The monitoring function for discharged ostomy patients enables systematic patient management through a smartphone app; this is more robust than traditional patient management through a conventional telephone. A patient can be asked to upload several stoma pictures for assessment through their smartphone; guidance markers are displayed on the smartphone screen to ensure that the correct area is photographed. Stoma complications (e.g., bleeding, prolapse, hernia, necrosis, ischemia, stenosis, depression, intestinal obstruction, fistula formation, or mucosal skin boundary separation), skin complications (e.g., irritant contact dermatitis, allergic dermatitis, folliculitis, candidiasis, pyoderma gangrenosum, periosteal varices, softening/infiltration, epidermal hypertrophy, or physical damage), and information concerning the stoma bag cycle, weight, and other side effects were collected and used for education and counseling.

Patients living with a stoma can experience difficulty maintaining a healthy life because they lack knowledge and are recovering from physical damage. Therefore, it is important to reduce these burdens and support a rapid return to daily life through the use of an appropriate lifestyle guide. Some guides have been proposed for physical, psychological, and social well-being (Table 1). The main guides referenced in the app are the patient guide published by the United Ostomy Associations of America Inc (UOAA), the travel and exercise guide published by the Ileostomy and Internal Pouch Association (IA), and the symptom coping guide for cancer patients published by the Korean Oncology Nursing Society and the Korean Cancer Study Group [1, 14–18]. Each well-being category includes guidance concerning difficulties with replacing the stoma bag, difficulties with daily life and social activity, difficulties with diet and nutrition, the management of frequent stool leakage, and psychological problems. The app is configured to provide relevant guidance for specific patient questions.

Guidance for physical well-being includes the provision of customized stoma management, provision of checklists for stoma management, management of stoma product inventories, and considerations regarding nutrition and physical activity. Patients discharged from the hospital may not be accustomed to replacing the stoma bag; the suggested guide in the app may help them to manage this task. Additionally, ostomy patients may experience difficulty preparing a stoma-compatible diet; the nutritional management guide can provide helpful information [17]. This management guide contains stoma-specific recommendations concerning water intake and dietary habits. Moreover, the importance of physical activity may be underestimated by ostomy patients; their recovery may be delayed because of insufficient physical activity. Thus, the suggested physical activity guide in the app can help patients to quickly improve their health. The app provides pictures and videos to help patients follow the recommended physical activities [14], warnings about specific activities, and explanations of stoma-specific exercise modifications [16]. In addition, psychological problems can develop in ostomy patients. Because most of these patients have impaired body image recognition, self-esteem, depression, sexual problems, and low psychosocial adaptation [19], the app provides guidance to alleviate stoma-related psychological symptoms and to stabilize mood through meditation and abdominal respiration; it also assists with self-management [18]. Ostomy patients may experience difficulties controlling stool, which limits their ability to engage in social activities [13]. A guide for maintaining social function; engaging in travel, transportation, and sex; and returning to daily work will assist ostomy patients in their daily social activities is also provided (Table 2) [1, 15].

According to a report published by the Korea Disabled People’s Development Institute, most ostomy patients are discharged from the hospital without adequate education; they gain useful tips through trial and error, which is a painful process [20]. In addition, patients will likely find it difficult to attend external education because of the psychological burden. Accordingly, there might be a demand for community support at the time of discharge. The community function for the social and spiritual well-being of ostomy patients consists of functions that connect people outside the home, such as ostomy patient gatherings, bulletin board communities, and the provision of a space for sharing welfare benefits with ostomy patients. In addition, a bulletin board related to a specific religion or belief in the community may be used to share spiritual beliefs.

Patients discharged from the hospital after surgery are registered as outpatients; they receive a registration number and temporary app password from the app administrator. They access the home screen after logging in using the given information; available sections are “all about ostomy” (containing stoma information) and “health records.” The ostomy information section provides information necessary for daily life, such as an introduction to the digestive system, methods to manage the ostomy, types of ostomy complications, replacement of the ostomy bag, diet management, and a checklist for emergency management. Such information supplements the patient’s physical, psychological, and social well-being. In the “health records” section, patients enter their ostomy status and receive feedback from the medical staff through regular checkups twice monthly on a set date through the “check ostomy” function; this function directly addresses the patient’s physical well-being. In addition, the “health diary” function enables patients to make daily entries regarding their weight, water intake, bowel movements, and meals consumed.

Ostomy inspections can be initiated by the patient or the patient’s guardian; they begin by determining the patient’s body weight and major problems requiring education (e.g., difficulty replacing the stoma or difficulties with diet and nutrition). The questionnaire about stoma and skin complications may differ depending on the type of ostomy (e.g., colostomy or ileostomy). Then, patients are asked to upload three photos of their stoma and skin condition for assessment by medical staff; a video guide is provided for an accurate collection of images containing the front, left, and right sides of the stoma. In addition, patients can ask questions in the app before they submit the questionnaire. Medical staff at the affiliated hospital will review the submitted documents within a few days to evaluate the patient’s stoma status; they provide feedback to the patient in the app. The patient confirms receipt of the feedback and explains whether they understand the information provided by the medical staff. The community function within the app supports social well-being in ostomy patients; it allows information exchange between patients and the support system. Registered patients support each other by clicking the support button or writing comments for a new post on the community bulletin (Fig. 2).

The web-based administration platform is a system in which the medical staff of the affiliated hospital access and manage information entered through the app. After login, the staff can view information (e.g., the total number of patients to be managed, patient sex, distribution of stoma types, and number of recent stoma inspections) along with graphs on the dashboard. In terms of stoma inspection, stomas can be managed according to the date of each patient’s regular ostomy check; the questionnaire is completed and feedback is provided by the medical staff. A separate patient list is created with the names of individuals who have not requested an ostomy check on the expected day; if a patient does not request the ostomy check service after 3 days of push notification reminders, medical staff will directly contact the patient and remind them to request the ostomy check service.

Each patient is evaluated on the ostomy check screen; medical staff review basic patient information, ostomy management records, health diary data, and any graphs or photos. The medical staff checks the questionnaire and stoma photos entered through the app; they then enter the evaluation and consultation details. When all items have been entered, the full document is printed in the form of a report and exported from the web interface. In addition, the health diary data and any graphs or photos allow medical staff to identify health problems that require more than a standard stoma inspection before the next outpatient visit (Fig. 3).