Increased use of smartphone and related software applications has created a new era in clinical data exchange among patients and clinicians. This study describes use of the smartphone-based application WhatsApp to share clinical oral medicine information

DE BENEDITTIS, MICHELE

PETRUZZI, MASSIMO

Archivio istituzionale della ricerca - Università di Bari

LETTERS TO THE EDITORVol. 121 No. 5 May 2016WhatsApp: a telemedicineplatform for facilitatingremote oral medicine consultationand improving clinicalexaminationsda commentaryTo the Editor:We congratulate the authors for their commendablework on telemedicine systems. It is an innovative studywhere the authors used information technology to di-agnose various lesions of the oral cavity. The authorsalso discussed studies done in an oral medicine settingand their limitations.1 The authors reported valuesabout which the authors were in agreement as well asthe techniques used, whereas kappa statistics wouldhave been more appropriate in this context. Kappastatistics are based on the difference betweenobserved and expected agreement. Kappa statisticscan be seriously affected by the low prevalence of acondition but still can provide more information thanmeasures of agreement alone.2The various devices used by the examiners werehighlighted, but it would have been more meaningful ifthe authors had reported the gadgets that had used tocapture images. Also, a note on the agreement withregard to intraoral sites and kappa statistics would haveadded more information to the paper. The authors couldalso have added a note on various applications that aresimilar to WhatsApp (Hike, Telegram), which can beused for data sharing for the benefit of readers so thatresults can be extrapolated to these applications.Kalyana Chakravarthy PentapatiAssociate ProfessorDepartment of Public Health DentistryManipal College of Dental SciencesManipal UniversityManipal, IndiaKomal SmritiAssistant ProfessorDepartment of Oral Medicine and RadiologyManipal College of Dental SciencesManipal UniversityManipal, IndiaSrikanth GadicherlaAssociate ProfessorDepartment of Oral and Maxillofacial SurgeryManipal College of Dental SciencesManipal UniversityManipal, IndiaREFERENCES1. Petruzzi M, De Benedittis M. WhatsApp: a telemedicine platformfor facilitating remote oral medicine consultation and improvingclinical examinations. Oral Surg Oral Med Oral Pathol OralRadiol. 2016;121:248-254.2. Viera AJ, Garrett JM. Understanding interobserver agreement: thekappa statistic. Fam Med. 2005;37:360-363.http://dx.doi.org/10.1016/j.oooo.2015.12.015Response to: WhatsApp: atelemedicine platform forfacilitating remote oral medicineconsultation and improving clinicalexaminationsIn reply:We thank you for your commentary about our articleand appreciate your interest in our research. In thecommentary you wrote: “.the authors used informa-tion technology to diagnose various lesions of the oralcavity”; however, the aim of our study was not to testthe diagnostic efficacy of WhatsApp but to describehow an app may represent a “strategy for facilitatingeveryday patient-doctor interactions and providingfaster clinical communication between oral healthprofessionals.”1We agree with you about the importance and utility ofkappa statistics in the evaluation of differences betweenan observed agreement and an expected agreement (weused it in our previous articles),2 but in this case, wedeliberately used only descriptive statistics to avoidsupporting and emphasizing the idea of a “message-based diagnosis.” Evaluation of the photos andcomments would not be sufficient to make a diagnosis.As you can note, we use the term “telemedicineimpression” or “telemedicine assessment” instead of“WhatsApp diagnosis” just to avoid conveying themessage that in oral medicine the diagnosis is possiblefrom an app alone.We have not reported data about the various elec-tronics used to capture images because it was not one ofthe aims of our study. However, all images were sentthrough a smartphone.In relation to the various applications that are similarto WhatsApp (Hike, Telegram), we confirm that about20 apps similar to WhatsApp allow data sharing on asmartphone. In Italy, Viber is the most employed573LETTERS TO THE EDITOR OOOO574 May 2016competitor. An interesting statistic about the mostpopular global mobile messenger apps confirmedWhatsApp as a prominent app, with more than 500million monthly active users worldwide.3 Many usersare possibly dentists, dental hygienists, and potentialpatients.Massimo Petruzzi, DDS, PhDMichele De Benedittis, MD, DDS, PhDUniversity of BariBari, ItalyREFERENCES1. Petruzzi M, De Benedittis M. WhatsApp: A telemedicine platformfor facilitating remote oral medicine consultation and improvingclinical examinations. Oral Surg Oral Med Oral Pathol OralRadiol. 2016;121:248-254.2. Petruzzi M, Lucchese A, Nardi GM, et al. Evaluation of auto-fluorescence and toluidine blue in the differentiation of oraldysplastic and neoplastic lesions from nondysplastic and neoplasticlesions: a cross-sectional study. J Biomed Opt. 2014;19:76003.3. Most popular global mobile messenger apps. Available at: http://www.statista.com/statistics/258749/most-popular-global-mobile-messenger-apps/ Accessed January 3, 2016.http://dx.doi.org/10.1016/j.oooo.2016.01.018

English

Response to: WhatsApp: a telemedicine platform for facilitating remote oral medicine consultation and improving clinical examinations

Massimo Petruzzi

Michele De Benedittis

Crossref

Oral Surgery Oral Medicine Oral Pathology and Oral Radiology