Guidance Issued on Instant Messaging in Emergency Medicine

Peter Russell

November 12, 2018

The NHS has issued doctors and nurses with guidelines on the safe use of instant messaging during emergency situations.

The guidance recognised that instant messaging, such as WhatsApp, contributed to patient care during emergencies such as the Croydon tram crash, Grenfell Tower fire, and terrorist attacks on London Bridge and the Manchester Arena.

The guidance, published jointly by NHS England, NHS Digital, Public Health England, and the Department of Health and Social Care, reminded NHS organisations and staff to take into account data sharing and privacy rules when using instant communication channels.

Aiding an Emergency Response

"Helping people during a crisis like the Grenfell fire, demands a quick response and instant messaging services can be a vital part of the NHS toolkit," said Dr Simon Eccles, chief clinical information officer for health and care. "Health service staff are always responsible about how they use patients' personal details and these new guidelines will help our doctors and nurses to make safe and effective use of technology under the most intense pressure."

Dr Helgi Johannsson, consultant anaesthetist at Imperial College Healthcare NHS Trust, set up a 'major incident' WhatsApp group following the Westminster Bridge and London Bridge terror attacks.
He later reflected on how this group helped galvanise his hospital's response to Grenfell Tower. "Fast mass communication, the ability to coordinate our response, and being able to plan the service for later on that day vastly improved the care we were able to provide," he wrote in a blog.

Data Rules and Patient Confidentiality

The new guidance recognised that instant messaging "can have clinical utility", but cautioned that "the law places obligations on organisations to protect patient confidentiality" and that clinicians may have to defend themselves against regulatory investigation if they do not take sufficient steps to safeguard confidentiality.

Steps that staff should take include:

  • Only using apps and other messaging tools that meet the NHS encryption standard of AES 256

  • Ensuring that the app can verify the identity of people using the system

  • Not allowing anyone else to use their device

  • Ensuring PIN protection and enabling a 'time out' function for the app

  • Disabling message notifications on the device's lock-screen to protect patient confidentiality

  • Enabling a remote wipe of messages in the event that the device is lost or stolen

  • Keeping separate clinical records and deleting original messaging notes once any advice has been transcribed and attributed in the medical record

The guidance said that staff should only use a standalone instant messaging system if their organisation had not provided a suitable alternative.

Choice of App

It did not recommend any particular tool, but mentioned WhatsApp, Viber, Telegram, and Signal that were capable of end-to-end encryption.

Mr Andrew Miles, consultant general surgeon and Royal College of Surgeons council member, said: "Patient safety is enhanced when NHS staff can quickly communicate confidential patient information between teams, such as by instant messaging.

"Doctors have a responsibility to abide by all relevant rules on patient confidentiality and a professional responsibility to ensure they do not breach that confidentiality when using instant messaging tools.
"This important guidance will keep our patients safer by empowering clinical teams to use the latest and best available technology."

Dr Johannsson, who was involved in reviewing the new NHS guidance, commented:  "These sensible guidelines will make the care of our patients safer through better communication by NHS staff."


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