Technology is increasingly utilised to improve and streamline patient care. Electronic medical record systems and hand held smart devices are increasing, as is the use of applications (Apps). In our endeavours to digitise a manual scar assessment tool previously developed at our centre, we uncovered many important considerations unique to this rapidly evolving space.
A needs assessment was conducted prior to project initiation. The optimal digital platform was determined, based on accessibility, ongoing App maintenance requirements, and subsequent costs. An experienced health Apps designer was consulted. Project funding was sourced via grant application. Local ethics and research governance consent was obtained for the reliability testing on patients, along with the use of de-identified and consented clinical photographs within the App itself.
Following project initiation, local information computer and technology (ICT) security requirements changed along with implementation of European General Data Protection Regulations (GDPR), leading to changes in the App design relating to patient data input and output capabilities. For launching within the US the Health Insurance Portability and Accountability Act (HIPPA) requirements were also considered. The App disclaimer was reviewed by health department legal experts. Inter-rater reliability testing was conducted with the guidance of a statistician.
A scar assessment App the ClinMAPS(TM) Pro was developed that complies with regulations pertaining to safety of sensitive individual data. The App assists clinicians and researchers with assessment of scars with a reporting output suitable for inclusion in paper or electronic medical records.
Smart devices are increasing, supporting clinical decision making. Due to rapidly changing requirements and various international regulations governing the collection, use and storage of patient information, a considered approach is needed prior to development of Apps for use in burn injury care. 
Local ICT security, GDPR and HIPPA requirements should be considered when implementing App based assessment tools into clinical practice.

2 - Considerations for the development of an App to measure burn patient outcomes: an international IT perspective