Harnessing mobile technology to support the community care of chronic ulcers under the direction of a tertiary unit

Background: Chronic ulcers affect roughly 60,000 Irish people at e600,00 or e10,000 per patient annually. We propose utilising mobile technology to decentralise care from tertiary centres to the community, improving efficiency and patient satisfaction, while maintaining safety. Methods: Bespoke mobile software was developed for Apple's iPhone 4 platform. This allowed for the remote collection of patient images prospectiively and their transmission with clinical queries, from the primary healthcare team to the tertiary centre. Training and iPhones were provided to five public health nurses (PHNs) in geographically remote areas of Cork/Kerry. Data was uploaded securely and user end software developed allowing the review and manipulation of images, along with two way communication between the teams. Establishing reliability, patients were reviewed clinically as well as via transmitted images, and concordance analysed. Qualitative data was collected from PHNs through focus group discussion. Results: From October to December 2011, eight patients (aged 61-83 years, mean 75.3 years) with chronic venous ulceration and their five PHNs were recruited. Data was transmitted using 3G, Edge, GPRS and WiFi at a mean speed of 69.03kps. Concordance was 100 % for wound bed assessment, 80 % for skin integrity/colour and 60 % for exudate assessment. Focus group analysis explored the concept, practicalities and future applications of the system. Conclusions: With an evolving national data network, the secure transmission of clinical images is a safe alternative to regular clinic appointments for patients with chronic venous ulceration. With further development, packaged as a freely downloadable application, this has potential to support the community care of chronic wounds.