Chapter 10 178 patients engagement in their own healthcare more assessable. Patients can take photographs with their smartphone of wounds and/or puncture sites, after discharge, and forward them to a health care professional for assessment. This simplistic approach aligns with the needs of patients and health care professional, and therefore empowers patients in post-discharge treatment (68). Although smartphone photography cannot fully replace clinical appraisal, it can act as a preliminary indicator for consultation. Importantly, patients need to have sufficient digital literacy. The current level of digital literacy of the Dutch population is approximately 80 percent, with the younger and higher educated cohorts scoring highest (69). Therefore, the challenge may lie in assessing if the patient is capable in using eHealth technologies and introducing it to the standard discharge procedure. In addition, a set of concise instructions should be provided to aid these patients. Meanwhile, photographic telemedical evaluation of puncture sites and surgical wounds using smartphones has been fully implemented in the short stay cardiology department of our hospital. This innovation has also been established to other subspecialities, including patients treated with a Left Ventricular Assist Device (LVAD). Importantly, the quality of the photographs has increased significantly with the improved camera possibilities of current day smartphones. The next development phase is the opportunity for patients to upload clinical photographs directly into their own electronic health care record. This aspect, avoiding data breaches, adheres therefore with the EU-GDPR (70). Assessing clinical photographs can be labour intensive for healthcare professionals and novel Artificial Intelligence (AI) initiatives may reduce the assessment workload. In 2024 the Erasmus MC will start a single center feasibility study on the use of AI in smartphone photography telemedical assessment of LVAD wounds/puncture sites. A topical challenge for the health care system and professionals focusses on reducing the ecological footprint. Using photograph-based telemedicine will substantially reduce visits to outpatient departments. When focusing on discharge letters, these may be forwarded to the patient as a PDF file through a secure email server, instead of handing out a printed version. Both may be small contributions in reducing the ecological footprint but are easily implemented.
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