The rise of the smartphone

Technology is changing the way we work in many professions, and the rise of smartphone 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 patients.

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

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

However, data protection concerns mean this last benefit is not straightforward. The government is intent on 'harnessing the power of technology and creating an environment to enable innovation' to manage the growing demand for services securely and sustainably, but there is still tension between how to implement these advances without breaching data protection legislation. Currently, the use of generic, commercial online messaging platforms to share patient identifiable information is not advised.

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 despite introducing end to end encryption, WhatsApp '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 in the NHS because it was a consumer service without relevant data security certification, and therefore didn't 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.

NHSE has since adapted its advice and released guidance in 2018 in response to crises such as the Grenfell Tower fire and terrorist attacks. This guidance has now been replaced by NHSX guidance on using mobile messaging, but it recognised that medics had utilised instant messaging to help co-ordinate efficient and safe patient care in these emergency situations. It should be noted NHSX does not currently endorse a particular app. Instead, it offers advice to support the safe and secure use of mobile messaging.

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.

As well as the apps mentioned in NHSE's guidance, several messaging options have been created specifically for the healthcare sector, including Hospify, Forward, and Siilo - all of which have been used in NHS trusts.

If clinicians do choose to use instant messaging that is approved by their organisation in their professional role, they will need to be mindful of any local trust policies and their ethical obligations around confidentiality. Some key points from the above NHSE guidance are laid out below.

• There's a need to balance the privacy risks of using instant messaging against the potential benefits in specific situations.
• Minimise the extent of patient identifiable information sent over instant messaging.
• Instant messaging threads are no substitute for comprehensive, legible medical records.
• Double-check the message is going to the correct intended recipient(s) before hitting send.
• Make sure messages can't be read on your device's lock-screen.

In addition, if you are sending images of patients, even if they will be anonymised, you will need to ensure the patient has consented not only to their photograph being taken but also it being shared via instant messaging.

The future of smartphones in healthcare

It's remarkable how prevalent smartphones are in our day to day lives, especially considering the first smartphone was only launched in 2008. At this point the guidance on using them for sending clinical information may have to change to keep up with an ever changing healthcare system - or perhaps an alternative NHS information governance compliant solutions will need to be agreed upon.

Whatever the future holds, it's plausible that as both smartphones and the technology powering them become more powerful over the next few years, reliance on mobile solutions for delivering healthcare will also grow.