How GPs can use messaging apps safely during the COVID-19 outbreak

MDU medico-legal adviser Ellie Mein offers advice to GPs about the use of messaging apps, highlighting latest guidance relating to the coronavirus pandemic.

(Photo: PhotoAlto/Sigrid Olsson/Getty Images)
(Photo: PhotoAlto/Sigrid Olsson/Getty Images)

As technology advances, smartphones are becoming more useful as medical devices but with these developments come new challenges in using them appropriately and safely, for both doctors and patients.

At the MDU we are regularly asked by members for advice about the benefits and risks of using mobile technology including for education, monitoring patients and communicating with colleagues.

In the midst of the COVID-19 pandemic, GP practices have quickly adapted to working remotely and many are turning to messaging apps and other technology to keep in touch with colleagues and patients. A 2015 study concluded that around a third of doctors used WhatsApp or other web-based messaging apps to send clinical information, but usage is likely to have increased since then.

Data protection and confidentiality

While the NHS has long understood mobile technology’s ability to redefine how care is delivered the swift changes that have come about due to the pandemic have highlighted the need to ensure necessary safeguards are in place.

Key to this is ensuring data protection and patient confidentiality concerns that accompany the increasing use of these devices are considered.

NHS England’s stance has changed in recent years about the use of web-based messaging apps. While initially advising healthcare professionals against using commercial messaging apps, following their use during the WannaCry ransomeware attack and terrorism incidents, NHS Digital released further guidance on the use of instant messaging software.

This guide outlines the information governance points that should be considered when sending patient information via these routes (see below).

Several messaging options have also been created specifically for the healthcare sector, including Siilo, Forward, and Hospify – the latter of which has now been approved for inclusion in NHS apps library.

Weighing up the risks

In light of the ongoing COVID-19 pandemic, new information governance advice has recently been issued by NHSX, a joint unit of organisations including, the Department of Health and Social Care and NHS England.

This states it is fine to use commercial mobile messaging apps to communicate with colleagues or patients, provided there is no alternative and the benefits outweigh the risks.

The guidance highlights the importance of considering what type of information is being shared and with whom as well as limiting the communication of confidential patient information as far as possible.

By way of further reassurance the Information Commissioner's Office (ICO) has recognised the need for healthcare professionals to be able to communicate directly with people while dealing with the pandemic. Therefore, the ICO has assured NHSX that it cannot imagine a situation where it would take action against a healthcare professional trying to deliver care.

These latest statements are reassuring for clinicians who may need to rely on mobile messaging with colleagues and patients to deliver efficient and comprehensive health care during the pandemic.

Points to consider

If you choose to use instant messaging, ensure you have an agreed practice policy and follow it. It is important to comply with your ethical obligations around confidentiality, and with data protection rules.

The GMC in its guidance on confidentiality recognises that electronic messaging can be convenient for patients and support effective communication, but highlights that doctors should take reasonable steps to make sure that whatever communication method they use is secure.

In addition, if you need to send or receive images of patients via messaging apps, even if the image is anonymised, you will need to make sure the patient has consented not only to their photograph being taken, but also it being shared via instant messaging.

The MDU has also issued advice on the medico-legal risks of receiving and storing patient images during online consultations.

The guidance from NHS Digital suggests further safeguards, including the importance of:

  • balancing the privacy risks of using instant messaging versus the potential benefits in specific situations
  • minimising the extent of patient identifiable information sent over instant messaging
  • recording advice provided in the notes – instant messaging threads are no substitute for comprehensive, legible medical records
  • double checking the message is going to the correct intended recipient(s) before hitting send
  • ensuring messages cannot be read on your device's lock-screen.

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