The study began in the hospital the day of surgery. Prior to the study period, the software program was installed in the patients’ own mobile phones.
Each patient was given information individually and had the opportunity to test the application and provide test answers. The functionalities of the mobile phone, including how to move from question to question both forward and backward, as well as how to input a response and use the navigation keys, were carefully explained.
The follow-up of the mobile phone group was conducted by using a numeric rating scale from 0 to 100 (0 = no pain, 100 = terrible pain) with a mobile computer system, Medipal (Novatelligence AB, Stockholm, Sweden). After waking from the anesthesia, the patients’ mobile phones initiated pain measurements by a “push” function every four hours, for a period of six days following surgery. If the patient did not respond, a reminder in the form of an incoming Short Message Service (SMS) was sent once, after 13 minutes. The specified response time was a feature built into the program itself. Each question appeared separately in real time on the mobile phone screen and disappeared from the screen immediately after the response was given.
Communication was transferred between the handset and the company's server via the mobile network GPRS, General Packet Radio Service. From the server, the encrypted health information was available to dedicated staff members in hospital.
The strong encryption used by this technology ensured the safe transfer of information through the system. All patient-related information that was sent from the mobile phone, whether iPhone, Android or Java was encrypted. In addition, only authorized users had access to patient information, and user names and passwords were required for access. If an incorrect password was entered three times, the service was blocked and could only be activated manually by an authorized technician at Novatelligence. All traffic between the web browser and website was encrypted with a certificate. Medipal's servers and databases are hosted at www.interoute.com
, which is not only ISO27001 certified but also holds data and records for some Swedish public healthcare providers. Furthermore, Medipal's server has the same security and requirements as those prescribed for all medical record administration within Swedish public healthcare.
Patients were also able to report additional assessments between the specified time periods if they experienced especially painful episodes. All health information was incorporated into the patients’ health record. After six days, the nurse called the patient to remove the program from the mobile phone. At the same time, designated nurses asked structured questions that focused on potential difficulties in managing the mobile phone technology or in providing the daily responses to the questionnaires.
The control group received the follow-up questionnaire before surgery and was asked to reply to the questions at the same points in time as the mobile phone group, starting immediately after waking from the anesthesia. These questionnaires were returned in a prepaid envelope after the study period. No reminders were given to this group, which was followed up for four days postoperatively.