Clinical teams are increasingly using WhatsApp to communicate amongst themselves but the tool is not safe in terms of data security and is ineffective in managing clinical workflow, warn Dr Harry Claireaux and colleagues
Founded in 2009, WhatsApp (Mountain View, California, US) now has over one billion users. In healthcare, WhatsApp is increasingly used to communicate within and between teams.
This unsanctioned medium offers efficiency benefits over radio frequency paging systems which rely on users finding a landline, knowing the recipient’s number, and suspending care while hoping that the recipient receives the “bleep” and calls back.
While pagers have the advantage of not relying on cellular or WiFi signal, the recipient is unaware who is bleeping, why, and how urgently. Work is interrupted, time is wasted, prioritisation is difficult, and the evidence trail remains limited.
In the UK, the NHS forbids the use of WhatsApp for transmitting information in the healthcare environment.
WhatsApp has been shown to reduce communication delays, freeing up clinicians for service delivery and training, while helping to overcome human factor challenges around hierarchies. However, WhatsApp is not a secure or effective application for managing clinical workflow.
On data security:
- WhatsApp’s update to offer end to end encryption has been hailed as resolving security concerns.
- However, data transits through servers located internationally, constituting transfer of information overseas.
- Data is decrypted onto each smartphone, yet unlike online banking applications, WhatsApp does not require password protected login. Any misplaced or stolen phone can serve as a gateway to patient data.
- Clinical images received via WhatsApp are by default downloaded to phone memory and often uploaded to cloud servers automatically, accessible on linked devices and transmitted abroad.
- Various techniques have been described to improve data security when using WhatsApp clinically, including identification of patients by initials, record number, bed location, and intermittent message deletion. However, if clinicians are unable to clearly identify which patient the advice pertains to, there is a risk of patient harm.
- In the UK, the NHS forbids the use of WhatsApp for transmitting information in the healthcare environment. Incoming 2018 European Union data protection regulation will mean trusts could face fines of 4 per cent of annual turnover or £20m for patient data breaches involving smartphones.
On clinical effectiveness
- Group chats produce a string of text without any method of assigning tasks, or monitoring workflow. Our survey across 60 hospitals showed that 92 per cent of doctors would find a purpose built workflow app useful or very useful.
- There is no connected user directory. A bespoke solution would connect health professionals across each hospital, enabling nurse to doctor messaging and task assignment and interspecialty consults.
- Text transcripts of WhatsApp communication are downloadable, but structured information relating to specific patients cannot be easily extracted, making it difficult to integrate this data into medical records.
- WhatsApp runs whether staff are on shift or elsewhere: qualitative research has highlighted clinician dissatisfaction with receiving messages outside of working hours. An optimal solution would have geofencing functionality and clear settings to indicate clinical status.
WhatsApp use amongst clinicians represents a poorly understood ticking time bomb given current UK data protection law and NHS guidelines, with 90 per cent of clinical NHS staff using this social messaging tool daily.
The authors believe there is an unmet need for a bespoke clinical communication and workflow application, designed to retain published benefits of WhatsApp use whilst innovating in areas of weakness.
"""Timu za kliniki zinatumia WhatsApp zaidi na zaidi kuwasiliana kati yao, lakini chombo hicho hakina usalama wa data na haifai katika kusimamia mtiririko wa kazi ya kliniki,"" alisema Dk Harry Clareaux na wenzake." Katika huduma za afya, WhatsApp inazidi kutumiwa kuwasiliana ndani na kati ya timu. Hii unsanctioned kati inatoa faida ufanisi juu ya mifumo ya radio frequency paging ambayo kutegemea watumiaji kupata landline, kujua mpokeaji nambari, na kusimamisha huduma wakati matumaini kwamba mpokeaji anapokea <unk>bleep<unk> na wito nyuma. Wakati pagers kuwa na faida ya kutotegemea simu au WiFi ishara, mpokeaji hajui ambaye ni bleeping, kwa nini, na jinsi haraka. Kazi imevurugwa, wakati umeharibiwa, ni vigumu kuweka vipaumbele, na uthibitisho unabaki mdogo. Shirika la afya la Uingereza (NHS) limepiga marufuku matumizi ya WhatsApp kwa ajili ya mawasiliano ya kijamii. WhatsApp imeonyeshwa kupunguza ucheleweshaji wa mawasiliano, kuachilia madaktari kwa utoaji wa huduma na mafunzo, wakati kusaidia kushinda changamoto za sababu ya kibinadamu karibu na hierarchies. Hata hivyo, WhatsApp si programu salama au yenye ufanisi kwa ajili ya kusimamia mtiririko wa kazi ya kliniki. Kuhusu usalama wa data: - Sasisho la WhatsApp la kutoa encryption ya mwisho hadi mwisho limesifiwa kama kutatua wasiwasi wa usalama. - Hata hivyo, data transit kupitia seva ziko kimataifa, kuunda uhamisho wa habari nje ya nchi. WhatsApp ina programu ya kuhifadhi data kwenye simu yako, lakini tofauti na programu za benki za mtandaoni, WhatsApp haihitaji kuingia kwa kutumia nenosiri. Simu yoyote iliyopotea au kuibiwa yaweza kutumika kama lango la kupata habari za mgonjwa. Picha za kliniki zilizopokelewa kupitia WhatsApp zinapakuliwa kwa kumbukumbu ya simu na mara nyingi hupakuliwa kwenye seva za wingu moja kwa moja, zinapatikana kwenye vifaa vilivyounganishwa na kusambazwa nje ya nchi. "Utafiti huo unaelezea mbinu mbalimbali za kuboresha usalama wa data wakati wa kutumia WhatsApp kliniki, ikiwa ni pamoja na utambulisho wa wagonjwa kwa herufi za kwanza, nambari ya rekodi, eneo la kitanda, na kufuta ujumbe wa mara kwa mara. """ Hata hivyo, kama madaktari hawawezi kutambua waziwazi ni mgonjwa gani anayehusika katika ushauri huo, kuna hatari ya kumdhuru mgonjwa. Shirika la afya la Uingereza (NHS) limepiga marufuku matumizi ya WhatsApp kwa ajili ya mawasiliano ya kijamii. Sheria mpya ya ulinzi wa data ya Umoja wa Ulaya ya 2018 inamaanisha kuwa maduka ya kuaminika yanaweza kukabili faini ya asilimia 4 ya mauzo ya kila mwaka au £ 20m kwa ukiukaji wa data ya mgonjwa unaohusisha simu mahiri. Juu ya ufanisi wa kliniki - mazungumzo ya kikundi hutokeza mstari wa maandishi bila njia yoyote ya kugawa kazi, au kufuatilia mtiririko wa kazi. Utafiti wetu katika hospitali 60 ulionyesha kwamba asilimia 92 ya madaktari wangepata programu ya kazi iliyoundwa kwa kusudi muhimu au muhimu sana. - Hakuna directory ya mtumiaji kushikamana. Suluhisho la kibinafsi litashikilia wataalamu wa afya katika kila hospitali, ikiwezesha ujumbe wa muuguzi kwa daktari na mgawo wa kazi na mashauriano ya kati ya taaluma. Maandishi ya mawasiliano ya WhatsApp yanaweza kupakuliwa, lakini habari iliyoundwa inayohusiana na wagonjwa maalum haiwezi kuchukuliwa kwa urahisi, na kufanya iwe vigumu kuunganisha data hii katika rekodi za matibabu. WhatsApp inaendesha ikiwa wafanyakazi wako katika zamu au mahali pengine: utafiti wa ubora umeangazia kutoridhika kwa daktari kupokea ujumbe nje ya masaa ya kazi. Suluhisho bora ingekuwa na geofencing utendaji na mipangilio wazi kuonyesha hali ya kliniki. """Utumizi wa WhatsApp miongoni mwa madaktari unawakilisha bomu la wakati ambalo halijaeleweka vizuri, ikizingatiwa sheria ya sasa ya ulinzi wa data ya Uingereza na miongozo ya NHS, na asilimia 90 ya wafanyikazi wa kliniki ya NHS wakitumia chombo hiki cha ujumbe wa kijamii kila siku." "Wanahabari wanaamini kuna haja isiyotimizwa ya mawasiliano ya kliniki ya kibinafsi na maombi ya mtiririko wa kazi, iliyoundwa kuhifadhi faida zilizochapishwa za matumizi ya WhatsApp wakati wa kubuni katika maeneo ya udhaifu. """