Summary and general discussion 177 upload the photographs to a secure email address 6 days after hospital discharge. Received photos were assessed by two nurse practitioners independently on highresolution screens. The intervention was evaluated using a peer-reviewed questionnaire and a photo assessment scheme. Thirty-three of 40 patients (83%) were able to upload their photographs. However, smartphone users were significantly more successful in uploading their photographs compared with feature phone users (93% vs 55%, P < .01). Eighty-eight percent of the clinical photographs were interpretable. The interobserver variability had an agreement between 93% and 97%. Discussion In part III we evaluated the applicability of selected eHealth tools implemented in our clinical practice, specifically for patient discharge and supporting follow-up. Importantly, when developing eHealth tools, we focused on pre-identified gaps in the patient care pathway. The identified lack of uniformity in the discharge information was approached via a computer-generated discharge letter, merging various elements from diverse information sources. This novel letter enhanced the discharge process in which the nurses were able to inform better the patient. Importantly, with the introduction of a new electronic heath record system (HiX™ by Chipsoft) these gaps were addressed. Consequently, after two years the computer-generated letter program was discontinued. Nonetheless, patients with low or insufficient (health) literacy levels, constituting almost 30% of the Dutch population, experience difficulty in comprehending health related information irrespective of the method in which information is provided (65, 66). The level of literacy or preferences for the form of patient discharge information has not been screened in our clinical practice. It is recommended to assess the level of health literacy prior to providing discharge information, for example via the three question Set of Brief Screening Questions questionnaire (67). Moreover, other forms of media communication, such as illustrations, online animations or videos may be more appropriate for low literacy level patients. A novel approach in wound assessment has been the confluence of patient empowerment and telemedicine. Previously, wound assessment was the sole domain of healthcare professionals. The adoptability of smartphones has made 10
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