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Calling time-out on WhatsApp: The need for secure and integrated clinical messaging service

25 June 2018

While the widespread use of WhatsApp in the NHS shows that clinicians see value in technology, Dr Jonathon Bloor thinks the health service needs secure messaging platforms that are part of clinical workflow tool and integrated with EPRs to deliver benefits across whole health economies.

The NHS has known about the widespread use of WhatsApp by doctors and nurses for a long time. The BBC, Guardian and Times have all written articles on the subject, with headlines ranging from ‘Use of WhatsApp in NHS ‘widespread’, say doctors’ to ‘Health apps used by NHS staff putting ‘highly sensitive and confidential’ patient data at risk, new report warns’. Doctors have also openly written about its use in medical journals.

The problem is that WhatsApp is being used outside current information governance rules, often without local NHS oversight and with huge confusion about just how secure information held in WhatsApp really is.

Problems with WhatsApp

Mark Zuckerberg recently testified before US Congress that Facebook systems do not see the content of messages being transmitted over WhatsApp. But that same week the BBC also reported the resignation of WhatsApp’s co-founder Jan Koum, saying that he had objected to Facebook’s attempts to use WhatsApp’s personal data and weaken its encryption standards.

The NHS centrally is also apparently beset with confusion, first coming down against WhatsApp use, then changing its mind (and issuing a guidance on its use) –only to later retract this guidance.

Finally, at the end of April a new report from Centre of Policy Studies, which has been backed by Jeremy Hunt, called for the introduction of a ‘WhatsApp’-style instant messaging service for NHS doctors and nurses. This is welcome news for many who have identified the crucial need to stop the use of pagers and fax machines as primary forms of clinical communication but who are concerned about the inherent issues of using WhatsApp itself for clinical communication. Trust is a fundamental requirement that underpins data sharing in healthcare.

When I signed up to Facebook and WhatsApp I understood that I would be providing my data for free in exchange for the use of a free service. I consented to this. Patients do not have the luxury of making decisions around consent for data sharing when clinicians share personal data about them via WhatsApp.

But the CPS report misses an important point and doesn’t go far enough – a secure instant messaging service alone will not give the NHS what it needs.

The case for integration with clinical systems

There is no doubt about the clinical utility of tools that provide team-based approaches to coordinating care. The ability to self-organise and communicate as a team wherever you are, using your own phone, and to know when information has been received and read – these are powerful and immediate benefits, which explain why clinicians are so quick to embrace the technology.

The majority of WhatsApp use in the NHS is for the purpose of improving the efficiency and safety of the care that is delivered.

However, our frontline experience over the last 10 years is that secure messaging needs to be part of a wider package of team-based clinical workflow tools, integrated with clinical systems such as EPRs and shared care records that work across whole health economies.

This delivers all the well-recognised benefits to be had from capturing that information as part of an individual’s clinical record, giving care professionals the latest information available at their fingertips.

Without this level of integration, a WhatsApp style messaging system becomes nothing more than yet another information silo, with all the inefficiencies and risks that implies.

Benefits of transparency

Add to this the benefits of transparency – integration back into the record provides an audit trail, and there is plenty of evidence about the value of transparency in driving different kinds of clinical behaviour.

The widespread use of WhatsApp tells us that clinicians see value in the technology.

NHS organisations are also starting to recognise and value the efficiency, safety and governance benefits of virtually connected clinical teams – we know this because they are starting to pay for this sort of technology.

This growing recognition that there is a cost involved to the NHS is the final hurdle. WhatsApp might come without an initial charge, but Facebook has been a timely reminder that business models that provide services for free always monetise the data.

We need wider recognition that secure care co-ordination platforms, designed specifically to meet the needs and workflows of NHS nurses and doctors, already exist but they come with a price tag.

Building highly scalable, highly usable, integrated, sustainable, secure, compliant and clinically safe platforms is a complicated and expensive business. They require highly skilled people to design, develop, integrate and deploy.

The alternative, if the NHS doesn’t step forward to buy safer alternatives for clinicians, is that WhatsApp’s use in the NHS will continue.