Realizing the potential of real-time clinical collaboration in maternal-fetal and obstetric medicine through WhatsApp

The role of WhatsApp™ in pediatric difficult airway management: A study from the PeDI Collaborative

BACKGROUND

Management of the pediatric difficult airway can present unique clinical challenges. The Pediatric Difficult Intubation Collaborative (PeDI-C) is an international collaborative group engaging in quality improvement and research in children with difficult airways. The PeDI-C established a WhatsApp™ group to facilitate real-time discussions around the management of the difficult airway in pediatric patients. The goals of this study were to evaluate the patterns of use of the WhatsApp™ group, themes on messages posted on pediatric difficult airway management and to assess the perceived usefulness of the WhatsApp™ group by the PeDI-C members.

METHOD

Following research ethics approval, we performed a database analysis on the archived discussion of the PeDI-C WhatsApp™ group from 2014 to 2019 and surveyed members to assess the perceived usefulness of the PeDI-C WhatsApp™ group.

RESULTS

5781 messages were reviewed with 350 (6.0%) original stems. The three most common original stem types were advice seeking 98 (28%), announcements 85 (24.2%), and clinical case-sharing 78 (22.2%). The median number of responses to original stems was 9 [2-21.3]. Post types associated with increased responses included those seeking advice on medication/equipment (regression coefficient 0.78, 95% CI [0.41-1.16]; p < .0001); seeking advice on patient care (regression coefficient 1.16, 95% CI [0.86-1.45]; p < .0001), sharing advice on medication/equipment availability (regression coefficient 0.87, 95% CI [0.33-1.40], p < .0016), and clinical case-sharing (regression coefficient 1.2547, 95% CI [0.9401-1.5693] p < .0001). 46/64 members of the group responded to the survey. Replies offering advice regarding patient management scenarios were found to be of most interest and 77% of surveyed members found the discussion translatable into their own clinical practice.

DISCUSSION

The PeDI-C WhatsApp™ group has facilitated timely knowledge exchange on pediatric difficult airway management across the world. Participants are satisfied with the role the Whatsapp™ group is playing.

An Audit and Survey of Informal Use of Instant Messaging for Dermatology in District Hospitals in KwaZulu-Natal, South Africa

Background. In KwaZulu-Natal (KZ-N), South Africa, recent reports have indicated that spontaneous use of smartphones has occurred, providing access to specialist dermatological care to remote areas. This informal use has raised a number of practical, legal, regulatory, and ethical concerns. Aim. To assess the nature and content of WhatsApp messages sent to dermatologists, to determine the referring doctors’ reasons for, and satisfaction with, their interactions, as well as their knowledge of legal, regulatory, and ethical requirements. Methods. A retrospective study of WhatsApp messages between referring doctors and dermatologists, as well as a cross-sectional survey of doctors working at district hospitals in KZ-N who used IM for teledermatology. Results. Use of IM (primarily WhatsApp) for teledermatology was almost universal, but often not considered ‘telemedicine’. Few referring doctors were aware of South Africa’s ethical guidelines and their requirements, and few of those who did followed them, e.g., the stipulated and onerous consent process and existing privacy and security legislations. No secure methods for record keeping or data storage of WhatsApp content were used. A desire to formalize the service existed. Conclusions. Based upon these findings, it was proposed that a number of described steps be followed in order to formalize the use of IM for teledermatology.

Use of WhatsApp messaging technology to strengthen obstetric referrals in the Greater Accra Region, Ghana: Findings from a feasibility study

In Ghana, the high-risk obstetric referral system is inadequate. Delay is common and patients often arrive to receiving hospitals in compromised states. An effective referral system should include an adequately resourced referral hospital, communication across sectors, accountability, transport, monitoring capability and policy support, which are currently lacking. A pilot program was undertaken to facilitate communication between hospital staffs. Additionally, data was collected to better understand and characterize obstetric referrals in Accra. Thirteen institutions were selected based on referral volume to implement the use of pre-referral treatment guidelines and WhatsApp as a mobile technology communication platform (Platform). Participants included healthcare workers from 8 health centers, 4 district hospitals, the Greater Accra Regional Hospital (GARH), administrators, doctors from other tertiary hospitals in Accra and medical consultants abroad. Facilities were provided smartphones and guidelines on using WhatsApp for advice on patient care or referral. Data were collected on WhatsApp communications among participants (March-August 2017). During this period, 618 cases were posted on the Platform and users increased from 69 to 81. The median response time was 17 min, a receiving hospital was identified 511 (82.7%) times and pre-referral treatment was initiated in 341 (55.2%). Subsequently, data collected on 597 referrals to GARH (September-November 2017) included 319 (53.4%) from Platform and 278 (46.6%) from non-Platform hospitals. Of these, 515 (86.3%) were urgent referrals; the median (interquartile range) referral to arrival time was 293 (111–1887) minutes without variation by facility grouping. Taxis were utilized for transportation in 80.2%; however, referral time shortened when patients arrived by ambulance and with a midwife. Only 23.5% of urgent referrals arrived within two hours. This project demonstrates that WhatsApp can be used as a communication tool for high-risk obstetric referrals and highlights the need to continue to improve urban referral processes due to identified delays which may contribute to poor outcomes.

WhatsApp in Clinical Practice-The Challenges of Record Keeping and Storage. A Scoping Review

The use of WhatsApp in health care has increased, especially since the COVID-19 pandemic, but there is a need to safeguard electronic patient information when incorporating it into a medical record, be it electronic or paper based. The aim of this study was to review the literature on how clinicians who use WhatsApp in clinical practice keep medical records of the content of WhatsApp messages and how they store WhatsApp messages and/or attachments. A scoping review of nine databases sought evidence of record keeping or data storage related to use of WhatsApp in clinical practice up to 31 December 2020. Sixteen of 346 papers met study criteria. Most clinicians were aware that they must comply with statutory reporting requirements in keeping medical records of all electronic communications. However, this study showed a general lack of awareness or concern about flaunting existing privacy and security legislation. No clear mechanisms for record keeping or data storage of WhatsApp content were provided. In the absence of clear guidelines, problematic practices and workarounds have been created, increasing legal, regulatory and ethical concerns. There is a need to raise awareness of the problems clinicians face in meeting these obligations and to urgently provide viable guidance.

Use of WhatsApp®, for distance teaching during COVID-19 pandemic: Experience and perception from a sub-Saharan African setting

BACKGROUND

In the midst of the COVID-19 pandemic, to palliate to the lockdown and cover academic programs, the faculty of medicine and pharmaceutical sciences (FMPS) of the university of Dschang (UDs) in Cameroon has implemented e-learning using WhatsApp®.

AIM

Describe the opinion of students and lecturers after its implementation of e-learning at the FMPS of UDs.

METHODS

We designed a uniform teaching scheme using WhatsApp® during the university lockdown. Students and members of the teaching staff of the FMPS of UDs were enrolled after receiving clear information on the study implementation. At the end of the online-teaching period of two and a half months, we surveyed our students and teaching staff. Sociodemographic characteristics and opinions about e-learning were collected using a standard questionnaire.

RESULTS

We enrolled 229 students and 40 lecturers of the FMPS. Students reported a decremented quality of internet connection (p < 0.001, p-homogeneity < 0.001) despite an increased expenditure related to internet use. Electronic devices were broadly used before the implementation of mobile learning. The use of course materials was significantly more challenging among students because of the size/format of lecture notes and internet connection/cost (all p < 0.05). Perception of discipline compared to classroom-based lessons was not significantly different among students compared to lecturers (all p > 0.05). While lecturers were mainly more comfortable conveying the contents of their lectures, students tended to be less prone to actively participate. The motivation and satisfaction of the latter group toward e-learning were modest compared to classroom-based lectures while their feedback about the organization was positive.

CONCLUSIONS

E-learning using WhatsApp® could be an effective alternative to conventional classroom-based lessons in the context of COVID-19 pandemic. The use of a blended-learning program including classroom-based sessions could help improve its limitations.

What Surgeons Want: Access to Online Surgical Education and Peer-to-Peer Counseling-A Qualitative Study

Study Design

Mixed methods study including quantitative data analysis and qualitative analysis of semi-structured interviews.

Objectives

Utilizing information and communication technology can facilitate professional communication within health care on a global scale. This study aimed to identify the educational and peer-to-peer communication needs of craniomaxillofacial (CMF) surgeons across the globe, determine preferred modes of communication, and assess technological and other barriers to online education and peer-to-peer communication.

Methods

We performed semi-structured videoconference interviews of 92 CMF surgeons from around the globe, with the largest number in the Asia/Pacific region, the Middle East, and Latin America. We triangulated quantitative summaries with qualitative themes to improve validity and enable a more comprehensive understanding of participant perspectives.

Results

The interviews revealed 3 main areas of technology use: new surgical technology, technology that enables information exchange, and communication technology. When asked about technology and communication platforms used in the course of their work, 33 participants (36%) mentioned PubMed or other journal-related sites; 25% recalled using YouTube as a resource; 23% described conducting internet searches using Google or other search engines; 21% used WhatsApp groups; and 11% used closed Facebook groups.

Conclusion

CMF surgeons embraced communication technologies that allowed them to quickly obtain knowledge especially on new surgical technology, discuss cases on demand, and maintain strong communication with their global peers.

Health informatics publication trends in Saudi Arabia: a bibliometric analysis over the last twenty-four years

OBJECTIVE

Understanding health informatics (HI) publication trends in Saudi Arabia may serve as a framework for future research efforts and contribute toward meeting national "e-Health" goals. The authors' intention was to understand the state of the HI field in Saudi Arabia by exploring publication trends and their alignment with national goals.

METHODS

A scoping review was performed to identify HI publications from Saudi Arabia in PubMed, Embase, and Web of Science. We analyzed publication trends based on topics, keywords, and how they align with the Ministry of Health's (MOH's) "digital health journey" framework.

RESULTS

The total number of publications included was 242. We found 1 (0.4%) publication in 1995-1999, 11 (4.5%) publications in 2000-2009, and 230 (95.0%) publications in 2010-2019. We categorized publications into 3 main HI fields and 4 subfields: 73.1% (n=177) of publications were in clinical informatics (85.1%, n=151 medical informatics; 5.6%, n=10 pharmacy informatics; 6.8%, n=12 nursing informatics; 2.3%, n=4 dental informatics); 22.3% (n=54) were in consumer health informatics; and 4.5% (n=11) were in public health informatics. The most common keyword was "medical informatics" (21.5%, n=52). MOH framework-based analysis showed that most publications were categorized as "digitally enabled care" and "digital health foundations."

CONCLUSIONS

The years of 2000-2009 may be seen as an infancy stage of the HI field in Saudi Arabia. Exploring how the Saudi Arabian MOH's e-Health initiatives may influence research is valuable for advancing the field. Data exchange and interoperability, artificial intelligence, and intelligent health enterprises might be future research directions in Saudi Arabia.

Understanding the stakeholders' preferences on a mobile application to reduce door to balloon time in the management of ST-elevated myocardial infarction patients - a qualitative study

Background

ST-elevated myocardial infarction (STEMI) is a critical and time-sensitive emergency. The survival depends on prompt initiation of treatment requiring high precision and multi-level coordination between healthcare staff. The use of a mobile application may facilitate prompt management and shorten the door-to-balloon time by capturing information at the point of care and provide immediate feedback to all healthcare staff involved in STEMI management.

The objective of the present study has two primary components: (i) to explore the suggestions and opinions of stakeholders in the development of a novel mobile app for code activation in management of STEMI patients (ii) to find out the healthcare workers’ expectations including facilitating steps and challenges in the activation process of the proposed mobile app.

Methods

Unstructured interviews were conducted with key informants (n = 2) to identify all stakeholders, who also helped in developing the interview protocol and prototype designs. In-depth, semi-structured, open-ended, face to face interviews were conducted on 22 stakeholders involved in managing STEMI patients. All interviews were recorded and transcribed verbatim. Data were analyzed using ATLAS.ti 8 software, allowing themes and subthemes to emerge.

Results

The 22 participants included in the study were cardiology physicians (n = 3), emergency consultants (n = 4), emergency room (ER) senior nurses (n = 10), and cardiac catheterization lab staff (n = 5). The main themes identified during analysis were workflow and the App. The themes identified from the interviews surrounding the App were: 1) facilitating ideas 2) management steps needed 3) features 4) preferred code activation method 5) steps of integration 6) possible benefits of the App 7) barriers and 8) possible solutions to the suggested barriers. Most of the interviewed stakeholders expressed their acceptance after viewing the proposed mobile app prototype.

Conclusion

The study identified the mandatory features and the management steps needed from the stakeholder’s perspectives. The steps for integrating the current paper-based workflow with the suggested mobile app were identified. The expected benefits of the App may include improved and faster management, accuracy, better communication, and improvement in data quality. Moreover, the possible barriers might comprise of doubtful acceptability, device-related issues, and time and data-related challenges.

Wildfire-Like Effect of a WhatsApp Campaign to Mobilize a Group of Predominantly Health Professionals With a University Degree on a Health Issue: Infodemiology Study

BACKGROUND

Online interactions within a closed WhatsApp group can influence the attitudes and behaviors of the users in relation to health issues.

OBJECTIVE

This study aimed to analyze the activity of the members of a WhatsApp group initiated to raise awareness of the possible health effects of 5G mobile networks and mobilize members to sign the related petition.

METHODS

We retrospectively analyzed data from the WhatsApp group of 205 members that was active during 4 consecutive days in August 2019. The messages exchanged were collected, anonymized, and analyzed according to their timing and content.

RESULTS

The WhatsApp group members were invited to the group from the administrator's contacts; 91% (187/205) had a university degree, 68% (140/205) were medical professionals, and 24% (50/205) held academic positions. Approximately a quarter of the members (47/205, 23%) declared in their messages they signed the corresponding petition. The intense message exchange had wildfire-like features, and the majority of messages (126/133, 95%) were exchanged during the first 26 hours. Despite the viral activity and high rate of members openly declaring that they signed the petition, only 8 (8/133, 6%) messages from the group members, excluding the administrator, referred to the health issue, which was the topic of the group. No member expressed an opposite opinion to those presented by the administrator, and there was no debate in the form of exchanging opposite opinions.

CONCLUSIONS

The wildfire-like activity of the WhatsApp group and open declaration of signing the petition as a result of the mobilization campaign were not accompanied by any form of a debate related to the corresponding health issue, although the group members were predominantly health professionals, with a quarter of holding academic positions.

WhatsApp guidelines - what guidelines? A literature review

INTRODUCTION

Instant messaging (IM) is pervasive in modern society, including healthcare. WhatsApp, the most cited IM application in healthcare, is used to share sensitive patient information between clinicians. Its use raises legal, regulatory and ethical concerns. Are there guidelines for the clinical use of WhatsApp? Can generic guidelines be developed for the use of IM, for one-to-one and one-to-many healthcare professional communication using WhatsApp as an example?

AIM

We aimed to investigate if there are guidelines for using WhatsApp in clinical practice.

METHOD

Nine electronic databases were searched in January 2019 for articles on WhatsApp in clinical service. Inclusion criteria: paper was in English, reported on WhatsApp use or potential use in clinical practice, addressed legal, regulatory or ethical issues and presented some form of guideline or guidance for WhatsApp use.

RESULTS

In total, 590 unique articles were found and 167 titles and abstracts met the inclusion criteria. Twenty-one articles identified the need for general guidelines. Twelve articles provided some form of guidance for using WhatsApp. Issues addressed were confidentiality, identification and privacy (eight articles), security (seven), record keeping (four) and storage (three). Mandatory national guidelines for the use of IM for patient-sensitive information do not appear to exist, only advisories that counsel against its use.

CONCLUSION

The literature showed clinicians use IM because of its simplicity, timeliness and cost effectiveness. No suitable guidelines exist. Generic guidelines are required for the use of IM for healthcare delivery which can be adapted to local circumstance and messaging service used.

Development of a "Cellphone Stewardship Framework": Legal, Regulatory, and Ethical Issues

Introduction: Use of mobile devices within the health care sector has become commonplace in most developed countries, and increasingly common in developing countries. Such technological innovations have outpaced the necessary awareness and understanding of the spectrum of issues that ensure appropriate use of these innovations. The term "stewardship" has been defined and is applied to the appropriate care and use of cellphones by health care providers. Aim: To examine cellphone stewardship issues, and develop a simple framework by which to categorize these issues, using clinical WhatsApp^® (WhatsApp Inc., Menlo Park, CA) use as the exemplar. Methods: Nine electronic databases were searched (January 2019) for articles on WhatsApp in clinical service. Inclusion criteria were article was in English, reported on WhatsApp use or potential use in clinical practice, and identified cellphone stewardship issues. Results: Of 590 articles related to WhatsApp use in clinical practice, 167 potentially addressed some form of stewardship issue. After further review of full-text articles, 13 met the inclusion criteria, addressing specific issues related to cellphone stewardship, as defined. Articles were from nine countries (six developing and seven developed economies). Cellphone stewardship issues were abstracted and categorized into legal, regulatory, and ethical aspects, leading to development of the Cellphone Stewardship Framework for Health Care Providers (CSF-HCP). Conclusion: The CSF-HCP facilitates informed and structured debate around this topic, and encourages application of the term "cellphone stewardship" to describe and encompass the diverse legal, regulatory, and ethical issues requiring debate, resolution, and routine practice to ensure appropriate use of cellphones, and other mobile devices, by health care practitioners.

Secure Instant Messaging Application in Prenatal Care

The use of mobile phone for medical purposes is rapidly expanding as the number of medical applications rise. Studies show improvement of patient management and communication between medical team members using instant messaging applications. There are currently several smartphone applications routinely used by doctors and nurses. WhatsApp is by far the most common, however, it has several limitations when it comes to medical confidentiality. The aim of this paper is to introduce "Siilo" as an alternative secure messaging application and its advantages in the medical field, specifically in obstetrics. The typical course of consultation for an abnormal fetal finding is very long, cumbersome, frustrating and depends a lot on the patient, whereas, via Siilo the process is fast, efficient, depends more on the medical caregivers and helps ensuring minimum lost to follow-up. This paper demonstrates for the first time the utility of the use of Siilo application in medical management.

The role of WhatsApp® in medical education; a scoping review and instructional design model

BACKGROUND

Technological advances have driven huge change in educational practices though concerns exist about a lack of evidence informing this change, in particular with social media-based medical education activities. The purpose of this study was to conduct a scoping review of WhatsApp use in medical education, narratively describing how it has been used and evaluated, and the theoretical considerations in relevant articles.

METHODS

A modified 5-stage scoping review model was used. We performed 2 searches from February 2009 to February 2019 in EBSCO, SCOPUS, Web of Science, EMBASE, Medline PubMed and Google Scholar) using the term "WhatsApp" in all search fields. A 3-stage process for study selection was performed. Only original articles in English presenting original data about WhatsApp in medical education were included. The Kirkpatrick model of training evaluation was used to describe learning outcomes in included studies.

RESULTS

Twenty-three articles were selected for review. Three strategies for WhatsApp use were apparent; primarily educational use with a pre-defined curriculum (n = 5), primarily educational use without a curriculum (n = 11), and primarily non-educational use (n = 7). Most of the educational studies used an online moderator and were in a local hospital or university department. Studies not primarily educational were national or international and seldom included an online moderator. All 5 studies with a pre-defined curriculum reported Kirkpatrick level 2 learner knowledge outcomes. A majority of the remaining studies only reported Kirkpatrick level 1 learner attitudes. Seven studies with 647 participants reported an improvement in learners' knowledge following WhatsApp learning, though methodological weaknesses were apparent. Evidence for underlying learning theory considerations were scant throughout the studies.

CONCLUSIONS

WhatsApp is popular and convenient in medical education. Current published literature suggests it may also be effective as a medical learning tool. By combining the 3 strategies for WhatsApp use and the exploration-enactment-assessment integrated learning design framework, we propose an instant messenger design model for medical education. This may address the need for theory-driven instructional design in social media learning. Further research would clarify the role of WhatsApp and our design model in this area.

Use of Social Networks for Data Collection in Scientific Productions in the Health Area: Integrative Literature Review

Objective: To investigate evidence on the use of social networks to collect data in scientific productions in the health area. Material and method: An integrative literature review from primary studies indexed in the SciELO, PubMed, LILACS, Scopus, and Web of Science platforms. Results: 16 scientific articles were selected, of which nine focused on the use of WhatsApp; five, on the use of Facebook; and two, on employing Twitter to collect data in scientific productions. Growth was noted on the number of investigations associated to the use of social networks, although an important paradigm still exists related to the use to generate scientific evidence, resulting in a still low number of investigations on this theme. Conclusions: The health area needs to approach evermore the development of research associated to social networks, given that this would enable a viable and rapid intervention in obtaining responses, besides being a low cost and very promising tool for data collection.