Table 2 Description of the four iterations performed during the pilot study to develop the digital platform for managing data from the clinical side, based on clinicians’ and patients’ feedback

Iteration 1

Patient 1

Clinical team daily receives patient’s data in a report by email.

Feedback from clinicians: Graphics received are not well perceived, daily reports are very extensive, historic data should be strict to a 7-day period.

Iteration 2

Patients 2–6 (1 dropout)

Clinical team daily receives patient’s data in a report by email.

Improvements: Data reports were improved with the feedback given by the clinical team. Alerts were introduced in the patients’ report, based on rules defined by the clinical team.

Feedback from clinicians: Need for registering clinical notes related to each patient’s reported data. Difficulty in managing information of one email (daily report) per patient.

Feedback from patients: Problems with the bluetooth connection with the smartwatch was reported by some patients.

Iteration 3

Patients 7–16

Improvements: The first version of a RPM web application to manage patients’ data was launched. Data monitoring process became more efficient for the clinical team as they had a monitoring list with the individual patient alerts. Email reports were eliminated. Access to each patient record allows the access to the historic data and registering notes from the clinical team. Patient instructions were improved to reduce problems with Bluetooth connection.

Feedback from clinicians: Concern of using their time in phone calls related to technical issues of the equipment. Also, text messages could save time for communicating simple literacy reminders.

Iteration 4

Patients 17–30

Improvements: Added a feature in the RPM application for sending literacy text messages to the patients. This feature included a set of predefined messages that can be sent on demand or in a scheduled scheme. Patients received the text messages once a day, after reporting the photo of the wound. To better manage the technical issues, a ticket system was added to allow the clinical team to report to our support team a problem with a DHK, avoiding phone calls. Service quantitative metrics were made available to the clinical team, in the RPM application (e.g. number of alerts and their type, type of actions taken by the clinical team based on those alerts).

Feedback from clinicians: Preference for the predefined scheduled messages as can optimize their work.

Feedback from patients: the app asks to daily answer to the same questions even if the answer is the same as in the previous days (“I was reporting every day that I didn’t feel tired”).