International Journal of Reliable and Quality E-Healthcare

Volume 6 • Issue 4 • October-December 2017

The Potential of Mobile Health in Nursing:

The Use of Mobile Communication
Technology in Plasma-Supported
Outpatient Wound Care in Germany
Anne Kirschner, Vocational Education Centre Müritz, Waren, Germany
Stefanie Kirschner, Vocational Education Centre Müritz, Waren, Germany
Christian Seebauer, Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Greifswald, Greifswald,
Germany
Bedriska Bethke, Department of Health, Nursing and Administration, University of Applied Sciences Neubrandenburg,
Neubrandenburg, Germany

ABSTRACT

Mobileinformationandcommunicationtechnologiesareincreasinglyusedinnursing.Inanew plasma-
supportedtreatmentforpatientswithchronicwoundsinoutpatientnursingsettings,the LiveCitycameraca
nbeusedasaninnovativemobilecommunicationtechnology.Itenablesrapid andhighqualityexchangeofi
nformationbetweenremotelylocateddoctorsandnursingstaff.This procedurepromisestodeliverpositiv
eoutcomesregardingthequalityofthetreatmentandpatient safetywhileavoidingadditionalhospitalisatio
nandsavingtimeandcosts.Thisisachievedbyrapidly confirmingdiagnosesandagreeingonajointtreatme
ntappropriateforthecurrentwoundstatus.Thus, complicationsinwoundhealingcanbepromptlyidentifie
dandcountermeasuresinitiatedthrough quickandeasyaccesstomedicalandnursingexpertise.

KEyWORdS
Chronic Wound, Cold Atmospheric Plasma, Communication Technologies, Delegation, LiveCity Camera,
Mobile
Health in Nursing, Wound Care

INTROdUCTION

Theuseofdigitalandelectronictechnologiesinmedicineisreferredtoase-health.E-
healthservices includetelemedicineandmobilehealth(m-
health),bothofwhicharebecomingincreasinglypopular amonghealthexperts.Telemedicineenablesmed
icalinformationtobeexchangedbetweentwosites usingelectronicinformationandcommunicationtechn
ology.Itisusedforprevention,diagnostics, treatmentandongoingcarewiththeaimofimprovingthehealth
statusofpatientsaswellasthe qualityoftreatmentincludingitsefficiency(Andelfinger,2016;Omboni,Cas
erini&Coronetti,2016; Marx&Deisz,2015;CentralAssociationofHealthInsuranceFunds,2013).Asarul
e,telemedicine isrestrictedtostationarydevices,unlikem-
health(Metelmann&Metelmann,2016).Theterm

DOI: 10.4018/IJRQEH.2017100106

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International Journal of Reliable and Quality E-Healthcare
Volume 6 • Issue 4 • October-December 2017

Copyright©2017,IGIGlobal.CopyingordistributinginprintorelectronicformswithoutwrittenpermissionofIGIGlobalisprohibited.

m-
healthisthereforeusedifcommunicationbetweendoctorsandpatientstakesplaceusingmobile telecomm
unicationdevicesormultimediatechnologies(Omboni,Caserini,&Coronetti,2016).
In2009WHOcollecteddataontheimplementationofe-healthinitiativesinitsmemberstates.
Thedataindicatethatm-
healthwasorisbecomingestablishedinarangeofprogramsaroundthe world.Inparticular,projectssuchas
healthcallcentresandtoll-freeemergencyserviceshavebeen setup.InEuropeancountriesm-
healthinitiativesarealsobeingestablishedwithabout60%ofall Europeancountriesintroducingtoll-
freeemergencynumbers,about30%launchingmobiletreatment servicesandabout5%introducingdecisi
onsupportsystems(WHO,2009).
ParticularlyintheGermanhealthcaresystem,mobileinformationdevicesandtelemedicineare beco
mingmoreandmoreimportanttoovercomethechallengescreatedbythedemographicchange anditsconse
quences(includingtheincreasingageofthepopulationandtheassociatedmultimorbidity andincreasedne
edfornursingcare)(Breitschwerdt,Reinke,KleineSextro,&Thomas,2016). Telemedicineandmobileinf
ormationandcommunicationtechnology(m-
health)isalsoincreasingly usedintheareaofnursingcareinGermany.

BACKGROUNd

Todeterminetheextenttowhichtelemedicineandmobileinformationandcommunication technologies(
m-
health)havebecomeestablishedinnursingcare(particularlyinwoundcare),the (predominantlyGerman)l
iteraturewasfirstanalysed.Thisincludedareviewofrelevantprojectson theinternet.TheGermanTelemed
icinePortal,whichwasestablishedasaninitiativeoftheGerman FederalMinistryofHealthtoenableanatio
n-
widesearchforinformationaboutpreviousandongoing telemedicineprojects,wasincludedasanessential
sourceoftelemedicineandm-healthbasedprojects.
Itprovidedinformationaimedatusersaboutmorethan200differenttelemedicineprojects(Deutsches Tele
medizinportal,2016;GermanFederalMinistryofHealth,2016a).
Therearetelemedicineprojectsthatuseassistivetechnologiestoexpandthecareandsupport optionsfo
rthehomesettingwhilealsomeasuringandvisualisingthequalityofcareachieved.1In otherprojects,GPSte
chnologyisusedthatenablespeoplewithdementiatobelocatedatalltimes, helpingthepatientsthemselves,
theirrelativesandnursingstafftomanagedailylife.2Severalother telemedicineprojectsintheareaofnursin
gcarewerecarriedoutinGermanybetween2008and2013:

• ZIMNEMOTECLA(anetworkoftechnicalnursingassistantsystems);
•Mneme(developmentofatelemedicinecaremodelforpatientswithdementiainthedomesticsetting);
• RoBIn(Rosenheimnursingnetworkbyinternet)(DeutschesTelemedizinportal,2016).

ItisbecomingclearthattelemedicineinGermanyisusedincreasinglytoencourage interdisciplinarya
ndinterprofessionalcooperationbetweenmedicineandnursing.Particularlyin regionalareas(inregional
areasofGermany)withlowpopulationdensities,whereprovidingmedical careisonlypossibletoalimitedd
egree,telemedicineprojectsasanadjuncttomedicalcareare becomingmoreimportant.In2005thisledtoth
edevelopmentoftheAGnESconcept(localsystemic e-
healthinterventionsthataimtoprovidedoctorswithrelief).Speciallyqualifiedstaff(nursingstaff, medical
assistants)takeoverselectedmedicaltasksandaresupportedintheprocessbyvarious telemedicinesystem
s(e.g.monitoringofthepatientusingtelecaresystemsanddirecttelemedicine communicationbetweenthe
generalpractitionerandthenursingstaff)(VandenBerg,2009).

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 International Journal of Reliable and Quality E-Healthcare
Volume 6 • Issue 4 • October-December 2017

In2012theThuringianTelemedicineProjectstartedinGermany.Theaimoftheprojectisto expandre
motecollaborationbetweenvariousprofessionalgroupsingerontopsychiatryaswellasto transfercross-
facilityqueries,treatment-
relatedinformationanddiagnosticandtherapeuticprocesses quicklyandeasilybetweendoctors,specialis
tsandnursingstaff(InstitutfürBiomedizinischeTechnik undInformatik,2012).Anothersimilarprojectth
atwasalsostartedin2012istheDocConnectproject thataimstoimprovethecareofpatientsinagedcareandn
ursinghomesbyincreasingthespeedof informationtransferbetweendoctorsandthehomes(DeutschesTel
emedizinportal,2016).
InWesternAustraliaastudysurveyedmanagersanddoctorsabouttheirprioritiesfortelemedicine.
Managementplacedwoundcareatthetopoftheirlistofprioritiesandfordoctorsitwasinsecond position(Ba
haadiniK,YogesanK,WoottonR.;2009).Wewerenotabletofindasimilarsurveyfor Germanybutitisobvi
ousthattelemedicineandm-
healtharebecomingincreasinglyimportantin Germany,particularlyaspartofwoundcareprovidedbynurs
ingstaff.
Telemedicineandm-
healtharealsobecomingmoreimportantindermatology,particularlyas partofwoundcareprovidedbynur
singstaff.RelevantprojectscanbeseeninTable1.
WhatisremarkableisthatoutpatientwoundcareinGermanydoesnotincludeasystemthat enablesdire
ctcontactbetweenadoctorandnursingstaff.Thisrapidcommunicationwouldbe importantparticularlyint
heGermansystemforoutpatientwoundcarebecausetheresponsibilities betweendoctorsandnursingstaff
aresopreciselydelineated.OutpatientwoundcareinGermanyis structuredasfollows:

1. Doctorsareresponsibleformakingthediagnosisforwoundcare.Itisataskthatmustnotbe delegatedtoot
herprofessionalgroups(e.g.nursingstaff)becauseoftheparticularspecialist knowledgerequired.Int
hewoundcareprocess,doctorsarealsoresponsiblefortakingthemedical history,determiningtheindi
cation,examiningthepatient,includinganyinvasivediagnostic procedures,andinformingandadvisi
ngthepatient.Theydecidewhichtreatmenttoapplyand carryoutanyinvasivetreatmentsandsurgicalp
rocedures.Consultantsorgeneralpractitioners areresponsibleformakingthediagnosis;
2. Insuredpatientscanclaimhome-
basednursingcareaccordingtosection37oftheGerman SocialCodeVifthenursingcareisintendedtos
afeguardmedicaltreatment.Thatalsoincludes woundcaredelegatedbythedoctortonursingstaff.Sec
tion28oftheGermanSocialCode Vparagraph1legislatesthedelegationofmedicaltaskstonursingsta
ff(BMJV2016).In the‘Agreementonthedelegationofmedicalservicestonon-
medicalpersonnelinoutpatient contractedmedicalcareaccordingtosection28paragraph1page3ofth
eGermanSocial CodeV’datedOctober2013,‘woundcarefollowingconsultationwithadoctor’isdefi
nedas ataskthatcanbedelegated.Thedoctor,therefore,decidesifandtowhomongoingoutpatient

Table 1. Telemedicine projects related to wound care (as of September 2016)

Telemedicine projects related to wound care that can be found in the German Telemedicine Portal 2016, a portal that provides
information about completed and ongoing telemedicine projects

Project Description Aim of the Project Project

Name Schedule
Inexpertdiscussions(GPs,specialistsand clinicians)usingan Theaimoftheprojectwasto acceleratewoundtreat
etworkedtelemedicine system,digitalphotosofwoundsaredi ment,to minimisethenumberofdressing changes Noinformati
Wundnetz scussed andsuggestedtreatmentspreparedonthe basisofthep andtoreducepatient transportation on providedb
Witten hotos yproject man
agement

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International Journal of Reliable and Quality E-Healthcare
Volume 6 • Issue 4 • October-December 2017

Nursingstafftransmithigh-
Telekonsult qualityvideos withan(optional)oralreporttowound specialis
tswhosuggesttreatment.Thegeneral practitionerprescribesa Theaimwastominimiseexpensive personalhouse
ation Chro 01.10.2008to
ndifnecessary supplementsthetreatmentandthisiscarried ou callsbydoctorsthat wereoftenrequiredsimplytoa
nischeWun 30.06.2012
tbytheoutpatientnursingservice. ssess wounds.
de

Medicalpractitionersshouldhave thesimplestpos
DigiWund– sibleaccesstodigital wounddocumentation.Itsho
Digitale W Awoundphotographyapplicationwith importantimagepara uld provideinstructionsforwoundcareas wellass 01.03.2013to
unddokume metershasbeen developedfordigitalwounddocumentation. oftwareforwoundanalysis. 30.04.2014
ntation

Source: Deutsches Telemedizinportal, 2016; Imhoff-Hasse, 2008; Walter, 2012

woundcareisdelegated.Heorsheisresponsibleforselectingthetasksandmust,therefore, ensurethatt
henursingstaffarecapableofcarryingoutthedelegatedtasksbasedontheir professionalqualification
sorgeneralskillsandabilities(KBVandGKVSpitzenverband, 2014).Nursingstaffinoutpatientservi
cesandnursingassistantsspecificallytrainedinwound care(e.g.woundexpertsfromICW®3)areemp
loyed;
3. Alongwiththeresponsibilitytoselectthetasks,thedoctorsarealsoresponsibleforanytraining andmuste
nsurethattheemployeesaretrainedtocarryoutthedelegatedwoundcaretasks independently.Regular
monitoringofthedelegatedwoundcaretasksbythedoctorisrequired (monitoringduty)(KBV&GKV
Spitzenverband,2014);
4. Theresponsibilityforimplementingtasksinoutpatientwoundcarethenlieswiththenursing stafforthew
oundexperts.Theymustbeproficientintheproceduresusedinwoundcareand befamiliarwithhygiene
requirements.Theymustalsodocumentthecourseofthewound andthetreatmentindetail.Thisdocum
entationformspartofthecommunicationneedsofthe professionalgroupsinvolvedinthewoundcarea
ndenablesdoctorstoexercisetheirresponsibility formonitoringanddiagnosis.

Outpatientwoundcareisthusconsideredataskdelegatedbydoctorstonursingstaff.However, particul
arlyinoutpatientwoundcare,situationscanariseinwhichnursingstaffwouldliketoormust consultwithap
hysicianurgentlytohaveadiagnosisconfirmedortodiscussaparticulartreatment procedure.Whatisremar
kableisthattherearenosystemsinremotewoundcarethatenableimmediate contactbetweenadoctorandnu
rsingstaff.Particularlyinoutpatientwoundcare,situationscanarise inwhichnursingstaffneedtourgentlyc
onsultadoctortohaveadiagnosisconfirmedortodiscuss aparticulartreatment.
Thedoctorisusuallynotonsite,however.Mobileinformationandcommunicationtechnologies, spec
ificallytheLiveCitycamerasystem,enablesfastandhigh-
qualityexchangeofinformationbetween thedoctorandthenursingstaff.TheLiveCitycamerasystemisdes
cribedbelowusingtheexample ofplasma-
supportedwoundcareintheoutpatientnursingsettinginGermany.

MOBILE TELECOMMUNICATION IN PLASMASUPPORTEd

OUTPATIENT WOUNd CARE

AccordingtotheGermanProfessionalAssociationforMedicalTechnology,thereareabout2 millionpeopl
einGermanywhosufferfromchronicwounds(BundesverbandMedizintechnologie e.V.,2015).Thisnum
berwillcontinuetogrow.Thereasonforthisdevelopmentisthemeasurable increaseindiseasesthathavean
associatedriskofchronicwoundssuchasobesity,diabetesor arteriosclerosis.Chronicwoundsaretheresul
tofoneormoreunderlyingdiseases,andtheirtreatment istime-
consuming,costlyandrequiresconsiderablematerialandstaffresources(Augustin,Mayer &Wild,2016).
Ideally,patientswithchronicwoundsshouldbetreatedintheirhomes,because carebasedonthemodelofac
utecareisnotindicatedforchronicwounds.Theacutecaremodelis notcompatiblewitheitherthechronicnat
ureofthediseasenorwiththedailyneedsofthepatients (DeutschesNetzwerkfürQualitätsentwicklungind
erPflege,2015;Schmidt,2016).However, statisticsindicatethatinGermanyonlyminimalnumbersofpati

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Volume 6 • Issue 4 • October-December 2017

entswithachronicwoundare treatedathome(0.4%ofpatientswithdiabeticfootsyndromeand1.7%ofpatie
ntswithalegulcer)
(MedizinischerDienstdesSpitzenverbandesBundderKrankenkassen,2012,citedfromDeutsches Netzw
erkfürQualitätsentwicklunginderPflege,2015).Theyarepredominantlytreatedinhospital
(Heyer,2016).Thereasonbehindthisisconsideredtobethelackofmulti-
professionaloutpatient teamsaswellasafailuretonegotiatecareinterfaces.Oneapproachtoprovidingopti
malcareand treatmentforpatientswithchronicwoundsathomeandtoavoidhospitalisationandreadmissio
nis plasma-
supportedoutpatientwoundcare,whichcouldbesupportedbyusingmobilecommunication andinformati
ontechnologies.
Coldatmosphericplasma(CAP)isanewcontactlessandpain-
freetreatmentoptionavailable fortreatingpathogen-
associated,superficialdermatoses,particularlychronicinfectedwounds. Poorcirculationandtropism,as
wellasreducedlocalimmuneresponseandregenerationpotential, encouragetheinfectionofchronicwoun
dswithpathogenicmicroorganisms(RKI,2014).Effective treatmentofwoundsinfectedwithbacteriahas
becomeachallengebecauseofrisingresistanceand alackofnovelantimicrobialsubstances.Severalstudie
shaveverifiedtheoutstandingantimicrobial potentialofthecoldphysicalplasma,regardlessofthespecies
ofmicroorganismandtheresistance pattern(Karrer&Arndt,2015).Aswellasitsantimicrobialproperties,
somestudieswereableto demonstrateapositiveeffectonthewoundhealingthankstoalocalincreaseintheb
loodcirculation andtissueregeneration(Tiede&Emmert,2016).Thatreducedthehealingtimeforchronic
wounds andimprovedthequalityoflifeofpatients.

delegation of Plasma-Supported Wound Care

Closecooperationbetweendoctorsandnursingstaffcanconsiderablyimproveplasma-
supported woundcareforthoseaffectedbecausemedicalandnursingexpertisearerequiredtocarryoutloca
l woundcarethatisadaptedtotheparticularstageofthewound,andthatisbasedoncomprehensive diagnost
ics.Plasma-
supportedwoundcareisamedicaltaskthatcouldbedelegatedtospecialistnursing staff.Thatwouldinvolve
initialwoundcarebyadoctor(responsibleforthediagnosis)whodecides ifandtowhomheorshewilldelega
teongoingwoundcareofthepatient.Thedoctoris,therefore, responsibleforthedutyofselecting,initiating
andmonitoringthewoundcare(Kassenärztliche Bundesvereinigung&GKV-
Spitzenverband,2014).Plasma-
supportedwoundcareinpatients’homes couldbetakenoverbyspecialistnursingstaffbasedonadelegation
agreement4.Nurseswould, therefore,assumeresponsibilityforcarryingoutthetreatmentandwouldthems
elvesberesponsible forprovidinghighqualityandeffectivewoundcare.Outpatientplasma-
supportedwoundcareis ahighlyspecialisedandindividualtreatmentcarriedoutdirectlyonthepatientwhic
hwouldbe administeredfarfromanyinpatientinfrastructure.Inthiscase,specialistnursingstaffwouldhav
eto relyonthemselvesasarule.Ifinformationtocompareorconfirmadiagnosisoraboutthetreatment isurg
entlyrequired,thisusuallyhastobeobtainedlaboriouslybytelephone.Thatcoststimeand money,bothofw
hichareinshortsupplyinoutpatientcareinparticular.Nursingservicesareunder enormouscostpressuresfr
omnursingandhealthinsurancefunds.Theyaresupposedtodesignpatient treatmentthatisasefficientandc
osteffectiveaspossible(Breitschwerdt,Reinke,KleineSextro,& Thomas2016).Oneoptiontoensurerapi
d,efficientandcost-effectiveaswellashigh-
qualityexchange ofinformationbetweendoctorsandspecialistnursingstaffismobileinformationandcom
munication technologies,specificallythem-healthsystemofLiveCitycamera.

The LiveCity Camera System

TheLiveCitycamerawasdevelopedaspartofanEU-fundedproject“LiveCity–LiveVideo-to-Video
SupportingInteractiveCityInfrastructure”.Theaimoftheprojectistoenableorimprovereal-
time communicationbetweenindividualsorgroupswhoarefarawayfromeachotherusingHDvideo com

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International Journal of Reliable and Quality E-Healthcare
Volume 6 • Issue 4 • October-December 2017

munication(Metelmann&Metelmann,2015).Video-to-
videocommunicationhasawiderange ofpossibleuses,forexample,inemergencyservicestocreatealinkb
etweenadoctorandparamedics; inthecityadministrationtoimproveconvenienceandaccessfor(particula
rlyolder)residentsand asavirtualclassroomtoenabledistanceeducation(EuropeanCommission,2012).T
heLiveCity camerasystemismadeupof:

• Avideocamerathatiswornovertherightearusingaheadband;
• Headphoneswithanintegratedmicrophone;
• AsmallPC(tomaketheinternetconnection)thatcanbecarriedinabackpackorbeltbag.
Thecamerasystemandtheconnectiontoremotelylocatedpersonsareoperatedusingasimple pushbut
tononthestrapofthebackpackorbeltbag(Metelmann&Metelmann,2016).

Incorporation of the LiveCity Camera into PlasmaSupported

Outpatient Wound Care
Therearemanyspecificsituationsinnursingandmedicalcareinwhichm-
healthcouldbeused, includingplasma-
supportedoutpatientwoundcare.Asmentionedabove,situationsmayarisein outpatientwoundcareinwhi
chitisvitalthatmedicalandnursingstaffbeabletocommunicatewith oneanother.Particularlywhencompa
ringorconfirmingdiagnosesandtreatments,detailedinformation isessential.Thatincludesanassessment
ofthewound,whichcanonlybedonebymakingaclose examination.Untilnow,itwasnecessaryforthedoct
ortovisitthepatientathomeorforthepatient tovisitthedoctor’ssurgery.WiththeLiveCitycamerasystem,t
hewoundcanbeassessedremotely bythedoctor.Thatsavestimeandmoney,bothofwhichcanrapidlyrisep
articularlyinruralregions, e.g.asaresultoflongtravellingdistancesfordoctorsorambulancetransportofpa
tientsrequiring caretothemedicalpractice.TheLiveCitycameratransmitsHDvideosandtheassociatedvo
ice messageswithnotimedelayfromonesitetoanother(Metelmann&Metelmann,2015).Becausethe ca
meraisfixedovertherightearofthespecialistnursingstaff,thedoctorcanviewthewoundfrom theperspecti
veofthenurse.Thatmakesiteasierforthedoctortoorientthemselvesinthevideoand enablescoordinatedag
reementbetweenthedoctorandspecialistnursingstaff.Havingthecamera fixedovertherightearalsomean
sthatthenursehasbothhandsfree.Thatmeansthatanymeasures discussedbetweenthedoctorandthespeci
alistnursingstaffcanbeimmediatelyimplemented.This savestimeandcanincreasethequalityofthetreat
mentmeasures.Acloseassessmentofthewound couldalsobeenabledinthattheexaminingdoctorcanadjus
tthetransmittedvideototheirneeds.The softwareisdesignedsothatthelight,contrastorvolumecanbeadju
sted,forexample.Thesnapshot functionenablesthevideotobeanalysedingreaterdetailthankstothehighpi
xelcount(Metelmann &Metelmann,2015).Particularlywhenassessingthewoundmarginsorthewoundfi
lm,thisfunction couldbeusefulforthetreatingdoctor(off-site).

dISCUSSION ANd CONCLUSION

Todate,theLiveCitycamerahasbeentrialledinemergencyservicesinGermany(Metelmann
&Metelmann,2015).ThetrialoftheLiveCitycamerainthesimulationcentreoftheGreifswald University
MedicalCentreindicatedthatinemergenciesanm-health-
supportedlinkcanbecreated betweenparamedics(inthepatient’shome)andtheemergencydoctor(intheh
ospital)usingthe LiveCitycamera.Internet-
supportedcommunicationispossible(Metelmann&Metelmann,2016).
Thispotentialcouldinouropinionalsobeusedinoutpatientwoundcareprovidedbynursingstaff.
Theimplementationstillneedstobetrialed.Althoughoutpatientnursingandemergencyservicesare veryd
ifferentareasofapplicationandthetrainingofthespecialiststaffinvolveddiffers,bothareas aresimilarinth
athighlyspecialisedandcomplexmeasureshavetobecarriedoutinanunknown environment(e.g.apatient
’shome)andsometimessupportisrequired.Anothercommonfeature ofbothareasisthatcertaintaskshavet
obespecifiedbyresponsiblemedicalstaff,anddiscussions andexchangeofinformationareessentialinthis

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 International Journal of Reliable and Quality E-Healthcare
Volume 6 • Issue 4 • October-December 2017

regard(Breitschwerdt,Reinke,KleineSextro,& Thomas,2016).Asinemergencyservices,theoperationo
fthecamera–aspartofplasma-
supported outpatientwoundcare–shouldbeplacedinthehandsofspecialistnursingstaffwhoaretrainedin
itsuse.Thathasseveraladvantagesincluding:

• (Predominantlyolder)patientsarenotfurtherstressedbytheoperationofthecamera
•
Thenursingstaffcancontinuouslymonitorandreviewtheequipment,whichassuresthequality o
ftheprocedure;
• Onedevicecanbeusedforseveralpatientswhichiscosteffective(Metelmann&Metelmann,2016).
Forpatients,usingm-healthinplasma-
supportedoutpatientwoundcareisalsoassociatedwith otheradvantagessuchas:

•
Animprovementinthediagnosisandtreatmentbypromptexchangeofinformationbetween prof
essionalswhichisassociatedwithfasterandimprovedhealingandwhichcanincreasethe qualityoflife
;
•
Areductioninhospitalisationsbecausemedicalandnursingexpertisecanbemorereadily accesse
d.Moreover,complicationscanbeavoidedoridentifiedsooner;
•
Avoiding(often)longandstrenuousjourneystogeneralpractitionersandspecialistsandthelong
waitingtimesthatareusuallynecessary.Particularlythosepatientswith(open)chronicwounds feelun
comfortableinclosedspaceswithstrangers,becausethewoundisfrequentlyaccompanied byodours.
Thatisdistressfulforpatients(Panfil,Uschok&Osterbrink,2009).

Whatmustalsobeconsideredisthattimely,high-
qualitytreatmentofchronicwoundsisalso ofinteresttothehealthcaresystemfromaneconomicperspectiv
e.InGermanwoundcentres, thefollowinghealthcarecostsforstatutoryhealthinsurancewereidentifiedusi
ngtheexampleof venouslegulcers:onaverage(n=218)themeantotalcostsperpatientandyearwereabout€
9570. Statutoryhealthinsuranceincurredcostsofabout€7630(Purwinsetal.,2010inBVMed,2015)and th
emajorityofthecostsresultedfromthetreatment,whichcanlastbetween6monthsandsixyears. Rapidandt
ailoredwoundmanagementcouldreducethetreatmenttime,however,andthuslower thecosts(BVMed,20
15,Heyer,2016).
LegallyandlawfullyinGermanyactionisnecessarythatsimplifiesandimprovesthecross-
sector useoftelemedicineandparticularlyofm-
health(inpatient,outpatient)andthusofintegratedcarein thehealthcaresystem.Thefirststepsaretheintrod
uctionofseveralactsinGermany(theStatutory HealthInsuranceModernisationAct,theActtoEnhanceCo
mpetitioninStatutoryHealthInsurance andthePanelPhysiciansAmendmentAct)andinparticularthefra
meworkagreementonthescope oftheprovisionofoutpatientservicesbytelemedicineasdefinedinsection
87,paragraph2a(8)of theGermanSocialCode(SGBV).Medical,nursingandrehabilitationservicescann
owbeprovided andinvoicedcentrallybyspecialisedfacilities(Klar,2011).Inaddition,the“ActonSafeDig
ital CommunicationandApplicationsintheHealthcareSystem”5inGermanyisintendedtofurther reinfor
cetelemedicineservices(BundesministeriumfürGesundheit,2016).Thesedevelopments couldalsohave
apositiveeffectontheintroductionofm-
healthsupportedoutpatientwoundcareand openupfunding.Itmustbementionedatthispointthat,accordin
gtotheframeworkagreementon thescopeofservicesprovidedbyoutpatienttelemedicine,telemedicinean
dalsomobileinformation andcommunicationtechnologiesmayonlybeimplementediftheappropriate,re
gularandpersonal doctor/patientcontactcontinuestobeavailable(GKV-Spitzenverband,2013).M-
healthsupported outpatientwoundcarecaninnowayreplacepersonalmedicalcontactbutcanminimiseit.F

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International Journal of Reliable and Quality E-Healthcare
Volume 6 • Issue 4 • October-December 2017

inally,it mustalsobementionedthatanm-health-
supportedlinkbetweenspecialistnursingstaffandadoctor viatheLiveCitycamerashouldnotbeconsidere
dasmonitoringofthenursingstaffbutratherisa meanstoproviderapidsupportwhentreatingpatients.How
ever,itshouldbetakenintoaccountthat woundcareinGermanyisataskthatcanbedelegatedbymedicalprac
titionerstospecialistnursing staff.Theresponsibilityfordiagnosisandarrangementoftreatmentstillremai
nswiththedoctor. Thankstom-
health,adiagnosiscanbemadeconfidentlyandquicklyandtreatmentadjustedfrom aremotelocation.
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ENdNOTES
Anne Kirschner has a Master of Science in Nursing and Administration, University of Applied Sciences
Neubrandenburg; doctorate at the medical faculty, University Greifswald, Dr. rer. med.

Stefanie Kirschner has a Master of Science in Nursing and Administration, University of Applied Sciences
Neubrandenburg; doctorate at the medical faculty, University Greifswald, Dr. rer. med.; Bachelor of Arts in
vocational education studies in nursing and healthcare; University of Applied Sciences Neubrandenburg; Teacher,
Vocational Sector of Health and Nursing, Vocational Education Centre Müritz, Germany; Membership: National
Center for Plasma Medicine.

Christian Seebauer born 6th Decembre 1979 in Zeulenroda, Germany Degree • 2012 medical degree Education
• 1999-2006 medical school, Jena, Germany • 2011-2015 dental medical school, Greifswald, Germany Career •
2007-2010 resident for trauma surgery, CMSC Berlin, Germany • 2011 resident for maxillofacial surgery, Jena,
Germany • 2011 – to date resident for maxillofacial surgery, Greifswald, Germany Membership • National Center
for Plasma Medicine.

Bedriska Bethke is Professor ambulant care/nursing science, Department of Health, Nursing and Administration,
University of Applied Sciences Neubrandenburg; Membership: National Center for Plasma Medicine.

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