Introduction

Mobile technology is poised to revolutionise the way healthcare professionals connect, communicate and collaborate. The mobile phone could stand alongside the stethoscope as one of medicine’s most important tools ever created.

Through handheld devices, both healthcare providers and clients now have an enormous range of readily available software tools to assist in managing all aspects of healthcare ranging from educational services, symptom tracking, medication management and communication portals. These tools, sometimes delivered free, serve as new and potentially powerful ways to empower and engage clients.

The number of freely available apps continue to soar. At the end of 2017, there were approximately 325,000 health apps in the leading app stores. Data from Accenture shows as of 2021 this number has grown to over 400,000 but with most having less than 10,000 downloads. The use of such apps not only have implications on user privacy but safety is now an emerging public health issue. A study by Akbar showed that the biggest safety issue was not technical performance of the software, but the quality of information provided by the apps.1 A lack of regulatory oversight is an important contributor to the problem.

The overreliance on freely available consumer apps is not unique to healthcare clients. Healthcare providers frequently resort to utlising consumer apps to communicate about clinical topics with other health professionals and even their clients.

Clinical communication and consumer apps

Global healthcare has an entrenched communication problem that remains dangerously reliant on phone tag, paging, fax and email to communicate and coordinate customer care.

These dated technologies create communication silos which inhibit accurate and efficient information transfer among care providers and stand in stark contrast to modern enterprise communication solutions that benefit other industries.

Published literature clearly demonstrates ineffective communication as one of the leading causes of healthcare error and avoidable client harm. According to the Joint Commission on Accreditation of Healthcare Organizations, about 70% of ‘sentinel’ client events are underpinned by communication errors.

Communication silos are not just a client safety issue. They are a major driver of inefficiencies and unnecessary costs within healthcare. They contribute to fragmented customer care, unnecessary test duplications, poor customer experience and clinician dissatisfaction. According to the Australian Institute of Health and Welfare, communication silos and access to timely healthcare advice and information transfer are recognised factors that contribute to the inequities of healthcare delivery to regional centres.

“We often experience phone tag between my clinic and referring medical centres in relation to client notes, information, or advice. This results in a lot of wasted time.”

– Adrian Pudlyk, Podiatrist. The Foot and Balance Centre

Published figures highlighting the impact these inefficiencies have on healthcare delivery is concerning. For instance, it has been estimated the average Australian Healthcare Provider loses up to 1 hour of consulting time per day due to inefficiencies related to poor interoperability of healthcare systems. The impact on care coordination is just as profound. Twenty percent of clients do not follow through on a referral when given a paper-based referral.

The last decade has seen health professionals work around these communication silos by resorting to consumer communication apps to coordinate patient care and connect healthcare teams. The ubiquitous availability of tools such as WhatsApp and Facebook Messenger coupled with the ease with which users can connect and share information serves as a refreshing alternative to the traditional communication tools health professionals rely on. An Australian study that focused on Victorian hospitals showed almost universal demand amongst junior healthcare professionals for mobile solutions to communicate around customer care. Usage of Whatsapp was widespread with more than 85% of respondents using it on a regular basis. The findings echo a recent news article published in Queensland that reported high usage of Whatsapp in public and private healthcare.

Why does the unsanctioned use of communication apps continue?

Firstly, communication apps like WhatsApp are both widely available, and very easy to use. Most health professionals already have WhatsApp on their phone, so it’s very easy for one clinician to connect and share information with another user.

“Sometimes it can take half a day to a day to find the right person to get in contact with. Then, dealing with switch boards and waiting on emails can be hell… We fall back on WhatsApp to send information between physiotherapists because there isn’t anything else suitable on offer.”

– W.Kirby, Physiotherapist

Solutions which public clinics often endorse, such as fax or encrypted email, are impractical when clinicians urgently need to share critical information. Often health professionals are away from a computer, or must share a clinical image. Consider an ambulance worker in the field with an unstable client or an allied health worker in a nursing home. Whether it’s an image of a fractured limb, a photo of a wound, or a 12 lead ECG often the mobile phone is the quickest and most decisive way to send information. Alternatively, imagine another common scenario where a surgeon is scrubbed and another health professional is wanting advice or providing a clinical update. Phone tag is a significant problem and drives unnecessary interruptions to work and delivering customer care in a timely way. The use of fax or encrypted email is often entirely impractical in these settings. Health professionals demand a much simpler and practical solution than fax, email, or phone tag.

The second driver for continued consumer app is policing. As far as we are aware, there has never been a legal case within Australia penalising a clinician around non-secure mobile app usage for clinician communication. However, with the inception of the Mandatory Data Breach reporting scheme within Australia, the landscape is changing.

What risks do health professionals face when using consumer apps?

Health professionals have legal obligations when handling sensitive client information. 

Healthcare providers and carers often confuse the security of an app with their privacy obligations as custodians of sensitive client information. WhtasApp and many other platforms offer end-end encryption on messaging. However, there is more to client privacy than just end-end encryption.  

In Australia, both state and territory and Federal laws govern how client information must be handled by health professionals and organisations in the public and private sector respectively.  

For example, under these laws health professionals must ensure sensitive client information remains stored on data servers within Australia (data sovereignty) and is not stored on their own personal mobile devices or 3rd party cloud servers (e.g. iCloud). Users must also take steps to ensure other parties can’t access sensitive client information in the event of theft of the mobile device.  

WhatsApp, for instance, does not offer password protection and  has data servers located outside of Australia (Figure 1.).  However, using innovative, purpose designed technologies, a solution is at hand where the  use of  dedicated medical messaging apps can circumvent these issues. 

Figure 1.  

Furthermore, in 2018 the Mandatory Data Breach reporting scheme came into effect in Australia. The scheme now makes it mandatory, under certain circumstances, to report data breach. A data breach is said to occur when personal information held by an organisation or an individual is either lost, accessed or disclosed without authorisation. Failure to do so risks steep financial penalties not only to healthcare organisations  but also the individual clinicians who mishandle patient information. 

Data from the Office of the Australian Information Commissioner (OAIC)  shows the biggest reason for data breach (i.e. the mishandling of client information),  is actually user error.  Simply put  this means one health provider sending sensitive client information to the wrong provider.  

In Australia, healthcare has the unenviable status of having more data breaches reported than any other industry sector. This is likely a reflection as to the high volumes of communication events within healthcare but also a testament to the legacy solutions clinicians continue to adopt – sending information to the wrong recipient often came in the form of a fax or email to the wrong recipients.  

Client-Clinician Communication 

Mobile apps have enormous potential to improve Clinician-Client communication. Clear, timely and accurate communication is vital for building the clinician-client relationship and delivering quality care.   Physician-client portals serve as ideal virtual care solutions to deliver client education initiatives and to allow better customer engagement and improved continuity of care. 

Research demonstrates better clinician-client communication improves client adherence, lowers hospital readmission and malpractice risk and delivers better value-based care. 

The Australian Commission on Safety and Quality in Healthcare provides national guidance on safety initiatives for healthcare organisations within Australian healthcare. This framework serves as accreditation benchmarks for healthcare organisations. The commission promotes effective client-clinician communication at transitions of care as a means to: 

• Improve client satisfaction 
• Reduce adverse events  
• Reduce readmissions to clinics.  

Unfortunately, whilst rarer, clinicians sometimes resort to consumer apps for client-provider communication.  In a 2018 NSW Civil and Administrative Tribunal case, where a psychologist was exchanging information with a client via WhatsApp,  expert evidence suggested the form of communication was  ‘demeaning’ and could result in ‘confusion created by the familiarity and loosening of boundaries’.  

Conclusion 

Healthcare lags other industries in adopting enterprise communication solutions. Secure, enterprise grade, desktop and mobile communications stand ready to improve clinician-clinician and provider to client communication. Under the new Mandatory Data Breach scheme healthcare providers face increasing financial risk in using unsanctioned consumer apps for clinical communication. At Foxo we believe the industry needs to update guidelines around communication app usage within healthcare and adopt and endorse purpose built, secure, enterprise grade solutions as the preferred means for real time communication. 

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References:

• Journal of the American Medical Informatics Association, Volume 27, Issue 2, February 2020, Pages 330–340 

• Joint Commission on Accreditation of Healthcare Organizations. National Patient Safety Goals. 2005 

• JMIR medical informatics, vol. 6, no. 1, article e9, pp. 1-7