The rise of the smartphone

Technology is changing the way we work in many professions and the rise of smartphones use is just one way this is happening on a rapid scale. Mobile technology is transforming our world, including the way we learn, deliver healthcare, manage our time and monitor our patients.

A 2015 survey by the BMJ confirmed 98.9% of doctors own a smartphone and that figure is likely to have increased in the last four years. The NHS recognises mobile working has the power to redefine how it delivers care with NHS Digital citing the potential benefits to include:

  • Patients self-monitoring and communicating with clinicians remotely.
  • The more efficient delivery of healthcare by streamlining service models.
  • Improved communication using messaging tools and emails.

However, this last benefit is not straightforward because of data protection concerns. The government is intent on “harnessing the power of technology and creating an environment to enable innovation” to manage the growing demand for services in a secure and sustainable manner. But there remains a tension between how to implement these advances while not breaching data protection legislation. Currently, the use of generic, commercial online messaging platforms to share patient identifiable information is advised against.

It’s also clear instant messaging apps are commonly used by doctors with reports that the use of unapproved messaging apps being used to send patient information is widespread in day to day medical practice including for handovers. These reports have been supported by larger studies which concluded that around a third of the doctors surveyed said they’ve used WhatsApp or other web-based messaging apps to send clinical information.

NHS response to rising mobile technology

NHSE advised in 2015 that WhatsApp, despite introducing end to end encryption, “should never be used for the sending of information in the professional healthcare environment” because of security concerns. Its position was that there was no valid reason for it to be used within the NHS given that it was a consumer service without relevant data security certification; it therefore did not conform to NHS information governance standards.

In 2017, its stance softened slightly as it agreed WhatsApp could be useful for staff to communicate with each other. This announcement came in the wake of the WannaCry ransomware attack of May 2017 which disabled many NHS communication systems, including email, which did meet its IG standards. Regardless of this concession, NHSE reiterated WhatsApp should still not be used to send patient information.

Around a third of the doctors surveyed said they’ve used WhatsApp or other web-based messaging apps to send clinical information.

NHSE has since adapted further and released new guidance, in response to crises such as the Grenfell Tower fire and terrorist attacks. This guidance recognised that medics had utilised instant messaging to help co-ordinate efficient and safe patient care in these emergency situations. It should be noted NHSE does not currently endorse a particular app. Instead it outlines the information governance points that should be considered when sending patient information through these routes.

Dr Simon Eccles, chief clinical information officer for Health and Care, explained:

“Helping people during a crisis like the Grenfell fire, demands a quick response and instant messaging services can be a vital part of the NHS toolkit. Health service staff are always responsible about how they use patients’ personal details and these new guidelines will help our doctors and nurses to make safe and effective use of technology under the most intense pressure.”

Messaging app dilemmas

At present, the NHS has not provided or endorsed a suitable solution for effective and confidential information sharing between colleagues. Doctors are therefore resorting to using potentially non-compliant apps to fill this void. Despite the cautions from NHSE, it seems likely that doctors will continue to use whatever mode of communication is the most efficient until a suitable solution is found.

In addition, to the apps mentioned in NHSE’s guidance there are several messaging options that have been created specifically for the healthcare sector including Hospify, Forward, and Siilo all of which have been used in NHS trusts.