WhatsApp, Facebook Messenger and other unauthorised instant messaging (IM) apps are being used by approximately 500,000 NHS staff at work, as a growing number turn to consumer tools to communicate with colleagues and even patients, a new report has revealed.
Instant Messaging in the NHS, published this week by mobile technology company CommonTime, found that more than one in 50 personnel had faced disciplinary action for using consumer IM – the equivalent of some 29,000 NHS employees in England. For staff aged 18-24, where usage was found to be greatest, an even higher 9.4% had faced action.
In one of the most extensive examinations of the growing challenge, researchers questioned more than 800 individuals in England working in clinical and non-clinical roles across acute hospitals, GP surgeries, ambulance, community and mental health trusts, and other parts of the NHS.
Confidentiality threats were identified, and alleged malicious uses reported, as 43% of staff said they relied on consumer IM at work – equating to around 500,000 NHS employees across England.
Although respondents to the survey were anonymous, and consequently specific allegations could not be verified, eight individuals stated they were aware of cases where patient information had been sent to the wrong person, and in one case this was a personal contact of a staff member.
One respondent referenced a case in which patient details were posted on social media, while another reported pictures of patients being sent to others for ‘entertainment purposes’. In other responses there were mentions of staff ‘taking [patient] photos without permission’, ‘sharing addresses and phone numbers’, ‘complaining about patients’, ‘discussing a recently deceased patient’, ‘unauthorised access to patient details’ and ‘taking pictures of x-ray images to send to friends’.
Of the frequent users identified in the report, substantially higher usage emerged amongst frontline clinical staff to keep up with care needs. Nearly three quarters of those staff used group chat functionality. And the research revealed that 59% of doctors and nurses questioned use consumer IM messaging apps at least once per week, despite the fact that trust policies do not permit their use, and even though 75% of users questioned in the report expressed confidentiality concerns.
It was also found that 39% of staff were not aware of their organisation’s governance and data protection documentation, and one in five had not been offered or received data protection training.
But patient care would suffer, warned nearly a third of NHS staff, if they were prevented from using consumer apps, with many respondents arguing that IM had improved communication leading to higher care standards. Fewer than half of respondents were satisfied with NHS provided channels.
Based on research commissioned by CommonTime and conducted by VIGA, the report has triggered reaction from senior clinicians and NHS IT professionals, who warned that in addition to security concerns, consumer IM applications risk isolating information from NHS systems.
Rowan Pritchard-Jones, chief clinical information officer at St Helens and Knowsley Teaching Hospitals NHS Trust, said: “For me, the ability to prioritise tasks with the detail of IM is helpful to clinical staff and therefore a driver for use above pagers, for example. Yet the drawback remains that such detail of care never makes it into the patient record.
“Increasing numbers of electronic patient record vendors are creating solutions to support secure messaging as well as recording these tasks in the patient record. It will be critical that trusts ensure their infrastructure can support mobile devices working in this sophisticated way.”
Andy Hadley, head of the IT Development, Service Delivery & Transformation Directorate at NHS Dorset Clinical Commissioning Group, said: “We need standards based, cheap as chips, ubiquitous instant messaging for the NHS, and for this to integrate well with the clinical records. The NHS needs to step up to enable secure use of technology to empower staff, and this needs to extend to social care and others involved in providing multi-agency health and care.”
Martin Wilson, clinical lead for IT, The Walton Centre NHS Foundation Trust, said: “The ability to have ‘group chats’ is perhaps the most obvious benefit, and reflects the clinical reality that we work in teams, and often make decisions as teams. Phone and pager systems of working, [as well as] email, just don’t support that clinical workflow particularly if you need a rapid response from multiple team members.”
Steve Carvell, head of healthcare at CommonTime, the organisation which authored the report, said: “Despite clear concerns for data security and information governance associated with consumer applications, instant messaging has become indispensable in the NHS.
“It is helping many NHS professionals to do their job, and has become vital to many patient-facing staff, who are placed under an enormous amount of pressure. To tackle the challenge, IT professionals must transform healthcare communication, balancing organisational and user needs.”
The report found many valid reasons for staff turning to consumer apps. At varying levels across the survey staff recalled using IM to support shift handovers, to organise rotas, to ask for second opinions, to develop care plans and to organise community care.
On engaging with patients, 18% of respondents either personally use instant messaging apps to communicate with patients, or were aware of colleagues who do. One healthcare professional explained their use of WhatsApp enabled patients who could not afford phone credit to reach them.
CommonTime’s latest report into instant messaging follows revelations from its 2017 investigation into pager usage in the NHS, which found that the NHS still relies on 10% of the world’s pagers.
