WhatsApp Telemedicine For the Developing World: What Can We Learn From India by Maurice Mars Head Dept of TeleHealth, Nelson, R Mandela School of Medicine @ University of KwaZulu-Natal, South Africa
WhatsApp Telemedicine For the Developing World: What Can We Learn From India by Maurice Mars Head
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WhatsApp Telemedicine In The Developing
World: What Can We Learn From India?
Maurice Mars and Richard Scott
Dept of TeleHealth
Nelson R Mandela School of Medicine
University of KwaZulu-Natal, South Africa
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Proprietary, free, instant messaging app
Works across operating systems
Allows text, image, video and audio messages
One to one communication or
One to many “group” chats
1,000,000,000 users (Feb 2016)
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Searched 5 Databases up to 31 December 2015
Inclusion criteria - use of WhatsApp
• in clinical services
• paper or abstract in English
• peer reviewed paper or abstract
Exclusion - use of WhatsApp
• for education
• lifestyle management
Narrative Scoping Literature Review
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PubMed - “WhatsApp”[All Fields]
Science Direct – WhatsApp
Scopus - WhatsApp (All Fields)
IEE Explore - WhatsApp
Google Scholar (first 100)
WhatsApp AND Telemedicine
WhatsApp AND mHealth
WhatsApp AND TeleHealth
Search Strategy
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WhatsApp Groups = 6
Intradepartmental
Admission assessment
Advice from seniors
Daily status updates
Administration
Education
Flattened hierarchy
↑ communication
Improved handovers
Improved records
Data at hand
↓ Registrar autonomy
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Taking photos and sharing with group 2
Taking photos 3
Transmission by phone 0
Storage on phone 0
Record keeping 0
Consent – 5
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Minimise mention of identifiers 2
Ward & bed number and procedure 2
Protocol HIPAA compliant 1
“Ensure patient confidentiality” 1
Only shared with group 2
Consent implies confidentiality 1
Confidentiality - 8
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“There are no clear guidelines for patient
confidentiality from both the Dental
Council and Medical Council of India
currently and as such is less of an issue in
India as compared to the developed
countries.” Pandian 2014
Confidentiality
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WhatsApp messages and calls between a sender and
receiver that use WhatsApp client software released
after March 31, 2016 are end-to-end encrypted
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Implied – not stated
“no longer lose X-Rays”
BUT
Can email chats
No mention of this
KZ-N Burns – enter data
Record Keeping
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More input on patient management
Better communication
Better than pager
Flattening hierarchy
Simple, effective, cheap
Upside
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Frequent interruptions
Disparity on urgency
↓ Verbal communication
Online 24 h
Can’t print record
Not in medical record
Identifying patients difficult
Downside
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Little research published
Wide range of disciplines
Chat groups
Patients and family can send
Business plans ?
Legal and ethical ?
What Have We Learned ?
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Legal and Regulatory issues
Confidentiality
Encryption
Data security
Data storage
Record keeping
Evidence of consent
Prescription
WhatsApp Service Concerns
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WhatsApp Services
Is this the new face of telemedicine success
in the developing world?
Is telemedicine too regulated for this in the
developed world?