. When all elements that are essential for optimal telemedical wound care are covered (i.e., high success rate of uploading pictures, objective measurements of clinical pictures, clear agreements how to deal with complications), then the next phase would be to investigate whether telemedical wound care reduces healthcare use (eg, reduction in clinical visits). This pilot study is the first step in moving toward this direction. 6. Conclusions In conclusion, this pilot study indicated the usefulness of smartphone mobile photography as a feasible option in augmenting existing telecare. Smartphone users were able to make and upload pictures. The agreement on assessing clinical images was good between the 2 nurse practitioners. Smartphone mobile photography matched the patients’ expectations of providing contemporary care.
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