Surgical site infection (SSI) remains the most common post-operative complication, and is a leading cause of preventable morbidity and avoidable hospital readmissions. Indications of incipient infection may go undetected because symptoms often arise days or weeks following hospital or ambulatory surgical center discharge. The current standard for SSI diagnosis requires in-person physical examination of the surgical wound. Patient-generated wound photographs and other forms of patient-generated health data (PGHD) provide a way to enhance post-discharge SSI surveillance by allowing patients to submit information about post-operative recovery to their care providers for remote clinical evaluation and management. Such data are increasingly submitted to and reviewed by surgical providers via email, text messaging, and electronic health record-based patient portals.
The increasing availability and use of patient-owned digital devices, such as smartphones and tablets, to generate text and images in the post-discharge phase of surgical care presents new opportunities and challenges for practicing surgeons, healthcare organizations, and patients themselves. Through leveraging new data streams of PGHD, inclusive of patient-generated post-operative wound photos, surgeons and other healthcare providers have a new opportunity to perform clinical decision-making, increase efficiencies in care delivery, improve SSI reporting and surveillance, and reduce barriers to patient access to care. However, current application of PGHD in clinical, research, and public health settings is characterized by wide variations in practice and uncertainty regarding how to best employ this data to support clinical care and surveillance efforts. Because the transmission of such PGHD is increasingly common in the post-operative care setting, systematic evaluation of the potential clinical, administrative, public health, and economic impacts is needed.
The purpose of the ASSIST project is to evaluate and define the current uses and possible roles of PGHD and mobile devices in post-operative surgical care and SSI surveillance, provide a set of best practice recommendations, and identify gaps in current knowledge on the use of mHealth and PGHD in SSI surveillance. While the current use of telemedicine for post-discharge surgical care has been systematically reviewed, the specific use of mHealth for SSI surveillance and the process of work associated with this activity is highly variable and generally unacknowledged in the medical literature.1 ASSIST grew from a project at the University of Washington that developed an mHealth platform for patient-initiated communication of post-operative wound symptoms and photographs (mPOWEr). That work revealed that patients are highly motivated to record detailed assessments of their wounds in the immediate post-operative post-discharge period out of the desire for better, more personalized follow-up communications with their surgical providers.2,3 The mPOWEr project also demonstrated that the provider’s diagnostic confidence increases with the use of wound photography over symptom reporting alone.4 The initial pilot implementation demonstrated the feasibility of remote early detection of SSI and the documentation of evolving symptoms and photographic features of SSI.5 Other investigators have begun to publish similarly promising work, and there are some companies now working in the post-discharge care coordination space, delivering mHealth products directed specifically at post-operative wound monitoring (Seamless MD, Health Outcomes Worldwide, QoC Health Inc.).6-8