The recent news that doctors and nurses across the NHS are using instant messaging services such as WhatsApp and Snapchat comes as no surprise.
The NHS, for all of its progress towards digitisation, is still in a state of fragmentation. Targets for the NHS’ goal of being paperless by 2020 have been regularly labelled as unrealistic.
Robert Watcher’s review of Healthcare IT in the NHS last year recommended that the NHS’ goals of being paperless by 2020 should be pushed back to 2023. It went on to state that the “aggressive push to digitise the entire secondary care sector by 2020 was more likely to fail than succeed”.
One of issues is the amount of variation in services’ digital maturity. My NHS data shows a large difference between the digital capabilities on NHS trusts across the country. Some trusts like Salford Royal, which is well-known for its digital services, are performing well in relation to digital maturity, where others haven’t progressed much. Indeed the Watcher review stated that in 2015 the digital capabilities of the NHS showed that “information in acute trusts is less digitised and less structured and they are less able to share information digitally”.
Health secretary Jeremy Hunt spoke about these levels of variation at the NHS Expo last year. Hunt said: “The single biggest point Bob makes about how hospital IT systems work is that there is huge variation in the system, just as we know there is huge variation in clinical.
“I think he is absolutely right to say that people will need to go at different speed. A hospital in special measures, which has severe problems with their A&E performance or waiting times, may not be able to invest in a huge IT transformation programme – and we need to recognise that.”
One of the most well-known reasons for the NHS’ struggles is a mixture of under-funding, overburdened staff and ageing populations. With the pressures placed on staff, a quick and easy-to-use instant messaging service can help doctors and nurses communicate with each other – potentially benefitting patient care and reducing unnecessary paperwork.
The use of WhatsApp and Snapchat by clinicians has been linked to an increased need for digital sharing systems. Jim Beagle, president and CEO of data management company BridgeHead Software spoke to DHA about the issue, saying: “Clinicians under pressure to do the very best for their patients, in a timely manner, are resorting to consumer messaging apps including Snapchat and WhatsApp in order to share information relating to patients across their teams. Why? Seemingly because they do not have the official provision of safe data sharing across departments and health providers.”
But these services put doctors and nurses at risk of breaching data security laws. Those using the services can easily anonymise patients by using initials instead of names, but a situation where a patient’s identity is revealed, as well as their condition, could easily occur.
Outside of data security, these services fail to incorporate the patient into the whole conversation. Beagle writes that whilst “these apps enable a convenient way of sharing data…the result is the creation of further data silos, whereby the data is locked into the devices…. i.e. it will never formulate part of the patient record”.
Then there are issues surrounding the use of the data created on WhatsApp and Snapchat. Beagle recommends an independent clinical archive (ICA), where patient data can be stored so clinicians have access to data when they need it.
Messaging services for NHS staff do exist, but if trusts across the country implement different software then there is still the issue of interoperability. Watcher’s recommendation for national interoperability is timetabled for 2022 and highlights the importance for appropriate data sharing on the NHS.
The use of WhatsApp and Snapchat by clinicians is comparable to a larger problem on the NHS. The service as it stands is simply too fragmented to offer clinicians a method of quick and easy communication. Hopefully the issue will be addressed, and as the NHS pushes towards further digitisation a system will be introduced that doesn’t put clinicians at a risk of breaching data security laws.